Transcript Lecture 10 - Activity and Exercise

Mobility and Biomechanics. Activity
and Exercises.
By Nataliya Haliyash,
MD, BSN
Chapters
Lecture objectives:
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The role of musculosceletal and nervous
systems in the regulation of movement
Body alignment, body mechanics and joint
mobility
Learn how to maintain and use proper body
mechanics
Benefits of exercise and activity
Planning an exercise program for clients across
the lifespan
Assess clients for impaired mobility and activity
intolerance
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Why is it important to know?
• The action of walking, turning, lifting and
carrying are essential components in the
provision of nursing care.
• To reduce the risk of injury to the client or
nurse, the nurse must know and practise
proper body mechanics.
• Nurses must promote activity and exercise
because beneficial impact on wellness,
prevention of illness, and restoration of optimal
functioning.
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Body mechanics
• Purposeful and coordinated use of body parts
and positions during activity.
• Involve three basic elements:
– body alignment / posture,
– stability / balance,
– and coordinated movement.
• It helps to maintain body alignment during
lifting, bending, moving and performing
activities of daily living (ADLs)
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Body Alignment (posture)
– Position of body parts in relation to each
other along a horizontal or vertical line.
– Center of gravity is evenly distributed.
– Promotes balance, reduces strain and injury.
– Promotes efficient circulatory, renal,
pulmonary, and gastrointestinal functions.
– Influences self-esteem and body image.
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• Proper body alignment and posture:
standing male and female
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• Proper sitting
posture and line of
gravity
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• Proper supine posture and line of
gravity
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• Hold weight
close to your
center of
gravity
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Body Alignment
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Client comfort
Prevention of contractures
Promotion of circulation
Reduces stress on muscle, tendons,
nerves, and joints
• Prevention of foot drop (plantar flexion)
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Body Alignment
• Muscle Tone: Normal state of balanced tension
present in the body.
– Hypotonicity: A decrease in muscle tone (flaccidity).
– Spasticity: An increase in muscle tension that is
often noted with extreme flexion or extension.
• Muscle Shape
– Hypertrophy: Increased muscle size and shape due
to an increase in muscle fibers.
– Atrophy: A reduction in muscle size and shape that
manifests as thin, flabby muscles with indistinct
contour.
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Overview of Mobility
• Mobility
– Ability to engage in activity and free
movement
– Walking, running, sitting, standing, lifting,
pushing, pulling
– Activities of daily living (ADLs)
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Overview of Mobility
• Mobility
– Enhances muscle tone, increases energy
levels
– Psychological benefits of independence
and freedom
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Overview of Mobility
• Range of motion reflects the extent to
which a joint can move.
– Active range of motion Range of motion
exercises performed independently by the
client.
– Active assistive range of motion Range-ofmotion exercises performed by the client
with the assistance of the nurse.
– Passive range of motion Range-of-motion
exercises performed by the nurse for the
dependent client.
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Range of motion
– Abduction To move a body part away from the
midline.
– Adduction To move a body part toward the
midline.
– Extension To straighten a joint.
– Flexion To bend a joint.
– Opposition One part being across from another
part at nearly 180º.
– Supination Turning a body part upward
(palm/forearm or foot inward and upward). Act of
lying flat on the back.
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Physiology of Mobility
• Musculoskeletal System
– Bones
– Joints
– Tendons
– Ligaments
– Bursa
– Cartilage
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Physiology of Mobility
• Nervous System
– Proprioception
• Tells us where our body is in space relative to
other objects.
– Postural Reflexes (righting)
• Maintain postural tonus.
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Exercise
• Any physical activity involving muscles
that elevates the heart rate above
resting levels
• Reduces joint pain and stiffness.
• Increases flexibility, muscle strength,
and endurance.
• Weight reduction and improved sense
of well-being
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Exercise
• Types of Exercise
– Aerobic
– Strengthening
– Isometric
– Isotonic
– Isokinetic
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Exercise
• Range-of-Motion Exercise (ROM)
– Passive
– Active
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Exercise
• Physical Fitness
– Endurance and strength
– Joint flexibility
– Cardiorespiratory fitness
– Body composition
– Fitness in older adults
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Factors Affecting Mobility
• Health Status
• Developmental Stage
– Children
– Adolescents
– Adults
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Factors Affecting Mobility
• Environment
– Attitudes and Beliefs
– Lifestyle
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Physiological Effects of Mobility
and Immobility
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Neurological Effects
Cardiovascular Effects
Respiratory Effects
Musculoskeletal Effects
Digestive Effects
Elimination Effects
Integumentary Effects
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Assessment
• Health History
– ADLs
– Exercise patterns
– Activity tolerance
– Medications
– Alteration in health status
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Physical Examination
• Musculoskeletal Assessment
– Movement and Gait
– Alignment
– Endurance
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Musculoskeletal Assessment
• Muscle Impairments (common overuse
injuries)
– Strain
– Tendonitis
– Bursitis
– Sprain
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Pathological Alterations
• Postural Abnormalities
– Scoliosis
– Kyphosis
– Lordosis
– List
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Pathological Alterations
• Contractures
– Contracture deformities occur when a
muscle group is not moved for a period of
time or if proper body alignment is not
maintained.
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Pathological Alterations
• Musculoskeletal Trauma
– Fractures
– Amputation
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Pathological Alterations
• Central Nervous System (CNS)
– Any disruption in the CNS can impair
mobility.
– Spinal cord injury can lead to partial
paralysis or complete loss of mobility.
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Neurological Assessment
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Cranial Nerves
Motor System
Sensory System
Reflexes
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Functional Assessment
• Focuses on client’s ability to perform
ADLs.
– Client’s ability to feed, dress, toilet, move,
transfer, and ambulate self independently,
or with assistance
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Nursing Diagnoses
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Activity Intolerance
Impaired Physical Mobility
Risk of Disuse Syndrome
Self-Care Deficits
Altered Health Maintenance
Risks for Falls
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Planning and Outcome
Identification
• Realistic Outcomes Consider Client’s
– Understanding of mobility status
– Values, thoughts, and concerns
– Health status in general
– Ability to solve problems
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Planning and Outcome
Identification
• Interventions
– Bed Rest
– Restorative Nursing Care
– Health Promotion and Fitness
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Implementation
• Meeting Psychosocial Needs
• Applying Principles of Body Mechanics
• Maintaining Body Alignment: Positioning
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Fowler’s
Recumbent (supine)
Prone
Lateral
Sim’s
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Implementation
• Maintaining Body Alignment: Assistive
Devices
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Implementation
• Range-of-Motion Exercises
– Performed several times a day.
– Each joint is placed through its full
functional motion.
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Implementation
• Transfer Techniques
– Moving clients
– Logrolling the client
– Transferring from bed to chair
– Transferring from bed to stretcher
– Assistive devices
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Implementation
• Assisting with Ambulation
– Preparing the client to walk
– Client education
– Preambulating exercise
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Assisting with Ambulation
• Nurse promotes
safety of a client
using a quad cane.
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Assisting with Ambulation
• Assistive Devices
– Canes
– Walkers
– Crutches
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Implementation
• Wellness Promotion
– Emphasizes the need for physical fitness.
• Complementary Treatment Modalities
– Range from physical activity and relaxation
exercises to herbs, yoga, acupuncture,
acupressure, and biofeedback.
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Evaluation
• Transfer of skills and knowledge from
the acute care hospital or rehabilitation
facility to home
– Mobility status
– Activities of daily living capacity
– Use of appropriate adaptive devices
– Client’s ability to function within his or her
own environment
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Evaluation
• Ongoing assessment in the home
setting is important because
compliance with home exercise
programs may lessen over time after
discharge.
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ANY QUESTIONS??
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