Chapter 36 and 46

Activity and Exercise

Mobility and Immobility

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Body Mechanics, Exercise, and
Activity
• Body alignment
• Body balance
• Coordinated body movement
• Friction
• Exercise and activity
– Isotonic, isometric, resistive isometric
exercises

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 Regulation of Movement

• Skeletal muscle
– Bones
– Joints
– Ligaments, tendons, cartilage

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Regulation of Movement (cont'd)

• Skeletal muscle
– Movement
– Posture
– Groups
• Synergistic
• Antigravity

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Regulation of Movement (cont'd)

• Nervous system
– Movement
– Posture
– Proprioception
– Balance

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Principles of Body Mechanics

• Pathological influences
– Congenital defects
– Disorders of bones, joints, and muscles
– Musculoskeletal trauma

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 Behavioral Aspects

• Support by significant others, health

care team
• Knowledge of exercise and activity
• Readiness to change behavior
• Program customized to meet
personalized needs

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 Culture
• Box 36—4 p. 936

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 Environmental Issues

• Worksite
• Schools
• Community

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 Psychosocial Issues

• Cultural and ethnic influences

• Family and social support

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 Effects of Exercise
• P. 939 box 36—5

• Recommendation: P. 945 box 36--9

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Box 36—11
p. 947

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 Assessment

• Body alignment and posture

– Standing
– Sitting
– Recumbent position

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 Assessment (cont'd)
• Body alignment and posture (cont'd)
– Mobility
• Range of motion
• Gait
• Exercise
– Activity tolerance

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 Nursing Diagnoses

• Activity intolerance
• Disturbed body image
• Risk for injury
• Impaired physical mobility
• Acute/Chronic pain

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THINK PROACTIVE:
Risk for Disuse Syndrome

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 Planning

• Goals and outcomes

– Examples
• Participates in prescribed activity
• Expresses understanding of
balancing rest and activity
– Setting priorities
– Continuity of care

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 Implementation

• Health promotion: exercise programs

• Nursing safety
– Body mechanics
– Lifting techniques

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 Good posture
Knees flexed
Wide base of support
Hips flexed
Using large muscles
Do not arch your back
See page 946 table 36-1 - body mechanics for
the health care worker
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 Implementation (cont'd)

• Acute care
– Muscle strengthening, isometric
exercise
– Joint mobility: ROM, CPM machines

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 Implementation (cont'd)

• Ambulation
– Nurse assistance
– Assistive devices
• Walkers
• Canes
• Crutches

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 Implementation (cont'd)

• Restoration of activity
– Coronary heart disease
– Hypertension
– COPD
– Diabetes mellitus

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 Evaluation

• Activity tolerance
• Mobility, balance
• Client expectations

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 EFFECTS OF IMMOBILITY
• Assignment: 8 groups; – Musculoskeletal
present to the class - – Cardiovascular
effect of immobility – Respiratory
on the assigned body – Metabolic
system & nursing – Urinary
interventions to – GI
minimize negative – Integumentary
effects – Psychoneurolgic

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 Practice
• Ambulating a client
• Walking with walker
• Walking with crutches
• Transfer bed-chair
• PROM
• Positioning
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 Mobility

• Physiology and principles of body

mechanics
– Alignment: posture
– Balance
– Gravity and friction

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 Regulation of Movement

• Bones
• Joints
• Ligaments
• Tendons
• Cartilage
• Skeletal muscle

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Muscle Movement and Posture

• Musculskeletal function
• Nervous system

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 Pathological Influences on
Mobility
• Postural abnormalities
• Impaired muscle development
• CNS damage
• Musculoskeletal trauma

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Systemic Effects of Immobility
• Metabolic
• Respiratory
• Cardiovascular
• Musculoskeletal
• Urinary and bowel elimination
• Integumentary

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 Psychosocial and
Developmental Effects

• Infants, toddlers, preschoolers

• Adolescents
• Adults
• Older adults

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 Assessment

• Mobility
• Range of motion (ROM)
• Gait
• Exercise and activity tolerance
• Body alignment: standing, sitting,
lying

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 Physiological Assessment

• Metabolic: anthropometric
measurements, wound healing
• Respiratory system: ventilatory
status, breath sounds
• Cardiovascular system: BP, pulse,
peripheral circulation, signs of DVT

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 Physiological Assessment
(cont'd)

• Musculoskeletal: ROM; muscle

strength, tone, and mass
• Integumentary: color, integrity, turgor
• Elimination: I&O

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Psychosocial Assessment

• Reactions to immobility
• Developmental stages
• Client expectations

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 Nursing Diagnoses

• Activity intolerance
• Ineffective breathing pattern
• Risk for disuse syndrome
• Impaired physical mobility
• Impaired skin integrity
• Social isolation

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 Planning

• Goals and outcomes

– Client’s skin remains dry and intact
• Setting priorities
• Continuity of care

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 Implementation:
Health Promotion

• Lifting techniques
• Exercise

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 Prevention of the Hazards
of Immobility

• Metabolic
– Nutritional needs: protein, calories,
vitamins (B and C)
• Respiratory system
– Promotion of chest and lung expansion
– Removal of secretions
– Maintenance of patent airway

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Prevention of the Hazards of
Immobility (cont'd)

• Cardiovascular system
– Reducing orthostatic hypotension
– Reducing cardiac workload: discourage
Valsalva maneuver
– Preventing thrombus formation:
medications, exercise, fluids, TED
stockings, pneumatic compression,
positioning

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Prevention of the Hazards of
Immobility (cont'd)

• Musculoskeletal system
– ROM
– Isometric exercise

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Prevention of the Hazards of
Immobility (cont'd)

• Integumentary system
– Turning every 1 to 2 hours
– Hygienic care
– Protection: preventive aids
• Elimination
– Hydration
– I&O
– Nutritional intake: fiber

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Prevention of the Hazards of
Immobility (cont'd)
• Psychosocial
– Orientation
– Communication
– Client participation
• Developmental
– Age-appropriate activities

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Prevention of the Hazards of
Immobility (cont'd)
• Positioning
– Supports: footboards, trochanter rolls,
hand rolls, and splints
– Trapeze bar
– Bed positions: Fowler’s, supine, prone,
side-lying, Sims’

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 Transfer Techniques

• In bed
• Bed to chair
• Bed to stretcher

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Implementation: Restorative Care

• Instrumental activities of daily living

• Physical and occupational therapy
• Exercises—ROM
• Ambulation: canes, walkers, crutches

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 Evaluation

• Client care
• Client expectations

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