Transcript Chapter_027
Chapter 27 Exercise and Activity Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Exercise and Activity 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, affects: Every body system Mental well-being Deconditioning is the loss of muscle strength from inactivity. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 2 Exercise and Activity (cont’d) Nurses use the nursing process to promote exercise and activity in all persons to the extent possible. To help promote exercise and activity, you need to understand: Bedrest How to prevent complications from bedrest How to help with exercise Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 3 Bedrest Generally, bedrest is ordered to: Reduce physical activity. Reduce pain. Encourage rest. Regain strength. Promote healing. These types of bedrest are common: Strict bedrest Bedrest with some ADL [activities of daily living] allowed Bedrest with commode privileges Bedrest with bathroom privileges (bedrest with BRP) Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 4 Bedrest (cont’d) Complications from bedrest include: Pressure ulcers Constipation and fecal impaction Urinary tract infections and renal calculi (kidney stones) Blood clots (thrombi) Pneumonia (inflammation and infection of the lung) Contractures Atrophy Orthostatic hypotension (postural hypotension) Syncope (fainting) Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 5 Bedrest (cont’d) Good nursing care prevents complications from bedrest. Important measures included in the care plan include • Good alignment • Range-of-motion exercises • Frequent position changes Supportive devices are often used. Bed-boards Foot-boards Trochanter rolls Hip abduction wedges Hand rolls or hand grips Splints Bed cradles Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 6 Bedrest (cont’d) Exercise helps prevent: Contractures Muscle atrophy Other complications from bedrest Some exercise occurs: With ADL When turning and moving in bed without help A trapeze is used: For exercises to strengthen arm muscles To move up and turn in bed Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 7 Range-of-Motion Exercises Range-of-motion exercises (ROM) involve moving the joints through their complete range of motion. They are usually done at least 2 times a day. Active ROM exercises are done by the person. Passive ROM exercises—someone moves the joints through their range of motion. Active-assistive ROM 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. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 8 Ambulation (Walking) After bedrest, activity increases slowly and in steps. First, the person sits on the side of the bed (dangles). Sitting in a bedside chair follows. Next, the person walks in the room and then in the hallway. Regular walking helps prevent deconditioning. Use a gait (transfer) belt if the person is weak or unsteady. The person also uses hand rails along the wall. Always check for orthostatic hypotension. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 9 Ambulation (Walking) (cont’d) Walking aids support the body. The need may be temporary or permanent. The type ordered depends on the: • Person’s condition • Amount of support needed • Type of disability Crutches are used when the person cannot use one leg or when one or both legs need to gain strength. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 10 Ambulation (Walking) (cont’d) The person on crutches is at risk for falls. Follow these safety measures: • Check the crutch tips. • Check crutches for flaws. • Tighten all bolts. • Make sure the person wears street shoes with flat, • • • • non-skid soles. Make sure clothes fit well. Practice safety rules to prevent falls. Keep crutches within the person’s reach. Know which crutch gait the person uses. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 11 Ambulation (Walking) (cont’d) 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 gives more support than a cane. Wheeled walkers are common. Baskets, pouches, and trays attach to the walker. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 12 Ambulation (Walking) (cont’d) Braces support weak body parts. They also prevent or correct deformities or prevent joint movement. A brace is applied over the ankle, knee, or back. • An ankle-foot orthosis (AFO) is placed in the shoe. You need to: • Keep skin and bony points under braces clean and dry. • Report redness or signs of skin breakdown at once. • Report complaints of pain or discomfort. The care plan tells you when to apply and remove a brace. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 13