7-Mobility-and-Activity.pdf nursing notes ppts reviewer

Nursing

1. NURSING INTERVENTIONS TO PROMOTE
HEALTHY PHYSIOLOGIC RESPONSES
MOBILITY AND ACTIVITY

2. •MOVEMENT : is a complex process that requires coordination between the musculoskeletal and
nervous systems
•BODY MECHANICS : describes the coordinated efforts of the musculoskeletal and nervous
systems. An efficient, coordinated and safe use of the body to produce motion and maintain balance
during the activity. It prevents injury to self and clients
•BODY ALIGNMENT and POSTURE : the positioning of the joints, tendons, ligaments and
muscles while standing, sitting, and lying

3. •Correct body alignment:
Reduces strain on musculoskeletal structures
Aids in maintaining adequate muscle tone
Promotes comfort
Contributes to balance
Conservation of energy

4. •MOBILITY: refers to a person’s ability to move about freely
•IMMOBILITY: the inability to do or move about freely

5. OVERVIEW OF EXERCISE AND
ACTIVITY
•BODY ALIGNMENT
relationship of one body part to another along a horizontal or vertical line, an individual’s center of
gravity is stable
•BODY BALANCE:
Occurs when a relatively low center of gravity is balanced over a wide, stable base of support and a
vertical line falls from the center of gravity through the base of support
Techniques:
a. Widening the base of support by separating the feet to a comfortable distance
b. Increasing balance by bringing the center of gravity closer to the base of support

•COORDINATED BODY MOVEMENT
Is a result of weight, center of gravity, and balance
•FRICTION:
Force that occurs in a direction to oppose movement
•EXERCISE AND ACTIVITY:
Exercise: is physical activity that conditions the body, improves health, and maintains fitness

6. FACTORS INFLUENCING ACTIVITY
AND EXERCISE
•Developmental changes
•Behavioral aspects
•Environmental issues
•Family and social support
•Cultural and ethnic origin

7. PRINCIPLES OF BODY MECHANICS
•Balance is maintained and muscle strain is avoided as long as the line of gravity passes
through the base of support
•Start body movement with proper alignment
•Stand as close as possible to the object to be moved
•Avoid stretching, reaching and twisting
•The wider the base of support and the lower the center of gravity, the greater the stability.
Before moving objects, put your feet apart, flex the knees, hips and ankles

8. •Balance is maintained in minimal effort when the base of support is enlarged in the direction
in which the movement will occur
•Enlarge the base of support by moving the front foot forward when pushing an object
•Enlarge the base of support by either moving the rear leg back (facing the object or moving the
front foot forward if facing away from the object) when pulling object
•Objects that are close to the center of gravity are moved with least effort
•Adjust the working area to waist level, and keep the body close to the object

9. •The greater the preparatory is0metric tensing, or contraction of muscles before moving an
object, the less the energy required to move it and the less musculoskeletal strain injury
•Synchronized use of many large muscles as possible during the activity increases overall
strength and prevents muscle fatigue and injury
•The closer the line of gravity to the center of the base of support the greater the stability

10. •The greater the friction against the surface beneath an object, the greater the force required to move an
object. Provide a firm, smooth, dry bed foundation before moving the client in bed
•Pulling creates less friction than pushing
•The heavier an object, the greater the force needed to move an object
•Encourage the client to assist as much a possible (pushing or pulling)
•Use own body weight to counteract the weight of the object
•Obtain the assistance of other persons or use mechanical devices to move objects that are too heavy

11. •Move objects along a level surface requires less energy than moving an object up an inclined
surface or lifting it against the force of gravity
•Instead of lifting objects, pull, push, roll or turn
•Lower the head of the client’s bed before moving the client up in bed
•Continuous muscle exertion can result in muscle strain and injury

12. EXERCISES
PURPOSES:
•To maintain good body alignment
•To improve muscle strength
•To improve muscle tone
•To improve circulation
•To relieve muscle spasm
•To relive pain
•To prevent or correct contracture deformities
•To promote sense of well-being

13. Types of exercises:
•Active Range-of-Motion exercises: done by the client
•Passive Range-of-Motion exercises: done for the client by the HCPs
•Active-Passive Range-of-Motion exercises: done by the client against a weight or force
•Active-assistive Range-of-Motion exercises:: done by the stronger arm and leg to the weaker
arm and leg

14. •Isotonic exercises: involves change in muscle length and tension
•Isometric exercises: involve change in muscle tension only
•Quadriceps setting: alternate tension and relaxation of thigh muscles
•Gluteal setting: alternate tension and relaxation of buttocks
•Kegel’s exercise: alternate tension and relaxation of pubococcygeal muscles

15. ASSISTING CLIENTS IN
AMBULATION
Purposes:
•To increase muscle strength and joint mobility
•To prevent some potential problems of immobility
•To increase the client’s sense of independence and self-esteem

•Considerations:
•Ambulate client gradually (to prevent orthostatic hypotension)
•Assist client in a sitting position if orthostatic hypotension occur or extreme weakness (Lower the
head to facilitate blood flow to the brain)
•Ensure safety during ambulation

16. ASSISTIVE DEVICES FOR
WALKING
•WALKERS:
lightweight movable device that stands about waist high and consists of a metal frame with handgrips,
four widely placed sturdy legs and one open side Can be used by patient who is weak and has
problems with balance
The top of the walker should line up with the crease on the inside of the wrist
Elbows should be flexed about 15 – 30 degrees when standing inside the walker, with hands on the
handgrips
A patient holds the handgrips on the upper bars, takes a few steps, moves the walker forward, and
takes another step.
Lift the device up and forward

17. ASSISTIVE DEVICES FOR
WALKING
•CANES:
are lightweight, easily movable devices made up wood or metal
Provide less support than a walker and are less stable
Types:
single-legged cane – more common; support and balance a patient with decreased leg strength
quad cane – provides the most support; used when there is partial or complete leg paralysis or hemiplegia

18. Cane length is equal to the distance between the greater trochanter and the floor
Cane on the stronger side of the body
Place the cane forward 15 – 25 cm (6-10 inches) keep body weight on both legs
Move weaker leg forward to the cane so body weight is divided between the cane and the
stronger leg.
Advance the stronger leg past the cane (so the weaker leg body weight are supported by the cane
and weaker leg)

20. ASSISTIVE DEVICES FOR
WALKING
•CRUTCHES:
Is a wooden or metal staff needed to increase mobility
Types: double adjustable or forearm crutch and the axillary wooden or metal
crutch
When crutches are fitted, ensure the length of the crutch is two to three finger
widths from the axilla
Position the tips approximately 2 inches lateral and 4-6 inches anterior to the
front of the patient’s shoes

21. Position the handgrips so the axillae are not supporting the patient’s body weight (Pressure
on the axillae increases risk to underlying nerves, which sometimes results to partial
paralysis of the arm)
Position of handgrips with the patient upright, supporting weight by the handgrips with the
elbows slightly flexed at 20 – 25 degrees (Elbow flexion can be verified using goniometer)
Distance between the crutch pad and the axillae is approximately 2 inches (2 – 3 finger
width)

22. •Basic crutch stance is the tripod position. Crutches are placed 15 cm (6 inches) in front and
15 cm (6 inches) to the side of each foot

24. Four-point
alternating
Gait gives stability but requires bearing on
both legs
Each leg is move alternately with each
opposing crutch
Have the patient move the right crutch forward and
then move the left foot forward to the level of the
right crutch.
Then have the patient move the left crutch forward
and then move the right foot forward to the level
of the left crutch.
Three-point
alternating
Gait requires the patient to bear all of the
weight on one foot
Patient bears weight on both crutches and
then on the uninvolved leg
Have the patient move the affected leg and both
crutches forward about 12 inches.
Have the patient move the stronger leg forward to
the level of the crutches

25. Two – point
alternating
Gait requires at least partial weight on
each foot
Patient moves a crutch at the same time
as the opposing leg so the crutch
movements are similar to arm motion
during normal walking
For the two-point gait:
Have the patient move the left crutch and the
right foot forward about 12 inches at the same
time.
Have the patient move the right crutch and
left leg forward to the level of the left crutch
at the same time.
Swing-to gait:

Have the patient move both crutches forward
about 12 inches.
Have the patient lift the legs and swing them
to the crutches, supporting his or her body
weight on the crutches
Swing through

28. •Swing through

29. PRINCIPLES OF SAFE PATIENT
TRANSFER AND POSITIONING
•The use of the principles of safe patient transfer and positioning during routine activities
decreases work effort and places less strain on musculoskeletal structures

30. PRINCIPLES OF SAFE PATIENT
TRANSFER AND POSITIONING
•Mechanical lifts and lift teams are essential when a patient is unable to assist
•When a patient is able to assist, remember the following principles:
The wider the base of support, the greater the stability of the nurse
The lower the center of gravity, the greater the stability of the nurse
The equilibrium of an object is maintained as long as the line of gravity passes through its base of
support
Facing the direction of movement prevents abnormal twisting of the spine
Dividing the balance activity between arms and legs reduces the risk of back injury
Leverage, rolling, turning or pivoting requires less work than lifting
When friction is reduced between the object to be moved and the surface on which it is moved,
less force is required to move it

31. PATHOLOGICAL INFLUENCES ON
BODY ALIGNMENT, MOBILITY, AND
ACTIVITY
•Congenital defects:
Congenital abnormalities affect the efficiency of the musculoskeletal system in regard to
alignment, balance and appearance
Osteogenesis imperfecta: an inherited disorder that affects bone (bones are porous, short,
bowed, and deformed resulting to children’s experience of curvature of the spine and shortness of
stature

32. PATHOLOGICAL INFLUENCES ON
BODY ALIGNMENT, MOBILITY, AND
ACTIVITY
•Disorders of Bones, Joint and Muscles:
Osteoporosis: results in reduction of bone density or mass
Osteomalacia: uncommon metabolic disease characterized by inadequate and delayed
mineralization, resulting in compact and spongy bone

33. PATHOLOGICAL INFLUENCES ON
BODY ALIGNMENT, MOBILITY, AND
ACTIVITY
•Inflammatory disease
•Arthritis: inflammation or destruction of synovial
membrane and articular cartilage and systemic
signs of inflammation
•Noninflammatory disease
Have none of the characteristics of inflammatory
disease, and the synovial fluid is normal

•Articular disruption:
Involves trauma to the articular capsules and
ranges from mild, (such as a tear resulting in a
sprain, to severe (such as separation leading
to dislocation)

34. PATHOLOGICAL INFLUENCES ON
BODY ALIGNMENT, MOBILITY, AND
ACTIVITY
•Central Nervous System Damage
Damage to any part of the CNS that regulates
voluntary movement causes impaired body
alignment and immobility
Example:
A patient with SCI has permanent damage
below the level of the injury and has control
on the trunk muscle but not the lower
extremity muscles
•Musculoskeletal trauma
Often results in bruises, contusions, sprains
and fractures
Fracture: disruption of bone tissue
continuity

35. SAFE PATIENT HANDLING
•Nurses are exposed to the hazards relating to lifting and transferring patients in many settings such
as nursing units, long-term care facilities and operating room
•Elements of Safe patient-handling programs:
An ergonomics assessment protocol for HC environments
Patient assessment criteria and algorithms for patient handling and movement
Special equipment kept in convenient to help transfer patient
Back-injury resource nurses
An “after-action review” that allows the HC team to apply knowledge about moving patients safely in
different settings
A no-lift policy

ERGONOMICS: the study of people's efficiency in their working environment.
ALGORITHMS: a process or set of rules to be followed in calculations or other problem-solving operations

36. TRANSFER TECHNIQUES
•Assess every situation that involves patient handling and movement to minimize risk of injury
•Use algorithm to guide decisions about safe patient handling (describes the steps commonly used in
transferring patients safely and effectively)
•Use a patient’s strength when lifting, transferring or moving when possible (Involving the patient helps in
increasing participation in self-care, thus promoting a sense of accomplishment)
•Nurses need to assume an active role in their workplaces to ensure that a culture of safety exists and that
appropriate patient-handling equipment is readily available

37. PHYSIOLOGIC RESPONSES TO
IMMOBILITY
•Musculoskeletal system
Decrease in muscle strength (due to unused muscle atrophy)
Muscle atrophy (decrease in size of muscles)
Disuse osteoporosis (the bones become depleted of calcium)
Demineralization (Calcium is withdrawn from the bones after 48 hours of immobility)
Fibrosis and ankyloses (Stiffness and rigidity of joints; excess calcium may deposit in the joints)
Contracture (muscle no longer shorten or lengthen, limiting joint mobility)

38. PHYSIOLOGIC RESPONSES TO
IMMOBILITY
•Cardiovascular System
Use of Valsalva maneuver
Orthostatic (postural) hypotension
Thrombophlebitis (due to venous stasis, blood clots forms in the venous wall)

39. PHYSIOLOGIC RESPONSES TO
IMMOBILITY
•Respiratory System
Atelectasis: is collapse of the lungs. This may be due to:
Hypostatic pneumonia: accumulated secretions enhance bacterial growth
Respiratory acidosis (retention of carbon dioxide due to slow, shallow respiration)

40. PHYSIOLOGIC RESPONSES TO
IMMOBILITY
•Metabolic and Nutritional Systems
Anorexia (results from decreased metabolic rate, and decreased energy requirements)
Hypoproteinemia
Hypercalcemia

41. PHYSIOLOGIC RESPONSES TO
IMMOBILITY
•Urinary system
Urinary stasis
Urinary Tract Infection (accumulation of urine in the bladder enhances bacterial growth)
Renal calculi
Incontinence (poor sphincter control due to increased pressure within the bladder)
Retention with overflow (due to bladder distention, involuntary dribbling of urine occurs)
Urinary reflux (due to bladder distention; contaminated urine from the bldder backs up into the renal
pelvis)

42. PHYSIOLOGIC RESPONSES TO
IMMOBILITY
•Fecal elimination
Constipation
Flatulence
•Integumentary system
Loss of skin turgor
Decubitus ulcer

43. ETIOLOGY AND PATHOGENESIS
OF PRESSURE SORES
•Pressure Sores (Decubitus Ulcers/Pressure Ulcers/Bed sores):
•Reddened areas, sore or ulcers of the skin occurring over bony prominences due to interruption of
the blood circulation to the tissue, resulting in a localized ischemia

•Causes:
Pressure
Friction
Shearing force

44. PREVENTING PRESSURE SORES
•Provide smooth, firm, wrinkle-free foundation on which the client can lie down
•Use foam, rubber pads, sheepskin, egg crate mattress under pressure areas
•Ongoing assessment of early signs and symptoms of pressure sores
•Change position of bedfast clients every 15 to 2 hours
•Reduce shearing force by elevating HOB of bedfast clients no more than 30 degrees
•Meticulous hygiene
•Keep skin clean and dry
•Avoid massaging bony prominences with soap when bathing the client
•Apply cream or lotion on dry skin
•Apply powder to tissues with limited blood flow

45. TRANSPORT OF CLIENT
A.Bed to wheelchair
Position wheelchair parallel to the bed
Lock the wheels of the wheelchair
B.Bed to stretcher
Place the stretcher parallel to the bed
Lock the wheels of the bed of the stretcher
Push the stretcher from the end where the
client’s head is positioned
When entering the elevator, maneuver the
stretcher so that the client’s head goes first
Note: Lock the wheels on bed, stretcher or wheelchair always because unexpected
movement may result to injury

46. QUIZ

47. QUESTION 1
It is the inability to do or move
about freely

48. QUESTION 2
What type of exercise is done for
the client by the Health care
provider?

49. QUESTION 3
An alternate tension and relaxation of
pubococcygeal muscles is ________.
A.Quadriceps setting
B.Gluteal setting
C.Kegel’s exercise

50. QUESTION 4
It is the study of people's
efficiency in their working
environment.

51. QUESTION 5
In giving health teaching on how to use walker,
the elbows should be flexed about
__________________ degrees when standing
inside the walker, with hands on the handgrips

52. QUESTION 6
Distance between the crutch pad and the
axillae is approximately _____ inches

53. QUESTION 7
Write one (1) nursing intervention on how to
prevent bed sore / pressure sore

54. QUESTION 8 - 10
List three (3) Purposes of Exercises