1. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd. Chapter 24 Exercise and Activity

2. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 2 Being active is important for physical and mental well-being. Being active is important for physical and mental well-being. Illness, surgery, injury, pain, and aging cause weakness and some activity limits. Illness, surgery, injury, pain, and aging cause weakness and some activity limits. Inactivity, whether mild or severe, affects: Inactivity, whether mild or severe, affects: Every body system Every body system Mental well-being Mental well-being

3. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 3 Nurses promote exercise and activity in all clients to the extent possible. Nurses promote exercise and activity in all clients to the extent possible. To help promote exercise and activity, you need to understand: To help promote exercise and activity, you need to understand: Bed rest Bed rest How to prevent complications from bed rest How to prevent complications from bed rest How to help with exercise How to help with exercise

4. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 4 Bed Rest Generally bed rest is ordered to: Generally bed rest is ordered to: Reduce physical activity Reduce physical activity Reduce pain Reduce pain Encourage rest Encourage rest Regain strength Regain strength Promote healing Promote healing

5. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 5 Bed Rest (Contd) These types of bed rest are common: These types of bed rest are common: Strict bed rest Strict bed rest Everything is done for the client. Everything is done for the client. Bed rest Bed rest Some activities of daily living (ADL) are allowed. Some activities of daily living (ADL) are allowed. Bed rest with commode privileges Bed rest with commode privileges Bed rest with bathroom privileges (bed rest with BRP) Bed rest with bathroom privileges (bed rest with BRP)

6. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 6 Bed Rest (Contd) Complications of bed rest include: Complications of bed rest include: Pressure ulcers Pressure ulcers Constipation and fecal impaction Constipation and fecal impaction Urinary tract infections and renal calculi (kidney stones) Urinary tract infections and renal calculi (kidney stones) Blood clots (thrombi) Blood clots (thrombi) Pneumonia (inflammation and infection of the lung) Pneumonia (inflammation and infection of the lung) Contractures Contractures Muscle atrophy Muscle atrophy Orthostatic hypotension (postural hypotension) Orthostatic hypotension (postural hypotension) Syncope Syncope

7. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 7 Bed Rest (Contd) Good nursing care prevents complications from bed rest. Good nursing care prevents complications from bed rest. Good alignment Good alignment Range-of-motion exercises Range-of-motion exercises Frequent position changes Frequent position changes These are part of the care plan. These are part of the care plan.

8. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 8 Bed Rest (Contd) Supportive devices are often used. Supportive devices are often used. Bed boards prevent the mattress from sagging. Bed boards prevent the mattress from sagging. Foot boards prevent plantar flexion and serve as bed cradles. Foot boards prevent plantar flexion and serve as bed cradles. Trochanter rolls prevent the hips and legs from external rotation. Trochanter rolls prevent the hips and legs from external rotation. Hip abduction wedges keep the hips abducted. Hip abduction wedges keep the hips abducted. Hand rolls or hand grips prevent contractures of the thumb, fingers, and wrist. Hand rolls or hand grips prevent contractures of the thumb, fingers, and wrist. Splints keep the elbows, wrists, thumbs, fingers, ankles, and knees in normal position. Splints keep the elbows, wrists, thumbs, fingers, ankles, and knees in normal position. Bed cradles keep the weight of top linens off the feet and toes. Bed cradles keep the weight of top linens off the feet and toes.

9. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 9 Exercise Exercise helps prevent: Exercise helps prevent: Contractures Contractures Muscle atrophy Muscle atrophy Other complications of bed rest Other complications of bed rest Some exercise occurs: Some exercise occurs: With ADL With ADL When turning and moving in bed without help When turning and moving in bed without help A trapeze is used: A trapeze is used: For exercises to strengthen arm muscles For exercises to strengthen arm muscles To move up and turn in bed To move up and turn in bed

10. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 10 Exercise (Contd) Range-of-motion exercises Range-of-motion exercises Range-of-motion exercises involve moving the joints through their complete range of motion. Range-of-motion exercises involve moving the joints through their complete range of motion. Active range-of-motion exercises are done by the client. Active range-of-motion exercises are done by the client. With passive range-of-motion exercises, someone moves the joints through their range of motion. With passive range-of-motion exercises, someone moves the joints through their range of motion. With active-assistive range-of-motion exercises, the client does the exercises with some help. With active-assistive range-of-motion exercises, the client does the exercises with some help.

11. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 11 Exercise (Contd) Ambulation Ambulation Ambulation is the act of walking. Ambulation is the act of walking. After bed rest, activity increases slowly and in steps. After bed rest, activity increases slowly and in steps. To achieve the goal of walking: To achieve the goal of walking: Contractures and muscle atrophy must be prevented. Contractures and muscle atrophy must be prevented. Proper positioning and exercises are needed during bed rest. Proper positioning and exercises are needed during bed rest. Walking regularly helps prevent deconditioning. Walking regularly helps prevent deconditioning.

12. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 12 Walking Aids Walking aids Walking aids Walking aids support the body. Walking aids support the body. The type ordered depends on: The type ordered depends on: The clients condition The clients condition The amount of support needed The amount of support needed The type of disability The type of disability

13. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 13 Walking Aids (Contd) Crutches are used when the client cannot use one leg or when one or both legs need to gain strength. Crutches are used when the client cannot use one leg or when one or both legs need to gain strength. Follow these safety measures: Follow these safety measures: Check the crutch tips. Check the crutch tips. Check crutches for flaws. Check crutches for flaws. Tighten all bolts. Tighten all bolts. Make sure the client wears street shoes with flat, non-skid soles. Make sure the client wears street shoes with flat, non-skid soles. Make sure clothes fit well. Make sure clothes fit well. Practice safety rules to prevent falls. Practice safety rules to prevent falls. Keep crutches within the clients reach. Keep crutches within the clients reach. Know which crutch gait the client uses. Know which crutch gait the client uses.

14. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 14 Walking Aids (Contd) Canes are used for weakness on one side of the body. Canes are used for weakness on one side of the body. They help provide balance and support. They help provide balance and support. Single-tip and four-point (quad) canes are common. Single-tip and four-point (quad) canes are common. A cane is held on the strong side of the body. A cane is held on the strong side of the body. A walker is a four-point walking aid. A walker is a four-point walking aid. It gives more support than a cane. It gives more support than a cane. There are many kinds of walkers. There are many kinds of walkers. Baskets, pouches, and trays attach to the walker. Baskets, pouches, and trays attach to the walker.

15. Copyright © 2009 Elsevier Canada, a division of Reed Elsevier Canada, Ltd Slide 15 Walking Aids (Contd) Braces support weak body parts. Braces support weak body parts. They also prevent or correct deformities or prevent joint movement. They also prevent or correct deformities or prevent joint movement. A brace is applied over the ankle, knee, or back. A brace is applied over the ankle, knee, or back. An ankle-foot orthosis (AFO) is placed in the shoe. An ankle-foot orthosis (AFO) is placed in the shoe. You need to: You need to: Keep skin and bony points under braces clean and dry. Keep skin and bony points under braces clean and dry. Report redness or signs of skin breakdown at once. Report redness or signs of skin breakdown at once. Report complaints of pain or discomfort. Report complaints of pain or discomfort. The care plan tells you when to apply or remove a brace. The care plan tells you when to apply or remove a brace.