Transcript Chapter 24 Movement

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Benefits of regular activity
Multiple health problems can be avoided with
maintenance of an active state
Maintaining physical activity can be a challenge in
late life
◦ Effects of aging
◦ Common chronic health conditions
 Nursing interventions: guiding them in maintaining
and improving their physical condition; assisting them in
effectively managing conditions that could threaten an
active physical state
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Decline in size and number of muscle fibers,
and reduction in muscle mass
◦ Decreased body strength
◦ Endurance declines
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Connective tissue changes
◦ Reduced flexibility of joints and muscles
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Sarcopenia
◦ Age-related reduction of muscle mass or function
resulting from a reduction in protein synthesis and
an increase in muscle protein degeneration
◦ Can lead to disability
◦ Causes
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Psychosocial factors impacting activity
◦ Loss of one’s spouse
◦ Retirement
◦ relocation
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Promotion of physical exercise
Education related to importance: encouraging
persons of all ages to exercise regularly; can
influence health of today’s and future
generations
All exercise programs should address:
◦ Cardiovascular endurance
◦ Flexibility
◦ Strength training
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Health assessment includes:
◦ Quality of exercise
◦ Quantity of exercise
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Review desirable exercise goals and strategies
Is the following statement True or False?
Key elements of strength training are
resistance and progression.
True
Key elements of strength training are resistance and
progression. Resistance is achieved by lifting weights
and the use of weight machines and isometric
exercises or the use of one’s own body weight
through calisthenics.
Progression involves increasing the workload on the
muscles, such as by lifting heavier weights.
Maximum heart rate = 220 – age
Target heart rate = maximum heart rate × 75%
Target heart rate range = 65% to 80% of maximum heart
rate
(Commercial heart rate monitors, available at sports
supplies stores, can provide feedback on heart rate during
exercise without the inconvenience of having to stop to
palpate the pulse.)
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Exercise programs
◦ Benefits
◦ Need for adjustments based on age
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Age-related changes affect a person’s ability
to exercise
Importance of assessment prior to starting a
program and monitoring status during
physical activity
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Match individuals’ interests and needs
Range of options should be considered
Enhance physical activity during daily
routines
Pace exercise throughout the day to avoid
fatigue
Begin gradually and increase over time
Rest after activity
Which of the following age-related changes
warrants adjustments in exercise programs for
the older adult?
a. Increased stroke volume
b. Increased resistance to blood flow
c. Decreased residual capacity of the
lungs
d. Proportionate decrease in body fat
b. Increased resistance to blood flow
The increased resistance to blood flow may result
in higher systolic blood pressure during exercise.
A decreased stroke volume makes it difficult to
increase the cardiac response necessary for
exercise. An increased residual capacity of the
lungs may limit air movement and effect
respiratory function during exercise. An increase
in body fat causes heat to dissipate less effectively
which increases susceptibility to heat stroke.
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Cognitive and emotional states can influence
physical activity
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Inactivity and ill effects of immobility
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Positive effects on mood and cognition
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Individualized activities
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Therapeutic recreation
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Inactivity can result in deconditioning
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Need to compensate for age-related changes
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Public education is crucial
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Education for family caregivers
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Creativity in suggesting stimulating pastimes
results in increased movement
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Enhance motivation by demonstrating a
sincere interest in their activities
Community resources: senior centers, local
clubs, libraries
Arranging transportation to and from
activities
Assessment of capacities, limitations,
interests, and abilities
Avoid stereotyping: don’t assume all older
adults like the same activities
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Recognize the importance of good nutrition
Well-balanced diet helps maintain the
structure of bones and muscles
◦ Calcium
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Both quality and quantity are important
Obesity places strain on the joints
◦ Weight reduction
Is the following statement True or False?
Choosing an exercise program for an older
adult can be achieved by identifying common
activities that older adults enjoy and
implementing a program based on your
findings from the literature.
False
An older adult’s unique capacities and limitations, as
well as interests, will dictate appropriate activities
for that individual. Stereotyping older adults by
assuming they all enjoy exactly the same activities
violates the underlying principles of individualized
care and limits the opportunities available for older
persons.
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Discomfort, disability, deformity, and
functional impairment result from
musculoskeletal disorders
Leading cause of functional impairment
Assessment of musculoskeletal system and
functional abilities
Prevention
Aggressive intervention to minimize the
impact of functional impairment
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Risk factors and potential causes
Common sites
Brittle bones fracture more easily and heal at
a slower rate
◦ Potential for complications associated with
immobility
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Interventions aimed at prevention: use basic
common sense measures
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Fracture should be suspected when an older
adult falls or has trauma to their bones
Signs and symptoms
Assessment of a potential fracture
The absence of typical signs of fracture does
not guarantee no fracture present
Immobility of the injured site
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Nursing observation essential: due to risk of
complications
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Nursing interventions to prevent
complications after a fracture
◦ Older adults heal more slowly
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Explanation and reassurance essential
Which of the following fractures is/are
common in older adults as a result of a fall?
a. Neck of the femur
b. Colles’ fracture
c. Vertebral fracture
d. All of the above
d.
All of the above
The neck of the femur is a common site for fractures
in older people, especially in women, and most
fractures result from falls. Colles’ fracture (radius)
occurs when attempting to stop a fall with an
outstretched hand. Older adults are at risk for
compression fractures or the vertebrae, resulting
from falls or lifting heavy objects.
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Progressive deterioration of joint cartilage with
the formation of new bone at the joint surface
Incidence
Pathophysiology
Causes
Signs and symptoms
Treatment/management
Nursing interventions
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Incidence/prevalence
Deformities and disability begin at an early age
and peak during middle age
Pathophysiology
Causes
Signs and symptoms
Treatment/management
Nursing interventions
Is the following statement True or False?
Systemic symptoms often accompany
osteoarthritis.
False
Systemic symptoms are not common in persons with
osteoarthritis.
Systemic symptoms of rheumatoid arthritis are more
common and include fatigue, malaise, weakness,
weight loss, wasting, fever, and anemia.
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Most prevalent metabolic disease of the bone
Incidence
Risk factors:
◦ Inactivity or immobility
◦ Diseases:
◦ Reduction in anabolic sex hormones
◦ Diet
◦ Drugs
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May cause kyphosis, spinal pain, and fractures
Often asymptomatic
Diagnosis
◦ Bone density
◦ Radiography
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Treatment/management
Nursing interventions
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Metabolic disorder in which excess uric acid
accumulates in the blood
Pathophysiology: uric acid crystals are
deposited in and around the joints
Signs and symptoms
Exacerbations and remissions
Treatment/management
Nursing interventions
Which of the following diets is encouraged for
those who have the diagnosis of gout?
a. High calorie
b. High protein
c. Low carbohydrate
d. Low purine
d. Low purine
Dietary treatment for gout aims to reduce sodium
urate through a low-purine diet which means
avoidance of bacon, turkey, veal, liver, kidney, brain,
anchovies, sardines, herring, smelt, mackerel,
salmon, and legumes.
Alcohol should also be avoided because it increases
uric acid production and reduces uric acid excretion.
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Foot problems are a common occurrence
Incidence: by age 65, nearly 90% of all people
have some type of foot problem
Impact on mobility and dependence
Podogeriatrics
Referral to podiatrist necessary for treatment
Education related to proper foot care
Nursing interventions
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Common conditions:
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Calluses (plantar keratoses)
Corns (heloma)
Bunions (hallux valgus)
Hammer toe (digiti flexus)
Plantar fasciitis
Infections (onychomycosis; tinea pedis)
Ingrown nails (onychocryptosis)
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Managing pain
◦ Degenerative changes cause joint pain
◦ Cramps
◦ Unrelieved pain affects independence and quality
of life
◦ Nursing interventions to decrease pain essential in
promoting optimal physical, mental, and social
function
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Preventing injury
◦ Safety interventions essential
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Promoting independence
◦ Impact on physical, emotional, and social wellbeing
◦ Interventions