1. 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

2. 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

3. 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

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

5. 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

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

7. 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

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

9. 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

10. 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.

11. 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

12. 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

13. 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

14. 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.

15. 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.

16. 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.

17. Copyright © 2016 F.A. Davis Company Osteoporosis

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

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

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

21. 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

22. 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?

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

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

25. Copyright © 2016 F.A. Davis Company Immobilization Device

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

27. Copyright © 2016 F.A. Davis Company Traction

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

29. 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

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

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

32. Copyright © 2016 F.A. Davis Company Stump Care

33. 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?