Chapter 38 Activity and Exercise Copyright © 2021, Elsevier Inc. All Rights Reserved. 2 Introduction Physical activity Elevates mood and attitude. Enables physical fitness. Helps one to quit smoking and stay tobacco-free. Boosts energy levels. Helps in the management of stress. Promotes a better quality of sleep. Improves self-image and self-confidence. Copyright © 2021, Elsevier Inc. All Rights Reserved. 3 Scientific Knowledge Base Nature of movement Body mechanics Alignment Body alignment Gravity and balance and friction Unsteady patients fall if their center of gravity becomes unbalanced Friction is a force that occurs in a direction to oppose movement. Copyright © 2021, Elsevier Inc. All Rights Reserved. 4 Case Study (1 of 7) Mr. Indelicato is a 72-year-old AfricanAmerican who is hospitalized for surgery on his right knee. He relates the problem with his knee to previous sports injuries. He first sought medical advice and treatment 6 years ago. He has tried various treatments, including physical therapy, rest, and pain medication. His only preoperative medication is ibuprofen 600 mg every 6 to 8 hours. He and his wife are very active. Copyright © 2021, Elsevier Inc. All Rights Reserved. 5 Case Study (2 of 7) Marilyn Sweeney is a 40-year-old nursing student. She has just finished rotating through a general surgical unit and is spending the remaining 6 weeks in the orthopedic/rehabilitation division of the agency. Her assignment is to follow Mr. Indelicato through his surgery and rehabilitation. As Marilyn prepares to assess Mr. Indelicato, she reviews musculoskeletal anatomy and physiology and exercise physiology. Copyright © 2021, Elsevier Inc. All Rights Reserved. 6 Regulation of Movement Skeletal Joints Ligaments, tendons, and cartilage Skeletal muscle Muscles concerned with movement Muscles concerned with posture Nervous system system Proprioception Balance and alignment Copyright © 2021, Elsevier Inc. All Rights Reserved. 7 Activity and Exercise Physical activity (PA) is any movement produced by skeletal muscles that results in energy expenditure. Physical exercise is a subset of PA that is planned, structured, and repetitive and has a final or an intermediate objective, such as the improvement or maintenance of physical fitness. Active lifestyle Resistive isometric exercise Copyright © 2021, Elsevier Inc. All Rights Reserved. 8 Principles for Transfer and Positioning Pathological influences on body alignment, mobility, and activity Using the principles of balance and alignment aids in safe patient transfer and positioning during routine care activities Congenital defects Disorders of bones, joints, and muscles Central nervous system damage Musculoskeletal trauma Obesity Copyright © 2021, Elsevier Inc. All Rights Reserved. 9 Nursing Knowledge Base Safe patient handling and mobility (SPHM) Involves improved assessment, the use of mechanical equipment, and safety procedures to lift and move patients SPHM programs The use of SPHM techniques is a standard for best practices in the moving, handling, and transfer of patients. Copyright © 2021, Elsevier Inc. All Rights Reserved. 10 Factors Influencing Activity and Exercise (1 of 2) Developmental Infants through school-age children Adolescence Young to middle-age adults Older adults Behavioral changes aspects Patients are more likely to incorporate an exercise program if those around them are supportive Copyright © 2021, Elsevier Inc. All Rights Reserved. 11 Factors Influencing Activity and Exercise (2 of 2) Cultural background Environmental issues Work site Schools Community Family and social support Copyright © 2021, Elsevier Inc. All Rights Reserved. 12 Critical Thinking Successful critical thinking Requires a synthesis of knowledge, experience, information gathered from patients, critical thinking attitudes, and intellectual and professional standards Consider the relationship among a variety of concepts to provide the best outcome for your patients Professional standards provide valuable guidelines for exercise and physical fitness. Encouragement, support, commitment, and perseverance are important critical thinking Copyright © 2021, Elsevier Inc. All Rights Reserved. attitudes. 13 Nursing Process: Assessment (1 of 2) Must be comprehensive, considering: Physical condition Activity history Socioeconomic resources Readiness to exercise Consider normal physiological growth changes Observe posture Use critical thinking Copyright © 2021, Elsevier Inc. All Rights Reserved. 14 Nursing Process: Assessment (2 of 2) Through the patient’s eyes Readiness to exercise Socioeconomic factors Physical health Body alignment Mobility Sitting/standing Range of motion Gait Exercise Activity tolerance Copyright © 2021, Elsevier Inc. All Rights Reserved. 15 Case Study (3 of 7) Mr. Indelicato is hesitant to ambulate or use his continuous positive motion machine. He rates his pain as 6-7 on a scale of 0 to 10 and is using a patient-controlled analgesia (PCA) pump. His degree of knee flexion is now 70 degrees. He can ambulate 10 feet with a walker. He describes the muscle in his right leg as feeling weak and tired after walking a short distance. Marilyn observes Mr. Indelicato using the walker incorrectly. Copyright © 2021, Elsevier Inc. All Rights Reserved. 16 Nursing Diagnosis Activity intolerance Risk for injury Impaired mobility in bed Impaired mobility Acute or chronic pain Copyright © 2021, Elsevier Inc. All Rights Reserved. 17 Planning Goals and outcomes Goal: improve or maintain the patient’s motor function and independence Setting priorities Take into account the patient’s most immediate needs Teamwork and collaboration Physical and occupational therapists Discharge planning Copyright © 2021, Elsevier Inc. All Rights Reserved. 18 Case Study (4 of 7) Mr. Indelicato will attain a tolerable level of pain during ambulation. Mr. Indelicato will gain optimal functioning of the right knee with independent, purposeful movement. Mr. Indelicato’s pain will be a 2 to 3 on a scale of 0 to 10 during ambulation. Mr. Indelicato will ambulate 50 to 75 feet with the aid of a walker without reports of increasing fatigue. Mr. Indelicato will gain a minimum of 90-degree flexion in the right knee by the time of discharge. Mr. Indelicato will demonstrate proper use of a walker while ambulating. Mr. Indelicato will perform a return demonstration of proper use of a walker. Copyright © 2021, Elsevier Inc. All Rights Reserved. 19 Implementation (1 of 3) Health promotion Use patient-centered approach Teach patients to calculate maximum heart rate. Body mechanics Acute care Early mobility Isometric exercises Range of motion exercises Walking Copyright © 2021, Elsevier Inc. All Rights Reserved. 20 Quick Quiz 1 1. A patient with a long history of arthritis complains of sensitivity and warmth in the knees. To determine the degree of limitation, the nurse should assess: A. posture. B. activity tolerance. C. body mechanics. D. range of joint motion. Copyright © 2021, Elsevier Inc. All Rights Reserved. 21 Implementation (2 of 3) Helping a patient walk Assess patient’s ability to walk safely Evaluate environment for safety Assist patient to sitting position, dangle patient’s legs over the side of the bed 1 to 2 minutes before standing Provide support at the waist so the patient’s center of gravity remains midline (gait belt) Restorative and continuing care Implement strategies to assist patient with ADLs Copyright © 2021, Elsevier Inc. All Rights Reserved. 22 Implementation (3 of 3) Copyright © 2021, Elsevier Inc. All Rights Reserved. 23 Case Study (5 of 7) Marilyn wants to help Mr. Indelicato with ambulation and strength training. To implement her plan of care, she: Encourages Mr. Indelicato to use a PCA pump before ambulation. Explains why he should sit in bed and dangle his legs before standing to ambulate. Establishes realistic increments for Mr. Indelicato to increase walking distance during ambulation. Talks with him about exercise tolerance. Copyright © 2021, Elsevier Inc. All Rights Reserved. 24 Case Study (6 of 7) As part of the teaching process, Marilyn consults with a physical therapist on proper use of the walker. She and the physical therapist instruct Mr. Indelicato and family caregivers on the proper use of a walker, and Marilyn provides written material that reinforces these verbal instructions. Copyright © 2021, Elsevier Inc. All Rights Reserved. 25 Assistive Devices for Walking Walkers Canes Crutches Measuring Crutch gait Ascend and descend stairs Sitting in a chair Copyright © 2021, Elsevier Inc. All Rights Reserved. 26 Crutch Gait Copyright © 2021, Elsevier Inc. All Rights Reserved. 27 Restoration of Activity and Chronic Illness Coronary artery disease Hypertension Chronic obstructive pulmonary disease Diabetes mellitus Copyright © 2021, Elsevier Inc. All Rights Reserved. 28 Evaluation Through Are the patient’s expectations being met? Patient the patient’s eyes outcomes Make comparisons with baseline measures Consider standards for physical activity performance Compare actual outcomes with expected outcomes. Copyright © 2021, Elsevier Inc. All Rights Reserved. 29 Case Study (7 of 7) Marilyn evaluates how effective her plan of care has been. She asks Mr. Indelicato to rate his level of pain from 0 to 10, observes his range of motion and use of the continuous passive motion (CPM) machine, and observes his ambulation with a walker. Mr. Indelicato rates his pain as a 3 and is able to perform range of motion (ROM) exercises and use the CPM machine. He has a steady gait with the aid of the walker. Copyright © 2021, Elsevier Inc. All Rights Reserved. 30 Safety Guidelines for Nursing Skills Know patient’s level of mobility Assess patient’s risks for activity intolerance Mentally review transfer steps before beginning Stand on unaffected side Determine transfer equipment needed Raise bed’s side rail on opposite side Arrange equipment Evaluate for correct body alignment Understand equipment before starting Copyright © 2021, Elsevier Inc. All Rights Reserved.
