chapter 38: Activity and excercise

Question 1

AHA benefits of physical activit

Answer 1

• 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

Question 2

Deconditioning

Answer 2

physiological changes aft period of inactivity

• risk for hospitalized patients
• gets in way of activities of daily living

Question 3

Nature of movement

Answer 3

body mechanics = coordinated efforts of musculoskeletal and nervous systems

Question 4

Alignment and balance

Answer 4

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

Question 5

Gravity and friction

Answer 5

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

Question 6

Common friction issue in hospitals

Answer 6

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

Question 7

Regulation of movement

Answer 7

Integration of musculoskeletal and nervous system

Question 8

Skeletal system

Answer 8

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

Question 9

joints

Answer 9

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

Question 10

ligaments, tendons, and cartilage

Answer 10

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

Question 11

Skeletal muscle

Answer 11

• 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

Question 12

Isotonic contractions

Isometric contractions

Answer 12

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

Question 13

Prime mover
Antagonist
Synergists
Fixators

Muscle tone

Answer 13

• 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

Question 14

Nervous system

diseases that fuck up movement

Answer 14

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

Question 15

Proprioceptin

Answer 15

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

Question 16

Balance and alinment

-steps to maintaining it

Answer 16

maintained by sense organs in vestibule and semicircular canals of ears

1. widen base by widening stance
2. bring center of gravity close to base of support
3. bend knees and flex hips til squatting and keep back erect

Question 17

Physical activity and excercise

benefits of isotonic vs isometric

Answer 17

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

Question 18

Conditions affecting body alignment and mobiity

Answer 18

Congenital defects
bone, joint, and muscle disorders
inflammatory joint diseases
central nervous system disorders
musculoskeletal trauma

Question 19

problems caused by obesity

Answer 19

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

Question 20

Overextension injuries

Ergonomics

Answer 20

Come from HCPs using too much effort at work (usually moving patients)

design of work tasks to best suit capabilities of workers

Question 21

Factors influencing activity and excercies

Answer 21

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

Question 22

Transtheoretical Model r/t self efficacy for PA

Answer 22

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

Question 23

Objectives of assessing body alignment

Answer 23

• 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

Question 24

Positions to check patient’s mobility

Answer 24

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

Question 25

How much exercise should an adult get?

Answer 25

150 mins of moderate intensity aerobic activity muscle-stregthening on at least 2 days that target all major muscle gps

Question 26

Activity intollerance vs fatigue

Answer 26

Activity intollerance comes with abnormal heart rate and mild shortness of breath after exercise

Question 27

Nursing diagnoses associated with activity/exercise

Answer 27

``` activity intollerence risk for fall-related injury impaired mobility in bed impaired mobility acute or chronic pain ```

Question 28

What kind of exercise do older adults have to do that younger ones don't?

Answer 28

Balance exercises

Question 29

How to calculate targeted heart rate during exercise

Answer 29

subtract age from 220 (max HR) | 60-90% of max is the target

Question 30

What should be included no matter what exercise perscription is given?

Answer 30

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

Question 31

Early mobility - risks of limited activity/ prolonged bed rest - who needs it most?

Answer 31

-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

Question 32

Isometric exercises general procedure specific examples

Answer 32

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

Question 33

Types of ROM exercises

Answer 33

active active assisted passive

Question 34

contraindictions to AROM

Answer 34

``` healing fracture site healing surgical site severe/acute soft tisue trauma joint pain limited joint movement joint inability, deformation, and contractures ```

Question 35

Orthostatic hypotension and Neurogenic orthostatic hypotension

Answer 35

SBP drops 20 mm Hg within 3 mins shifting to upright position sustained reduction in BP upon standing caused by autonomic dysfunction

Question 36

Who's at risk for orthostatic hypotension and neurogenic orthostatic hypotension

Answer 36

ppl who've been in bed a long time old ppl those with chronic illnesses (diabetes mellitius or cardiovascular disease) Neurogenic: e.g. Parkinsons

Question 37

gait belt dos and don'ts

Answer 37

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

Question 38

How to catch a falling patient

Answer 38

wide base with one foot in front of other | let patient slide against leg and lower them to floor while protecting their head

Question 39

Restorative and continuing care

Answer 39

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

Question 40

Reasons for using assistive devices for walking

Answer 40

reduce risk of falls decrease pain with mobility increase balance

Question 41

What not to do with a walker

Answer 41

walk behind it lean on it use it on the stairs

Question 42

How to use a cane

Answer 42

put cane forward 15-25 cm move weaker leg forward move strong leg past cane

Question 43

when are quad canes appropriate?

Answer 43

partial or complete leg paralysis or some hemiplegia same steps as normal cane

Question 44

Standard crutch gaits

Answer 44

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:

Question 45

tripod position for crutches

Answer 45

Assumed position before walking ``` crutches in front of feet erect head and neck straight vertebrae extended hips and knees no weight on axillae ```

Question 46

Up and down stairs with crutches

Answer 46

one crutch and hand rail Up stairs: hand rail, good leg, crutch, bad leg Down stairs: hand rail, bad leg and crutch, good leg

Question 47

sitting in chair with crutches

Answer 47

legs touch back of chair hold crutches in one hand opposite affected leg hold arm of chair with other hand lower self into chair

Question 48

Coronary artery disease interventions

Answer 48

promote regular moderate exercise

Question 49

HTN interventions

Answer 49

low to moderate intensity exercise | relaxation exercises to combat stress

Question 50

COPD interventions

Answer 50

tailored to individual | w/o it patients have dyspnea

Question 51

Diabetes mellitus intervention

Answer 51

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