Exercise, Transfers

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Exercise, Transfers Ambulation

• Nursing 125

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Mobility

• 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.

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Ability 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.

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Medical Conditions that can Alter Mobility

• Fractures/sprains
• Neurological conditions spinal cord injury,
  head injury
• Degenerative neurological conditions Myasthenia
  gravis, Huntingtons chorea

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Nursing 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

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• Major concern during transfer Safety of both
  the client and the nurse

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Range 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.

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ROM(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.

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ROM (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.

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Two 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

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Contraindications 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.

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Perform 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

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Start at the Neck PP p. 830
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Elbow
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Fingers Thumb
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Hip
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Ankle
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Spine
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Types 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.

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Isometric/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.

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Applying 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

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Antiembolism 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)

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Orthostatic 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 15 mmHg or decrease diastolic pressure
  10 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

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Therapeutic 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.

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Therapeutic 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

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Benefits 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

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Transfers

• 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

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Transfers - 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

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Nursing Process - Transfers
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Nursing Process (cont.)
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Ambulation

• 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

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Assisting 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.

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Cane

• 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

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Walker

• 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

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Walker (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.

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Crutches

• 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)

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Crutches (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