Exercise and activity

Question 1

Name three purposes of the skeletal system.

Answer 1

• 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

Question 2

Identify three types of muscle.

Answer 2

• 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.

Question 3

How do the muscles and the nerves interact?

Answer 3

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
33
as reciprocal innervation. Movement also occurs through reflex mechanisms. Reflexes are protective mechanisms. Common reflexes include the knee jerk and corneal reflex.

Question 4

Identify the four components of body mechanics.

Answer 4

Body mechanics, a term used to describe the way

we move our body, includes four components: body alignment, balance, coordination, and joint mobility.

Question 5

Abduction

Answer 5

is moving away from midline.

Question 6

Adduction

Answer 6

is moving toward midline.

Question 7

Flexion

Answer 7

is bending, decreasing the joint angle.

Question 8

Extension

Answer 8

is straightening, increasing the joint angle.

Question 9

Circumduction

Answer 9

is moving in a circular fashion

Question 10

Internal rotation

Answer 10

is turning toward midline.

Question 11

Supination

Answer 11

is turning upward.

Question 12

Pronation

Answer 12

is turning downward.

Question 13

Isometric exercises involve

Answer 13

muscle contraction without motion. They are usually performed against an immovable surface or object. For example, when pressing the hand against a
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.

Question 14

Isotonic exercise involves

Answer 14

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.

Question 15

Isokinetic exercise utilizes

Answer 15

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.

Question 16

Aerobic exercise acquires

Answer 16

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 main- tained 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

Question 17

Anaerobic exercise occurs

Answer 17

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.

Question 18

State the components of an exercise program.

Answer 18

The three components of a well-rounded exercise program are flexibility, resistance training, and aerobic conditioning.

Question 19

What are the signs and symptoms of a fracture?

Answer 19

• 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.

Question 20

A sprain is

Answer 20

a stretch injury of a ligament that causes the ligament to tear.

Question 21

A strain is

Answer 21

an injury to muscle caused by excessive stress on the muscle.

Question 22

immobility affects the cardiovascular system by

Answer 22

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, activa- tion 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 for- mation in the effected blood vessels. An immobile person is also more prone to orthostatic hypoten- sion. Bedrest causes inactivation of the barorecep- tors 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 com- plains of feeling dizzy and light-headed and may be unable to support his own weight.

Question 23

Immobility affects the musculoskeletal system by

Answer 23

causes signifi- cant 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.

Question 24

Immobility affects the integumentary system by

Answer 24

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.

Question 25

Why might immobility be referred to as a stressor?

Answer 25

because it triggers the release of epinephrine and norepinephrine, thyroid hormones, adrenocorticotropic hormone 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.

Question 26

What are three effects of immobility on the GI system?

Answer 26

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.

Question 27

What changes in mood might be seen with immobility?

Answer 27

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.

Question 28

Fowler’s position

Answer 28

is a semi-sitting position. The head of the bed is elevated 45° to 60°.

Question 29

Lateral position

Answer 29

is a side-lying position with the top hip and knee flexed and placed in front of the rest of the body.

Question 30

Prone position

Answer 30

is a position in which the patient lies on his stomach, with his head turned to one side.

Question 31

Sims’ position

Answer 31

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.

Question 32

Supine position

Answer 32

also known as the dorsal recum- bent position, is a position in which 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.

Question 33

What is the advantage of the oblique position versus the lateral position?

Answer 33

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.

Question 34

A trapeze bar is

Answer 34

a triangular bar that is attached to an overhead bed frame. The patient can use the base of the triangle as a grip bar to move up in bed, turn, pull up in preparation for getting out of bed, or pull up to get on and off the bedpan.

Question 35

A footboard is

Answer 35

a device placed at the end of the bed that prevents plantar flexion.

Question 36

A foot cradle is

Answer 36

a metal or plastic device that is secured at the foot of the bed to prevent bedding from constricting the movement of the lower extremities.

Question 37

Trochanter rolls are made from

Answer 37

ightly rolled tow- els or foam pads. They are usually 12 to 18 inches in length. The rolls are placed adjacent to the hips and thighs to prevent external rotation of the hips.

Question 38

Splints may be premade or fashioned from rolled wash clothes.

Answer 38

The purpose of a splint is to hold the wrist and hand in a natural position and prevent claw-hand deformities.

Question 39

What are three uses for siderails?

Answer 39

• Ensure patient safety
• Provide a grip for the patient who is able to repo- sition himself in bed
• Provide a sense of security for the patient in bed

Question 40

What criteria determine whether your patient should be logrolled when he is repositioned?

Answer 40

Logrolling is a special turning technique used when the patient needs to maintain the spine in straight alignment.

Question 41

How often should you turn and reposition a patient?

Answer 41

Patients should be turned at least every 2 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.

Question 42

What type of cane should a patient with significant balance problems use?

Answer 42

A multipronged cane should be used by a patient with a balance problem.

Question 43

When are forearm support crutches used?

Answer 43

The forearm support crutch is more likely to be used by a patient with permanent limitations.

Question 44

The five crutch gaits are

Answer 44

two-point gait, three- point gait, four-point gait, swing-to gait, and swing- through gait.

Question 45

Two-point and four-point gaits are used

Answer 45

for partial weight-bearing.

Question 46

Three-point gait is used

Answer 46

for non-weight-bearing.

Question 47

Swing-to and swing-through are used when

Answer 47

weight-bearing is permitted.