Activity And Exercise

1
Activity And Exercise

• Mobility and Body Mechanics

2
Altered Mobility

• Therapeutic Modalities
• Limitation in Motion for treatment
• Types of Bed rest
• Manifestations of altered mobility
• Decreased muscle strength and tone
• Lack of Coordination
• Altered Gait
• Falls
• Decreased joint flexibility
• Pain on Movement

3
Activity/ Exercise

• Musculoskeletal
• Atrophy
• Contractures/ Joint stiffness
• Anklosed/Anklosis
• Cardiovascular
• Increased cardiac work load
• Increased heart rate (Tachycardia)

4

• Orthostatic (Postural) Hypotension
• Venous Vasodilation/Statis
• Edema
• Thrombus/Embolism
• Thrombus-blood clot
• Large veins-legs
• DVT-Deep vein thrombosis
• Embolism- clot breaks away and travels
• Obstruction
• Lungs- Pulmonary emboli-possible death

5

• Three factors that contribute to DVT
• Impaired venous return of blood to heart
• Positioning, edema
• Injury to vessel wall
• Blood gets caught and clots
• Hypercoagulability
• Dehydration
• Blood viscosity to increase
• Elevated serum calcium levels
• Seen in immobilized clients

6

• Respiratory
• Decreased lung span
• Decreased vital capacity
• Decreased inflation of lungs
• Restricted movement
• Pooling of secretions
• Hypostatic Pneumonia
• Atelectasis
• Decreased gas exchange in the lungs

7
Nutrition/Metabolic

• Decreased Metabolic rate
• Basal metabolic rate decreases
• Alters drug metabolism
• Weight loss R/T loss of muscle mass and diuresis
• Negative Nitrogen Balance
• Depletion of protein stored
• Elevated urine nitrogen

8

• Anorexia
• Loss of appetite
• R/T decreased metabolic ratedecreased caloric
  needs
• Decreased energy, malnutrition
• Disuse Osteoporosis
• Bone demineralization secondary to immobility

9

• Pressure sores (decubitus)
• Pressure induced sores
• Decreased blood supply to tissue
• Decreased nutrients, 02, waste removal decreased
• Cells dienecrotic
• Pressure greater in the supine position
• Back, skull, elbows, scrum, ischial tuberosities,
  heels

10
Elimination

• Urinary stasis
• Decreased urge to void in supine position
• Inconvenient for the staff/bother
• Cannot void lying down
• Delayed micturition
• Urine pools in the bladder
• Overstretching of the bladder muscle
• Permanent change in bladder tone

11

• Urine must flow upward against gravity
• Urinary retention
• UTI R/T stagnant urine
• Renal Calculi (kidney Stones)
• Urinary stasis increases serum calcium levels
  from the loss of calcium from the bones
• Urinary calcium can precipitate to form crystals
  that may produce stones
• Urine is more alkaline calculi development

12

• Constipation
• Abdominal and perineal muscles weaken
• Decreased ability to bear down and exert pressure
  to pass stool.
• Decreased peristalsis
• Hardening of stool
• Dehydration
• Impaction
• Decreased activity
• Liquid stool will seep around the obstruction

13
Sleep/Rest

• Interferes with normal sleep patterns
• Lack of fatigue
• Increase naps
• Awaken by frequent turning
• Unfamiliar noisy environment.

14
Cognition/Perception

• Immobility decreases freedom to socialize
• Preoccupation with somatic complaints
• Decreased ability to recognize and respond to
  pain r/t prolonged pressure

15
Self-perception/Self-Concept

• Feelings of powerlessness
• Dependence on others
• Embarrassment r/t devices
• Crutches, walker, cane, wheelchair

16
Roles/ Relationships

• Disruption of school and social activities
• Inability to work
• Disruption of parental or spousal activities
• Care of children/parents

17
Coping/Stress

• Not a desired function ability
• Trauma
• Permanent
• Many hours alone
• Bored, lonely
• Depression, anxiety, anger
• Withdrawal, demanding

18
Sexuality

• Limited mobility
• Lack of privacy
• Depression
• Fatigue
• Impede grooming
• Sexual identity

19
Nursing process

• Assessment
• Normal patterns vs abnormal ability
• Alignment
• Balance
• Coordination
• Gait
• Joint function
• Muscle mass, tone, strength
• Postural B/P
• Risk for falls

20

• Diagnostic Test /Procedures
• X-ray
• Arthroscopy
• Fiberoptic examination of abnormalities
• Blood test
• H H

21
NDX

• Impaired Physical Mobility
• R/T pain, intolerance to activity, decreased
  strength, depression, cognitive impairment
• Activity Intolerance
• R/T bedrest, immobility, generalized weakness,
  dyspnea.

22
Expected Outcomes

• Client will increase endurance and tolerance for
  physical activity
• Client will maintain optimal functional ability.

23
Interventions

• Health Promotion
• Physical fitness
• Exercise programs
• Injury prevention
• Positioning
• Turning schedules
• ROM