Transcript Geriatric Nursing: Activity and Exercise

Geriatric Nursing: Activity and
Exercise
Sandy Mishkin, RN, BC, MSN,
M.Ed.
©2008
Normal Activity Patterns
Activity is anything that requires the expenditure of
energy.
 Exercise helps people look and feel better.
 Preventing mobility problems is easier than trying to
overcome problems with mobility once they occur.
 The neurologic, musculoskeletal, cardiovascular, and
respiratory systems interact to enable physical activity.

Changes in Activity With Aging
Decrease in the rate or
speed of activity
 Loss of muscle mass
 Reduced joint flexibility
 Decreased agility


The ability to move quickly
and smoothly

Reduced dexterity

The ability to perform fine
manipulative tasks
Decreased stamina
 Reduced ability to
coordinate multiple
activities

Effects of Disease Processes on
Activity

Neurologic dysfunction


Head injury, infection,
degenerative diseases, toxic
drug reactions


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Fractures, gout, arthritis,
foot conditions
COPD, pneumonia
Cardiac dysfunction

Musculoskeletal
dysfunction

Respiratory dysfunction
MI, CHF, heart block,
arteriosclerosis,
hypertension
Malnutrition
 Psychiatric conditions


Grief, depression, anxiety
Nursing Process for Impaired Physical
Mobility: Interventions
 Identify
prescribed activity level.
 Assess strength and joint mobility.
 Perform physical mobility activities during daily
care.
 Provide good body alignment and frequent
position changes.
 Avoid unnecessary restraint that limits physical
mobility.
Nursing Process for Impaired Physical
Mobility: Interventions
Consult with physical therapist.
 Verify that person is dressed appropriately for activity.
 Provide pain medication so that maximal benefit occurs
when greatest physical effort is expected.
 Verify that person knows how to use assistive devices and
uses them.
 Encourage wheelchair-bound persons to move using arms
or feet whenever possible.
 Provide adequate assistance during ambulation.

Nursing Process for Activity
Intolerance: Interventions
 Identify
factors that contribute to activity
intolerance.
 Identify activities that the individual views as
essential or desirable.
 Plan activities that progress from easy to more
demanding.
 Encourage pacing of activities throughout the day,
alternating activity with rest.
Nursing Process for Activity
Intolerance: Interventions
 Monitor
vital signs to assess the physiologic
response to activity.
 Teach methods to conserve energy.
 Teach methods to reduce psychological stress.
Nursing Process for Problems of
Oxygenation: Interventions
 Assess
pulse and respiration before, during, and
after activity.
 Monitor lab values and other diagnostic tests.
 Observe respiratory effort, including use of
accessory muscles.
 Evaluate oxygenation by observing for signs of
cyanosis and delayed capillary refill.
Nursing Process for Problems of
Oxygenation: Interventions
 Assess
peripheral pulses, especially in the lower
extremities.
 Position the person to maximize chest expansion.
 Encourage frequent changes of position if
bedridden.
 Clear secretions and teach effective coughing.
 Administer medications and oxygen as ordered.
Nursing Process for Problems of
Oxygenation: Interventions
Use spirometers to improve ventilation.
 Assess pain.
 Administer sedative-hypnotics and analgesics with
caution.
 Teach stress reduction techniques.
 Promote good fluid and nutritional intake.
 Maintain a calm, restful environment.
 Provide emotional support.

Nursing Process for Self-Care
Deficits: Interventions
Assess for age-related changes, disease processes,
medications, cognitive impairment, and perceptual
changes.
 Include person in problem identification and care
planning.
 Allow adequate time for completion of activities.
 Develop a plan that progresses in stages to highest
possible level of functioning.
 Give positive reinforcement for each success.

Nursing Process for Self-Care
Deficits: Interventions
 Consult
with occupational and physical therapists
as indicated.
 Modify the environment with assistive devices as
needed.
Nursing Process for Deficient
Diversional Activity: Interventions
 Assess
current and past hobbies, activities, and
interests.
 Include individual in selecting and planning
activities.
 Provide suitable reading materials such as large
print books or books on tape.
 Focus on what the person can do, not what he/she
cannot do.
Nursing Process for Deficient
Diversional Activity: Interventions
 Suggest
activities offered in the facility.
 Encourage activities department to plan new
activities based on patient input.
 Encourage social interaction among residents with
shared interests.
 Spend time with individual to demonstrate interest
in their personal interests.
Nursing Process for Deficient
Diversional Activity: Interventions
 Alter
the physical environment to stimulate
interest.
 Use volunteers to read, play games, or talk with
residents.
 Display results of resident activities.
 Consider pet therapy.
 Ensure that physical needs are met before and
during activities.
The Rehabilitation Focus in Care
Planning
Acknowledge the intrinsic worth of older adults in spite of
their limitations.
 Accept that older adults have the right to make their own
decisions regarding care.
 Recognize that loss of function or disability seriously
impacts the older person and his/her significant others.
 All the significant persons in the older adults life should
be involved in decision-making.

Rehabilitation Nursing
 The
long-term goal is to help older adults achieve
and maintain maximal physical, psychosocial, and
spiritual health.
The Plan of Care With a
Rehabilitation Focus
Prevent complications
 Restore optimal
functioning
 Minimize impact of
dysfunction
 Maintain highest
achievable level of
functioning

Provide for comfort needs
 Help adjust to lifestyle
conducive to health
 Assist to adapt to changes
 Help maintain control over
life
 Reduce impact of social
factors hindering
independence

References
G. (2004). Basic geriatric nursing (3rd ed.).
St. Louis: Mosby.
 Wold,