Chapter 26: Exercise and Activity The actions of walking, turning, or carrying are all common nursing activities, which require the use of muscles. To reduce the risk for injury, nurses need to comprehend and practice proper body mechanics and remain knowledgeable of current research, standards, and guidelines concerning safe transfer and positioning techniques.

Body Mechanics Coordinated efforts of the musculoskeletal and nervous systems Maintain balance, posture, and body alignment Mandatory for Lifting, bending, and moving Performing activities of daily living As young nurses, you want to “save your backs” to avoid life long problems. You want to incorporate concepts of body mechanics.

Body Mechanics Body Alignment Body Balance Coordinated Body Movement Relationship of one body part to another Body Balance Achieved by a low center of gravity Enhanced by posture Coordinated Body Movement Must overcome an object’s weight and be aware of its center of gravity Friction Effect of rubbing or resistance when a moving body meets a surface when turning When moving a patient, you must keep all of these topics in mind. If you do not practice proper body mechanics, both the patient and nurse can be injured.

Regulation of Movement Skeletal System Bones Joints Ligaments Tendons Cartilage Skeletal Muscle Movement Posture Groups Synergistic Antigravity Nervous System Regulates movement and posture Proprioception Balance Review these sections in your anatomy and physiology books. Skeletal, muscular, and nervous systems work together to provide mechanical support to the body. Muscles span at least one joint and attach to both articulating bones. When contraction occurs, one bone is fixed and the other one moves. The major voluntary motor area, located in the cerebral cortex, is the motor strip, located in the precentral gyrus. Proprioception is the awareness of the position of the body and its parts. It is dependent on impulses from the inner ear and from receptors in joints and ligaments. Balance is controlled through the nervous system, cerebellum, and inner ear. The major function of the cerebellum is to coordinate voluntary movements.

Pathological Influences on Body Alignment, Exercise, and Activity Congenital Defects Osteogenesis imperfecta Scoliosis Disorders of Bones, Joints, and Muscles Osteoporosis Inflammatory and noninflammatory joint disease Central Nervous System Damage Damage to any component that regulates voluntary movements Musculoskeletal Trauma Bruises Contusions Sprains Fractures Many conditions affect body alignment, exercise, and activity.

Growth and Development The body changes throughout the life span Newborn Toddler 3 years of age through adolescence Aging Newborn infant’s spine is flexed and lacks the anteroposterior curves of the adult. The toddler’s posture is awkward because of the slight swayback and protruding abdomen. From three years of age through adolescence, the musculoskeletal system continues to form and develop. Greater coordination enables a child to perform tasks that require fine motor skills. Changes in musculoskeletal function limits patient activity with age-related changes. With aging, changes in musculoskeletal function limit patient activity.

Assessment Body alignment Mobility Standing Range of motion Sitting Recumbent Mobility Range of motion Gait Exercise Activity tolerance The first step in the nursing process is to assess body alignment. You need to put the patient at ease to make a proper assessment. The adequacy of the patient’s mobility determines the patient’s coordination and balance while walking, the ability to carry out activities of daily living, and the ability to participate in an exercise program. You will need to thoroughly assess the patient’s range of joint motion, gait, and exercise tolerance as well as activity tolerance. Table 26-1 on page 684 shows a focused assessment.

Diagnosis Activity intolerance Risk for activity intolerance Disturbed body image Impaired physical mobility Acute pain Chronic pain Impaired skin integrity Risk for impaired skin integrity After you make the assessment, you will cluster the data and defining characteristics to select the NANDA-I nursing diagnosis.

Planning Goals and outcomes Setting priorities Collaborative care When selecting goals and outcomes, you will need to consider a patient’s most immediate needs. While planning, you will want to consider how to use good body mechanics and to supervise nursing assistive personnel so they will not experience a body injury. You will definitely include physical therapy when planning individualized care for a patient.

Implementation Lifting techniques Place object close to center of gravity Bend knees Use stronger leg muscles Avoid twisting Tighten abdominal muscles and tuck in the pelvis Maintain an erect trunk Always ask for assistance if you cannot handle a patient by yourself.

Positioning Techniques Fowler/semi-Fowler Head of bed elevated, support and align hips and spine Supine Lying on back, support with pillows, trochanter rolls, or splints Prone Face down Lateral Lying on a side with proper spine alignment Sims Semiprone on right or left side with weight placed on anterior ilium, humerus, and clavicle Patients with impaired nervous or musculoskeletal system functioning, patients with increased weakness, or those restricted to bed rest benefit from therapeutic positioning. Ask students why patients in bed need to be repositioned every two hours and patients in a chair every 20 to 30 minutes. Ask students if they can identify when patients should be placed in these positions.

Transfer Techniques Patient safety Nurse safety GET HELP Assess for orthostatic hypotension A caregiver should never lift more than 35 pounds without assistance. Transfers occur from bed to chair or bed to stretcher. Ask for help. Monitor nursing assistive personal for their personal safety. Be especially attentive to patients with neurological deficits.

Joint Mobility and Ambulation Range of motion exercises Active Patient can move joints Passive The nurse moves the patient’s joints Walking Assisting the patient Walker Canes Crutches You will want to work with a physical therapist or physical therapist assistant to learn specific hospital policy, procedures, and protocols. Depending what type of injury a patient has sustained and the type of cane or crutches being used, you will need to learn what type of gait is appropriate to meet the patient’s needs. Box 26-9 on page 694 presents patient teaching and crutch safety.

Evaluation Patient care Patient expectations During this last step of the nursing process, you will evaluate all of the nursing interventions you have used. Did the patient meet the expected outcomes and goals? If not, you will use the information to change the plan of care.

Practice Questions 1. A patient with a long history of arthritis complains of sensitivity and warmth in the knees. To determine the degree of limitation, the nurse should assess which of the following? A. Posture B. Activity tolerance C. Body mechanics D. Joint range-of-motion

Practice Questions (continued) 2. When teaching a patient with a long leg cast how to ambulate with crutches, the nurse should instruct the patient to use which of the following? A. Two-point gait B. Three-point gait C. Four-point gait D. Tripod cane

Practice Questions (continued) 3. Before repositioning an unconscious patient in bed, to avoid injuries, the nurse should: A. Bend at the knees B. Relax the abdominal muscles C. Retract the pelvic muscles D. Place the patient at arms’ length