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What are the four basic elements of normal movement?
- Body Alignment (posture)
- Joint Mobility
- Balance
- Coordinated Movement
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List the 3 different types of exercises.
- Isotonic
- Isometric
- Isokinetic
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This exercise is dynamic and it is aerobic.
Isotonic
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This exercise is static and involves stretching.
Isometric
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This exercise is resistive and involves strength training.
Isokinetic
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What are the 3 ways we measure the intensity of an exercise?
- Target Heart Rate
- Talk Test
- Borg scale of perceived exertion (cardiac rehab)
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How do we measure our maximum heart rate?
220 - age = max HR
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What kind of exercise is better for frail patients?
Isometric
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This exercise contracts, shortens our muscles, and is active movement.
Isotonic
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Aerobic exercise activates what in our bodies?
Opioid receptors and endorphins are released in our body resulting in a "high."
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What has been the Healthy People 2010 objective, and it's been the objective for the past 10 years?
Moderate physical activity 30min/day
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What are the other Healthy People 2010 objectives?
- Focus on strength, endurance, flexibilty
- Employer sponsored fitness programs
- Less chronic back disability
- Less overweight ppl
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Successful aging is based on...
- continued social connections
- resiliency-ability to bounce back
- self-efficacy-belief you can accomplish a task
- regular physical activity
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What is the number one reason women do not exercise?
Urinary incontinence
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Lack of mobility =
disability
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The lack of mobility is a result of multiple chronic diseases and injuries, physical function, lack of social support and healthy behaviors, what kind of individual is described here?
Aging/deconditioned individual
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This lack of mobility is often a result of a single event. What kind of individual is described here?
Younger individual
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These days people live longer, but...
quality of life goes down.
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Walking outside, shopping, and doing housework are all examples of...
Instrumental ADLs
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Exercise prevents, reverses or improves health of people with...
- Cardiovascular disorders
- Pulmonary dysfunction
- Aging
- Depression
- Diabetes
- Chronic fatigue syndrome
- Cancer
- Arthritis
- Fibromyalgia
- Menopause
- Urinary incontinence
- HIV/AIDS
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Consequences of less exercise means our muscles..
atrophy
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We want Ca⁺ to stay in the bone by doing...
weight bearing exercises.
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What happens when Ca⁺ gets into our blood?
- Ca⁺ deposits can move to the kidneys= kidney stones
- Move to the heart = calcification
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Which of the following provide the best forms of health promotion and maintenance? Select all that apply.
a. Immunizations
b. Healthy Eating
c. Regular Physical Activity
d. Annual doctor checkups
e. Adequate health insurance
- b. Healthy Eating
- c. Regular Physical Activity
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Mild exercise does what?
Maintains muscles.
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Strenuous exercise does what?
increases muscle strength
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List the benefits of exercise.
- Affects shape, tone, strength of muscles with mild exercise and increased streuous exercise
- Increases joint flexibility
- Weight bearing and high impact exercise maintains bone density and strength
- Decreases the risk and incidence of falls
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What are the cardiovascular benefits of exercise?
- Strengthens heart muscle and blood supply
- Increased HDL
- Decreased stress response
- Increases venous return to heart
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What the best types of exercise for cardiovascular benefits?
-
Yoga's benefits include...
- increases HR
- increases circulation
- decreases stress
-
Cardiovascular benefit of increasing venous return to heart prevents...
risk for DVT
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What are the respiratory benefits of exercise?
- improved gas exchange
- increased O₂ to brain
- prevention of secretion pooling
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What are the best types of exercise to get respiratory benefits?
- LE exercise for people with COPD (ex. walking around)
- Yoga for ppl with asthma
- Incentive spirometer in the hospital
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Sitting up and standing up tall leads to...
breathing better and increases O₂
-
Strong chest muscles means...
can cough mucus out
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What are the GI benefits of exercise?
- Improved appetite
- Increased GI tone-increased peristalsis
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What happens to the GI motility of someone on bedrest?
Slows down and less BMs
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What are the best types of exercise for GI benefits?
Working the abdominal muscles – decreases constipation and decreases IBS
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What are the metabolic/endocrine benefits of exercise?
- increased metabolic rate - lasts 20 min after exercise
- decreased triglycerides
- decreased cholesterol
- weight loss
- stabilized blood sugar & more response to insulin (which then can decrease amt. of insulin)
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How much weight loss can decrease one's risk for diabetes?
5% weight loss which is about 10lbs, which is a 58% overall decrease and 71% in ppl over 60 yrs old
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What are the urinary benefits of exercise?
- increased blood flow
- prevention of urinary stasis (kidney stones)
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What specific exercise for urinary benefits can we do?
- Kegels
- 50 kegels/day/ 7 days/wk
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Kegels benefit...
Men at risk for prostate and women at risk for urinary incontinence
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How much cardiac output goes to our kidneys?
20%
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What are the immune system benefits of exercise?
- Improved lymph flow
- Increased T cell function and cytokine production
-
Moderate exercise benefits the immune system by...
increases resistance to viral infections and prevents formation of malignant cells
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Strenuous exercise affects our immune system by...
reducing immune function so pts with cancer shouldn't do strenuous exercise.
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After vigorous training what should we do?
Allow our body adequate rest.
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What are the psychoneurologic & cognitive benefits to exercise?
- Improved mood
- Decreased stress & anxiety
- Increased endorphins
- Increased O₂ to brain
- Improved quality of sleep
- Better decision making & problem solving
- Increased attentiveness
- Purpose in life
- Spiritual Health
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Factors affecting body alignment and exercise in older adults.
- Decreased muscle mass & tone
- Decreased bone density, osteoporosis
- Loss of joint flexibility
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Healthy Goal for 2020 involves...
Schools, physical activity for kids
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As adults get older what do they lose?
Proprial perception/balance
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What is the assumption behind the elderly-flexed posture position?
Assumed to prevent falling
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Elderly-flexed posture instead of preventing falling it really leads to...
- fatigue
- decreased joint excursion, stride, and speed
- limits ankle movements
- poor balance
- increases risk for falling
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List the Giants of Geriatrics.
- Immobility
- Instability
- Incontinence
- Intellectual Impairment
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What factors concerning nutrition affect body alignment and exercise?
- Undernutrition
- Overnutrition, Obesity
- Vitamin D Deficiency
- Calcium Deficiency
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What are the factors concerning personal values & attitudes that affect body alignment & exercise?
- Family values about exercising
- Values about personal appearance
- Motivational status
- FIT: Frequency, Intensity, Time
- *professional values– as a nurse if you tell someone to quit smoking, then nurse should be a nonsmoker
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What are the external factors affecting body alignment and exercise?
- Temperatures & humidity (ex. turn on AC and exercise inside during summer)
- Proper hydration
- Safe, available locations for exercise
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What are the prescribed limitations affecting body alignment and exercise?
- Immobilized body parts
- Therapeutic bedrest
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What are the hazards of immobility?
- Affects all body systems
- Severity depends on duration of inactivity
- Encourage pt movement
- Early ambulation after illness and surgery is KEY!
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What are the musculoskeletal changes with immobility?
- Joint stiffness and pain
- Atrophy
- Contractures
- Disuse osteoporosis
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This is caused by decrease in muscle use.
Atrophy
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This is permanent flexion and fixation of joint in nonfunctional position.
Contractures
-
This is bone demineralization, in which Ca from the bone is released into the blood.
Disuse Osteoporosis
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Patients with neuromuscular problems have an increase in...
atrophy and contractures
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Contractures are found mostly in the...
legs because they are heavier to move.
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What happens to our feet when we are on bedrest for a long time?
Foot Drop
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How can we prevent foot drop in our pts on bedrest?
Put sneakers on or other devices.
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What are some interventions for the musculoskeletal system?
- Positioning in bed for proper body alignment– use pillows or wedges
- Ambulate
- ROM at least 3-4 times/day
- Incorporate Active ROM in ADLs
- Physical therapy consult for individualized exercise programs
- Hand Rolls or hand wrist splints
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List some devices used for helping those on bedrest.
- Trochanter roll
- ankle/wrist splints
- footboard
- loose linens over feet
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What are the cardiovascular changes with immobility?
- Diminished cardiac reserve
- Orthostatic hypotension (postural hypotension)
- Venous dilation and stasis, edema
- Thrombus formation
- Increased Valsalva maneuver
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A resting HR that increases 4-15BPM and there's a decrease in coronary blood flow, this is...
diminished cardiac reserve
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When the systolic BP decreases more than 20mmHg, and HR increases more than 20 BPM, there's dizziness with position change from lying to sitting to standing, this is...
Orthostatic hypotension
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An elderly HR of 120 or higher can lead to...
ischemia
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When a patient is on bedrest the blood is...
static, there's no circulation, can lead to DVT
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How do we lower our risk for DVTs?
- Early Ambulation
- Calf pumps, foot circles, hip rotation, knee flexion
- No crossing legs, sitting long periods, tight clothing
- Elastic hose (TEDS)
- Sequential pneumatic compression stockings (FLOTRONS)
- Avoid pillows under knees or massaging legs
- Anticoagulation management if ordered like heparin
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What are the interventions for cardiovascular changes in immobility?
- Monitor VS
- Monitor dependent areas for edema
- Monitor peripheral body regions for temp changes
- *Rocking chair increases circulation due to pushing with feet– venous return in legs
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What are the respiratory changes with immobility?
- Decrease lung expansion
- Decreased ability to cough=pooling of secretions
- Atelectasis– collapse of alveoli
- Hypostatic Pneumonia– inflammation of the lung from stasis
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What treatments can we use to minimize effects on the respiratory system?
- Turn C&DB Q2
- IS
- Early mobility
- Unless contraindicated, 200mL/day fluid intake
- Chest postural drainage and suction
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What are the metabolic changes with immobility?
- ↓BMR
- ↓insulin production which means ↑blood glucose
- Anorexia
- ↑Protein Breakdown & negative nitrogen balance = problems with wound healing/normal tissue growth
-
Exercise increases our
BMR=Basal Metabolic Rate
-
What are the treatments for metabolic changes?
- Dietician consult
- Exercise/PT
- TPN (Total Parenteral Nutrition) if ordered
- Manage diabetes
-
How does exercise and PT treatment help with metabolic changes?
Utilizes the glucose and decreases protein breakdown
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What Renal System changes take place with immobility?
- Urinary stasis
- Renal Calculi
- Urinary retention
- UTI
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Recumbent position slows downward flow of urine, this is known as...
Urinary stasis
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Ca⁺ loss from bones causes hypercalcemia= precipitation and calculi formation in kidneys. What is this called?
Renal Calculi
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Urinary retention happens with...
overflow incontinence
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Where does the blood flow once it's pumped from the heart? What is it's first stop?
Kidneys
-
How do we minimize renal changes?
- Increase fluid intake and monitor I&O
- Cranberries and Blueberries (research unconclusive)
- Positoning for bladder emptying
- Monitor s/s UTI or kidney stones
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What are the GI changes with immobility?
-
Within constipation what else happens?
- Decreases peristalsis 2〫to hypercalcemia
- Decrease intake of fiber
- Abnormal positioning of bedpan
- Valsalva maneuver
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When we are not actively using our muscles in our abdomen then...
↓motility = constipation
-
How do we minimize GI changes?
- Monitor bowel sounds and BMs
- Adequate fiber
- Adequate fluid intake
- Positioning for elimination
- Stool softeners, laxatives, enemas if ordered
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What are the integumentary changes with immobility?
- Risk for pressure ulcer
- Prolonged pressure = ischemia, greater risk of skin breakdown
-
Risk of pressure ulcer 2〫
- Risk for incontinence
- ↓activity
- ↓muscle tone for movement
- ↓protein in diet
- ↑friction and sheer
- ↓turgor (elasticity)
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What can actually stimulate circulation in our head?
Brushing our hair
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What are interventions for integumentary changes?
- Frequent position changes
- Pressure reducing devices
- Maintain skin clean and dry
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What qualifies as frequent position changes?
- As needed and Q2H in bed
- Limit OOB chair to 1HR or less
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What are some pressure reducing devices?
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What are the psychological changes in immobility?
- Depression
- Changes in sleep-wake cycle
- Impaired coping
- Inability to concentrate will affect problem solving and memory
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What are psychological interventions?
- Cluster nursing and medical interventions to assure adequate sleep
- Clocks and calendars
- Newspapers and tv
- Conversation
- Watch for behavioral changes
- Communication with pt's family (about pt's behavior)
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For activity/exercise problems what do we assess for?
History: ADLs, activity tolerance, exercise, environmental factors, health problems
- Physical Exam:
- Body alignment/posture while standing
- Gait and pace with/without assistive device
- Joint appearance and ROM
- Capabilities & limitations for movement
- Activity tolerance
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COPD/cardiac pts cannot do ADLs quickly so we need to provide...
rest periods
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What are some nursing Dx?
- Activity intolerance
- Impaired physical mobility
- Sedentary lifestyle
- Risk for disuse syndrome
-
What are some planning & interventions?
- Safe positioning, moving, lifting, ambulating pts
- Body Mechanics– RN and pt
- ROM–(see pg 1108-1111 Kozier)
- Nurses assist and teach
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What are the interventions for Dx: Activity Intolerance?
- Check HR, RR, BP
- Before activity, baseline data
- During activity
- Immediately after activity stops
- Five minutes/rest
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What are s/s of activity intolerance?
- sudden facial pallor
- dizziness
- weakness
- change in LOC
- increased HR and RR
- Weakening of HR
- Change in rhythm of HR or RR
- dyspnea
- SOB
- Chest pain
- diastolic BP change of 10mmHg or more
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Respiratory therapy lets the case manager know if...
- pt needs O₂ @home
- they monitor O₂ sat during activity
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When ambulating pts we need to...
- use good body mechanics, hydraulic lifts if needed
- Preambulation: quadriceps femoris exercises (isometric)
- Gait Belts
- Canes
- Walkers
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