JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OF NURSING Copyright © 2016 F.A. Davis Company Chapter 32: Physical Activity & Mobility

Copyright © 2016 F.A. Davis Company Activity and Exercise Involves mobility Interaction of bones, muscles, and nervous system Involves body mechanics: the way people move Body alignment (posture) Balance Coordination Joint mobility

Copyright © 2016 F.A. Davis Company Principles of Body Mechanics To move your body without causing injury Proper alignment Wide base of support Avoid bending and twisting Squat to lift Keep objects close when lifting Raise beds Push versus lift Get help

Copyright © 2016 F.A. Davis Company Factors Affecting Mobility and Activity Life span Nutrition Lifestyle Stress External environment Disease

Copyright © 2016 F.A. Davis Company Exercise Contraction/relaxation of muscles Increases muscle tone/strength 150 to 300 min/week of moderate- and vigorous- intensity exercise recommended

Copyright © 2016 F.A. Davis Company Types of Exercises Isometric Isotonic Isokinetic Aerobic Anaerobic

Copyright © 2016 F.A. Davis Company Benefits of Exercise Improves cardiovascular health Increases muscle tone and flexibility Enhances immune system Promotes weight loss Decreases stress/increases overall feeling of well-being

Copyright © 2016 F.A. Davis Company Effects of Immobility Muscle atrophy Joint dysfunction Atelectasis/pneumonia Venous stasis Increased coagulability Orthostatic hypotension Glucose intolerance

Copyright © 2016 F.A. Davis Company Effects of Immobility (cont’d) Pressure ulcers Constipation Paralytic ileus Urinary tract infection Renal calculi Depression Sleep disturbances Disorientation

Copyright © 2016 F.A. Davis Company Nursing Measures to Promote Activity and Exercise Promote exercise Plan and vary exercise routine. Use buddy system and rewards. Integrate exercise into routine activities. Attain target heart rate.

Copyright © 2016 F.A. Davis Company Nursing Measures to Promote Activity and Exercise (cont’d) Positioning patients Proper alignment of hospital bed Use of range of motion Incorporation of pillows, wedges, side rails, overhead trapeze, footboard, sandbags/trochanter rolls, splints

Copyright © 2016 F.A. Davis Company Nursing Measures to Promote Activity and Exercise (cont’d) Positioning patients: common positions Fowler’s: High or semi- Lateral Prone Sims’ Supine

Copyright © 2016 F.A. Davis Company Nursing Measures to Promote Activity and Exercise (cont’d) Helping the client out of bed Use of transfer board Mechanical lift Transfer belt

Copyright © 2016 F.A. Davis Company Nursing Measures to Promote Activity and Exercise (cont’d) Assisting with ambulation This may require conditioning exercises. Obtain appropriate assistive devices.

Copyright © 2016 F.A. Davis Company ClickerCheck Identify the true statement about devices used when assisting clients to ambulate. a.The client should stand a foot back from the back legs of a walker. b.A cane should be used by the client to support the weakest side of the body. c.A transfer belt should be placed around the client’s chest for maximum lift. d.Each crutch-walking gait begins with the client in the tripod position.

Copyright © 2016 F.A. Davis Company ClickerCheck (cont’d) Correct answer: D The tripod position is the basic crutch standing position from which the client then moves forward.

Copyright © 2016 F.A. Davis Company Osteoporosis

Copyright © 2016 F.A. Davis Company Diagnostic Testing Laboratory tests Imaging DEXA

Copyright © 2016 F.A. Davis Company Primary Problems in Metabolic Bone Disease Strength Risk for fracture Injury prevention Nutritional status

Copyright © 2016 F.A. Davis Company Interventions Safety precautions Medications Surgical management Patient teaching Collaborative health care team roles Community resources

Copyright © 2016 F.A. Davis Company Classification of Fractures Fracture – break or disruption in continuity of a bone Types: – Complete – Incomplete – Open or compound – Closed or simple – Pathologic (spontaneous) – Fatigue or stress – Compression

Copyright © 2016 F.A. Davis Company Fracture Activity What should the nurse be most concerned about regarding a patient with a fracture? How does this fracture impact mobility? What complications could this fracture cause? How does this type of fracture impact the healing process? What medical-surgical treatment should the nurse expect to occur?

Copyright © 2016 F.A. Davis Company Common Types of Fractures

Copyright © 2016 F.A. Davis Company Types of Hip Fractures

Copyright © 2016 F.A. Davis Company Immobilization Device

Copyright © 2016 F.A. Davis Company Fiberglass Synthetic Cast

Copyright © 2016 F.A. Davis Company Traction

Copyright © 2016 F.A. Davis Company External Fixation Device

Copyright © 2016 F.A. Davis Company Complications of Fractures Shock Fat embolism syndrome Venous thromboembolism Infection Chronic complications—ischemic necrosis, AVN, delayed bone healing Peripheral neurovascular dysfunction Pain Impaired physical mobility Inadequate nutrition

Copyright © 2016 F.A. Davis Company Amputations Surgical Traumatic Levels of amputation Complications—hemorrhage, infection, phantom limb pain, neuroma, flexion contracture

Copyright © 2016 F.A. Davis Company Common Levels of Amputation

Copyright © 2016 F.A. Davis Company Stump Care

Copyright © 2016 F.A. Davis Company Think Like a Nurse Review the scenario of Meet Your Patient in the textbook. How would you address your patient’s concerns about the risks associated with her engaging in an exercise program? Your patient has experienced a number of injuries as a result of his exercise. Based on your knowledge of physical activity, what questions would you like to ask about his exercise program?