Transcript PowerPoint Ch. 26

Chapter 26
Exercise and Activity
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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Being active is important for physical and
mental well-being.
Illness, surgery, injury, pain, and aging cause
weakness and some activity limits.
Inactivity, whether mild or severe:
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Affects every body system
Affects mental well-being
Deconditioning is the loss of muscle
strength from inactivity.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 2
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To help promote exercise and activity, you
need to understand:
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Bedrest
How to prevent complications from bedrest
How to help with exercise
The person’s care plan and your assignment
sheet tell you the activities allowed.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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Bedrest
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Generally bedrest is ordered to:
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Reduce physical activity
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Reduce pain
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Encourage rest
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Regain strength
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Promote healing
These types of bedrest are common:
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Strict bedrest
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Bedrest (some ADL [activities of daily living] allowed)
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Bedrest with commode privileges
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Bedrest with bathroom privileges (bedrest with BRP)
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 4
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Complications of bedrest involve every system
and include:
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Pressure ulcers
Constipation and fecal impaction
Urinary tract infections and renal calculi
Blood clots (thrombi)
Pneumonia
Contractures
Muscle atrophy
Orthostatic hypotension (postural hypotension)
Syncope
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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Good nursing care prevents complications from bedrest.
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The care plan includes:
• Good alignment
• Range-of-motion exercises
• Frequent position changes
Supportive devices are often used.
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Bed-boards
Foot-boards
Trochanter rolls
Hip abduction wedges
Hand rolls or hand grips
Splints
Bed cradles
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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Exercise helps prevent:
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Contractures
Muscle atrophy
Other complications of bedrest
A trapeze is used for exercises to strengthen
arm muscles.
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The trapeze is also used to move up and turn in
bed.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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Range-of-Motion Exercises
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Active range-of-motion (ROM) exercises are done by
the person.
With passive range-of-motion exercises, someone
moves the joints through their range of motion.
With active-assistive range-of-motion exercises, the
person does the exercises with some help.
Persons on bedrest need more frequent ROM
exercises. So do those who cannot walk, turn, or
transfer themselves because of illness or injury.
OBRA and the CMS require an assessment and care
planning process focused on a person’s range of
motion: preventing loss of ROM, increasing ROM,
preventing further loss of ROM.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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Ambulation (The Act of Walking)
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Some people need help walking.
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Some become strong enough to walk alone.
Others will always need help.
After bedrest, activity increases slowly and in
steps.
To achieve the goal of walking:
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Contractures and muscle atrophy must be
prevented.
Proper positioning and exercises are needed
during bedrest.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 9
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When helping the person to walk:
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Follow the care plan.
Use a gait (transfer) belt if the person is weak or
unsteady.
The person uses hand rails along the wall.
Check the person for orthostatic hypotension.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 10
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Walking aids support the body.
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The need may be temporary or permanent.
The type ordered depends on:
• The person’s condition
• The amount of support needed
• The type of disability
Crutches are used when the person cannot use
one leg or when one or both legs need to gain
strength.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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 Follow
these safety measures when crutches
are used:
• Check the crutch tips.
• Check crutches for flaws.
• Tighten all bolts.
• Street shoes are worn.
• Clothes must fit well.
• Practice safety rules to prevent falls.
• Keep crutches within the person’s reach.
• Know which crutch gait the person uses.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 12
 Canes are used for weakness on one side of the body.
• They help provide balance and support.
• Single-tip and four-point (quad) canes are common.
• A cane is held on the strong side of the body.
 A walker is a four-point walking aid.
• It gives more support than a cane.
• There are many kinds of walkers.
• Baskets, pouches, and trays attach to the walker.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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 Braces support weak body parts.
• They prevent or correct deformities or prevent joint
movement.
• They are applied over the ankle, knee, or back.
• You need to keep the skin and bony points under
braces clean and dry.
• You need to report redness, signs of skin
breakdown, and complaints of pain or discomfort at
once.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
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Recreational Activities
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OBRA requires activity programs for
residents.
A good activity program improves a person’s
quality of life.
Activities must meet each person’s interests
and physical, mental, and psychosocial
needs.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 15
Quality of Life
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You assist residents with exercise and
activity.
You must protect the rights to privacy and
personal choice.
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The person’s body is not exposed.
Choices are allowed whenever safe and possible.
Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 16