Activity and Exercise Chapter 31 Flashcards
Activity and Excercise involves what two things
Mobility and Body Mechanics
What is mobility
Interaction of bones, muscles, and the nervous system
What is body mechanics and what does it involve
The way people move. Involves their body alignment (posture) Balance Coordination Joint Mobility
When lifting someone what is the most important thing to use
the ergonomic lift if possible.
What principles of body mechanics are important to practice so that you so not cause injury to your body
Proper alignment wide base of support avoid bending and twisting squat to lift Keep objects close while lifting (10 lbs close to the core, 100 lbs arms length out) Raise the bed Push vs lift get help when needed
What 6 factors affect a patients mobility and activity
Life span (infants fall) Nutrition (Bone density, energy) Lifestyle ( Stress (Lack of Motivation) External Environment (Weather, Neiborhood) Disease (Sick, don't feel like it)
How many minutes of aerobic excercise is needed each week
150 min
What is excercise
Contraction and relaxation of muscles, can increase muscle tone and strength
What is the main point of excercise
bloodflow
Types of excercise
Isometric (hold) Isotonic (Lifting weights) Isokinetic (Machines) Aerobic (Excedes amount of oxygen) Anerobic (Does not exceed amount of o2)
What is one thing that you can do to maintain proper posture while sitting
avoid arching shoulders forward
Walking:
Increases HDL Protects the back Strenghens legs increases bloodflow stress reducer low impact, loss of bone mass
What are the benefits of excercise
Improves cardiovascular health increases muscle tone and flexibility enhances the immune system promotes weight loss (but not always) decreases stress increases overall feeling of well being
Effects of immobility include
Muscle attrophy
Joint Dysfunction
Atelectasis/Pneumonia (collapsed lung)
Venous stasis (Blood stays where it is)
Increased Coagulability (clotting)
Orthostatic hypotention
Glucose intolerance (stays at basal rate)
Pressure ulcers
Constipation
Paralytic ileus (Bowels not moving so they die)
Urinary tract infection
Renal calculi (Kidney stone)
Depression
Sleep disturbances
Disorentation
Renal calculi
Kidney stone
Paralytic ileus
Bowels not moving so they die
Venous stasis
Blood stays where it is
What are nursing measures to promote excercise
- plan and vary excercise routine
- use the buddy system and rewards
- integrate excercise into routine activities
- attain target heart rate
It is important to check and incorporate what things when Positioning Patients
Proper alignment of hospital bed
Use of range of motion
Incorporation of pillows, wedges, side rails, overheadtrapeze, footboard, sandbags/trochanter rolls, splints
When Assisting with Ambulation….
May require conditioning exercises
Obtain appropriate assistive devices
Positioning Patients: Common positions
Fowler’s: High or semi- Lateral Prone Sims’ Supine
Prone
Stomach
Supine
Back
90% of patients in a Fowler’s position are at what degree in the bed
30 degrees up and 30 degrees to the side to prevent skin breakdown
Semi fowlers
45 degrees
High Fowlers
Sitting straight up 90 degrees
When Helping the Client Out of Bed, the nurse should use…
=Use of transfer board
Mechanical lift
Transfer belt
What are nursing measures to promote activity and excercise
Promote excercise
Position Patients
Helping patients out of the bed
Assisting with ambulation
Name three purposes of the skeletal system.
Answer:
Answers may include any three of the following purposes of the skeletal system:
● Forms the framework of the body
● Protects the internal organs
● Produces red blood cells
● Serves as a storage site for calcium
● Works with the muscles to cause movement
Abduction
is moving away from midline
Adduction
is moving toward midline
Flexion
is bending, decreasing the joint angle
Extension
is straightening, increasing the joint angle
Circumduction
is moving in a circular fashion
Internal rotation
is turning toward midline
Supination
is turning upward
Pronation
is turning downward
Identify three types of muscle.
The three types of muscle are skeletal, smooth, and cardiac.
● Skeletal muscle moves the skeleton.
● Smooth muscle, found in the digestive tract and other hollow structures, such as the bladder and blood vessels, produces movement of food through the digestive tract, urine through the urinary tract, and blood through the circulatory system.
● Cardiac muscle is a unique form of muscle that possesses the ability to contract spontaneously. It is responsible for the beating of the heart.
How do the muscles and the nerves interact?
The nervous system controls the movement of the musculoskeletal system. When we want to make a conscious decision to move our arm, the thought originates in the motor area of the cerebral cortex. The upper motor efferent nerves communicate with the lower motor neurons that conduct an impulse to the muscle. When the muscle receives sufficient stimuli it contracts, shortening the biceps brachii and bending the elbow. A stimulus to cause a contraction of the biceps generates a stimulus to cause relaxation in the triceps in a process known as reciprocal innervation. Movement also occurs through reflex mechanisms. Reflexes are protective mechanisms. Common reflexes include the knee jerk and corneal reflex.
Identify the four components of body mechanics.
Body mechanics, a term used to describe the way we move our body, includes four components: body alignment, balance, coordination, and joint mobility.
Give at least five guidelines for good body mechanics.
Answers may include any five of the following guidelines for good body mechanics:
● Stand in good alignment with a wide base of support.
● Minimize bending and twisting. These movements cause an increase in the amount of stress on the back. Instead, face the object and bend at the hips or squat. Avoid bending at the waist.
● Squat to lift heavy objects from the floor. Push against the strong hip and thigh muscles to raise yourself to a standing position.
● When lifting or moving an object, the closer it is to the center of gravity, the greater the stability. Keep objects close to your body when you lift, move, or carry them.
● Use both hands and arms when you lift, move, or carry heavy objects.
● Raise the height of the bed and bedside table to waist level when you are working with a patient.
● Face objects or persons you are working with rather than twisting.
● When possible, keep your elbows bent when carrying an object.
● Use the muscles in your legs as the power for lifting. Bend your knees, keep your back straight, and lift smoothly. Repeat the same movements for setting the object down.
● If a ladder or stepstool is required to reach an object, make sure it is stable and adequate to position your body close to the object. Do not stand on tiptoes to reach an object.
● Push, slide, or pull heavy objects whenever possible rather than lift them.
● Make sure you have a good grip on the patient or object you are moving before attempting to move the patient or object.
● Work with smooth and even movements. Avoid sudden or jerky motions.
● Assess the object or patient you are going to lift. If you have any doubt that you can do it by yourself, get help from a coworker.
Isometric exercises
involve muscle contraction without motion. They are usually performed against an immovable surface or object. For example, when pressing the hand against the wall, the muscles of the arm contract but the wall does not move. Each position is held for 6 to 8 seconds with 5 to 10 repetitions. Isometric training is effective for developing total strength of a particular muscle or group of muscles. It is often used for rehabilitation because the exact area of muscle weakness can be isolated and strengthening can be administered at the proper joint angle. This kind of training requires no special equipment, and there is little chance of injury. Bedridden patients can use this form of exercise to maintain or regain muscle strength.
Isotonic exercise
involves movement of the joint during the muscle contraction. A classic example of an isotonic exercise is weight training with free weights. As the weight is moved throughout the range of motion, the muscle shortens and lengthens. Calisthenics, such as chin-ups, push-ups, and sit-ups, all of which use body weight as the resistance force, are also isotonic exercises.
Isokinetic exercise
utilizes machines that control the speed of contraction within the range of motion. Isokinetic exercise attempts to combine the best features of both isometrics and weight training by providing resistance at a constant preset speed while the muscle moves through the full range of motion. Specialized machines available at health clubs and physical therapy departments are used for this form of exercise.
Aerobic exercise
acquires energy from metabolic pathways that use oxygen—the amount of oxygen taken into the body meets or exceeds the amount of oxygen required to perform the activity. Aerobic exercise uses large muscle groups, can be maintained continuously, and is rhythmic in nature. It increases the heart and respiratory rate, thereby providing exercise for the cardiovascular system while simultaneously exercising the skeletal muscles
Anaerobic exercise
occurs when the amount of oxygen taken into the body does not meet the amount of oxygen required to perform the activity. Therefore, the muscles must obtain energy from metabolic pathways that do not use oxygen. Rapid, intense exercises, such as lifting heavy objects or sprinting, are examples of anaerobic exercise.
State the components of an exercise program.
The three components of a well-rounded exercise program are flexibility, resistance training, and aerobic conditioning.
In which age groups are you more likely to see health concerns that affect mobility?
Answer:
Health concerns that affect mobility may occur throughout the life span. Congenital problems (e.g., hip dysplasia, club foot) are usually identified and treated in infancy. In contrast, degenerative problems (e.g., osteoporosis) are more likely in older adults.
What types of disorders limit activity or mobility?
Answer:
Disorders that limit activity or mobility include the following:
● Congenital abnormalities of the musculoskeletal system
● Disorders of bone formation, integrity, metabolism, or joint mobility
● Disorders of the central nervous system or other body systems that produce fatigue, shortness of breath, or impaired circulation
What are the signs and symptoms of a fracture?
Answer:
Signs and symptoms of a fracture include the following:
● Tenderness at the site
● Loss of function
● Deformity of the area
● Swelling of the surrounding tissues
Diagnosis is confirmed by x-ray. Treatment of a fracture is stabilization until the body can create enough new bone to support function. The type and severity of fracture determine whether casting or surgical repair is necessary.
What is the difference between a strain and a sprain?
Answer:
A strain and sprain have the following differences:
● A sprain is a stretch injury of a ligament that causes the ligament to tear.
● A strain is an injury to muscle caused by excessive stress on the muscle.
Identify the effects of immobility on the cardiovascular system
Immobility increases the workload of the heart and promotes venous stasis. When you are active, the skeletal muscles of the legs assist with pumping blood back to the heart. Recall that the veins are thin-walled vessels with valves. Muscular activity propels blood toward the right side of the heart, and the valves prevent backflow of blood. Without muscular activity (immobility), blood pools in the periphery. To compensate, heart rate and stroke volume increase to maintain blood pressure. In addition to venous pooling, immobility leads to compression and injury of the small vessels in the legs and decreased clearance of coagulation factors, causing the blood to clot faster. These three changes—stasis, activation of clotting, and vessel injury—make up what is known as Virchow’s Triad, a trilogy of symptoms associated with a greater chance of thrombus formation in the effected blood vessels. An immobile person is also more prone to orthostatic hypotension. Bedrest causes inactivation of the baroreceptors involved with constriction and dilation of the vessels. As a result, when a patient who has been immobilized changes position, he is unable to maintain his blood pressure. The patient complains of feeling dizzy and lightheaded and may be unable to support his own weight.
Identify the effects of immobility on the musculoskeletal system
Inactivity causes significant wasting of the gastrocnemius, soleus, and the leg muscles that control flexion and extension of the hip, knee, and ankle. Confinement to bed leads to a 7% to 10% loss of muscle strength (atrophy) per week. Immobility also causes the joints to become stiff. The strongest muscles, usually the flexors, pull the joints in their direction, leading to contractures or joint ankylosis (fusion of the joints). Immobility affects parathyroid function, calcium metabolism, and bone formation. The result of these changes is osteoporosis, calcium depletion in the joints, and renal calculi (stones) due to increased excretion of calcium. These changes place the patient at risk for pathological fractures with minimal trauma.
Identify the effects of immobility on the Integumentary system.
External pressure from lying in one position compresses capillaries in the skin, obstructing skin circulation. Poor circulation causes tissue ischemia and possible necrosis (tissue death). Nursing interventions include frequent turning and skin care to prevent the formation of wounds, known as pressure ulcers.
Why might immobility be referred to as a stressor?
Immobility might be referred to as a stressor because it triggers the release of epinephrine and norepinephrine, thyroid hormones, adrenocorticotropic hormone (ACTH) from the pituitary gland, and aldosterone from the kidneys. These changes in hormone levels are the same as the stress response, letting us see that immobility can be a stress in itself.
What are three effects of immobility on the GI system?
Immobility slows peristalsis, which often leads to constipation, gas, and difficulty evacuating stool from the rectum. In extreme circumstances, a paralytic ileus (cessation of peristalsis) may occur. With peristalsis slowed, appetite diminishes and food that is consumed is digested slowly. The net effect is usually decreased caloric intake and inability to meet the protein demands of the body. Body muscle is broken down as a fuel source, and further wasting occurs.
What changes in mood might be seen with immobility?
Answer:
Patients who are in bed (immobile) for long periods of time can suffer depression, anxiety, hostility, sleep disturbances, and changes in their ability to perform self-care activities, as well as disorientation and apathy.
Describe a focused assessment for a patient experiencing mobility concerns.
Answer:
The focused assessment includes gathering a nursing history and performing a physical examination.
● A nursing history focused on activity and exercise assesses past and current activity, as well as future plans. The history addresses the following topics:
● Usual activity
● Fitness goals
● Mobility concerns
● Underlying health concerns
● Lifestyle
● External factors
● A physical examination focused on activity and exercise assesses the musculoskeletal system and activity tolerance. Important data include vital signs, pain assessment, height, weight, body mass index, body alignment, joint function, gait, and activity tolerance.
Identify the assessment methods (inspection, palpation, percussion, and auscultation) used when performing a physical examination focused on mobility concerns.
Answer:
The assessment methods used when performing a physical examination focused on mobility concerns include inspection, palpation, and auscultation (of joint movement, crepitus, etc.)
Fowler’s position
is a semi-sitting position. The head of the bed is elevated 45º to 60º
Lateral position
is a side-lying position with the top hip and knee flexed and placed in front of the rest of the body.
Prone position
is a position where the patient lies on his stomach, with his head turned to one side.
Sims’ position
is a semiprone position. The lower arm is positioned behind the patient and the upper arm is flexed. The upper leg is more flexed than the lower leg.
Supine position
also known as the dorsal recumbent position, is where the patient is placed on his back with the head and shoulders elevated on a small pillow. The spine is aligned and the arms and hands comfortably rest at the side.
What is the advantage of the oblique position versus the lateral position?
Answer:
The oblique position is an alternative to the lateral position that places less pressure on the trochanter. The patient turns on the side with the top hip and knee flexed, but the top leg is placed behind the body.
What are three uses for side rails?
Answer:
Side rails are designed primarily for three uses:
● Ensure patient safety
● Provide a grip for the patient who is able to reposition himself in bed
Provide a sense of security for the patient in bed
What criteria determine whether your patient should be logrolled when he is repositioned?
Answer:
Logrolling is a special turning technique used when the patient needs to maintain the spine in straight alignment
How often should you turn and reposition a patient?
Answer:
Patients should be turned at least every two hours to protect their skin and prevent problems associated with immobility. Turning is often done at the same time the patient is moved up in bed.
Identify the most appropriate device for the following activities:
Transferring an obese patient from a bed to a stretcher
Answer:
A transfer board should be used when transferring an obese patient from a bed to a stretcher.
Identify the most appropriate device for the following activities:
Assisting an immobile patient to a recliner chair
Answer:
A mechanical lift should be used when assisting an immobile patient to a recliner chair.
Identify the most appropriate device for the following activities:
Helping a weak patient from a bed to a chair
Answer:
A transfer belt should be used when helping a weak patient from a bed to a chair.
Identify four principles to be followed when performing passive range of motion (PROM).
Answer:
Answers may include any four of the following principles when performing PROM:
● Explain to the patient the purpose of PROM. You also wish to teach family members and caregivers about the importance of range-of-motion exercises and enlist their help in exercising the patient when they visit.
● Observe the patient as you perform PROM. You may need to perform PROM in several short segments when the patient easily fatigues.
● Support the patient’s limb above and below the joint that is to be exercised.
● Move the joint in a slow, smooth rhythmic manner. Avoid fast movements, as they may cause muscle spasm.
● Use Table 31-3 (in Volume 1) as a guide to move each joint through the range of motion it is able to attain.
● Never force a joint. Some patients may have limited range of motion. Move each joint until there is resistance, not pain.
● Perform PROM at least twice daily. Move each joint through its range of motion three to five times with each session. Consider incorporating PROM into care activities—for example, while bathing or turning the patient.
● Return the joint to a neutral position when exercise is complete.
● Encourage active exercise whenever possible.
Describe activities that can promote a patient’s readiness for ambulation.
Answer:
Conditioning exercises that promote a patient’s readiness for ambulation include the following:
● Quadriceps and gluteal drills. The quadriceps muscle group and the gluteal muscles are the largest muscles of the body. When practicing good body mechanics, you use these muscles to lift objects to protect your back. Patients who have been confined to bed can perform isometric muscles in bed to increase muscle tone and facilitate the transition to ambulation. Ask the patient to tighten her thigh muscles by pushing downward with her knees and flexing her feet. Hold the position for a count of five and then relax. Repeat this process two to three times per hour during the waking hours. To exercise the gluteal muscles, ask the patient to pinch her buttocks together. Repeat this exercise when the patient exercises the quadriceps muscles. Instruct the patient not to hold her breath as she exercises.
● Arm exercises. The arm muscles are used when getting out of bed and for crutch walking. To prepare the patient for ambulation, install a trapeze bar. The trapeze bar exercises the biceps muscles. To exercise the triceps muscles, ask the patient to lift his upper body off the mattress by firmly pressing down with the palms. Push-ups can also be done from a seated position at the side of the bed or from a stationary chair or wheelchair.
● Dangling. Dangling is a seated position at the side of the bed. The patient can rest his feet on the floor or a footstool. This position readies the patient to get up in a chair, to stand, or to ambulate. Patients who have been bedridden frequently become lightheaded or develop orthostatic hypotension when first getting up. Dangling allows the patient to experience being upright with limited risk of falling. As a result, patients should not be moved further unless they are comfortable and stable in the dangling position.
● Daily activities. Encourage your patient to be active in bed and get out of bed into the chair prior to attempting to walk. Performing ADLs exercises many of the muscle groups used in ambulation. Getting up to the chair readies the patient for an upright posture and is an important predictor of success with ambulation.
What action should you take if a patient begins to fall when ambulating?
Answer:
If the patient begins to fall, do not attempt to hold the patient up independently. Instead, do the following:
● Protect the patient as you guide him to a seated or lying position.
● Create a wide base of support, and project the hip closest to the patient forward.
● Assist the patient to slide down your leg as you call for help.
● Protect the patient’s head as his body descends.
What type of cane should be a patient with significant balance problems use?
Answer:
A multipronged cane should be used by a patient with a balance problem.
When are forearm support crutches used?
Answer:
The forearm support crutch is more likely to be used by a patient with permanent limitations.
Identify five crutch gaits.
Answer:
The five crutch gaits are the two-point gait, three-point gait, four-point gait, swing-to gait, and swing-through gait.
● Two-point and four-point gaits are used for partial weight bearing.
● Three-point gait is used for non–weight bearing.
● Swing-to and swing-through are used when weight bearing is permitted.
Which of the following could put a nurse or healthcare worker at risk for sustaining a back injury?
A. Lifting a box of IV supplies up and over the head to place on a shelf
B. Placing the feet 2 feet apart before sliding a patient up in bed
C. Squatting to measure chest tube drainage
D. Raising the bed to waist level when starting an IV
Answer:
A. Lifting a box of IV supplies up and over the head to place on a shelf
Rationale:
All other options represent the use of proper body mechanics.
To assess the patient’s strength, nurse asks the patient to push his palm against hers as hard as he can. What type of exercise is this?
A. Aerobic
B. Isotonic
C. Isometric
D. Anaerobic
Answer:
C. Isometric
Rationale:
Isometric exercises involve muscle contraction without motion. They are usually performed against an immovable surface or object—for example, pressing the hand against a wall.
In addition to proper positioning, which of the following would be an important nursing measure for a patient who is immobile?
A. Encouraging a low-calcium diet to prevent kidney stones
B. Limiting fluid intake so she does not have to use the bedpan as frequently
C. Encouraging the patient to lie still so he does not cause a blood clot to become dislodged
D. Performing a skin assessment to dependent areas at least once every shift
Answer:
D. Performing a skin assessment to dependent areas at least once every shift
Rationale:
Other responses are incorrect. A diet low in calcium will not prevent kidney stones; kidney stones develop only in susceptible people, regardless of calcium intake. Limiting the fluid intake will place the patient at risk for a urinary tract infection. Keeping extremities still will lead to increased venous pooling and risk for the development of blood clots.
Mary, who is working in a small rural hospital, is caring for a comatose patient who is beginning to develop foot drop. If there were no footboard available to use for attaining proper positioning of the feet, Mary could use which of the following?
A. Overhead trapeze
B. Basketball sneakers
C. Pillow
D. Trochanter roll
Answer:
B. Basketball sneakers
Rationale:
Basketball sneakers are a type of high-top shoes that help to keep the foot in flexion. The other responses are incorrect. A trapeze would not be used by a comatose patient. A pillow is too soft to maintain proper position of the feet. A trochanter roll prevents external rotation of the hips.
Mrs. Williams has severe chronic obstructive pulmonary disease and becomes very short of breath when completing her ADLs. Which of the following nursing diagnosis would most accurately reflect Mrs. Williams’ mobility problem?
A. Ineffective Coping
B. Impaired Physical Mobility
C. Activity Intolerance
D. Deficient Knowledge
Answer:
C. Activity Intolerance
Rationale:
There is no data to suggest the patient is not coping or has a knowledge deficit. While she does have impaired mobility, the most accurate diagnosis is Activity Intolerance related to her poor oxygenation status.
Flexibility training involves moving a muscle against resistance
Answer:
False
Rationale:
Moving a muscle against resistance is resistance training.
When checking a patient to be sure her body is aligned properly, it is desirable to observe the patient from the front, back, and side views.
Answer:
True
Orthopneic position
Leaning over a pillow on a table
Scoliosis
Lateral curvature of the spine
Logrolling
Used after spinal surgery
Ankylosis
Fusing of the joints
Crepitus
Creaking of the joint
1.A 10-year-old boy fell playing ice hockey. He comes to the emergency department complaining of pain in his right forearm. The nurse notes that the boy’s arm is swelling and tender to touch. There is an area of bruising on the lateral aspect of his arm, which upon palpation is very firm. The nurse suspects a fracture; however, it cannot be confirmed until:
1) a venous and arterial Doppler is obtained.
2) clinical exam of the arm indicates a fracture.
3) the swelling is decreased by applying ice.
4) an x-ray of the extremity is obtained.
Answer:
4) an x-ray of the extremity is obtained.
Rationale:
A venous or arterial Doppler is used to detect blood flow and would not be used to detect a fracture. Although the clinical exam of the arm indicates a fracture, an x-ray of the suspected bone is a cost-effective, reliable test to definitively diagnose fracture. Applying ice would aid in decreasing the swelling at the site. Signs and symptoms associated with a sprain, strain, or fracture are the same. The variation in density evident on an x-ray allows the clinician to visually diagnose a fracture.
2.A 50-year-old woman who had a surgical repair of a fracture of her right tibia 2 days ago. She has been using crutches for ambulation and must remain non-weight-bearing on her right leg but must learn to use the steps leading into her house. The nurse should instruct Mrs. Ray to:
1) set the crutches aside and use the stair rail to bear weight only on the left leg when going up or down stairs.
2) use the crutches, maintaining toe-touch weight-bearing on the right leg when going up or down the stairs.
3) have someone carry her up and down the stairs.
4) lead with the left leg when going up steps, and lean with the right leg when going down steps.
Answer:
4) lead with the left leg when going up steps, and lean with the right leg when going down steps.
Rationale:
Using the stair rail to bear weight while bearing weight only on the unaffected side is essentially going to be a hopping action, which is not safe when trying to go up or down stairs. Mrs. Ray is to remain non-weight-bearing (NWB) on the right leg; therefore, toe-touch weight-bearing is inappropriate. Having someone carry Mrs. Ray up and down stairs limits her independence and places both the helper and patient at risk for injury. Leading with the unaffected leg allows for balance and NWB status to be maintained when going up the stairs. By placing the crutches and the affected leg forward first when going down the stairs, balance can be maintained.
3.A middle-aged man has no known medical problems, although he is overweight. He tells the nurse that he is a computer programmer and gets little exercise. The nurse suggests to the patient that a fitness program would be beneficial to control his weight and improve his overall health. The patient states “I would like to exercise but I am afraid I will have a heart attack and die if I strain my heart too much.” The nurse’s best response would be:
1) “It sounds like you are fearful of having a heart attack and dying. I understand why you might feel this way.”
2) “There is a health history of heart attack in your family; tell me more about that.”
3) “The risk of having a heart attack during strenuous exercise is low, but you still should be checked out first.”
4) “The risk of having a heart attack during strenuous exercise increases in a high-risk patient such as you.”
Answer:
3) “The risk of having a heart attack during strenuous exercise is low, but you still should be checked out first.”
Rationale:
Exercise itself is rarely life-threatening, especially when compared with the alternative (not exercising). Before starting an exercise program or significantly increasing the intensity of normal workouts, seasoned athletes as well as rank beginners should be screened for underlying health problems, such as high blood pressure, thickened heart muscle (cardiac hypertrophy), electrical abnormalities, and blood vessel abnormalities. Although showing empathy might help establish rapport and asking questions about family medical history might elicit information, neither does anything to address Mr. Green’s concern and encourage him to exercise. Mr. Green is not a “high-risk” patient according to the data in this scenario and would not have a greater risk of heart attack with strenuous physical activity.
4.A patient who is morbidly obese with complaints of extreme fatigue. She states, “I am so tired, I can’t even walk out to my mailbox without resting every 5 minutes.” Her vital signs are within normal limits at rest; however, upon minimal exertion she experiences dyspnea, and her pulse rises from 80 to 140 beats/min. She denies chest pain and has full range of motion to all joints. The nurse practitioner explains to the patient that she needs to lose weight and begin a fitness program. The best nursing diagnosis for this patient is:
1) Impaired Physical Mobility related to obesity.
2) Risk for Disuse Syndrome related to musculoskeletal inactivity.
3) Activity Intolerance related to morbid obesity and dyspnea secondary to sedentary lifestyle.
4) Impaired Physical Mobility related to limited range of motion, secondary to obesity.
Answer:
3) Activity Intolerance related to morbid obesity and dyspnea secondary to sedentary lifestyle.
Rationale:
In this scenario, Impaired Physical Mobility is the etiology of another problem: Activity Intolerance. Activity Intolerance is a state in which a patient has insufficient physical or psychological energy to carry out daily activities. Subjective characteristics include fatigue, weakness, discomfort on exertion, dyspnea, and verbalization of no interest in activity. Objective characteristics include changes in heart rate, blood pressure disproportionate to activity, dysrhythmias, or evidence of ischemia on electrocardiogram (ECG), and pallor or cyanosis with activity. There is no evidence that Mrs. Gonzales has limited range of motion. Disuse Syndrome is a more severe complication of immobility, more likely to be seen where there is almost total lack of skeletal muscle activity.
5.A patient who is morbidly obese with complaints of extreme fatigue. The nurse is planning goals for this patient. Which of the following NOC outcome(s) relate(s) directly to the above nursing diagnosis; that is, which outcome(s), if achieved, would demonstrate resolution of her problem? Select all that apply.
1) Endurance
2) Activity Tolerance
3) Active Joint Movement
4) Mobility Level
Answer:
1) Endurance
2) Activity Tolerance
Rationale:
Both Endurance and Activity Tolerance, if demonstrated by Mrs. Gonzales, would show that her problem (Activity Intolerance) is improving. Active Joint Movement and Mobility Level relate to part of the etiology of her problem, which is lack of activity. Even if she demonstrates joint movement and other mobility, this would not necessarily indicate that she is tolerating the activity well.
6.A patient who is morbidly obese with complaints of extreme fatigue. Which of the following nursing interventions would be appropriate for this patient? Encourage her to (select all that apply):
1) participate in a scheduled fitness program.
2) participate in activities outside of the home.
3) increase her daily fluid intake.
4) increase the length of time between rest periods.
Answer:
1) participate in a scheduled fitness program.
2) participate in activities outside of the home.
4) increase the length of time between rest periods.
Rationale:
Interventions would include establishing a regular exercise program, with the expectation of better compliance if it is scheduled outside of the home. Increasing the length of time between rest periods will also increase the patient’s activity tolerance.
7.A patient who is morbidly obese with complaints of extreme fatigue. To evaluate your nursing care plan for this patient, at the end of 12 weeks an indication of its effectiveness would be that she:
1) has lost 15 pounds when measured at the same time as the initial weight.
2) has full range of motion to all joints without experiencing pain.
3) jogs five city blocks twice a week without tiring or stopping.
4) participates in a fitness program at the community center 3 days a week.
Answer:
4) participates in a fitness program at the community center 3 days a week.
Rationale:
By participating regularly in an exercise program, Mrs. Gonzales has demonstrated an increase in activity tolerance (recall that her goal was Activity Tolerance). This is also an indication that her sedentary lifestyle habits are changing.
8.To promote exercise for patient with morbid obesity, the nurse’s best statement would be:
1) “I know exercising is hard, but it is something you are just going to have to do to remain healthy.”
2) “Remember gaining weight and getting out of shape takes time, and reversing these changes also takes time.”
3) “I know exactly how you feel; I hate to exercise, too. It’s a real drag sometimes.”
4) “I know you feel that exercise didn’t make a difference; but it was probably the fitness program you participated in.”
Answer:
2) “Remember gaining weight and getting out of shape takes time, and reversing these changes also takes time.”
