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ACTIVITY & EXERCISE

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ACTIVITY & EXERCISE

Activity and Exercise

PRESENTED BY; N/C Rida zainab N/C Tehmina

Bsc(N) 3rd year (S-2011)

FACULTY; Maj Shagufta perveen

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ACTIVITY & EXERCISE

OBJECTIVES
At the end of this session learner will be able to; Review the anatomy & physiology of musculoskeletal system. Define physical activity,exercise,immobility ,joint mobility, body alignments & mechanics. Discuss benefits of exercise & mobility. Describe four basic elements of normal movement. Differentiate isotonic, isometric, isokinetic, aerobic, and anaerobic exercise. Identify the principle of gravity that affect balance.

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CONTD.
Compare the effects of exercise and immobility on body systems. Identify factors influencing a mobility. Apply nursing process while planning for client with altered musculoskeletal system

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ANATOMY & PHYSIOLOGY

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ACTIVITY EXERCISE PATTREN

Refers to a person's routine of exercise activity, leisure and recreation.It includes ADL e.g; Hygiene,Cooking, Shopping,Eating, Working, Home maintenance Exercise A planned,structured and repetitive bodily movement done to improve or maintain one or more components of physical fitness e.g sports etc

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CONTD
Physical activity Bodily movements produced by skeletal muscles that require energy expenditure and progressive health benefits Joint Mobility is the ability to move a limb through the full range of motion with control. Body Mechanics Body mechanics is the utilization of correct muscles to complete a task safely and efficiently, without undue strain on any muscle or joint.

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ACTIVITY OF DAILY LIVING

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NORMAL MOVEMENTS
Body movement requires coordinated muscle activity and neurologic integration. It involves four basic elements: Body alignment (posture) Joint mobility Balance Coordinated movement

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Body alignment

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TYPES OF JOINTS MOVEMENT

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TYPES OF EXERCISES
Isotonic Isometric Isokinetic Aerobic Anaerobic

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BENEFITS OF EXERCISES
Effect on the Musculoskeletal System Exercise
Maintain size, shape, tone, and strength of muscles Nourishes joints Increases joint flexibility, stability, and ROM Maintains bone density and strength

Immobility
Disuse osteoporosis Disuse atrophy Contractures Stiffness and pain in the joints

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Effect on the Cardiovascular System

Exercise
Increases heart rate, strength of contraction, and blood supply to the heart and muscles Mediates the harmful effects of stress

Immobility
Diminished cardiac reserve Increased use of the Valsalva maneuver Orthostatic (postural) hypotension Venous vasodilation and stasis Dependent edema Thrombus formation

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Effect on the Respiratory System

Exercise
Increase ventilation and oxygen intake improving gas exchange Prevents pooling of secretions in the bronchi and bronchioles

Immobility
Decreased respiratory movement Pooling of respiratory secretions Atelectasis Hypostatic pneumonia

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Effect on the Metabolic/Endocrine System

Exercise
Elevates the metabolic rate, thus increasing the production of body heat and waste products and calorie use Decrease serum triglycerides and cholesterol Stabilize blood sugar and make cells more responsive to insulin

Immobility
Decreased metabolic rate Negative nitrogen balance Anorexia Negative calcium balance

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Effect on the Gastrointestinal System

Exercise
Improves the appetite Increases gastrointestinal tract tone Facilitates peristalsis

Immobility
Constipation

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Effect on the Urinary System

Exercise
Promotes blood flow to the kidneys causing body wastes to be excreted more effectively Prevents stasis (stagnation) of urine in the bladder

Immobility
Urinary stasis Renal calculi Urinary retention Urinary infection

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Effect on Cognitive Function

Exercise

Positive effects on decision-making and problem-solving processes, planning, and paying attention Induces cells in the brain to strengthen and build neuronal connections Other Effects of Exercise and Immobility
Evidence that certain types of exercise increase spiritual health Immobility causes reduced skin turgor and skin breakdown

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Factors Affecting Body Alignment, Mobility, and Daily Activity Level

Growth and development Nutrition, personal values, and attitudes External factors Prescribed limitations

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INDIVISUAL BARRIER TO EXERCISE

Lack of time, energy, or motivation

Excessive cost
Illness or injury

Feeling uncomfortable
Lack of skill Fear of injury

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Assessment of Activity and Exercise

Nursing history Physical examination of the following:
Body alignment Gait Appearance and movement of joints Capabilities and limitations for movement Muscle mass and strength Activity tolerance Problems related to immobility

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A standing person with A, good trunk alignment; B, poor trunk alignment. The arrows indicate the direction in which the pelvis is tilted.
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Nursing Diagnoses for Activity and Exercise Problems

Activity intolerance Risk for activity intolerance Impaired physical mobility Sedentary lifestyle Risk for disuse syndrome

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NURSING PROCESS
ASSESMENT; Subjective
Pts daughter states that her mother was experiencing progressive right sided weakness over 2 days prior to admission.

Objective
Diagnosis of stroke Pt demonstrates right sided paralysis Pt demonstrates decreased grips and reflexes on the left side Pt demonstrates difficulty with mobility and activity.
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DIAGNOSIS; Impaired Physical Mobility r/t musculoskeletal impairment secondary to stroke a.m.b
Pts demonstration of right sided paralysis, decreased grips and reflexes on left side & diagnosis of stroke.

GOAL:Short Term:

Pt will perform passive range of motion exercises by the end of this shift, by 1900 Hrs. Long Term:

Pt will be able to ambulate around the nurses station 2X by discharge.

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INTERVENTION
Apply any ordered brace before mobilizing the client. Increase independence in ADLs. Maintain or improve strength, function and compensation of the body. Demonstrate techniques/behaviors that allow the activity. Obtain any assistive devices needed for activity. Assess the pts pain by using the 10 point pain rating scale q4 hrs. Before activity, treat pain.

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CONTD
Assist with range of motion active / passive, and resistive exercises as well as isometric if possible. Provide a safe environment, for example, raise the chair, use the handrails on the toilet, use a wheelchair. Encourage patient to maintain an upright posture in sitting, standing, and walking.

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EVALUTION
Restore ability of ambulate. Avoid any complications associated with immobility. Increased tolerance for physical activity. Avoid injury from falling & improper use of body mechanics.

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NURSING INTERVENTION
SAFE PRACTICE FOR POSITIONING, MOVING, LIFTING, AMBULATING CLIENTS General Guidelines for Moving and Lifting: Before moving, assess If indicated, use pain relief modalities Prepare any needed assistive devices Plan around encumbrances Be alert to the effects of any medications Obtain required assistance Explain the procedure to the client

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 PROVIDING ROM EXERCISES Active ROM exercises

These are isotonic exercises in which movement is performed by voluntary effort of the patient through full ROM omitting gravity without external assistance or resistance beyond the gravity.

Passive ROM exercises

These are exercises in which another person moves each client joint through its complete ROM maximally stretching all the muscles within each plane over joints

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ACTIVE EXERCISES

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EXERCISES

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PASSIVE EXERCISES

PASSIVE
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POSITIONING THE PATIENT

When positioning nurse can do following; Make sure that mattress is firm and support natural body curvature Bed is clean and dry Support devices must be used Avoid placing one body part particularly one with bony prominence directly on another

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DIFFERENT TYPES OF POSITIONS

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MECHANICAL AIDS

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