Transcript Let`s Get Moving!

Let’s Get Moving!
Lisa B. Flatt, RN, MSN, CHPN
The Cornerstones of Nursing Care
 Maintaining mobility
 Supporting increased mobility
 Priniciples of body alignment
 Body mechanics
 Range of Motion (ROM)
 Positioning
 Transfer
Mobility Principles
 Body alignment – ideal body position, proper anatomical
position
 Positioning changes depending on how/what you are doing
 Ideal position:
 Centered cranium (midline shoulders, facing forward)
 Arms hanging at sides palms midline and fingers slightly bent
 Weight is mostly on hips, knees not locked, feet slightly apart
and pointed forward
Body Mechanics
Protection of MS system
Nursing Care Plan &
Implications
 Weight to center of gravity
 Implementation: instruct
 Lift with legs
patient and family about
body mechanics and safe
patient handling
 Evaluation: return
demonstration and
verbalization of techniques;
injury free
 Straight back
ROM – part of every joint, nose to toes!
 Active ROM: patient does self
 Active-assisted ROM: patient does with assistance
 Passive ROM: caregiver does all the work
Influencing factors on Activity &
Mobility
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Age & developmental level
Preferences & patterns
Initial physical condition
Culture/spiritual/religious
Socioeconomic
Environmental
Psychological – depression
Obesity
Nutritional status
Finances
Housing (stairs)
 Cardiovascular status
 Educational level
 Congenital or acquired
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postural anomalies
Vitamin D deficiencies
MS disorders
Respiratory status
CV status
Chronic Illness
Climate
Altitude
Occupation
Nursing Implications
 Contracture prevention - ___ROM, positioning_______
 Nursing responsibility- _teaching, turning_____
 Positioning - ___reduce pressure, promote health____
 Importance of alignment - ___decrease injury___
 Transferring - __safety, prevent injury_____
 Exercise - ____promotes health____
 Bedrest - ___evil or good depending___
 Immobility issues - _contractures, pneumonia, pressure
sores, UTI, weakness, nerve damage_
The Evils of Bedrest!
 Encourage ROM and bed activity
 Systems affected
 Respiratory ___lung expansion decreases; fluids pool; decreased
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tolerance__
MS __decreased strength, muscle wasting, contractures, loss of mobility_
Cardiac __arrhythmias, decreased tone, fluids pooling, not increasing heart
rate_
Vital signs ___depressed__
Appetite __decreases__
GU__UTI, incontinence____
GI_incontinence, constipation____
Psychosocial – depression and isolation
Diseases & Nursing Considerations
 Osteoporosis – primarily effects___women___ who are of
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__asian, caucasian__descent ___thin____small boned?
Television and obesity ___more tv = less exercise = fatter__
Athletics – social outlet – teamwork with peers –increase muscle
mass
Older adults – kyphosis, gait changes, muscle tone, joint mobility
Chronic illnesses
Smoking/dipping/chewing
Sedentary lifestyle
Psychological benefits of exercise
Nutritional status
Disturbed…. Oh yeah.. Immobility 
 CV__diminshed cardiac reserve and muscle tone______
 Repiratory __decreases amt of air take in, lung compliance,
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decreased air exchange__
Orthostatic hypotension___shift in position causes bp changes/
lowering_
Metabolism ___slows way down…….._
Pressure Ulcers__bad__
Venous __stasis, stasis ulcers, blood pools, mottling, dvt__
GI _constipation, decreased motility___
GU__UTI, incontinence, decrease urination_
Skin _____poor, tenting__________________
Thrombophlebitis ___bid bad risk_________
Psychological
 Hopelessness
 Helpless
 Sensory deprivation
 Sleep issues
 Attention-seeking
 Powerlessness
 Developmental
Nursing Interventions
 Exercises
 Positioning
 Supportive devices
 Transfer techniques
 Prevention programs
 Assistive devices
 Alternative and complementary treatments
 Active and passive ROM
 Quadriceps-setting
 Weights
The lay of the land - positioning
 Fowlers – HOB 45*-90*
 Semi-fowlers – HOB 15*-45*
 High-fowlers- HOB- 90*
 Orthopneic – like high-fowlers with arms over table (ie)
 Dorsal recumbent – lying on back, shoulders slightly elevated
 Prone – lying flat on back
 Sims’ (semi-prone) – between lateral and prone (ie enema
assume the position)
Are you there for me? Support!
 Pillows, mattresses, bed boards, chair beds, foot boots, footboards, trochanter rolls, sand
bags, handrails, restraints
 Safe transfer techniques: elevate bed, get help
 Mechanical aids & Safety: lifts, slider sheets, chair riser, trapeze
 Wheelchairs – brakes, foot pads
 Crutches (117)
 4 point gait – safest, one crutch, one foot, one crutch opposite foot
 3 point gait – both crutches and weaker leg first
 2 point gait – opposite crutch and leg
 Swing through gait – crutches then body swings through
 Swing to gait – body and then crutches
 Canes – various kinds, depends on what is needed
 Transfer belts
 Bedside rails
 Trapeze
 Lifts
Sample of Nursing Care Plan (120)
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Assessment: SOB, Dyspenic when climbing stairs, Unemployed,
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Diagnosis: Activity intolerance R/T sedentary lifestyle manifested by SOB on exertion.
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Plan:
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Pt will verbalize the need to incorporate exercise into daily activity.
Find Pt’s activity preference
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Implementation:
 Pt will work with PT three times/wk. Nursing staff will also walk pt twice per day working towards
ambulating 100ft.
 Will educate pt on benefits of exercising.
 Administer Resp. Tx prior to ambulation
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Evaluation:
 Pt ambulated twice per day with stand by assist up to 150ft.
 Verbalizes education of benefits in exercising.
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RT gave Tx’s prior to ambulation.
Exercise – a dirty word?
 Aerobic – using air- hehe - burning calories
 Weight – what we have 
 Resistive (isokinetic)- pushing against
 Isotonic – muscles moves
 Isometric – muscle tenses
 Target heart rate – 60-85% of maximum
 Maximum heart rate – 220-age
 Talk test – carry on a conversation without labored breathing
 Borg’s scale is- perception of exertion or how difficult the
exercise feels related to heart and lung exertion
Complementary therapy
 Chiropractic
 Acupuncture
 Acupressure
 Therapeutic touch
 Massage
 Reflexology