Fundamentals of Nursing Chapter 44

• Body alignment (posture)
• Joint mobility
• Balance
• Coordinated movement

• Brings body parts into position that promotes optimal balance and body function
• Person maintains balance as long as line of gravity passes through center of gravity and base of support

Posture

The maximum movement possible for a joint

• Genetic makeup (double jointed, etc.)
• Developmental patterns (baby can put foot in mouth)
• Presence or absence of disease
• Physical activity

• Passive
• Active

• a. timing
• b. repetition

Patient performs the motion 

Nurse performs the motion for the client

• Decreasing the angle of the joint 
• Example: bending the elbow

• Increasing the angle of the joint
• Example: straightening the arm at the elbow

• Further extension or straightening of a joint
• Example: bending the head backward

Movement of the bone away from the midline of the body

• Movement of the bone toward the midline of the body
• NOTE: Add-uction

Movement of the bone around its central axis

Movement of the distal part of the bone in a circle while the proximal end remains fixed

Turning the sole of the foot outward by moving the ankle joint

Turning the sole of the foot inward by moving the ankle joint

Moving the bones of the forearm so that the palm of the hand faces downward when held in front of the body

Moving the bones of the forearm so that the palm of the hand faces upward when held in front of the body

• Complex mechanisms
• Proprioception
•  - Awareness of posture, movement, changes in equalibrium
•  - Knowledge of position, weight, resistance of objects in relation to body

• Balanced, smooth, purposeful movement
• Result of proper functioning of the cerebral cortex, cerebellum, basal ganglia

• 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
• Includes: Acitivities of daily living (ADL), Active ROM, Walking, Jogging, Swimming

• 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

• 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
• Includes: weight lifting or machines with weight for resistance

• 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
• NOTE: should be able to talk when exercising

• 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
• Includes: Marathon runners or sprint for a brief time to elevate HR

• Isotonic (dynamic) exercise
• Isometric (static or sitting) exercise
• Isokinetic (resistive) exercise
• Aerobic exercise
• Anaerobic exercise

Foot drop

• Footboards
• Sneakers

• Maintain: Size, shape, tone, and strength of muscles (heart muscle, too)
• Nourish: Joints
• Increase: Joint flexibility, stability, and ROM
• Maintain: Bone density and strength

• Increases: HR, strength of contraction, and blood supply to the heart and muscles
• Mediates: Harmful effects of stress

• Increases: Ventilation and oxygen intake, improving gas exchange
• Prevents: Pooling of secretions in the bronchi and bronchioles

• Elevates: The metabolic rate
• Decreases: Serum triglycerides and cholesterol
• Stabilizes: Blood sugar and makes cells more responsive to insulin
• Increases: Caloric use

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

• Inproves: Appetite
• Increases: GI tract tone
• Facilitates: Peristalsis

• Pumps: Lymph fluid from tissues into lymph capillaries and vessels
• Increases: Circulation through lymph nodes
• NOTE: Strenuous exercise may reduce immune function, thus, too much exercise can have the opposite effect

• Elevates: Mood
• Relieves: Stress and anxiety (giving a better quality of sleep)
• Improves: Quality of sleep for most individuals

• Positive effects on: Decision-making and problem solving processes, planning, and paying attention
• Induces cells in the brain to: Strengthen and build neuronal connections

• Disuse esteoporosis
• Disuse atrophy
• Contractures
• Stiffness and pain in the joints

• Diminished cardiac reserve (HR increases with minimal exersion)
• Increased use of the valsalva maneuver 
• Orthostatic hypotension
• Venous vasodilation and stasis
• Dependent edema
• Thrombus formation

• Decreased respiratory movement
• Pooling of respiratory secretions
• Atelectasis
• Hypostatic pneumonia

Absence of air in the lungs, due to secretions decreasing the lung volume

Infection in dependent portion of lungs due to decrease in ventalation in that area

• Decreased metabolic rate
• Negative nitrogen balance
• Anorexia
• Negative calcium balance

A condition in which nitrogen output exceeds nitrogen intake, resulting in the body's need to draw on its own stores of protein for energy; may be caused by dietary imbalances, illness, infection, anxiety, or stress.

The result of an increase in calcium extrated from the bones, which cannot be replaced quick enough

• Urinary statis 
• Renal calculi (Calcium, salts, cholesterol)
• Urinary retention
• Urinary infection (not able to empty the bladder completely = UTI)

May be caused by abnormalities in structure or innervation of the urinary outflow tract that result in incomplete emptying of the bladder or pooling of urine in diverticula. Important in the etiology of cystitis.

Constipation

• Decline in mood elevating substances
• perception of time intervals deteriorates
• Problem-solving and decision-making abilities may deteriorate
• Loss of control over events can cause anxiety

• Skeletal muscles don't contract, which leads to muscle atrophy, decreased assistance in pumping the blood back to the heart
• Blood pools and the vein valves no longer work properly, which causes edema, thrombus (blood clots)

Some people believe that Yoga-style exercise improves the mind-body-spirit connection, relationship with God, and physical well-being

• Reduced skin turgor
• Skin breakdown

It is generally synonymous with maze, but many contemporary scholars observe a distinction between the two: maze refers to a complex branching (multicursal) puzzle with choices of path and direction; while a single-path (unicursal) labyrinth has only a single, non-branching path, which leads to the center. A labyrinth in this sense has an unambiguous route to the center and back and is not designed to be difficult to navigate.

• Growth and development
• Nutrition
• Personal values and attitudes
• Prescribed limitations
• External factors

• Nursing History
• Physical Examination

• Body alignment
• Gait
• Appearance and movement of joints
• Capabilities and limitations for movement
• Muscle mass and strength
• Activity tolerance
• Problems related to immobility
• Physical fitness

• Activity Intolerance
• Risk for Activity Intolerance
• Impaired Physical Mobility
• Sedentary Lifestyle
• Risk for Disuse Syndrome

• Fear (of falling)
• Ineffective Coping
• Low Self-Esteem
• Powerlessness
• Risk for Falls
• Self-Care Deficit

• Ineffective Airway Clearance
• Risk for Infection
• Risk for Injury
• Risk for Disturbed Sleep Pattern
• Risk for Situational Low Self-Esteem

• Activity tolerance
• Body positioning
• Bowel elimination
• Fall prevention behavior
• Immobility consequences both physiological and psychocognitive
• Joint movement
• Mobility
• Respiratory status
• Ventilation and gas exchange
• Self-care
• Sleep
• Stress level
• Weight control
• Increased tolerance for physical activity
• Restored or improved capability to ambulate and/or participate in ADL's
• Absence of injury from falling or improper use of body mechanics
• Enhanced physical fitness
• Absence of any complications associated with immobility
• Improved social, emotional, and intellectual well-being
• NOTE: Remember to make these specific to your patient, measurable, and time oriented (be realistic)

• Maintain or promote bady alignment and mobility
• Positioning clients appropriately
• Moving and turning clients in bed
• Trasferring clients
• Providing ROM exercises
• Ambulating clients with or without mechanical aids
• Strategies to prevent complications of immobility

• Used to describe the efficient, coordinated, and safe use of the body to move objects and carry out ADL's
• Support "no manual lift" and "no solo lift"
• NOTE: Nurses must PUSH for policies that keep them safe!

• Widening the base of support
• Lowering the center of gravity, bringing it to the base of support

At a minimum two (2)

• 45-60 degree angle
• Pillow placement is under the thighs, legs (knee to ankle) and under arms (at the elbows)

• 15-45 degree angle
• Pillow placement is under legs (knees to ankle) and under small of back

60-90 degree angle

Unable to breathe while lying down

Dorsal Recumbant

Supine position

• Positioning the client on their back
• Pillows are placed under the small of the back and under the legs (knee to ankle)

• Positioning the client on their stomach
• Pillows are placed under the head (unless contraindicated due to promotion of mucous drainage from mouth) stomach and legs (knee to ankle)

• Positioning the client on their side with the top leg bent
• Pillows are placed between legs (at the knee), head to promose good alignment and at the stomach/chest for top arm to rest on

• Positioning the client on their stomach/side, with one leg bent and the arm on the same side as the unbent leg is placed behind them, while the top arm is facing forward
• Pillows are placed under the bent leg (knee to ankle), under the head (unless contraindicated for mucous drainage from the mouth), and under the forward facing arm

Prevents foot drop or contracture

• 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
• Raise the height of the bed
• Lock the wheels

• Face the direction of the movement
• Assume a broad stance
• Lean your trunk forward, flex your hips, knees, and ankles
• Tighten your muscles
• Rock from front leg to back leg when pulling
• Rock from bck leg to front leg when pushing

• Client's comfort
• Body alignment
• Tolerance of the activity
• Ability to assist
• Use of support devices
• Safety precautions required

• Plan what to do and how to do it
• Obtain esential equipment before starting 
• Remove obstacles
• Explain transfer to client and assistive personnel
• Support or hold client rather than equipment
• Explain what client should do
• Make written plan, including client's tolerance

• Assess the amount of assistance the client will require
• Assess for signs and symptoms of orthostantic hypotension
• Prepare client for ambultion
• Apply transfer or walking belt
• Physically support client
• Obtain assistance to follow with wheelchair or assist with physical support
• Teach client to correctly use mechanical aids

• Isotonic exercises
• Moves each joint in the body
• Maximally stretching all muscle groups

• Another person moves each joint (the nurse)
• Maximally stretching all muscle groups
• Useful in maintaining joint flexibility

• Cover body with a bath blanket
• Use correct body mechanics
• Position bed at appropriate height
• Expose only the limb being exercised
• Support clients limb above and below the 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
• Timing and repetition

• 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:
•  - Move the cane and leg forward at same time
•  - Move stronger leg forward
•  - Move the unaffected (stronger) leg forward ahead of the cane
• As you become stronger:
•  - Move the cane and leg forward at the same time
•  - Move stronger leg forward

• When maximum support is required:
•  - Move the walker ahead (body weight is borne on both legs)
•  - Move the right foot up to the walker (Body weight is borne by left leg and both arms)
•  - Move the left foot up to the right foot (Body weight is borne by right leg and both arms)
• If one leg is weaker than the other: 
•  - Move the walker and the weaker leg ahead together (Weight is borne by the stronger leg)
•  - Move the stronger leg ahead (Weight is borne by the affected leg and both arms)

• Ability to take steps
• Ability to bear weight and keep balance
• Ability to hold body erect
• Ability to get into and out of chairs safely
• Ability to go up and down stairs safely

• Crutch Stance (Tripod position)
• Four-Point Alternate Gait
• Three-Point Gait
• Two-Point Alternative Gait
• Swing-to Gait
• Swing-through Gait

• Stand with back of the unaffected leg centered against the chair
• Transfer crutches to the hand of the affected side
• Grasp the arm of the chair with the unaffected side
• Lean forward, flex the knees and hips, and lower into the chair

• Move forward to edge of the chair
• Place unaffected leg slightly under or at teh edge of the chair
• Grasp the crutches by the hand bars in the hand of the affected side
• Grasp the arm of the chair by the hand on the unaffected side
• Push down on the crutches and the chair armrest while elevating the body out of the chair
• Assume tripod position before moving

• Assume tripod position at bottom of stairs
• Transfer weight to the crutches
• Move the unaffected leg onto the step
• Transfer body to the unaffected leg on the step
• Move the crutches and affected leg up to the step
• The affected leg is always supported by the crutches
• Repeat until top of stairs

• Assume tripod position
• Shift weight to unaffected leg
• Move crutches and affected leg down onto next step
• Transfer body weight to crutches
• Move unaffected leg to that step
• Teh affected leg is always supported by the crutches
• Repeat until the bottom of stairs

• The goals established during the planning phase are evaluated according to specific desired outcomes.
• If outcomes not achieved, the nurse, client, and support person, if appropriate, need to explore the reasons before modifying the care plan

Fowler's

Lateral

Prone

Semi-fowler's

Sims

Supine or Dorsal Recumbant

• To prevent foot drop or contracture
• NOTE: a foot board can also be used

• Support the elbow 
• 

• Support the knee
• 

• Support the ankle
• 

• Foot drop or Contracture
• Foam boots or a foot board could have been used

Isokinetic

Isometric

Isotonic

• A labyrinth
• An intricate structure of interconnecting passages, which can be used to ease stress by walking the paths

Incorrect posture when lifting

Proper posture, when lifting

Ceiling mounted lift

• Hoyer Lift
• At least two healthcare workers should be available when moving a client with this device, as it has a tendency to "swing" the patient

Sit to stand lift

• A gait belt
• 

• Guide (lower) them to the floor
• Using your thigh, if necessary to slow the fall
• 

• Using the transfer sheet, do a log roll
• 1. Pull the patient to the opposite side that you want them to lay on.

• 2. One healthcare worker goes to the other side and pulls the sheet to "roll" the patient
•