Activity and Exercise : Chapter 44 Flashcards
Activity Exercise Pattern
person’s routine of exercise, activity, leisure, and recreation. Includes ADL’s and type quality, and quanity of exercise, including sports.
Mobility
the ability to move freely, easily, rhythmically, and purposefully in the environment, is an essential part of living. People must move to protect themselves from trauma and meet their basic needs. Mobility is vital to independence.
Joint Movements
- Flexion
- Extension
- Hyperextension
- Abduction
- Adduction
- Rotation
- Circumduction
- Eversion
- Inversion
- Pronation
- Supination
Flexion
decrease the angle of the joint
example : bent elbow
Extension
increased angle of the joint
example : straightened arm at the elboe
Hyperextension
further extension or straightening of a joint
example : bending the head backwards
Abduction
movement of the bone away from the midline of the body
Adduction
movement of the bone towards the midline of the body
Rotation
Movement of the bone around its central axis
Circumduction
Movement of the distal part of the bone in a circle while the proximal end remains fixed
Eversion
turning the sole of the foot outward by moving the ankle joint
Inversion
turning the sole of the foot inward by moving the ankle joint
Pronation
Moving the bones of the forearm so that the palm of the hand faces downward when held in front of the body
Supination
Moving the bones of the forearm so that the palm of the hand faces upward when held in front of the body
Types of Exercise
- Isotonic (dynamic)
- Isometric (static)
- Isokenetic (resistive)
- Aerobic
- Anaerobic
Isontonic (Dynamic) Exercise
Muscles shorten to produce muscle contraction and active movement.
Increases muscle tone, mass, strength, and maintain joint flexibility, and circulation
example : running, walking, swimming, hiking ADL’s, and ROM
Isometric (Static or Setting) Exercise
Muscle contraction without moving the joint. Involves exerting pressure against a solid object and are useful for strengthening abdominal, gluteal, and quadricep muscles in ambulation, for maintaining stength in immobilized muslces in casts or traction & endurance training.
example : squeezing a towel or pillow between the knees while at the same time tightening the muscles in the fronts of the thighs by pressing the knees backwards. “guad sets”
Isokenetic (Resistive) Exercises
Muscle contraction or tension against resistance. Person tenses (isometric) against resistance.
Aerobic Exercise
Activity during which the amount of oxygen taken into the body is greater than that used to perform the activity. Repetitive.
Anaerobic
Involves activity in which the muscles cannot draw out enough oxygen from the bloodstream and anaerobic pathways are used to provide additional energy for a short time.
example: endurance training for weight lifting and sprinting
Physical Activity
body movement that enhances health
Exercise
A type of physical activity defined as planned or structured and repetitive body movement performed to improve health and maintain fitness to achieve an optimal state of health
Benefit of Exercise : Cardiovascular
increases HR (walking 15-20 min), the strength of heart muscle contraction, and the blood supply to the heart and muscle through increased cardiac output. Decreases BP, improved oxygen uptake, and lower levels of stress
Benefit of Exercise : Musculoskeletal
muscles (hypertrophy) enlarge, efficiency of muscular contraction increases, joint flexibility, ROM, reduces weakness, frailty, depression, and risk of falls in older adults. Bone density and strength is maintained
Benefits of Exercise : Respiratory
Improves gas exchange, toxins are eliminated with deeper breathing, problem -solving and emotional stability are enhanced due to increased oxygen to the brain. Prevent pooling of secretions in the bronchi and bronchioles, decreased breathing effort and risk of infection. enhances oxygenation (stamina), circulation of lymph (improved immune system)
Benefits of Exercise : Gastrointestinal
Improves appetite and increases GI tract tone, facilitating peristalsis. Working the abdominal muscles can relieve constipation. Abdominal compressive exercises improve irritable bowel syndrome and other digestive disorders
Benefits of Exercise : Metabolic/Endocrine
increases metabolic (20x’s) rate thus increasing the production of body heat and waste products and calorie use, increases the use of fatty acids and triglycerides, resulting in a reduced level of serum triglycerides, A1C levels, and cholesterol. Weight loss and exercise control blood sugar and make cells more responsive to to insulin
Benefits of Exercise : Urinary
promotes efficient blood flow, body excretes wastes more effectively. In addition, stasis (stagnation) of urine in the bladder is usually prevented, which in turn decreases the risk for urinary tract infections
Benefits of Exercise : Immune
lymph fluid is efficiently pumped form tissues into lymph capillaries and vessels throughout the body due to respiratory and musculoskeletal effort increase. Circulation through lymph nodes where destruction of pathogens and removal of foreign antigens can occur is also improved. Improvements of T-cell function, and cytokine production, potentially increasing resistance to viral infections and preventing formation of malignant cells.
Benefits of Exercise : Psychoneurologic
Elevates mood and relieves stress, and depression. Exercise increases levels of metabolites for nuerotransmitters such norepinephrine and serotonin, exercise releases endogenous opiods thus increasing levels of endorphins, exercise increases levels of oxygen to the brain and other body systems including euphoria and through muscular excretion
Effects of Immobility : Musculoskeletal
Disuse Osteoporosis - bone demineralization due to diminished calcium, bones are spongy become fragile
- Muscle atrophy
- Contractures - limbs shorten due to immobility to shorten and lengthen muscle fibers, foot drop
- Stiffness and pain in the joints - w/o movement collagen (connective) tissues at the joint become ankylosed (permanently immobile), bone demineralization causes excess calcium contributes to to stiffness and paint
Effects of Immobiltiy : Cardiovascular
- Diminished Cardiac Reserve - imbalance in the ANS, rapid heart rate reduces diastole pressure, coronary blood flow, and the capacity of the heart to respond to any metabolic demands above the basal levels. Tachy HR even w/ little exertion
- Increase use of the Valsava maneuver - (holding breath and straining) against closed glottis. This builds up sufficient pressure on the large veins in the thorax and interferes w/ the return blood flow to the heart and coronary arteries.
- Orthostatic hypotension
- Venous vasodialation and stasis -
- Dependent edema
- Thrombus formation
Effects of Immobility : Respiratory
Decreased respiratory movement -
- Pooling of respiratory secretions - inactivity allows secretions to pool by gravity. Coughing up secretions may be hindered by loss of respiratory muscle tone, dehydration, or sedatives. Poor oxygenation and and retention of CO in the blood can cause respiratory aicdosis.
- Atlelectasis -
- Hypostatic Pneumonia - static respiratory secretions severely impaired by oxygen-carbon dioxide exchange in the aveoli
Effects of Immobility : Metabolic
- Decreased metabolic rate
- Neg nitrogen balance - catabolic processes exceed anabolic processes. Catabolic muscle mass releases nitrogen after awhile the buildup is ingested more than what is needed. Represents a depletion of protein stores that are essential for building muscle tissue for wound healing
- Neg calcium balance - excess amounts of calcium are extracted from the bone than can be replaced. Absence of weight bearing and stress are direct cause of calcium imbalance
Effects of Immobility : Urinary
- Urinary Stasis (slowed down urine flow) - impedes emptying of urine from the kidneys and bladder due to horizontal positioning
- Renal Calculi - excessive calcium in urine, becomes more alkaline, and salts comes as crystals.
- Urinary Retention - decreased muscle tone inhibits ability to void completely, stretched and distended bladder
- Urinary infection - alkalinity of urine caused by hypercalcuria supports bacteria growth
Effects of Immobility : GI
Constipation due to decreased peristalsis and colon motility, skeletal muscles weaken
Effects of Immobility : Integumentary
- Reduced Skin Turgor - atrophy due to prolonged immobility, shifts in fluid between the dermis and subcutaneous tissues in dependent parts of the body
- Skin breakdown - impedes circulation and diminishes the supply of nutrients to specific areas
Effects of Immobility : Psychoneurologic
- Negative effects on mood due to the decline of endorphins, dependence on others, low self-esteem,perception of time intervals change, problem solving skills and decision making abilities deteriorate
Prevention of Back Injury
client positioning, lifting, & transferring are risk for back injuries, 35 lb max weight limit, avoid twisting of the thoracolumbar spine & acute flexion of the back w/ hips and knees straight (stooping)
Fowler’s Position
head and trunk raised to a 45-60 degree angle
Semi Fowler’s Position
head and trunk raised to a 15-45 degree angle
High Fowler’s Position
head and trunk raised to a 60-90 degree angle
Orthopenic Position
sitting in bed with beside table over the lap. Facilitates respiration by allowing max chest expansion
Dorsal Recumbent Position
back-lying, shoulders on small pillow
Prone Position
lying on abdomen with head turned to one side, hips not flexed, only bed position that allows full extension of the hip and knee joints
Lateral Position
lying on one side of the body flexing the top hip and knee and placing this leg in front of the body creates a wider triangular base of support and achieves greater stability.
Sim’s (semiprone) Position
posture halfway between lateral and prone positions. lower arm is positioned behind client and upper arm is flexed at the shoulder and the elbow. both legs are flexed in front of the client.
Active ROM Exercises
isotonic exercises in which the client moves each joint in the body through it’s entirety (upper and lower extremities)
Passive ROM Exercises
another person moves each of the clients joints through its entirety
Crutches
Most common used crutches : underarm or axillary w/ hand bars, and the Lofstrand crutch which extends only to the forearm.
Four- Point Alternate Gait
Most safest gait, that provides at least three points of support at all times, but requires coordination. Bear weight on both legs
1) Move the right crutch ahead 10-15cm (4-6in)
2) Move the left front foot forward to the level of the left crutch
3) Move the left crutch forward
4) Move the right foot forward
Three-Point Gait
Bear entire body weight on the unaffected leg. The two crutches and the unaffected leg bear weight alternately
1) Move both crutches and the weaker leg forward
2) Move the stronger leg forward
Two-Point Alternate Gait
Faster than the four point gait. Requires more balance because only two points support the body at one time; partial weight bearing on each foot
1) Move the left crutch and the right foot forward together
2) Move the right crutch and left foot ahead together
Swing to Gait
Paralysis of the of the legs and hips
1) Move both crutches ahead together
2) lift body weight by the arms and swing to the crutches
Swing Through Gait
Requires skill, coordination, and strength
1) Move both crutches forward together
2) Lift body weight by the arms and swing through and beyond the crutch.
