ACTIVITY AND EXERCISE
Unit VII
I.
Review Body Mechanics/ safety
II. Discuss Benefits of exercise
III. Compare rehab and restoritive
IV. Discuss Effects of Immobility
V.
Describe Body Alignment
VI. Demonstrate Skills of Activity and Exercise
Ambulate Walk with Cane
Walk with Walker
Wheelchair Transfer
Wheelchair Transport
Wheelchair Transfer
(2 Person)
Mechanical Lift
Supine Position Placement
Side-lying Position Placement
Move up in Bed
Move up in Bed with Lift
Sheet
Passive Range of Motion/
Shoulder and Elbow
Passive Range of Motion
Hip and Knee
Support stocking application
I. Review Body Mechanics
A. Body mechanics is using muscles of the
body correctly to make the best use of
strength to lift or move objects.
1. Nursing Assistants must keep alert at
all times to the principles of good
body mechanics when transferring
residents or assisting them with activity.
2. Refer to Unit II for additional information on
body mechanics.
II. Discuss Benefits of Exercise
A. Define Exercise – exercise is physical
activity or a series of specific movements
designed to strengthen the body or parts
of the body.
B. Benefits of Exercise
1. Physical activity or exercise is
important for all ages.
2. Improves circulation and the
functioning of all body systems.
3. Keeps resident mobile, more
independent and mentally alert.
II. Discuss Benefits of Exercise (Cont.)
C. Discuss the Importance of Rest and Sleep
with Activity and Exercise.
1. Adequate rest and sleep promotes
improved strength and endurance
and successful results with exercise
activities.
2. Plan rest times as a part of the
resident’s daily activity.
3. Plan resident’s night time routine to
promote a restful night’s sleep.
III. Describe Principles of Rehabilitation
A. Define rehabilitation
Process of treatment and education that
leads the disabled person to attain
maximum function and a sense of well
being. Residents having strokes or
broken hips may have rehabilitation
therapy
III. Describe Principles of Rehabilitation (Cont.)
A. Define rehabilitation (Cont.)
1. Involves physicians as well as physical
therapists, occupational therapists and
speech therapists.
2. The nursing department participates in the
plan of treatment and education.
3. Nursing Assistants participate
in rehabilitation by following the
resident’s plan of care.
4. Principles of rehabilitation include
prevention, maintenance and restoration.
III. Describe Principles of Rehabilitation (Cont.)
B. Define Restorative Care
Process of assisting a person to help
himself/herself to maintain his/her
highest level of physical and mental
ability. Residents experiencing general
aging limitations will benefit from
restorative care.
III. Describe Principles of Rehabilitation (Cont.)
B. Define Restorative Care (Cont.)
1. Consult resident’s care plan for individualized
care.
2. Encourage resident self help with ADL’s by
using adaptive equipment such as long
handled shoe horn or grippers when
suggested by Occupational Therapist on care
plan.
3. Focus on resident’s abilities.
4. Encourage active range of motion.
III. Describe Principles of Rehabilitation (Cont.)
B. Define Restorative Care (Cont.)
5. Encourage to do part of bathing, dressing,
grooming and other ADL’s. Provide passive
range of motion when indicated on care
plan.
6. Encourage resident to be as independent as
possible if consistent with the care plan.
III. Describe Principles of Rehabilitation (Cont.)
C. Describe Progressive Mobilization
A process that builds on activity steps
which to increase the resident’s abilities.
IV. Discuss Effects of Immobility
Immobility affects the resident’s physical
and psycho-social needs. Inactivity leads
to deterioration and complications in all
body systems.
A. Physical effects of immobility
1. Circulatory
a. Blood vessels may tend to pool,
causing blood clots.
b. Poor blood flow may cause edema
(swelling) in tissues.
c. Increases work load for the heart.
d. Decreases functioning in all body
systems.
IV. Discuss Effects of Immobility (Cont.)
2. Respiratory
a. More difficult for lungs to expand.
b. Tendency toward respiratory infections.
3. Urinary
a. Without gravity, urine tends to be
retained in the bladder, causing
infections of the urinary tract (UTI).
4. Digestive
a. Loss of appetite.
b. Inactivity leads to constipation.
IV. Discuss Effects of Immobility (Cont.)
5. Musculo-skeletal
a. Calcium loss is increased when stress
(activity) is not placed on bones;
leads to risk for fractures.
b. Contractures (shortening and tightening) of
muscles occurs in muscles that are not
used.
6. Integumentary (skin)
a. Pressure ulcers involving skin and deeper
tissue develop quickly on the resident who
does not have frequent position changes.
IV. Discuss Effects of Immobility (Cont.)
B. Mental effects from immobility
1. Inactivity leads to loss of self
esteem, low self concept, poor
body image, and increased
dependence on others.
2. Inactivity can lead to depression.
C. Social effects from immobility
1. Lack of social activity or stimulation
leads to withdrawal, isolation or
loneliness.
V. Describe Body Alignment
The correct positioning of the resident’s
body is referred to as body alignment. Body
alignment means positioning the resident in
good posture, whether in a sitting or lying
position. It is the position where the body is
most comfortable and body systems
function the best.
V. Describe Body Alignment (Cont.)
A. Sitting
1. In Bed (Fowler’s position)
a. Resident is lying on his/her back. With
head and knees elevated.
b. Make certain resident’s hips are at
bend of bed.
c. May be necessary to move resident up
in bed at intervals.
d. Use pillows to assist if consistent with
care plan.
V. Describe Body Alignment (Cont.)
A. Sitting (Cont.)
2. In a chair
a. Feet should be flat on floor or foot stool.
b. Hip and knees at right ankles.
c. Buttocks should rest firmly against back
of
chair.
d. Spine should be straight (natural curve)
against back of chair.
e. Head should be directly over shoulders
f. Support elbows on armrests.
g. May be necessary to position some residents
with pillows to maintain good alignment.
V. Describe Body Alignment (Cont.)
B. Lying
1. Supine Position (lying on back)
a. A small pillow under the resident’s head
usually allows for better alignment than
a large pillow.
b. A footboard helps to keep the feet in
proper alignment and prevents
footdrop.
V. Describe Body Alignment (Cont.)
B. Lying (Cont.)
2. Side Lying Position (lateral position)
a. Pillows support upper arm and leg.
b. Position upper leg so weight does not
rest on lower leg.
c. A pillow placed lengthwise is used to
support the resident’s back and
maintain the position.
V. Describe Body Alignment (Cont.)
B. Lying (Cont.)
3. Prone Position
a. Use this position for residents only
if directed to do so by nurse or
care plan.
b. Turn the resident’s head to one
side when lying prone.
c. The resident’s feet may be placed
in space between mattress and
foot of bed to keep in good
alignment.
V. Describe Body Alignment (Cont.)
B. Lying (Cont.)
4. Use positioning devices if indicated.
a. Pillows
b. Cushions
V. Describe Body Alignment (Cont.)
C. Guidelines for Moving and Lifting
Residents
1. Plan your moves
a. Consult resident’s care plan.
b. Ask for assistance if needed.
Organize equipment.
c. Explain procedure to resident,
making certain he/she understands
what is to be done.
V. Describe Body Alignment (Cont.)
C. Guidelines for Moving and Lifting
Residents (Cont.)
2. Use lifting devices if indicated.
a. Lift sheets.
b. Mechanical lifts.
c. At least two people are required when
using a mechanical lift.
V. Describe Body Alignment (Cont.)
C. Guidelines for Moving and Lifting
Residents (Cont.)
3. Position bed at proper height
a. In low position when transferring resident
in or out of bed.
b. At working level when moving or changing
position of resident in bed.
V. Describe Body Alignment (Cont.)
D. Safety Reminders
1. Use brakes on equipment such as beds,
wheelchairs and lifts.
2. Always check to make sure equipment
used for lifting or moving residents is
in proper working condition.
3. When transferring a resident to
another surface, move resident toward
his/her stronger side.
V. Describe Body Alignment (Cont.)
D. Safety Reminders (Cont.)
4. Support resident’s weaker side when
transferring
a. Residents having had a stroke will have
hemiplegia (paralysis) on half (left or
right) side of the body.
5. Be alert to tubing safety.
6. Make certain all surfaces are stable.
7. Have resident wear non-skid shoes.
V. Describe Body Alignment (Cont.)
D. Safety Reminders (Cont.)
8. Apply artificial limbs and braces correctly.
9. Do not lift under arms of resident; this
can cause Shoulder dislocation.
10. Support body parts when turning resident.
11. Transport residents with care; approach
corners slowly and observe for cross
traffic.
V. Describe Body Alignment (Cont.)
D. Safety Reminders (Cont.)
12. Observe and report any change in resident
condition.
a. Dizziness, unsteadiness, ability to
complete or manage activity.
b. Signs of skin irritation.
c. Resident’s comments.
V. Describe Body Alignment (Cont.)
E. Psychosocial Influences
1. Allow resident to assist as much as
possible if consistent with care plan.
2. Encourage resident if able, to be “in
charge” of transfer.
a. Ask resident to count (1,2,3, move).
b. Offer choices to resident, such as
where to be transported to or when
to be transferred.
V. Describe Body Alignment (Cont.)
E. Psychosocial Influences (Cont.)
3. Be aware the inability to move about
freely is a great loss of the resident’s
independence.
4. Be alert to the resident’s fears, such as
falling or being left alone.
Use of TED Hose
TED hose are elastic stockings used to
promote circulation back to the heart.
TED hose are also called anti embolism
stockings. ( To prevent blood clots)
TED hose are put on residents in am
before getting up and removed at night.
TED hose are physician ordered.
Check care plan.
Home Health Aide
Unit VII
I. Discuss Assisting with Activity and Exercise
in the Client’s Home
A. Review principles of rehabilitation and
restorative care.
B. Review safety in the client’s home.
I. Discuss Assisting with Activity and Exercisein
the Client’s Home (Cont.)
C. Identify special considerations with activity
in the client’s home.
1. Choose a safe supportive chair.
a. A low to the floor, soft chair or a
reclining type chair is difficult to get
out of, especially if client is weak.
b. A chair with arms is easier for client
to push out of chair.
c. Should provide the most
independence.
I. Discuss Assisting with Activity and Exercise in
the Client’s Home (Cont.)
C. Identify special considerations with activity
in the client’s home (Cont.)
2. Plan Transfers
a. There is no one immediately available to
assist if a problem occurs.
b. Position chairs to prevent chairs from sliding and
to provide safe transfers.
c. Do a “walk through” by yourself to see that the
plan will work.
d. Instruct the client carefully so he/she understands
the plan.
e. Concentrate on what you are doing.
I. Discuss Assisting with Activity and Exercise in
the Client’s Home (Cont.)
C. Identify special considerations with activity
in the client’s home (Cont.)
3. Review mechanical lift procedure and follow
agency policy.
4. Assist with rehabilitation activities as
directed.
a. Home health agency may have or contract for
physical therapy services.
b. Follow care plan.
c. Report activities or concerns to supervisor.
II. Describe Sleep and Rest Needs of Child
II. Sleep and Rest Needs of Child
A. Sleep is necessary for the rapid
growth of infants and children.
1. Maintain child’s routine or plan
routine with supervisor.
2. Newborns usually sleep 20 out of 24
hours and are awake mostly to eat.
II. Sleep and Rest Needs of Child
3. Infants usually have morning and
afternoon naps.
4. Toddlers and preschoolers need 12
hours of sleep a day. Some take a nap
or have a rest time to look at books or
other quiet activity.
5. A child confined to bed for medical
reasons need to have play activity
included as part of the routine.
Appropriate activities for Infants,
children, toddlers
Infants – colorful mobiles, rattles,
stuffed animals
Toddlers – finger paints, blocks,
coloring, singing, read books,
educational toys, play dough.
Children – puppets, books, board
games, music, TV, pretend play.