Diagnosing – use NANDA list

Diagnosing – use NANDA list

1. impaired physical mobility

2. self-care deficit

3. situational low self-esteem

4. activity intolerance

Planning

1. planning - for positioning

2. transferring – lock wheels on wheelchair

3. ambulatory – clutter out of the way

4. planning- for home care (walker, cane)

5. bedrest – limbs supported, turn every 2 hrs.

Implementing: Transferring a Client from Bed to Wheelchair

1. inform client what you are doing

2. lock wheels on wheelchair

3. assist client to dangle on side of bed

4. assist client to standing position & pivot to chair

5. place client's hands on arm supports

6. bend at knees, easing client into chair

Preventing Back Injury

1. stand with a broad base of support

2. tighten abdominal muscles

3. tighten gluteal muscles

4. use large muscles to lift

5. keep objects close to body within base of support

Positioning Clients

1. Fowler's position

2. orthopneic position – (breathe easier) – sit with hands on table to support upper body can expand lungs easier

3. dorsal recumbent position – on back

4. prone position – on stomach

5. lateral position

6. Sim's position

7. moving & turning patients in bed – use support, pillows, foot board

Prevention is the Key

Incorporating physical activity

1. reduces stress

2. improves glycemic control

3. moderates weight

4. improves posture

5. helps prevent osteoporosis

   
   

Considering Restraints – use only as last resort, less restrictive measures better, must monitor

1. mitts

2. wrist restraints

3. vest or Posey

Highlights of the benefits of regular exercise

Highlights of the benefits of regular exercise

1. cardiovascular system – decrease blood pressure, increase stroke volume

2. respiratory system – increase vital capacity

3. musculoskeletal system – increase mineral retention, improve gait, balance, strength

4. metabolic system – increase metabolic rate, decrease weight, blood glucose control,

   heads off type II diabetes

Benefits of regular exercise, cont'd

1. gastrointestinal system – regular digestion & bowel activity

2. urinary system – increased bladder tone

3. skin – pores open & glow, vitamin D production,

4. psychosocial – decreased stress & depression, increased body image

Complications of Immobility

1. cardiovascular – decreased heart reserve, venous stasis, orthostatic hypotension,

   thrombophlebitis, dependent edema (lower limbs will swell)

2. respiratory – difficulty breathing, pulmonary embolism, pneumonia, decreased vital capacity, decreased chest expansion

3. musculoskeletal – atrophy, contracture, osteoporosis, decreased muscle tone, size, strength

4. metabolic – gain weight, negative N balance, protein synthesis (anabolism) exceeded by breakdown (catabolism), kidneys affected

5. gastrointestinal – slow down, decreased appetite & peristalsis

6. urinary – urine pool in kidneys get U.T. I.

7. skin – pressure ulcer risk

8. psychosocial – isolation, low self-esteem

Immediate vs Long Range Effects of Exercise

immediately during and after exercise: pulse & blood pressure rise, respiratory rate increases.

with regular exercise:

1. the heart is more efficient

2. improved pulmonary functioning

3. increased muscle efficiency

4. increased coordination

5. increased blood flow to all body parts

Assessing

nursing history – ask pt what their ADL's & IADL's are

physical examination

1. body alignment – increased lung expansion and better posture

2. gait – notice if pt limps

3. appearance & movement of joints (use pain scale 1to 10 if pain present)

4. capabilities &limitations for movement

5. muscle mass, strength & tone

6. activity tolerance

7. problems related to immobility

8. balance – have they fallen in last month

Physiology of Movement

Activity and Exercise

Physiology of Movement

1. Skeletal system – function is support, protect, surfaces for attachment, RBC formation,

2. Muscular system – function is movement, produce heat, breathing & heart muscles, posture

3. Nervous system – brain is center. nerves toward brain=afferent, nerves away=efferent

Body Mechanics- prevent injury to bones, strong core muscles needed, balance important

normal movement – use abdominal muscles, use wheeled objects to reduce back strain, put feet

up to rest, don't lock knees

1. alignment and posture

2. balance

3. coordinated movement

4. balance

Posture deviations

1. scoliosis – teenagers get (lateral curvature of spine)

2. lordosis – toddlers, pregnant & obese people have (increased lumbar curvature)

3. kyphosis – elderly ("dowager's hump" - increased thoracic spinal curvature)

Types of Exercise

1. isotonic – muscle shortening & active movement – ADL's, exercise, range of motion

2. isometric – muscle contraction without shortening (no change in muscle length) ie. tighten quadriceps or gluteal muscles

3. isokinetic – muscle contraction with resistance – ie rehabilitative. exercises for knee or elbow & lifting weights

4. aerobic – sustained (often rhythmic) muscle movements that increase oxygen flow

Factors affecting body alignment & activity

1. growth and development

2. physical health

3. mental health

4. nutrition

5. personal values and attitudes

6. external factors

7. prescribed limitations