Week 8 - Activity
Activity & Immobility
Identify proper assessment of the musculoskeletal system. Other than the
physical assessment, what other assessment data (think: interview) would the
nurse gather when assessing immobility, activity, and exercise?
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Physical assessment
o General ease of movement and gait
o Alignment
o Joint structure and function
o Muscle mass, tone, and strength
o Endurance
Interview
 Inquire about activity/sports
 Assess for risk factors for osteoporosis
 Ask about history of bone, muscle, or joint problems
 Inquire about pain
 Ask about normal activity and ADLs
Define and discuss abnormalities of the musculoskeletal system
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Posture abnormalities
o Kyphosis
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Lordosis
o Scoliosis
Muscle mass
o Atrophy- reduced in size, feels soft
o Hypertrophy- increased muscle mass
Muscle tone
o Hypertonicity (spasticity)- increased resistance with passive ROM
o Hypotonicity (flaccidity)- little tone, feels flaccid, extremity hangs
loosely, positioned by gravity
3. Discuss the effects of immobility on a patient (each system). Identify and
describe nursing interventions to promote prevention of complications due to
immobility.
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Musculoskeletal changes
o Immobility predisposes a person to: weakness, decreased muscle
tone, decreased bone and muscle mass
 Potential muscle atrophy, or wasting
 Contracture, or permanent fixation, of a joint
 Joint contractures can begin within hours of disuse
 Foot drop
Muscle effects
o Lean body mass loss
o Muscle weakness/atrophy
Skeletal effects
Week 8 - Activity
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Immobilization > impaired calcium metabolism and joint
abnormalities
o Disuse osteoporosis
o Joint contracture
Metabolic changes
o Decreases metabolic rate
o Alters metabolism
o Causes GI disturbances
Gastrointestinal
o Appetite disturbances
o Decreased food intake
o Poor digestion and utilization of food
o Decreased GI motility
Urinary Elimination changes
o Immobility- impairs the flow of urine through the renal system
(urinary stasis)
o Renal calculi (d/t hypercalcemia)
o Infection
Integumentary changes
o Pressure ulcers
o Older adults at greater risk
Psychosocial changes
o Emotional and behavioral responses
 Hostility, giddiness, fear, anxiety
o Sensory alterations
 Altered sleep patterns
o Changes in coping
 Depression, sadness, dejection
Positioning techniques
o Hand roll- holds hand in anatomical position
o Splints and braces are used on extremities to keep joints in
functional positions (ankle foot orthotic, foot board, hand roll)
o Trochanter roll- prevent hip from rotating
Describe the psychosocial/psychological effects of immobility.
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Psychosocial changes
o Emotional and behavioral responses
 Hostility, giddiness, fear, anxiety
o Sensory alterations
 Altered sleep patterns
o Changes in coping
 Depression, sadness, dejection
Discuss the prevention of DVT formation in the immobile patient.
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Anticoagulants (Lovenox, Heparin)
Antiembolic Stockings (TED)
Calf pumping Sequential compression
Sequential compression device (SCD)- inflates with air to accelerate venous
blood return
Week 8 - Activity
6.
Define the terminology for range of motion.
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Range of motion (ROM): Active, active-assistive, and passive techniques
Range of motion is the distance and direction a joint can move that is considered
normal for the patient
There are 3 types:
o Active ROM: the patient has full independent movement of all joints; this
is also known as isotonic exercise
o Active-assistive ROM: the caregiver minimally assists the patient or the
patient minimally assists himself or herself in the movement of joints
through a full motion
o Passive ROM: the caregiver moves the patient’s joints through a full
motion
ROM does not maintain nor improve strength but maintains flexibility and
prevents contracture and atrophy
7. What does the term body mechanics mean? Why is it important for nurses to
understand and utilize proper body mechanics? What measures does nurse use
to ensure use of proper body mechanics?
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Body mechanics- coordinated efforts of musculoskeletal & nervous systems to
maintain balance, posture, and body alignment during lifting, bending, moving,
and performing ADL’s
Proper use of body mechanics reduces risk for injury and ensures safe care
o Lifting
Patient care ergonomics- practice of designing equipment and work tasks to
conform to the capability of the worker
What are the effects of exercise on the body systems?
9. Discuss the importance of proper positioning. Identify the rationale behind
nursing interventions which help with positioning/various positions.
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Positioning patients in bed
o Promoting correct alignment
 Foam wedges
 Mattresses
 Adjustable beds
 Trapeze bar
 Foot boards, boots
Week 8 - Activity
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Trochanter rolls
Hand and wrist splints
Side rails
Trapeze bar- uses upper body strength
Hand roll- holds hand in anatomical position
Splints and braces- used on extremities to keep joints in functional positions
Nursing interventions
o Assisting with ambulation
 Gait belt
 Provides support at the waist
 Keeps patients center of gravity midline
 Do not use on patients with chest or abdominal incisions
Lateral Assist
o Side to side transfers
o Roller boards, slide board, transfer boards
o Mechanical lateral assist- used motor or crank
Stand assist
o Patients who need minimal assistance to stand
o Powered stand-assist
Powered full body lifts
o Either hand-operated or electrically operated
o Are used to prevent injury to caregivers when transferring patients
10. Explain the proper technique for cane, walker, and crutch use. How would you
know your patient understood teaching?
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Walker
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The patient holds the hand grips on the upper bars, takes a step, moves
the walker forward, and takes another step
Canes (quad, wood, aluminum)
o Keep cane on stronger side of the body
o Place cane forward 6 to 10 inches, keeping body weight on both legs
o Weaker leg is moved forward, divide weight between cane and stronger
leg
o Stronger leg is advanced past cane; divide weight between cane and
weaker leg
Crutches
o Measuring for crutches
 Patient’s height, the angle of elbow flexion, and the distance
between the crutch pad and the axilla
 Ensure the length of the crutch is 2 to 3 finger widths from the
axilla and position the tips approxiately 2 inches lateral and 4 to 6
inches anterior to the front of the patient’s shoes
11. What are principles of safe patient transfer? Explain methods of patient
transfer (including the use of assistive devices).
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Assess patient and their ability to assist and understand
Incorporate the patient’s priorities of care and preferences
Promote independence as appropriate
Communicate clearly with members of the health care team
Week 8 - Activity
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Use the best evidence when making decisions about your patient’s care
Ensure safety
o Consider the use of assistive devices
o Assess environment (clutter, patient tubes and lines, equipment, etc.)
o Explain process to patient
o Administer pain medications, if indicated
o Lock wheels!!!
o Smooth, rhythmic motions
Equipment and assistive devices
o Gait belts
o Stand-assist and repositioning ids
o Lateral-assist devices
o Friction-reducing sheets
o Mechanical lateral-assist devices
o Transfer chairs
o Powered stand-assist and repositioning lifts
o Powered full-body lifts
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1.
Discuss the effects of sleep deprivation.
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Sleep
Physiological effects of sleep deprivation
o Blurred vision
o Fine motor clumsiness
o Slowed reflexes
o Slowed response time
o Altered judgment
o Decreased alertness
o Cardiac arrhythmias
Psychological effects of sleep deprivation
o Confusion
o Disorientation
o Irritability
o Increased sensitivity to pain
o Agitation
o Hyperactivity
o Lack of motivation
Discuss interventions to promote a healthy sleep pattern.
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Encourage bedtime routine
Relaxation activity or exercise
Environment
o Temperature
o Lighting
o Noise
Eliminate pain
Avoid alcohol, caffeine, nicotine, and excessive alcohol at bedtime
Take a warm bath
Eat a light snack that contains carbohydrates
Week 8 - Activity
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Drink warm milk
Get a back massage
Relax using aromatherapy and music therapy
Elevate the head of the bed if diagnosed with gastroesophageal reflux
disease (GERD)
3. Discuss the signs and symptoms of obstructive sleep apnea (OSA). How
does the nurse identify OSA? Discuss interventions and management.
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In sleep apnea, a person experiences the absence of breathing (apnea) or
diminished breathing during sleep between snoring intervals
SLEEP APNEA (OSA): SNORING SOUND!!!
Sleep apnea assessment
o Has anyone told you that you snore loudly or stop breathing while you
sleep? Do you have headaches when you wake up? Do you have trouble
staying awake during the day? Do you feel tired all the time?
Treatment for OSA
o Lifestyle changes for good sleep practices
o Decreased alcohol use
o No use of tobacco products
o Weight loss
o Surgical procedures
o Oral appliance- CPAP