Four basic elements of normal movement

body alignment
joint mobility
balance
coordinated movement

alignment and posture

brings body parts into position that promotes optimal balance and body fxn
person maintains balance and balance as long as line of gravity passes through center of gravity and base of support.

Joint Mobility

ROM is maximum movement possible for joint
ROM varies and determined by:
-genetic makeup
-developmental patterns
-presence or absence of disease
-physical activity

Balance

complex mechanisms
proprioception
-awareness of posture, movement, changes in equilibrium
-knowledge of position, weight, resistance of objects in relation to body.

coordinated movement

Balanced, smooth, purposeful movement
result of proper functioning of
-Cerebral cortex-initiates voluntary movement
-Cerebellum-coordinates motor activity
-Basal ganglia-maintains posture

Isotonic (dynamic) exercise

muscle shortens to produce muscle contraction and active movement
increase muscle tone, mass, and strength
maintain joint flexibility and circulation
HR and CO quicken increase

Isometric (static or setting) exercise

muscle contraction without moving the joint(muscle length does not change)
involve exerting pressure against a solid object
produce a mild increase in HR and CO
no apparent increase in blood flow to other parts of the body

Isokinetic (Resistive) Exercise

muscle contraction or tension against resistance
can either be isotonic or isometric
person moves(isotonic) or tenses(isometric) against resistance
an increase in blood pressure and blood flow to muscles occurs

Aeboric exercise

activity during which the amount of oxygen taken in the body is greater than that used to perform the activity
improve cardiovascular conditioning and physical fitness

anaerobic exercise

activity in which the muscles cannot draw enough oxygen from the bloodstream
anaerobic pathways are used to provide additional energy for a short time
used in endurance training for athletes

musculoskeletal system

exercise
-maintain size, shape, tone, and strength of muscles(including the heart muscle)
-nourish joints
-increase flexibility, stability, and ROM
-maintain bone density and strength

musculoskeletal immobility

disuse osteroporosis
disuse atrophy
contractures
stiffness and pain in joints

cardiovascular system exercise

increases HR, strength of contraction, and blood supply to the heart and muscles
mediates harmful effects of stress

cardiovascular system immobility

diminished cardiac reserve
increased use of the Valsalva maneuver
orthostatic hypotension
venous

Respiratory system exercise

increase ventilation and oxygen intake improving gas exchange
prevents pooling of secretions in the bronchi and bronchioles

respiratory system immobility

decreased respiratory movement
pooling of secretions
atelectasis
hypostatic pneumonia

metabolic system exercise

elevates the metabolic rate
decreases serum triglycerides and cholesterol
stabilizes blood sugar and makes cells more responsive to insulin

metabolic system immobility

decreased metabolic rate
negative nitrogen balance
anorexia
negative calcium balance

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

Urinary system immobility

urinary stasis
renal calculi
urinary retention
urinary infection

GI system exercise/immobility

exercis
-improves the appetite
-increases GI tract tone
-facilitates peristalsis
immobility-constipation

immune system exercise

pumps lymph fluid from tissues into lymph capillaries and vessels
increases circulation through lymph nodes
strenuous exercise may reduce immune function
-leaving window open of opportunity for infection during recovery phase.

psychoneurological system exercise

elevates mood
relieves stress and anxiety
improves quality of sleep for most individuals

psychoneurological system immobility

decline in mood elevating substances
perception of time intervals deteriorates
problem-solving and decision making ability may deteriorate
loss of control over events can cause anxiety

cognitive function exercise

positive effects on decision-making and problem solving processes, planning, and paying attention
induces cells in brain to strengthen and build neuronal connections

spiritual health

yoga-style exercise improves mind-body-spirit connection, relationship with god and physical well-being.

Integumentary system immobility

reduced skin turgor
skin breakdown

factors affecting body alignment and activity

growth and development
nutrition
personal values and attitudes
external factors
-i.g. temperature, humidity, availability of recreational activities, safety of the neighborhood
prescribed limitations
-casts, braces, traction, activity restrictions including bed rest

Assessment

nursing history
physcial exam-body alignment, gait, appearance and movement of joints, capabilities and limitations for movement
muscle mass and strength
activity intolerance
problems related to immobility
physical fitness

NANDA nursing diagnoses

for activity and exercise
-activity intolerance
-risk for activity intolerance
-impaired physical immobility
-sedentary lifestyle
-Risk for disuse syndrome

Impaired physical mobility becomes the etiology

fear of falling
ineffective coping
low self-esteem
powerlessness
risk for falls
self-care deficit

prolonged immobility

ineffective airway clearance
risk for infection
risk for injury
risk for disturbed sleep pattern
risk for situational low self-esteem

planning

activity tolerance
body positioning
bowel elimination
fall prevention behavior
immobility consequences both physiological and psychocognitive
joint movement
mobility

planniing cont

respiratory status
ventilation and gas exchange
self care
sleep
stress level
weight control

Planning cont

increased tolerance for physical activity
restored or improved capability to ambulate and/or participate in ADLs
absence of injury from falling or improper use of body mechanics
enhanced physical fitness
absence of any complications assoc with immobility
improved social, emotional, and intellectual well-being

implementing

maintain or promote body alignment and mobility
positioning clients appropriately
moving and turning clients in bed
transferring clients
providing ROM exercises

implementing cont

ambulating pt with/without mechanical aids
strategies to prevent complications of immobility

body mechanics

used to describe the efficient, coordinated, and safe use of the body to move objects and carry out ADLs
support "no mannual lift" and "no solo lift"
body balance can be greatly enhanced by
-widening the base of support
-lowering the center of gravity, bringing it closer to the base of support

fowlers position

45-60 degrees

semi fowlers

15-45

high fowlers

60-90

moving and turning clients

before moving, assess
if indicated use pain relief modalities
prepare any needed assistive devices
plan around encumberances
be alert to the effects of any meds
obtain required assistance
explain the procedure to the client
raise the height of the bed
lock the wheels
face the direction of the movement
assume a broad stance

Determine and document moving and turning

clients comfort
body alignment
tolerance of activity
ability to assist
use of supportive devices
safety precautions required

general guidelines for transferring a pt

plan what to do and how to do it
obtain essential equipment before starting
remove obstacles
explain transfer to pt and assistive personnel
support or hold pt rather than equipment
explain what pt should do
make written plan, including pts tolerance

active ROM exercises

isotonic exercises
moves each joint in the body
maximally stretching all muscle groups

passive ROM exercises

another person moves each joint
maximally stretching all muscle groups
useful in maintaining joint flexibility

practice guidelines proving passive ROM

cover body with a bath blanket
use correct body mechanics
position bed at appropriate height
expose only the limb being exercised
support pts limb above and below joint
use a firm comfortable grip
move body parts smoothly, slowly, and rhythmically
avoid moving or forcing body part beyond the existing range of motion
if muscle spasticity occurs, stop
if contractures are present, apply slow firm pressure
if rigidity occurs, press against rigidity

client teaching using canes

hold cane with the hand on the stronger side of the body
position the tip of the cane about 15cm to the side and 15cm in front of the near foot so that the elbow is slightly flexed

maximum support canes

move the cane and leg forward at the same time
move stronger leg forward
move the unaffected(stronger) side forward ahead of time

cane teaching as you become stronger

move the cane and leg forward at the same time
move stronger leg forward

walker max assistance

move the walker ahead
-body wt is borne on both legs
move the right foot up to the walker
-body wt. is borne by left leg and both arms
move the left foot up the right foot
-body wt. is borne by right leg and both arms

crutch gaits

ability to take steps
ability to bear wt. and keep balance
ability to hold body erect
ability to get into and out of chairs safely
go up and down stairs safely