FUNDAMENTALS OF

NURSING
ACTIVITY, MOBILITY AND
EXERCISE
 ACTIVITY, MOBILITY AND
EXERCISE

1. Body Alignment – geometric

arrangement of body parts in relation
to each other
● Line of gravity
● Center of gravity
● Base of support
 ACTIVITY, MOBILITY AND
EXERCISE
Body Mechanics – efficient, coordinated and safe
use of the body to produce motion and maintain
balance during activity
Principles:
1. Line of gravity passes through the base of
support
2. The wider the base of support and the lower the
center of gravity, the greater the stability
3. Objects that are close to center of gravity are
moved with least effort
4. The closer the line of gravity to center of base of
support, the greater its stability
 ACTIVITY, MOBILITY AND
EXERCISE
1. Body Alignment
a. Stance – a manner in which a person stands
b. Sitting alignment – popliteal space from the
edge of chair : 1 inch away
2. Gait – walk
» Pace – number of steps taken/min:
(70 – 100 steps/minute);
elderly (40 steps/min)
 ACTIVITY, MOBILITY AND
EXERCISE

4. Muscle strength and endurance:

● Bent – knee sit up
● Women for 1 minute: 20 – 25/min
● Men for 2 minutes: 50 – 60/min

5. Joint flexibility
● Touch toes several times:
1- 3 inches in front of toes
 ACTIVITY, MOBILITY AND
EXERCISE
Pressure sores – reddened areas, sore, ulcers of skin
occurring over bony prominences. Due to
interruption of blood circulation to tissue, resulting
in localized ischemia
Stages:
I – non blanchable erythema of intact skin
II – partial thickness skin loss (epidermis and
dermis).
III – full thickness skin loss (subcutaneous tissue);
ulcer as deep crater
IV – full thickness with extensive destruction,
necrosis (muscle, bone)
Four Stages of Pressure Ulcer
Formation

A B

C D
 ACTIVITY, MOBILITY AND
EXERCISE

Measures to prevent and treat pressure sores:

1. Wrinkle – free bed or egg crate mattress
2. Turn to sides q 15 – 2 hours
3. Meticulous hygiene, skin kept clean and dry
4. ROM exercises
 ACTIVITY, MOBILITY AND
EXERCISE

PROTECTIVE DEVICES:
1. Handrolls or rubber balls
● to prevent clawhand deformity

2. Trochanter rolls –
● hips to upper third of thigh

3. Footboard
4. Wedge Pillow
 ACTIVITY, MOBILITY AND
EXERCISE
TYPES OF EXERCISE:
According to type of muscle contraction:
a. Isotonic – (dynamic)
● change in MUSCLE LENGTH AND
TENSION
● Ex. walking, running, ADL
 ACTIVITY, MOBILITY AND
EXERCISE

b. Isometric – (static)
● change in MUSCLE TENSION ONLY;
alternate tension & relaxation of group of
muscles
a. Quadriceps setting – thigh muscles
b. Gluteal - buttocks
c. Kegel’s – pubococcygeal muscles
 ACTIVITY, MOBILITY AND
EXERCISE

c. Isokinetic – (resistive)
● MUSCLE CONTRACTION AND
JOINT MOVEMENT
● Ex. lifting weights
 ACTIVITY, MOBILITY AND
EXERCISE

1. Active ROM
» done by the client
2. Passive ROM
» done by health care provider
3. Active – Resistive
» done by client against a weight or force
4. Active – Assistive
» done by stronger arm and leg to weaker arm
and leg
 ACTIVITY, MOBILITY AND
EXERCISE

During ambulation:
priority is to prevent what condition?

TRANSFERRING CLIENT FROM BED TO

STRETCHER, WHEELCHAIR:
● Lock the wheels of bed, stretcher, wheelchair
● Stretcher and wheelchair parallel to bed
* WHEN ENTERING ELEVATOR, WHICH
SHOULD GO FIRST? HEAD OR LOWER
BODY?
 ASSISTING CLIENT TO AMBULATE:

Nurse: behind the weaker side of

the client.
(moderately weak)

Nurse: behind the stronger side

of the client. (very weak)
 ACTIVITY, MOBILITY AND
EXERCISE

Mechanical Aids for walking:

1. Canes:
b. Straight legged
c. Tripod or crab cane
d. Quad Cane
• Length should permit the elbow to be
slightly flexed
• Distance that the cane should be positioned
(side and front) : 15 CM (6 INCHES)
AMBULATION AIDS:
A. CANES:
= on the stronger side of the body.
= rubber tips: to prevent slipping.
= for maximum support: cane forward,
next affected leg, then stronger leg.
= as pt becomes stronger: move cane
and weak leg at the same time.

REMEMBER: COAL
C = CANE, OPPOSITE, AFFECTED, LEG
WALKERS:
= for maximum support: move
walker, then right, then left leg.
= one leg is weaker: move walker
and the weak leg, then
stronger leg.

REMEMBER: WWW.LEG
MOVE WALKER WITH WEAKER LEG
 ACTIVITY, MOBILITY AND
EXERCISE
2. Walker
● Move the walker ahead about 15 cm (6 inches)
● For maximum support;

a. right foot up to the walker, then left foot up to

the right foot
● If one leg is weaker:

a. move walker and weak leg ahead together

about 15 cm (6 in), then move the stronger leg
 ACTIVITY, MOBILITY AND
EXERCISE
3. Crutches:
Methods of measuring crutch length:
1. Supine: anterior fold of axilla to heel of
foot + 2.5 cm (1 in)
2. Standing: position the crutch: shoulder
rest of the crutch is 1 – 2 inches below
the axilla
» Angle of elbow flexion = 30 degrees
CRUTCHES
 CRUTCHES
Correct fit:
= STAND STRAIGHT, ARMPIT TO FLOOR
= DEDUCT 5 CM/ 2 INCHES OR 3 FINGERS
= HANDGRIP: SLIGHTLY ABOVE WRIST
LEVEL
= ELBOW 30 DEGREES FLEXION
= IF pt in supine, measure from axillary fold
to heel of foot
= ADD 1 inch
4 point gait
= the safest, very slow.
= client can bear weight on both legs.
= tripod, R crutch, L foot, L crutch, L foot.

3 point gait
= pt bears entire weight on the unaffected leg.
= tripod, both crutches with bad leg, good leg.

2 point gait
= requires partial weight bearing on both legs.
= L crutch with R foot, L foot with R crutch.
 DIFFERENCE:
SWING TO AND SWING THROUGH

Swing to
= with paralysis of legs and hips.
= swing to the crutches

Swing through
= swing beyond the crutches.
 ACTIVITY, MOBILITY AND
EXERCISE

Going up and down stairs:

“Good leg goes to heaven”

“Bad leg goes to hell”
ACTIVITY, MOBILITY
AND EXERCISE

Practice test
To best prevent a pressure
(decubitus) ulcer in an older
adult, the nurse should
provide:
A. an air mattress
B. a daily bed bath
C. a high-protein diet
D. an indwelling urinary
catheter
16. TEST-TAKING TIP The word “best” in the stem sets
priority.
A. An air mattress distributes body weight over a
larger surface and reduces pressure over bony
prominences.
B. Although bathing removes secretions and promotes
clean skin, it can be drying, which can compromise
skin integrity.
C. Protein does not prevent pressure (decubitus)
ulcers. Protein is the body’s only source of nitrogen
and is essential for building, repairing, or replacing
body tissue.
D. An indwelling urinary catheter should never be used
to prevent a pressure (decubitus) ulcer; however, a
catheter may be used to prevent contamination of a
pressure (decubitus) ulcer after it is present.
To safely transfer a patient with one-
sided weakness (hemiparesis) to a
chair, the nurse should:
A. pivot the patient on the unaffected
leg
B. stand next to the patient’s affected
side
C. stand next to the patient’s strong
side
D. keep the patient’s feet together
19. TEST-TAKING TIP The words “one-sided
weakness” are a clue in the stern. Option A is
unique because it does not use the possessive form
of the word ‘‘patient’’ (“patient’s”). Options B and C
are opposites.
A. Pivoting avoids unnecessary movement by
transferring the patient to the chair while
supporting body weight on the unaffected leg.
B. When transferring this patient, the nurse should
stand in front of, not next to, the patient.
C. Same as B.
D. Keeping the patient’s feet together narrows the base
of support and decreases the patient’s stability.
 To increase stability during client
transfer, the nurse increases the
base of support by performing which
of the following?

1. Leaning slightly backward.

2. Spacing the feet farther apart.
3. Tensing the abdominal muscles.
4. Bending the knees.
 Rationale
1. Leaning backward actually decreases
balance.
2. Correct. A key word in the question is
“base,” and the feet provide this
foundation.
3. Tensing abdominal muscles alone does
not affect the base of support.
4. Bending the knees does not affect the
base of support.
 Five minutes after the client’s first
postoperative exercise, the client’s
vital signs have not yet returned to
baseline. An appropriate nursing
diagnosis might be:

1. Activity Intolerance.
2. Risk for Activity Intolerance.
3. Impaired Physical Mobility.
4. Risk for Disuse Syndrome.
 Rationale
1. Correct. Vital signs that do not return to
baseline 5 minutes after exercising
indicate intolerance of exercise at that
time.
2. This is a real problem, not “at risk for.”
3. There is no evidence that the client
requires assistance (impaired mobility).
4. There is no evidence that this client is
immobile (disuse syndrome)
 Which of the following statements from a client with
one weak leg regarding use of crutches when using
stairs indicates a need for increased teaching?
1. “Going up, the strong leg goes first, then the weaker leg
with both crutches.”
2. “Going down, the weaker leg goes first with both
crutches, then the strong leg.”
3. “The weaker leg always goes first with both crutches.”
4. “A cane or single crutch may be used instead of both
crutches if held on the weaker side.”
 Rationale
1. This is correct.
2. This is correct.
3. Correct. Although the crutches (or cane) are
always used along with the weaker leg, the
weaker leg should go down the stairs first.
The stronger leg can support the body as the
weaker leg moves forward. All of the other
statements are correct.
4. This is correct.
 The client is ambulating for the first time
after surgery. The client tells the nurse, “I
feel faint.” The best action by the nurse
includes which of the following?

1. Find another nurse for help.

2. Return the client to her room as quickly
as possible.
3. Tell the client to take rapid, shallow
breaths.
4. Assist the client to a nearby chair.
 Rationale
1. Leaving the client creates unsafe conditions
as the client may faint before being able to
return to her room.
2. The client may faint before being able to
return to her room.
3. Rapid, shallow breathing (hyperventilation)
may increase the dizziness.
4. Correct. Placing the client in a safe position
is the best maneuver.
What should the nurse do when
assisting a blind patient to walk?
A. Walk in front while the patient uses
the corridor handrail
B. Stand behind the patient and
provide verbal directions
C. Walk on the side while holding the
patient’s elbow
D. Instruct the patient to hold onto the
nurse’s arm
 TEST-TAKING TIP Options A and B are opposites.
A. Corridor rails are not continuous, and standing in
front does not position the nurse in a way that will
protect the patient; this method does not inspire
confidence.
B. The patient cannot see and should not lead.
C. Walking on the side while holding the patient’s elbow
is one method used to assist a patient who has a
mobility, not visual, deficit.
D. Instructing the blind patient to hold onto the
nurse’s arm allows the nurse to guide and the
patient to follow; it supports the patient’s
comfort and promotes confidence.
A patient with the highest risk of
developing a pressure
(decubitus) ulcer is the patient
who:
A. uses a reclining
wheelchair
B. uses crutches to ambulate
C. is ambulatory but is confused
D. is on bed rest but able to
move
 TEST-TAKING TIP The word “highest” is the key
word in the stem that sets a priority. The word “risk”
is a clue in the stem. Option A is unique because it
is the only option that does not mention that the
patient is able to move independently.
A. A patient using a reclining wheelchair would
have minimal lower- or upper-body control. A
reclining position places excessive pressure on
the sacral area.
B. As long as a person can move, positioning can be
changed to relieve pressure.
C. Same as B.
D. Same as B.
What should the nurse do to best
prevent a patient from developing
contractures?
A. Support the patient’s joint with
pillows
B. Transfer the patient to a chair
twice a day
C. Turn and reposition the patient
every 2 hours
D. Teach the patient to perform
active ROM exercise
29. TEST-TAKING TIP The word best is the key word in
the stem that sets a priority.
A. Although supporting joints contributes to maintaining
functional alignment, which can help prevent
contractures, it is not the best intervention.
B. Although movement of joints experienced during
activity will contribute to preventing contractures, it
will not move all joints through their full range; also,
prolonged sitting can cause flexion contractures of
the hips and knees.
C. Turning and repositioning a patient every 2 hours
will reduce pressure, not prevent contractures.
D. Range-of-motion exercises maximally stretch all
muscle groups; this prevents shortening of
muscles, which can result in contractures.
A patient who had a brain attack (stroke,
cerebrovascular accident) 3 days earlier
has left-sided hemiparesis. When
dressing the patient, the nurse should
plan to:
A. put the patient’s left sleeve on first
B. encourage the patient to dress
independently
C. instruct the patient to wear clothes
with zippers
D. tell the patient to get clothes with
buttons in the front
 TEST-TAKING TIP The phrase “3 days earlier” is a
significant clue in the stem. Options C and D are equally
plausible. Options B, C, and D are similar because they
contain the verbs “encourage,” “instruct” and “tell,” which all
require verbal interaction with the patient. Option A is unique
because it is the only option in which the nurse is actually
dressing the patient and that uses the possessive form of the
word “patient” (“patient’s”). Option B denies the patient’s
need for assistance during the acute phase of this illness.
-
A. Affected joints should be dressed first to avoid
unnecessary strain; the unaffected side generally has
greater joint range.
B. It is unreasonable to expect self-sufficiency during the acute
phase.
C. These are difficult to close with one hand. Velcro closures
maybe more appropriate.
D. Same as C.