Title: Exercise, Transfers
1Exercise, Transfers Ambulation
2Mobility
- Mobility refers to a persons ability to move
about freely. - Immobility refers to a persons inability to move
about freely. - Mobility immobility are the endpoints of a
continuum with many degrees of partial immobility
in between. - mobility immobility
- Some clients move back and forth, some clients
remain absolute.
3Ability to Move
- The ability to move function is a function most
people take for granted. - The level of mobility has a significant impact on
an ind.s physiological, psychosocial,
developmental well-being (Hamilton Lyon, 1995). - When there is an alteration in mobility, many
body systems are at risk for impairment. - Cardiovascular functioning orthostatic
hypotension - Pulmonary complications pneumonia
- Promote skin breakdown, muscle atrophy etc
- Such changes can lead to altered self-concept
lowered self-esteem.
4Medical Conditions that can Alter Mobility
- Fractures/sprains
- Neurological conditions spinal cord injury,
head injury - Degenerative neurological conditions Myasthenia
gravis, Huntingtons chorea
5Nursing Measures
- Attempt to maintain and/or restore optimal
mobility as well as to decrease the hazards
assoc. with immobility. - DB C exercises
- Muscle joint exercises
- Frequent repositioning q 2 hrs
- fluid intake/fiber intake
- Guidelines
- Check activity order
- Know clients past medical history limitations
- Baseline vital signs are necessary
- Become familiar with assistive devices
6- Major concern during transfer Safety of both
the client and the nurse
7Range of Motion Exercise (ROM)
- ROM exercises, in which a body part is moved
through a range of motion, are carried out to
promote circulation, maintain muscle tone
promote flexibility. In doing this, joint
stiffness debilitating contractures are
prevented. Active ROM is range of motion carried
out by the patient. It is a form of isotonic
exercise as such, it maintains strength, tone
flexibility. In patients unable to move body
parts due to paralysis or extreme illness, ROM is
performed by someone else. This is called
passive ROM exercise. Passive exercise helps to
maintain joint flexibility prevent stiffness
contractures. Because this type of exercise
involves no active movement on the part of the
muscles, it does not contribute to muscle tone or
strength.
8ROM(cont.)
- ROM exercises are planned as a regular part of
nursing activities. During a bath, for example,
the nurse has an excellent opportunity to move
the patients limbs through their full range of
motion. The patient is encouraged to exercise
actively those muscles that can be used.
However, in certain cases, the nurse may need to
assist the patient in performing ROM (active
assisted ROM), or to perform passive ROM.
9ROM (cont.)
- The maximum movement that is possible for a joint
is its range of motion. - If a joint is not moved sufficiently it begins to
stiffen within 24 hrs eventually becomes
inflexible, flexor muscles contract pull tight
causing contractures or fixed joint flexion. - To prevent joint contractures muscle atrophy
(wasting or decrease in size of a normally
developed organ or tissue), exercise must be
performed ROM exercise. - Contracture abnormal flexion fixation of
joints caused by the disuse, shortening atrophy
of muscle fibers. - Correcting contractures requires intensive
therapy over a prolonged period of time, and may
be impossible. Prevention is the key.
10Two Purposes of ROM
- Maintain joint function
- Restore joint function
- Do not exercise joints beyond the point of
resistance or to the point of fatigue or pain
11Contraindications to ROM
- ROM requires energy increased circulation, any
illness/disorder where increased use of energy or
increased circulation is hazardous is
contraindicated puts strain/stress in soft
tissues of the joint bony structures, therefore
not done with swollen, inflamed joints.
12Perform Exercises in Head to Toe Format
- Start with the head and move down, always do
bilaterally - Do not grasp the joint directly
- Cup the joint gently (prevents pressure)
- Do not grasp fingernail or toenail
- Important joints thumb, hip, knee, ankle
- Return to correct anatomic position
- Move joint through movement 5 times/session
13Start at the Neck PP p. 830
Neck Flexion look _at_ the toes Extension look straight ahead Hyperextension look up _at_ ceiling Lateral flexion look straight ahead, tilt head to shoulder
Shoulder Flexion raise arm forward overhead Extension return arm to side of body Abduction raise arm to side to position above head with palm away from head. Adduction return arm bring across chest Internal rotation elbow flexed, rotate the shoulder by moving arm til thumb is turned inward toward the back (fingers to the floor) External rotation elbow flexed, move arm until thumb is upward lateral to head. (fingers point up) Circumduction move arm in full circle (arm straight out, move hand as if to draw a circle.
14Elbow
Elbow Flexion bend elbow Extension straighten elbow Hyperextension bend lower arm back as far as possible
Forearm Supination turn lower hand so palm is up Pronation - turn lower hand so palm is down
Wrist Flexion bend wrist forward Extension straighten wrist (fingers, wrist arm in same plane) Hyperextension bring dorsal surface of hand as far back as possible Abduction (radial flexion) bring wrist medially towards the thumb Adduction (ulnar flexion) bend wrist laterally towards 5th finger
15Fingers Thumb
Fingers thumb Flexion bend fingers thumb into palm make a fist Extension straighten fingers thumb Hyperextension bend fingers as far back as possible Abduction spread fingers apart / extend thumb laterally Adduction bring fingers together/ thumb back to hand Circumduction move finger/thumb in circular motion Opposition touch thumb to each finger of same hand
16Hip
Hip Flexion move leg forward (ROM 90-120 deg) Extension move leg back beside other leg Hyperextension move leg backwards (ROM 30-50 deg) Abduction move leg laterally away from body (ROM 30-50 deg) Adduction move leg back to medial position beyond if possible (ROM 30-50 deg)
Knee Flexion bring heel toward back of thigh (120-130 deg) Extension return leg to floor
17Ankle
Ankle Dorsiflexion move foot so toes are pointed upward Plantarflexion move foot so toes are pointed downward
Foot Inversion turn sole of foot medially (ROM 10 deg) Eversion turn sole of foot laterally (ROM 10 deg) Flexion curl toes downward (ROM 30-60 deg) Extension straighten toes (ROM 30-60 deg) Abduction spread toes apart Adduction bring toes together
18Spine
Spine Flexion when standing bend forward from the waist Extension straighten up Hyperextension bend backward Lateral flexion bend to the side Rotation twist from the waist
19Types of ROM exercises
- Active exercises the client is able to perform
independently. - Passive exercises performed for the client by
someone else. - Active assisted performed by a client with some
assistance client can move a limb partially
through its ROM, but needs help completing the
ROM.
20Isometric/Isotonic Exercises
- In addition to ROM exercises, some immobilized
clients may be able to perform muscle-strengthenin
g exercises. - Isotonic cause muscle contraction change in
muscle length walking, aerobics, moving arms
legs against light resistance. - Isometric tightening or tensing of muscles
without moving body parts. This increases muscle
tension but do not change the length of muscle
fibers. Isometric exercises are easily performed
by an immobilized patient in bed. - Isotonic and isometric exercises help to prevent
muscular atrophy and combat osteoporosis.
21Applying Antiembolism Stockings (Elastic) PP p.
842
- Thromobophlebitis the development of a thrombus
or clot along with the inflammation of the vein
may be classified as superficial or deep. - Three elements contribute to the development of a
clot. - Hypercoagulability of the bld clotting
disorders, dehydration, pregnancy 1st 6 weeks
postpartum if the woman was confined to bed, oral
contraceptives. - Venous wall damage local trauma, orthopedic
surgeries, major abdominal surgery, varicose
veins, arteriosclerosis - Blood stasis immobility, obesity, pregnancy
22Antiembolism stockings
- Promote venous return by maintaining pressure on
superficial veins to prevent venous pooling. - Prevent passive dilation of veins
- Application of antiembolism stockings (refer to
p. 845 PP)
23Orthostatic hypotension
- A drop in blood pressure that occurs when the
client rises from lying to sitting or from
sitting to standing. (A decrease in systolic
pressure gt15 mmHg or decrease diastolic pressure
gt10 mmHg.) - At risk clients
- Immobilized clients
- Prolonged bed red
- Measures to minimized Orthostatic Hypotension
- Maintain muscle tone
- Increase venous return to the heart
- Decrease stasis of bld in the lower extremities
- ROM/isometric exercises/TEDs
- Mobilize ASAP
24Therapeutic Positions
- Chair feet flat on floor, footrest if unable to
reach floor, knees hips flexed 90-100 degrees.
Buttocks at back of the chair, spine straight,
pillows at side to prevent leaning. - Fowlers supine, HOB elevated 45 deg. Promotes
lung expansion, decrease ICP, comfortable for
eating. - High fowlers same as above, with HOB elevated
45-90 deg. Utilized for clients experiencing
difficulty breathing. - Semi fowlers as above with HOB elevated less
than 45 deg. - Orthopneic sit on side of bed with over bed
table across lap, pillow on table, lean forward
rest head arms on table. Utilized for patients
with extreme difficulty breathing promotes lung
expansion.
25Therapeutic positions cont.
- Lithotomy supine flex both knees so that feet
are close to hips, separate legs, feet in
stirrups. Utilized for perineal vaginal
examinations - Trendelenburg supine, entire bed frame tilted
down with head 30 deg below horizontal. - Postural drainage
- Increase venous return in case of shock
26Benefits of Proper Positioning
- Maintains body alignment comfort
- Prevents injury to musculoskeletal system,
prevents strain - Provides sensory, motor cognitive stimulation
- Prevents pressure sore (decubitus ulcer) joint
contractures
27Transfers
- Transferring is a nursing skill that helps the
client with restricted mobility attain/maintain
mobility independence. - Benefits of transfers
- Maintains improves joint motion
- Increases strength
- Promotes circulation
- Relieves pressure on the skin
- Improves urinary/respiratory function
- Increases social activity
- Increased mental stimulation
28Transfers - Safety
- Safety is a major concern when transferring.
Falls are a common hazard. If a patient starts
to fall do not try to stop the fall, instead
assist the patient to the floor while protecting
the head from injury. This will reduce the risk
of patient as well as staff injury. - Complete a thorough nursing assessment before you
move the patient to determine if she/he has
suffered any injuries. - Prevention of injury is the key, be aware of the
clients motor deficit, ability to support their
body weight and use effective body mechanics
lifting techniques. - When in doubt regarding the patients ability-GET
ASSISTANCE
29Nursing Process - Transfers
Assessment Activity orders Client capabilities
Planning Decide appropriate transfer technique Explain procedure to the patient
Implementation Wash hands Position chair 45 deg angle to bed on clients stronger side Lock bed brakes, lower bed, raise HOB as high as patient tolerates Lower side rail Assist to sitting (lift upper body swing legs around) Assist with robe slippers Position feet on floor Take wide stance, bend knees, grasp patient 1 2 3 stand Pivot to chair
30Nursing Process (cont.)
Evaluation Of note Body in alignment, patient comfortable, no injuries Nurse maintains good body alignment Two person lift (same as above) except one nurse is on each side of the patient Never lift under the axilla can damage nerves Mechanical lifts enables you to lift heavy patients, or those unable to help. (Use 2 people)
31Ambulation
- Clients who have been immobile even for a short
time may require assistance - A client may require the use of an assistive
device to aid in ambulation. - Assistive devices
- Increase stability
- Support a weak extremity
- Reduce the load on weight bearing structures
hip, knees
32Assisting the patient
- Simple assist
- Place arm near patient under the arm at the
elbow grasp pts hand, synchronize walking with
the pt (move inside foot forward at same time as
pts inside foot) - Grasp pts left hand in nurses left hand
encircle pts waist with the rt hand
synchronize walking as above - Using a transfer belt (held at the waist from the
rear by the belt helps maintain balance) - Nurse to stand on the pts weak side. The nurse
provides support with his/her leg to the pts
weakened one if necessary. Do not allow the pt.
to place their arm around your shoulder. - Walk slowly, even gait, synchronize your steps.
33Cane
- Helps maintain balance by widening the base of
support increases a pts security. - Should be held on stronger side
- Should have rubber tip prevent slipping
- Height (from greater trochanter to the floor
allowing 15-30 deg of elbow flexion. - Gait place cane 6-10 inches ahead, move
affected leg ahead to cane, place weight on
affected leg and cane, move unaffected leg ahead
of cane. - Stand from sitting
- Cane in hand opposite affected leg, grasp arm of
chair cane in other, push to stand, gain
balance
34Walker
- Wide base of support, provides great stability
security. Used for clients who are weak or who
has problems with balance. - Patient should have at least one weight bearing
leg and arm - Pick up walker is more stable, walker with wheels
easier for pts who have difficulty with lifting
or balance, however can roll forward when weight
is applied. - Height upper bar of walker should be slightly
below the clients waist with arms flexed 15-30
deg
35Walker (cont.)
- To stand walker in front of seat, push up off
arms of chair (walker is less stable, chair is
lower pt. can push with more force. Hands move
to walker one at a time. - To sit back up to chair, reach back with one
arm to arm of chair, then with the other arm and
lower to chair. - Gait walker ahead 6-8 inches, weight on arms.
Partial weight on affected leg first.
36Crutches
- Wooden or metal staff that reaches from the
ground to 11/2 2 inches below the axilla. When
standing tip of crutch rests 4-6 inches in front
4-6 inches to side of foot. - Do not rest on top of crutches pressure on
axilla nerves can lead to paralysis called
crutch paralysis (numbness, tingling, muscle
weakness)
37Crutches (cont.) PP p.859
- 3 point gait able to wt. bear on one foot, full
wt. on unaffected leg then on both crutches
begin in tripod position, move crutches
affected leg ahead, move stronger leg forward and
repeat. - 4 point gait (most stable crutch walk) weight
on both legs and both crutches muscular
weakness, improves balance by providing a wide
base of support, lack of coordination, move each
independently rt crutch-lt foot-lt crutch-rt leg