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Chapter 32: Physical Activity & Mobility

Terms in this set (32)

Body Mechanics
The way people move:
Body alignment (posture)
Balance
Coordination
Joint mobility
Body alignment
An important aspect of body mechanics. Proper posture places the spine in a neutral (resting) position. Good posture contributes to the normal functioning of the nervous system and improves feelings of well-being.
Balance
For your body to be balanced, your line of gravity must pass through your center of gravity, and your center of gravity must be close to your base of support. The line of gravity is an imaginary vertical line drawn from the top of the head through the center of gravity. The center of gravity is the point around which mass is distributed. In the human body, the center of gravity is below the umbilicus at the top of the pelvis. The base of support is what holds the body up. The feet provide the base of support.
Coordination
Smooth movement requires coordination between the nervous system and the musculoskeletal system. Voluntary movement is initiated in the cerebral cortex. However, the cerebellum coordinates movements.
Joint Mobility
Range of motion (ROM) is the maximum movement possible at a joint. Active range of motion (AROM) is defined as the movement of the joint through the entire ROM by the individual. Full ROM is part of being physically fit; for that reason, stretching exercises are included in a comprehensive exercise program.
Factors Affecting Mobility and Activity
Life span
Nutrition
Lifestyle
Stress
External environment
Disease
Exercise
Contraction/relaxation of muscles.
Increases muscle tone/strength.
150 to 300 min/week of moderate- and vigorous-intensity exercise recommended.
Types of Exercise
Isometric
Isotonic
Isokinetic
Aerobic
Anaerobic
Isometric
Involves muscle contraction without motion. They are usually performed against an immovable surface or object, such as 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 and repeated 5 to 10 times. Isometric training is effective for developing total strength of a particular muscle or group of muscles
Isotonic
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 ROM, the muscle shortens and lengthens.
Isokinectic
Combines the best features of both isometrics and weight training by providing resistance at a constant, preset speed while the muscle moves through the full ROM.
Aerobic
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 rates, thereby providing exercise for the cardiovascular system while simultaneously exercising the skeletal muscles.
Anaerobic
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 exercise, such as lifting heavy objects or sprinting, are examples of anaerobic exercise.
Benefits of Exercise
Improves cardiovascular health.
Increases muscle tone and flexibility.
Enhances immune system.
Promotes weight loss.
Decreases stress/increases overall feeling of well-being.
Effects of Immobility
Muscle atrophy
Joint dysfunction
Atelectasis/pneumonia
Venous stasis
Increased coagulability
Orthostatic hypotension
Glucose intolerance
Pressure ulcers
Constipation
Paralytic ileus
Urinary tract infection
Renal calculi
Depression
Sleep disturbances
Disorientation
Muscle Atrophy
Inactivity causes significant wasting of the gastrocnemius, soleus, and leg muscles that control flexion and extension of the hip, knee, and ankle. Confinement to bed leads to 7% to 10% loss of muscle strength (atrophy) per week.
Joint Dysfunction
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).
Atelectasis/pneumonia
When a patient is in bed, the depth of respirations decreases, and secretions pool in the airways. The ability to effectively cough and expectorate secretions diminishes as muscle tone of the abdomen and chest decrease. As a result, pooled secretions block air passages and alveoli, decrease oxygen and carbon dioxide exchange, and often lead to atelectasis (collapse of air sacs), or pneumonia.
Venous Stasis
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 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, such as deep vein thrombosis (DVT).
Orthostatic Hypotension
Prolonged bedrest inactivates the baroreceptors involved with constriction and dilation of the blood vessels. As a result, when a person who has been immobilized changes position, he is less able to maintain his blood pressure. The patient complains of feeling dizzy and light-headed, and may be unable to support his own weight.
Glucose Intolerance
As ATP concentrations decrease, so do the body's energy reserves. In response, metabolic rate drops, protein and glycogen synthesis decrease, and fat stores increase. Together, these effects cause glucose intolerance and reduced muscle mass.
Pressure Ulcers
External pressure from lying in one position compresses capillaries in the skin, obstructing skin circulation. Lack of circulation causes tissue ischemia and possible necrosis (death). Nursing interventions include frequent turning and skin care to prevent wounds, known as pressure ulcers, from forming.
Constipation
Immobility slows peristalsis, which leads to constipation, gas, and difficulty evacuating stool from the rectum. In extreme circumstances, a paralytic ileus (cessation of peristalsis) may occur. When peristalsis slows, appetite diminishes and food also is digested slowly. The net effect is usually decreased calorie intake and inability to meet the protein demands of the body.
UTI
Being supine inhibits drainage of urine from the renal pelves and bladder. Urine becomes stagnant, which creates an ideal environment for infection and kidney stone formation. Immobility triggers a rise in calcium levels, which also contributes to stone formation.
Depression
Prolonged immobility, whether in the hospital or at home, leads to isolation and mood changes. In the 1960s, the effects of immobility were studied among astronauts. Along with the many physical effects of immobility, these healthy men showed signs of depression, anxiety, hostility, sleep disturbances, and changes in their ability to perform self-care activities.
Promoting Exercise
Plan and vary exercise routine.
Use buddy system and rewards.
Integrate exercise into routine activities.
Attain target heart rate.
Fowler''s
It is also an ideal position for some patients with cardiac dysfunction. Common variations include semi-Fowler's position, in which the head of the bed is elevated only 30° and high-Fowler's position, in which the head is elevated 90°.
Lateral Position
The lateral position is a side-lying position with the top hip and knee flexed and placed in front of the rest of the body. The lateral position creates pressure on the lower scapula, ilium, and trochanter but relieves pressure from the heels and sacrum. The lateral recumbent position is side-lying with legs in a straight line.
Prone
The patient lies on his abdomen with his head turned to one side. This is the only position that allows full extension of the hips and knees. It also allows secretions to drain freely from the mouth and thus is helpful for an unconscious patient. However, this is the most difficult position to move an unconscious or frail patient into because it requires the greatest amount of manipulation to position the patient appropriately.
Sims
This 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. Sims' position facilitates drainage from the mouth and limits pressure on the trochanter and sacrum. This is an ideal position for administering an enema or a perineal procedure.
Supine
Also known as the dorsal recumbent position, the patient lies on his back with head and shoulders elevated on a small pillow. The spine is aligned and the arms and hands comfortably rest at the side.
Helping Client out of Bed
Use of transfer board
Mechanical lift
Transfer belt
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