MOBILITY and EXERCISE

ACTIVITY

EXERCISE PATTERN

MOBILITY - The ability to move freely, easily, rhythmically and purposely in the environment

- The persons routine of exercise, activity, leisure and recreation - Includes (a)activities of daily living(ADLs) that require energy expenditure such as hygiene, dressing, cooking, shopping, eating, working and home maintenance (b) the type of, quality and quantity of exercise

NORMAL

MOVEMENT

-4 elements:
Alignment and posture Joint mobility Balance Coordinated movement

 ALIGNMENT AND

POSTURE

(PROPER)
- Bring body parts into position in a manner that promotes optimal balance and maximal body function whether the client is standing, sitting or lying down - Line of gravity - Center of gravity - Base of support

 JOINT

MOBILITY

- JOINTS functional units of the musculoskeletal muscles - ROM (range of motion) maximum movement that is possible for a joint - CONTRACTURE condition where the muscles permanently shorten and the joint becomes fixed in a flexed position

 TYPES

FLEXION decreasing the angle of the joint EXTENSION increasing the angle of the joint HYPEREXTENSION further extension or straightening of a joint ABDUCTION movement of the bone away from the midline of the body ADDUCTION movement of the bone toward the midline of the body

OF JOINT MOVEMENT

 TYPES

ROTATION movement of the bone around its axis CIRCUMDUCTION movement of the distal part of the bone while the proximal end remains fixed EVERSION turning the sole of the outward by moving the ankle joint INVERSION turning the sole of the foot inward by moving the ankle joint

OF JOINT MOVEMENT

 TYPES

OF JOINT MOVEMENT

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 LATERAL movement to either left or right

 BALANCE

COORDINATED

- PROPRIOCEPTION term used to describe awareness of posture, movement and changes in equilibrium and knowledge of position, weight and resistance of objects in relation to the body

MOVEMENT

- balanced, smooth, purposeful movement

EXERCISE

PHYSICAL ACTIVITY bodily movement produced by skeletal muscle contraction that increases energy expenditure EXERCISE type of physical activity defined as planned, structured and repetitive bodily movement performed to improve or maintain one or more components of physical fitness BED REST strict confinement to bed or may have bedside commode or bathroom privileges

TYPES OF EXERCISE

ISOTONIC (DYNAMIC) exercises in which the muscle shortens to produce muscle contraction and active movement ISOMETRIC (STATIC or SETTING) exercises in which there is muscle contraction without moving the joint

TYPES OF EXERCISE

ISOKINETIC (RESISTIVE) involves muscle contraction or tension against resistance

- The person moves or tenses against resistance

AEROBIC activity during which the amount of oxygen taken in the body is greater than that used to perform the activity

BODY MECHANICS

BODY MECHANICS (ERGONOMICS)

The

efficient, coordinated, and safe use of the body to move objects and carry out the activities of daily living Reduce energy requirements, fatigue, and risk of injury for both nurses and clients esp. during lifting, transferring and repositioning

PRINCIPLES of Body Mechanics

The

broader the base of support and the lower the center of gravity, the greater the stability and balance
Widen the base of support by spreading the feet farther apart Lower the center of gravity by flexing the hips and knees until a squatting position is achieved

PRINCIPLES of Body Mechanics

Do

not lift more than 51 lbs without assistance from proper equipment and/or other persons
Use assistive devices Use the principle of leverage Push or pull an object instead of lifting PIVOTING

PRINCIPLES of Body Mechanics

When pushing an object, enlarge the base of support by moving the front foot forward When pulling an object, enlarge the base of support by either moving the rear leg back if facing the object or moving the front foot forward if facing away from the object

 Balance

is maintained & muscle strain is avoided as long as the line of gravity passes through the base of support.
Start any body movement w/ proper alignment, Stand as close as possible to the object to be moved, avoid stretching, reaching & twisting which may place the line of gravity outside the base of support

The wider the base of support and the lower the center of gravity, the greater the stability. Objects that close to the center of gravity are moved with the least effort
Before moving objects, increase your stability by widening your stance and flexing your knees, hips & ankles. Adjust the working area to waist level and keep the body close to the area Elevate adjustable beds and overbed tables or lower the side rails of the beds to prevent stretching & reaching

 Balance

is maintained with minimal effort when the base of support is enlarged in the direction in which the movement will occur
When pushing an object, enlarge the base of support by either moving the front foot forward When pulling an object, enlarge the base of support by either moving the rear leg back if facing the object or moving the front foot forward if facing away from the object.

 The

greater the preparatory isometric tensing, or contraction of muscles, before moving an object, the less the energy required to move it, and the less the likelihood of musculoskeletal strain or injury.
Before moving objects, contract your gluteal, abdominal, leg & arm muscles to prepare them for action

The synchronized use of as many large muscle groups as possible during an activity increases overall strength and prevents muscle fatigue & injury
To move objects below your center of gravity, begin w/ the back & knees flexed. Use your gluteal and leg muscles rather that the sacrospinal muscles of your back to exert an upward thrust when lifting the weight. Distribute the work load between both arms & legs to prevent back strain Always face the direction of the movements to prevent twisting of the spine and ineffective use major muscles groups

 The

closer the line of gravity to the center of the base of support, the greater the stability.
When moving or carrying objects, hold them as close as possible to your center of gravity. Pull an object toward you rather that pushing it away to control its movement and keep it close to your center of gravity.

 The

greater the friction against the surface beneath an object, the greater the force required to move the object.
Provide a firm, smooth, dry bed foundation before moving a client in bed

Pulling

creates less friction that pushing

Pull clients rather that push them whenever possible

The heavier an object, the greater the force needed to move the object.
Encourage clients to assist as much as possible to increase lifting power Use own body weight to counteract the weight of the object. For ex., lean forward when pushing an object, and rock your body weight backward when pulling an object or client toward you. Obtain the assistance of other persons or use mechanical devices to move objects that are too heavy

Moving an object along a level surface requires less energy that moving an object up an inclined surface or lifting it against the force of gravity

Avoid working against gravity Pull, push , roll or turn objects instead of lifting them Lower the head of the clients bed before moving client up in bed Continuous muscle exertion can result in muscle restrain and injury
Alternate rest periods w/ periods of muscle use to help prevent fatigue

POSITIONING CLIENTS
Changing

position regularly (every 2 hours) and systematically, and positioning the client in a good body alignment are essential aspects f nursing practice
- Maintain muscle tone and stimulate postural reflexes - It prevents:
- Muscle discomfort - Pressure ulcers - contractures

EFFECTS OF IMMOBILITY

Atrophy Contractures Orthostatic/Postural hypotension Dependent edema Thrombus formation Decreased respiratory movement Pooling of respiratory secretions Constipation Decubitus/Pressure ulcers

GUIDELINES in CLIENT POSITIONING

Make

sure the mattress is firm and level yet has enough give to fill in and support natural body curvature Ensure that bed is clean and dry, linens are wrinkle-free, and extremities can move freely Place support devices in specified areas according to the clients position
Pillows, mattresses, bed boards, chair beds, foot board

GUIDELINES in CLIENT POSITIONING

Avoid

placing one body part, particularly one with bony prominences, directly on top of another body part Plan a systematic 24-hour schedule for position changes

CLIENT POSITIONS
FOWLERS

POSITION a semi-sitting

position
- A bed position in which the head and trunk are raised 45 90 - LOW FOWLERS or SEMI-FOWLERS
- The head and trunk are raised 15 - 45

- HIGH FOWLERS
- The head and trunk are raised 90

CLIENT POSITIONS

ORTHOPNEIC - the client sits either in bed or on the side of the bed with an overbed table across the lap SUPINE - back-lying position; the clients head and shoulders are slightly elevated on a small pillow DORSAL RECUMBENT
- back-lying position with the knees flexed

CLIENT POSITIONS
PRONE

the client lies on the abdomen with the head turned to one side LATERAL side-lying position SIMS semi-prone position; the client assumes a posture halfway between the lateral and prone position

POSITIONING, MOVING and TRANSFERRING

 Perform

appropriate client assessment

- clients physical abilities - Ability to understand instructions - Degree of comfort or discomfort - Clients weight - Availability of equipment, assistive devices and other personnel

 Assemble

equipment and supplies

Pillows Trochanter roll Pull or turn sheets Transfer or sliding bar Footboard Assistive devices (if necessary)

 Identify

yourself and verify clients identity. Explain the procedure, why is it necessary and how the patient can cooperate Perform hand hygiene and other appropriate infection control measures Provide for client privacy

 Adjust

the bed to a comfortable working height. Lower the side rails nearest you
- Adjust the bed to a flat position or as low as the patient can tolerate - Raise the bed to a comfortable working height - Lock the wheels - Raise the side rail on the opposite side and lower the side rail near you

Moving the client up in bed

- Ask patient to bend legs (flex knees), feet flat on bed - Nurse maintains a broad stance (feet shoulderwidth-apart, one foot in front of the other, keep head up and back straight), flex knees and hips, one arm under the patients shoulder, other arm on the thigh - Ask patient to put arms across the chest, head up - Nurse rock back and forth and on signal, pull the patient up in bed while the patient push up with feet

Moving patient up in bed (2 nurses) Nurses position themselves on both sides of the bed Place a draw sheet under the patient Ask the client to flex knees and keep the head up Nurses position themselves on the patients midsection, feet shoulder-width apart facing the head of the bed Roll the draw sheet toward the patient, grasp securely and on signal pull the patient up

SUPINE POSITION
- Position the client on his back with his spine and legs straight, arms are at the side with the hands prone - Place the pillow under the head and the shoulders of the client - Place the footboard at the right angle to the legs.

FOWLERS/SEMI-SITTING POSITION
- Place the client in a supine position with the head near the top of the bed - Elevate the head of the bed 45-90 (low fowlers 15-45; high fowlers 90) - Place a small pillow on the lumbar region of the back if the space is felt on the lumbar curvature - Place a small pillow under the clients head or just rest the head against the mattress - Place 2 pillows under the legs below the knees to the ankles and position a trochanter roll lateral each femur then support the clients feet with a footboard

LATERAL OR PRONE POSITION Move patient to the side of the bed opposite to where the patient will be turned Move to the other side Ask patient to put arms across the chest and the farther leg on top of the other leg Grasp the draw sheet, position yourself for turning the patient
* Feet shoulder-width apart, one foot in front of the other, tighten gluteal and abdominal muscles, flex knees and hips, use leg muscle for pulling

LATERAL OR PRONE POSITION

- Place one hand on the clients far hip and the other hand on the clients far shoulder then roll the client onto the side facing you.

* Position the client on side with arms and legs positioned and supported properly (LATERAL POSITION) *Secure a pillow under the clients upper arm and flex the lower shoulder forward. Place another pillow between the clients upper legs and thigh

LATERAL OR PRONE POSITION

- Turn the client halfway between lateral and prone position with the lower arm behind the client. Flex the upper leg more accurately than the lower leg. (SIMS POSITION)

* Place a pillow under the clients head , under the spaces between the clients chest and abdomen, and between the pelvis and upper thigh

LATERAL OR PRONE POSITION

- Instead of abducting the far arm, keep the clients arm alongside the body to roll over then roll the client completely onto the abdomen and turn the clients head to one side (PRONE POSITION)

* Place a small pillow under the head, another in the abdomen in between the iliac crest and diaphragm

Raise the side rails. Lower the bed and ensure other safety and comfort measures Perform hand hygiene. Clean/dispose equipments/supplies appropriately Document relevant information
- Time and change of position moved from and position moved to - Any sign of pressure areas - Use of supportive devices - Other assessment findings - Response to the client to the procedure

ROM Exercise

Verify physicians order Perform hand hygiene Identify self and verify clients identity Explain the procedure Perform appropriate client assessment

Any limitation in activity/ROM Presence of pain

Adjust the bed to a comfortable working position

ROM Exercise

Head
Chin to chest Ear to shoulder Chin to shoulder

Shoulder & Elbow

Raise hand up above the head Hand to the side Hand across the body Right angle-elbow, forearm up

ROM Exercise

Forearm
Supine to prone

Wrist
Flex hyperextend Make a fist Spread fingers out Thumb to each finger

Uncover one leg, reach under the leg

ROM Exercise

Hip
Raise leg up then down Swing leg out and across the midline

Knee
Flex - extend

Ankle
Flex hyperextend Evert invert Curl toes spread out

Leg
Rotate in out

Move to the other side

Transferring from Bed to Stretcher

Verify

need to be out of bed Assemble equipments

Stretcher Bath blanket

Transferring from Bed to Stretcher

Verify physicians order Perform hand hygiene Identify self and verify clients identity Explain the procedure Perform appropriate client assessment

Any limitation in activity/ROM Presence of pain

Adjust the bed to a comfortable working position

Transferring from Bed to Stretcher

Use

the draw sheet to move the patient to the side of the bed where the stretcher will be on Place bath blanket over the patient and remove the top cover underneath Move the stretcher next to and parallel to the bed, make sure wheels are locked Take the pillow from the bed and place t on the stretcher

Transferring from Bed to Stretcher

The 2 persons work on the side of the stretcher and the other 1 works on the other side of the bed (1) kneel up on the bed, roll the draw sheet as close as possible toward the patient then grasp it securely (2) one person grasp the draw sheet on the patients head and chest area while the other grasp the draw sheet on the patients hip and thigh area

Transferring from Bed to Stretcher

Ask

client to place arms across the chest On signal, the 2 persons on the side of the stretcher pull patient toward the stretcher wile the person on the other side of the bed lift the patient toward the stretcher Ensure safety and comfort Document the procedure

Transferring from Bed to Wheelchair

Verify physicians order Perform hand hygiene Identify self and verify clients identity Explain the procedure Perform appropriate client assessment

Any limitation in activity/ROM Presence of pain

Adjust the bed to a comfortable working position

Transferring from Bed to Wheelchair

Place

wheelchair on the side of and parallel to the bed, brakes on Position patient on his side before raising his head and placing him in a sittingdangling position Assist client in wearing clothes and foot wear

Transferring from Bed to Wheelchair

Position

yourself with shoulder-width apart, flex knees and hips, arms around the patients waist while the patient holds on to the nurse between the shoulder and waist Slide patient forward from the bed until his feet touches the floor

Transferring from Bed to Wheelchair

On signal, stand the patient up, pivot until the patient feels the chair against his leg
Continue to brace the patients knees with your knees

Flex your knees and hips when helping him to sit on the chair Ask patient to use arm to steady himself on the arm of the chair then slowly lower him to the chair into a sitting position Ensure safety and comfort Document the procedure