chapter 38: Activity and excercise Flashcards
AHA benefits of physical activit
- elevates mood and attitude
- keeps us physically fit
- helps ppl stop smoking
- boosts energy levels
- stress management
- promotes better sleep
- improves self image and confidence
Deconditioning
physiological changes aft period of inactivity
- risk for hospitalized patients
- gets in way of activities of daily living
Nature of movement
body mechanics = coordinated efforts of musculoskeletal and nervous systems
Alignment and balance
body alignment is basically posture –> position of joints, tendons, ligaments, and muscles while in dif positions
Correct body alignment reduces strain on musculoskeletal structures, maintains muscle tone, promotes comfort, helps with balance and energy conservation
Gravity and friction
Patients’ center of gravity is usually at 55-57% of standing height along the midline
Greater surface area = greater friction
Shear = friction bt one’s own skin and bone
Common friction issue in hospitals
when hospital bed is raised over 60 degrees, skin stays against the sheets and bony structures slide down
-stretches and damages tissue and blood vessels –> pressure injuries
Not usually a problem for surface tissue
Full body sling helps to move patients
Regulation of movement
Integration of musculoskeletal and nervous system
Skeletal system
4 bones: long, short, flat, and irregular
babies have flexible, but not sturdy bones
toddlers have stronger, but pliable bones
old ppl are mores succeptible to bone loss and osteoporosis
joints
3 types:
- fibrous: close together and fixed (syndesmosis bt tibia and fibula)
- cartilaginous: little mvmnt but elastic (synchondrosis bt ribs and costal cartilage)
- synovial joins: true joints –> fee moving –> most common
ligaments, tendons, and cartilage
support skeletal system
-ligaments = dense fibrous tissue bands bt bone and cartilage –> elastic –> some are protective
-tendons –> connect muscle to bone –> achilles tendon is thickest and strongest (soleus muscle to calcaneal bone
cartilage -> nonvascular –> bears weight and absorbs shock bt bones –> permanent cartilage is unossified except in old age or disease
Skeletal muscle
- bundles of miscle fibers –> ATP (powered by glucose and O2) powers movement of actin and myosin along each other to contract muscles when stimulated by electrochem stimulus across NMJ
- disuse and use lead to atrophy ad hypertrophy
- during contraction, one bone moves (insertion) while other remains in place (origin)
- stretch reflex = body trying to maintain constancy of muscle length
Isotonic contractions
Isometric contractions
Isotonic
- concentric = increased muscle contraction causing muscle shortening
- eccentric = causes lengthening
isometric
-increase in muscle tension but no change in size of muscle
Voluntary movement combines the two
Prime mover
Antagonist
Synergists
Fixators
Muscle tone
- muscle that directly performs a specific movement
- muscle that directly opposes prime mover when it contracts
- contracts at same time as prime and facilitates its action
- muscles that stabilize joints - kinda like a synergist
normal state of balanced muscle tension
Nervous system
diseases that fuck up movement
Precentral gyrus = motor strip = major voluntary motor area in cerebral cortex
-most motor fibers descend from here and cross at medulla
- Parkinson alters NT production
- myasthenia gravis disrups NT transfer to muscle
- multiple sclerosis impairs muscle activity
Proprioceptin
muscle sense that makes us aware of position of the body and its parts including body movement, orientation in space, and muscle stretch
Proprioceptors live in muscle spindles
Balance and alinment
-steps to maintaining it
maintained by sense organs in vestibule and semicircular canals of ears
- widen base by widening stance
- bring center of gravity close to base of support
- bend knees and flex hips til squatting and keep back erect
Physical activity and excercise
benefits of isotonic vs isometric
Activity = any movement by muscle that expends energy Exercise = PA that's planned, structured, and repetitive
Isotonic up circulatory and respiratory func –> increase muscle mass, tone, and strength –> promote bone health
Isometric are good for ppl who can’t tolerate more activity –> increase muscle mass, tone and strength –> circulation to that body part –> osteoblast activity
Conditions affecting body alignment and mobiity
Congenital defects bone, joint, and muscle disorders inflammatory joint diseases central nervous system disorders musculoskeletal trauma
problems caused by obesity
musculoskeletal stuff: low back pain, gait disturbance, soft tissue damage, osteoprosis, gout, fibromyalgia, and CT disorders
Also HTN, atherosclerosis, heart disease, diabetes, high blood cholesterol, cancers, and sleep disorders
Overextension injuries
Ergonomics
Come from HCPs using too much effort at work (usually moving patients)
design of work tasks to best suit capabilities of workers
Factors influencing activity and excercies
Developmental changes
Patient behavior –> intrinic motivation
Lifestyle
Cultural background
Environmental issues –> work, home, schools, community
Family and social support (esp for women) –> also parents to kids
Transtheoretical Model r/t self efficacy for PA
Precontemplation: no plan to change - unaware of need
Contemplation: aware of need for change - plan to w/in 6 months
Preparation: decided to take action w/in the month - have a plan
Action: making changes
Maintenance: exhibited behavior for 6 months and are preventing relapse
Objectives of assessing body alignment
- determine normal changes from growth and development
- identify deviations caused by bad posture
- let patient view their own posture
- identify need to teach patient about posture
- identify trauma, muscle damage, or nerve damage
- Obtain info on things that could affect body alignment, like fatigue, malnutrition, and psychosocial problems
Positions to check patient’s mobility
Sitting: BMAT - can use side rail
Standing: BMAT - can use help (cane etc) - need to have butt off chair for 5 secs
ROM:
- too much = CT disorder, ligament tears, and possible joint fractures
- too little = inflammation, fluid in joint, altered nerve supply, and contractures
Gait = heal strike of one leg to heal strike of next leg
How much exercise should an adult get?
150 mins of moderate intensity aerobic activity
muscle-stregthening on at least 2 days that target all major muscle gps
Activity intollerance vs fatigue
Activity intollerance comes with abnormal heart rate and mild shortness of breath after exercise
Nursing diagnoses associated with activity/exercise
activity intollerence risk for fall-related injury impaired mobility in bed impaired mobility acute or chronic pain
What kind of exercise do older adults have to do that younger ones don’t?
Balance exercises
How to calculate targeted heart rate during exercise
subtract age from 220 (max HR)
60-90% of max is the target
What should be included no matter what exercise perscription is given?
warm up and cool down periods
Warm up = 5-10 mins –> stretching , calisthenics, low-level aerobics
Cool down = 5-10 mins –> stretching and mind-body awareness
Early mobility
- risks of limited activity/ prolonged bed rest
- who needs it most?
-especially for those in acute care –> avoid deconditioning
Risks:
-reduced phys func, sleep deprivation, delirium, altered nutrition
Important for: critically ill, orthopedic patients, those who’ve had general/neural surgery
Isometric exercises
general procedure
specific examples
General: flex/contract muscles for 10 secs and then relax w/o joint involvement –> work up to 8-10 reps –> work up to 4 times a day –> quads and gluts help with prepping to walk
Specific:
- palm stretches
- plantar flexion/dorsiflexion
- arm lifts
Types of ROM exercises
active
active assisted
passive
contraindictions to AROM
healing fracture site healing surgical site severe/acute soft tisue trauma joint pain limited joint movement joint inability, deformation, and contractures
Orthostatic hypotension and Neurogenic orthostatic hypotension
SBP drops 20 mm Hg within 3 mins shifting to upright position
sustained reduction in BP upon standing caused by autonomic dysfunction
Who’s at risk for orthostatic hypotension and neurogenic orthostatic hypotension
ppl who’ve been in bed a long time
old ppl
those with chronic illnesses (diabetes mellitius or cardiovascular disease)
Neurogenic: e.g. Parkinsons
gait belt dos and don’ts
keeps patients center of gravity at midline
helps stabilize patient if they lose balance
fit it snugly below belly button with room for 2 fingers
hold from behind with palms facing up
Dont lift or carry patient by waist with this
don’t place over incisions, stitches, tubes, or IV lines
Don’t do this with pregnant person
How to catch a falling patient
wide base with one foot in front of other
let patient slide against leg and lower them to floor while protecting their head
Restorative and continuing care
implementing activity and exercise strategies to help a patient perform ADLs after acute care is no longer needed
Includes activities and exercises that restore optimal func in patients with specific chronic diseases like coronary heart disorder (CHD), HTN, COPD, and diabetes mellitus
Reasons for using assistive devices for walking
reduce risk of falls
decrease pain with mobility
increase balance
What not to do with a walker
walk behind it
lean on it
use it on the stairs
How to use a cane
put cane forward 15-25 cm
move weaker leg forward
move strong leg past cane
when are quad canes appropriate?
partial or complete leg paralysis or some hemiplegia
same steps as normal cane
Standard crutch gaits
four-point alternating: left crutch, right foot, right crutch, left foot
three point alternating: both crutches, good foot, both crutches good foot
two point alternating: left crutch AND right foot, right crutch AND left foot
swing through:
tripod position for crutches
Assumed position before walking
crutches in front of feet erect head and neck straight vertebrae extended hips and knees no weight on axillae
Up and down stairs with crutches
one crutch and hand rail
Up stairs: hand rail, good leg, crutch, bad leg
Down stairs: hand rail, bad leg and crutch, good leg
sitting in chair with crutches
legs touch back of chair
hold crutches in one hand opposite affected leg
hold arm of chair with other hand
lower self into chair
Coronary artery disease interventions
promote regular moderate exercise
HTN interventions
low to moderate intensity exercise
relaxation exercises to combat stress
COPD interventions
tailored to individual
w/o it patients have dyspnea
Diabetes mellitus intervention
moderate to high intensity exercise
Type 1: increases heart and lung fitness, decreases insulin resistance, and improves lipid levels and endothelial func
Type 2: reduction in HbA10, triglycerides, blood pressure, insulin resistance
