Effects of exercise on: CV system
- increased CO
- improved myocard contraction, thereby strengthen cardiac muscle
- dcr. resting heart rate
- improved venous return
Effects of exercise on: Pulmonary system
- increased RR and depth followed by quicker return to resting state
- improved alvealor ventilation
- decreased work of breathing
- improved diaphragmatic excursion
Effects of exercise on: Metabolic system
- increased BMR
- increased use of glucose and FAs
- increased triglyceride breakdown
- increased gastric motility
- increased production of body heat
Effects of exercise on: MSK system
- improved muscle tone
- increased joint mobility
- improved muscle tolerance to phys exercise
- possible incr. in muscle mass
- reduced bone loss
Effects of exercise on: Activity Tolerance
- improved tolerance
- decreased fatigue
Effects of exercise on: Psychosocial Factors
- improved tolerance to stress
- reports of "feeling better"
- decrease in reports of illness (eg. cold, flu, etc.)
5 functions of skeletal systems
*which two are most important relating to body mechanics
-support**
-movement**
- protection
- mineral storage (calcium)
-hematopoiesis (blood cell formation)
Four types of bones:
1. long bones: contribute to height and length (phalanges, femur, fibula, tibia)
2. short bones: clusters; permit movement (patella, tarsals)
3. Flat bones: structural contour (bones in skull and ribs)
4. Irregular bones: vertebral column and some skull b
Bones are also characterized by firmness, rigidity and elasticity. Explain
Firmness-results from inorganic salts like calcium and phosphate
r/t Rigidity: necessary to keep long bones straight and bear weight
Elasticity-changes with age (newborns very flexible but unable to bear weight vs toddlers more pliable so it doesnt hurt w
What are joints and what are the four types?
Joints are articulations that connect bones
1. synarthrotic: bone to bone-no movement-provides strength and stability (ex. sacrum)
2. cartilaginous or synchondrodial: little movement but is elastic and uses cartilage to unit surfaces (found where body exp
ligaments
white shiny flexible bands of fibrous tissue that bind joints together and connect bones
elastic and aid joint flexibility and support
some have protective function
tendons
white, glistening fibrous bands that connects bone to muscle
strong, fexible, inelastic, various length and thickness
achilles is stronges and thickest in the body
cartilage
nonvascular supporting CT with flexibility simialr to firm plastic
sustain weight and serve as shock absorber between articulating bones
fetus has large amount which is replaced by bone
permanent cartilage is unossified (non hardened) except in advanced a
There are more than _____ skeletal muscles in body
600
Muscle contractions can be categorized by functional purpose:
_____________, _______________, or ____________ body parts
moving, resisting, stabilizing
Concentric tension
Eccentric tension
concentric = increased muscle contraction causes muscle shortening
eccentric = helps control speed and direction of movement as muscle lengthens
Concentric and eccentric muscle actions are referred to as _______ or _______ contraction
dynamic or isotonic
Static or _______ contractions causes an increase in muscle tension but not shortening or active movement
isometric
voluntary movement is a combo of ______ and _______ contraction
isotonic and isometric
Antagonistic muscles:
Synergistic muscles:
Antigravity muscles:
Antagonistic muscles: when one contracts, other relaxes
Synergistic muscles: work together to accomplish same movement
Antigravity muscles: involved in joint stabilization
Major voluntary area of the brain that controls movement is the _________
precentral gyrus aka motor strip (decent at level of medulla)
Movement can be impaired by disorders that
- alter neurotransmitter production such as:
- alter transfer from neuroT to muscle such as:
- alter activation of muscle activity such as:
Parkinson's
myasthenia gravis
multiple sclerosis
Proprioception
awareness of the position of the body and parts
Posture is regulared by NS and reqs coordination of _________ and ________
proprioception and balance
Balance is controlled by the NS, specifically the ______ and the _________
cerebellum and inner ear
Major function of the cerebellum is to :
coordinate all voluntary movement
Principles of Body Mechanics
-wider base of support=more stability
-lower center of gravity=more stability
-equilibrium of object is maintained as long as the line of gravity passes through base of support
-face direction of movement prevents abnormal twisting
-balance activity betwe
Body Alignment refers to:
Correct body alignment:
-
-
-
relationship of one body part along a horizontal or vertical line
- reduces strain on MSK structures
- maintains adequate muscle tons
- contributes to balance
Body balance is enhanced by proper posture aka the position that:
-
-
-
- favours function
- requires least muscular work to maintain
- places least strain on muscle, ligaments, etc.
To avoid friction:
-
-
-
-
- use mechanical lift
- when you have to move manually, use slider board or something like it
- when possible, use pts strength
- put pt arms across chest to decrease surface area and therefore friction
Congenital abnormalities that affect body mechanics and movement
- osteogenesis imperfecta: bones are porous, short, bowed, and deformed and kids have curved spine and short stature
-scoliosis: curve of spine associated with vertebral rotation
affects are often proprotion to the severity of abnormality of curve of spin
Degenerative diseases that affect body mechanics and movement
- NS: Parkinsons or MS
-Skeletal: osteoporosis and osteomalacia
-Autoimmune: rheumatoid arthritis
Chronic diseases that affect body mechanics and movement
- ability to be active and exercise
- heart disease
-lungs: COPD or asthma
- diabetes
- chronic renal impairment
- cancer
Episodic illnesses that affect body mechanics and movement
anything that causes abrupt change in bones, joints, muscles or CNS
-fractures, sprains, spinal cord injury, CVA
Activity tolerance is:
These 3 factors influence pt's activity tolerance:
the kind and amount of exercise and activity and person is able to do
-physiological, emotional, developmental
Isotonic exercises
-Definition
-Examples
-Benefits
definition:muscle contract and change length
examples: walking, swimming, dancing, etc.
benefits: increased CV and resp function, increased osteoblastic activity, muscle tone, mass, strength
Isometric exercises
-Definition
-Examples
-Benefits
resistanc eisometric
def: tightening and holding of muscle in stationary position
ideal for pts unable to tolerate isotonic
good for rehab
benefits: minimize muscle wasting, increased ciruclation, increased osteblastic activity
increase is good
plank, hiplift, wall push up, g
Developmental changes in appearance and function: Infants through school-aged
- newborn spine flexed and lacks anteroposterio curve
-first spinal curve develops when infant extends neck from prone position
-as growth and stability increase, thoracic spine straigtens and lumbar curve appears, which allows sitting
- toddler posture i
Developmental changes in appearance and function: Adolescents
-growth spurt
- growth frequent and uneven
- may appear awkward and uncoordinated
- girls faster than boys
- girls hips widen and fat is deposited in upper arms, thighs, and ass
- boys shape changes are result of long-bone growth and increased muscle mass
Developmental changes in appearance and function: Young to middle aged
- good posture=look good, feels good, confident
- necessary MSK dev to carry out ADLs
- pregnant ladies-swayback lordosis
Developmental changes in appearance and function: Elderly
- progressive loss of bone mass (possible causes: physical inactivity, hormonal changes, and increased osteoclastic activity)= weaker bones, softer vertebrae, long shaft bones less resistant to bending
- walk slower, less coordinating
-feet closer=more un
Falling is __________ part of aging
NOT A NORMAL
When assessing behaviour aspect of a pt encorporating exercise, you should take into consideration
-
-
-
- pts knowledge of exercise
- barriers to program of exercise
- current habits
Prochaska and DiClemente's Transtheoretical Model of Behaviour Change five stages
- precontemplation
- contemplation
- preparation
- action
- maintenance
An exercise program is most likely going to be initiated and maintained if the individual:
- perceives a benefit
- chooses enjoyable activity
- feels competent doing activity
- feels safe doing it
- can easily access on regular basis
- can fit into daily schedule
- feels it doesn't generate financial or social costs
- experience minimum negativ
For patients with limited exercise capability or activity tolerance, develop nursing care plan to include interventions that :
maintain present level of function with goal of increasing the level of function
When Ax body alignment of unconscious patient you should:
remove pillows and positioning supports if not contraindiated and place pt in supine position
Ax of alignment in sitting position is particularly important for the patient with __________, __________, or ______________. Why?
muscle weakness, muscle paralysis, nerve damage
- pt with these alterations has dimished sensation in affected areas and unable to perceive pressue/circulation decrease. Propper sitting and alignment reduces risk of MSK damage in such patient
Conditions that create risk of damage to MSK system when lying down include:
Your Ax is best done with you standing________
- impaired mobility (traction)
- decreased sensation (Stroke)
- impaired circulation (diabetes)
- lack of voluntary muscle control (spinal cord injuries)
@ foot or head of bed
4 components of mobility assessment:
- range of motion
- gait
- exercise
-activity tolerance
Limited ROM may indicate:
Hyper ROM may indicate:
Limited: inflammation such as arthritis, fluid in the joint, altered nerve supply, contractures
Hyper: connective tissue disorders, ligament tears, joint fractures
Gait, including _______, __________ and ________ is:
rhythm, cadence, speed is the manner or style of walking
Common descriptive names for gaits:
limp, propulsive, spastic, scissors, steppage, waddling
assessing gait allows you to draw conclusions about:
-
-
-
- ability to walk alone
- balance
- posture
During a gate assessment note:
-
-
-
-
-
- conformity
- smooth, regular rhythm
- symmetry in length of leg swing
- smooth swaying related to gait phase
- smooth, symmetrical arm swing
When Ax pt's expectations concerning activity and exercise, you will need insight into the pt's perception of _________
what is normal or acceptable with regard to physical fitness
A finding of abnormal hear rate or dyspnea would lead you to a diagnosis of _________ not fatigue
activity intolerance
Examples of Nursing Dx related to activity and exercise
- health-seeking behaviours
- readiness for enhanced self-care
- activity intolerance
- ineffective coping
- impaired gas exchange
- risk for injury
- impaired physical mobility
- imbalanced nutrition
- acute or chronic pain
11 Physiological factors that affect physical activity tolerance
- skeletal abnormalities
- muscular impairments
- endocrine or metabolic ilnesses
- hypoxemia
- decreased cardiac function
- decreased endurance
- impaired physical stability
- pain
- sleep pattern disturbance
- prior exercise patterns
- infection and fev
4 emotional factors that affect physical activity tolerance
-anxiety
-depression
-chemical addictions
-motivation
3 developmental factors that affect physical activity tolerance
-age
-gender
-*Pregnancy
When setting goals and outcomes, the plan should include consideration of :
- preexisting health concerns and of any risks on injury to pt
- home environment
General goal realted to exercise and activity is:
improve or maintain the patient's motor function and independence
3 examples of outcomes for patients with deficits in activity and exercise:
- participates in prescribed physical activity while maintaining appropriate HR, BP, and RR
- shows understanding of need to increase activity gradually and according to tolerance and symptoms
- expresses understanding of need to balance rest and activity
Setting priorities in care planning is individualized. The immediacy of any problem is determined by:
the effect that it has on the pt's physical and mental health
Implementation of Nursing interventions re: activity and exercise in acute care
-often have reduced activity tolerance or immobility
- promote activities that prevent effect of immobility
- moving in bed, transferring between surfaces, walking
- muscle strengthening-isometric
- joint mobility
In Ontario, over ___% of nurses who lost work time experienced ______disorders
50
MSK
Most common back injury strain is _______ which affects ability to bend______________ and ability to _________
lumbar
bend forward, back, side to side
rotate hips and low back
Do not attempt to move a patient alone unless they are
young child
lightweight adult who is able to help
6 Rules before/during performing lift
1. determine amount of assistance necessary and equipment
2. keep weight close to body (keeps center of gravity close to body for balance)
3. bend at knees (helps maintain center of gravity)
4. tighten abs, tuck pelvis (provides balance and protects the b
It is the responsiblity of the nurse to not only implement existing safe handling in the workplace but to also _____________________ (this involves:)
advocate for enhancements in safety
identifying unsafe situations/broken equipment/improper technique of others
-reviewing literature and government policy
- advocate for change
Older adults may be able to prevent functional decline and improve independence through _________
routine completion of ADLs
Recommended frequency of aerobic exercise is ______
3-5 times a week or every other day
for a patient who wants to exercise everyday, recommend _____
cross training
The purpose of weight training from a health perspective is to:
develop tone and strength and to stimulate and maintain healthy bones
Nurses can do the following to promote exercise:
- educate about importance in preserving health
- encourage pt to pace activities and increase gradually
- NSAIDs one-two hours before
- balance rest and acitivity
- teach pt to use canes and walkers as needed
- encourage smooth and even walking surfaces
Recommendations for EX (Preamble and Guidelines): Age 5-17
60 mins of moderate to vigorous per day
vigorous at least 3 times a week
activities that strengthen bones/muscle at least 3 times a week
more daily physical activity provides greater health benefits
Recommendations for EX (Preamble and Guidelines): Adults 18-64
150 minutes of mod-to-vig intensity aerobic per week in bouts of 10 mins or more
add muscle and bone strength work using major muscle groups 2 days a week
Recommendations for EX (Preamble and Guidelines): Adults 65+
150 minutes of mod-to-vig intensity aerobic per week in bouts of 10 mins or more
add muscle and bone strength work using major muscle groups 2 days a week
those with poor mobility sohuld perform phys activities to enhance balance and prevent falls
Restorative and continuing care involves implementing activities and exercise strategies to assist __________________________ after acute care is no longer needed
pt regaining mobility and activity capacity
Immediate Tx of Soft Tissue Injuries (Rice)
Most crucial period of time for treating is during the first 6-12 hours
R: rest minimizes potential for further famage to joint
I: ice reduces pain threshold; shouldnt be applied for more than 30 mins at a time
C: compression-wet elastic wrap with enough compression to hold ice in place
E: elevate injured part several cm abov
Benefits of exercise on pts with CHD (coronary heart disease)
-myocardial infarction, agina pectoris, or heart failure, etc.
-reduced mortability and morbidity, improved QOL, increased psychological, improved left ventrical function, increased functional capacity and decreased blood lipids
Benefits of exercise on pts with Hypertension
- reduction of BP
- low to moderate intensity
-high intensity and weight training minimal benefits
Benefits of exercise on pts with COPD
-prevent deconditioning
- pulmonary rehab--breathing techniques and work
Benefits of exercise on pts with diabetes
-improved CV fitness and psychological wellbeing
-need pre-exercise physical and monitor glucose before and after
type 2 diabetes: 150 minutes of cardio and 3 days a week of resistance
measure effectiveness of nursing intervention by the:
success in meeting the pt's expected outcomes and goals of care
Evalutation includes:
-vital signs
-strength
-endurance
-psychological well being
*compare actual with expected
Exercise is physical activity for the purpose of
-
-
-
-
- conditioning
- improving health
- maintaing fitness
- therapeutic
_______ and __________ is critical to prevention of MSK injuries
careful attention to body mechanics and appropriate use of equipment
_______, _________ ,__________ influence a persons activity tolerance
-physio
- emotional
-dev
Best phys activity programs include:
combo of ex that produce different physio and psych benefits
Muscles primarily associated with movement are located near the _________, whre movement results from ___________ which is characteristic of the _________
skeletal region
leverage
upper extremities
Coordination and regulation of muscle groups depend on ________ and _______ of ________, __________, and ________ ____________
muscle tone
activity of antagonistic, synergistic and antigravity muscles
Balance is assisted by the NS control in the __________ and by the __________
cerebellum
inner ear
Body balance is acheived when
-
-
-
- wide base of support
- centre of gravity is within it
- centre of gravity vertically aligned with base of support
The following affect pt's perception of and motivation to engage in physical activity:
- developmental changes
- behavioural aspects
- environmental issues
- cultural and ethnic influences
- fmaily and social support
ability to engage in normal phys activity depends on intact functioning of
nervous and MSK systems
in health care settings, injuries may occur when patients attempt to:
One way to reduce this is to:
address self-care needs inp.
formal routine of checking in frequently
Measures to protect older adults from falls
- treats uniform depth (22.5cm and 22.5 cm)
-uniform textrued or plain coloured surfaces on each treat, edges marked with contrastic colour (decrease vertigo)
- block glare and use proper lighting
- adequate headroom so they don't have to duck (dizziness)
A restraint is
physical, chemical, or environmental means of controlling individual actions or behaviour
least-restraint approach
all alternative interventions are attempted before moving to use of restraints and form selevted is the one that adresses pts needs in least restrictive way
What is a fall
unintentionally coming to rest on the ground, floor, or other lower level with or without injury
Cost of falls:
- emotional
- loss of independece
- loss of confidence
- fear of falling (spiral)
Falls are up to ___% of reported incidents
- seniors have __times more fall injuries
90%
9 times
Different types of incidents related to falls
- patient-inherent accidents (seizures)
- procedure related
- equipment related
Assessment for falls
- health history
- pt home environment
- health care environment
- risk for falls
- risk for medical errors
- patient expectations
Two nursing diagnosis related to falss
-risk for injury related to impaired mobility
-risk for injury related to barriers in the home environment
Risk factors for falls (Biological, Socioeconomic, Behavioural, Environmental)
Biological
-age related changes
-comorbidities
Socioeconomic
-social isolation
-low income
-lack of transport
Behavioural
-fear of falling
-use of meds
-lack of exercise
Environmental
-home hazards
-institutional hazards
-community hazards
restraint use algorithm provides
Ev informaed guidelines for determining if restrains are appropriate
If restraints must be used, explain these to family/pt:
-purpose
-pts expected care while restrained
-precautions that will be taken to avoid injury
-temporary and protective aspects
Alternatives to restraints
-orient to environment
-companionship and supervision
-diversionary activities
-rooms near nursing station
-calm, simple statements and physical cues
-de-escalation, time-outs, verbal interventions
-appropriate visual and auditory stimuli
-remove cues tha
Physical restraint
immobilizes a pt or pt's extremity
Physical restraints:
-are used for pts:
-do not prevent _____ and may increase_________
risk of injury to self and others
don't prevent falls, may increase risk
Negatives associated with physical restraints
-falls when trying to remove
-entangled in device
-strangulation or asphyxiation causing death
-pressure ulcers
-constipation
-pneumonia
-urinary and fecal incontinence
-urinary retention
-contractures
-nerve damage
-CV impairment
-humiliation
-fear
-ange
Proper documentation of restraints includes:
behaviours that necessitated them
procedure used in restraining
condition of body part restrained
evaluation fo pts response
Use of restraints must meet following 4 objectives:
- reduce risk of injury to pt
- reduce risk of injury to others
- prevent interruption of therapy
- prevent confused or combative pt from removing life-supporting equipment
Ambularm
worn on leg signals when leg is in dependent position like over rail or on the floor
Bed-Check
bed alarm; weight-sensitive sensor mat pressure released off sounds alarm
Posey Bed Enclosure
soft sided, self-contained enclosed bed
allows for freesom of movement and reduces negative effects like pressure ulcers and loss of dignity
works well for pts that a restless, unpredictable, cognitively impaired, or if they would get injured if fell out
Environmental restraints
locked nursing units-pts with dementia at risk for injury if they walk away
chemical restraint
any form of psychoactive med used, not to treat illness but to intentionally inhibit a particular behaviour or movement (Ex. pulling nasogastic tube)
Side rails
maay help increase mobility and stability, help ppl not fall out of bed
use in disoriented pt may cause more confusion and further injury
Mummy restraint
blanket or sheet used for a kid-maintains short-term restraint of infant or smile child for an exam or treatment involving the head and neck--effectively controls movement of torso and extremities
*Don't attach end to siderail!!
Procedure before physical restraint
1. assess need
2. assess pt behaviour
3. review agency policy; consider purpose, type, location and duration; get consent
4. review manufacturers instructions
5. hand hygiene
6. introduce yourself
7. inspect condition of skin
8. two identifiers
9. proper
Belt restraint
secures pt to bed or stretcher; over gown; remove wrinkles, avoid placing across chest or too tight; restrains centre of gravity and prevents from rolling of or sitting up
may interfere with ventilation
Extremity (wrist or ankle) restraint
- immob one or all extremities
sheepskin or foam
wrapped around and secured with velcro
protect pt from injury from a fall or accidental removal of therapeutic device
may interfere with circulation
Mitten restraint
thumbless--prevents from removing invasive equipment, removing dressing, scratching, more movement that wrist restraint
Elbow restraint
elbow joint rigid; children and infants when inserting IV line