FUNDAMENTALS OF NURSING - Activity and exercise (1109) - 1130

activity-exercise pattern

- refers to an individual's routine of exercise, activity, leisure, and recreation.

- It includes (a) activities of daily living (ADLs) that require energy expenditure such as hygiene, dressing, cooking, shopping, eating, working, and home maintenance, and (b) the type, quality, and quantity of exercise, including sports.

MOBILITY

the ability to move freely, easily, rhythmically, and purposefully in the environment, is an essential part of living.

- body alignment (posture)

- joint mobility

- balance

- coordinated movement

Body movement involves four basic elements:

Proper body alignment and posture

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

An individual maintains balance as long as the ____________ (an imaginary vertical line drawn through the body's center of gravity) passes through the _____________ (the point at which all of the body's mass is centered) and the ____________ (the foundation on which the body rests)

LINE OF GRAVITY

begins at the top of the head and falls between the shoulders, through the trunk, slightly anterior to the sacrum, and between the weight-bearing joints and base of support

JOINTS

are the functional units of the musculoskeletal system.

range of motion (ROM)

is the maximum movement that is possible for that joint.

BALANCE

involve informational inputs from the labyrinth (inner ear), from vision (vestibulo-ocular input), and from stretch receptors of muscles and tendons (vestibulospinal input).

Proprioception

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

- cerebral cortex

- cerebellum

- basal ganglia

Balanced, smooth, purposeful movement is the result of proper functioning of the ____________, ____________, and ____________

- cerebral cortex

- cerebellum

- basal ganglia

- __________ initiates voluntary motor activity

- __________ coordinates the motor activities of movement

- __________ maintain posture.

FLEXION

Decreasing the angle of the joint (e.g., bending the elbow)

EXTENSION

Increasing the angle of the joint (e.g., straightening the arm at the elbow)

HYPEREXTENSION

Further extension or straightening of a joint (e.g., bending the head backward)

ABDUCTION

Movement of the bone away from the midline of the body

ADDUCTION

Movement of the bone toward the midline of the body

ROTATION

Movement of the bone around its central axis

CIRCUMDUCTION

Movement of the distal part of the bone in a circle while the proximal end remains fixed

EVERSION

Turning the sole of the foot outward by moving the ankle joint

INVERSION

Turning the sole of the foot inward by moving the ankle joint

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

- PIVOT JOINT

Body Part—Type of Joint/Movement:

= NECK—____________

BALL-AND-SOCKET JOINT

Body Part—Type of Joint/Movement:

= SHOULDER—_____________

HINGE JOINT

Body Part—Type of Joint/Movement:

= ELBOW—_______________

CONDYLOID JOINT

Body Part—Type of Joint/Movement:

= WRIST—_____________

- CONDYLOID

- HINGE

Body Part—Type of Joint/Movement: hand and fingers

= METACARPOPHALANGEAL JOINTS— ___________

= INTERPHALANGEAL JOINTS—__________

- SADDLE JOINT

Body Part—Type of Joint/Movement:

= THUMB—____________

BALL-AND-SOCKET JOINT

Body Part—Type of Joint/Movement:

= HIP—______________

HINGE JOINT

Body Part—Type of Joint/Movement:

= KNEE—____________

HINGE JOINT

Body Part—Type of Joint/Movement:

= ANKLE—____________

- HINGE

- HINGE

- GLIDING

Body Part—Type of Joint/Movement:

= INTERPHALANGEAL JOINTS—_________;

= METATARSOPHALANGEAL JOINTS—________;

= INTERTARSAL JOINTS—__________

GLIDING JOINT

Body Part—Type of Joint/Movement:

= TRUNK—_____________

Osteoporosis

_____________ is a condition in which the bones become brittle and fragile due to calcium depletion.

Osteoporosis

is common in older women and primarily affects the weight-bearing joints of the lower extremities and the anterior aspects of spinal bones, causing COMPRESSION FRACTURES of the vertebrae and hip fractures

- Functional strength

_____________ is another goal of exercise, and is defined as the ability of the body to perform work.

Activity tolerance

___________ is the type and amount of exercise or ADLs an individual is able to perform without experiencing adverse effects.

- isotonic, isometric, or isokinetic

- aerobic or anaerobic

Exercises can be classified according to the type of muscle contraction (___________, ___________, or ___________) and according to the source of energy (___________ or ___________)

Isotonic (dynamic) exercises

_____________ are those in which the muscle shortens to produce muscle contraction and active movement.

Isotonic (dynamic) exercises

Most physical conditioning exercises— running, walking, swimming, cycling, and other such activities—are _________, as are ADLs and active ROM exercises (those initiated by the client).

Isotonic (dynamic) exercises

pushing or pulling against a stationary object, using a trapeze to lift the body off the bed, lifting the buttocks off the bed by pushing with the hands against the mattress, and pushing the body to a sitting position

Isotonic exercises

increase muscle tone, mass, and strength and maintain joint flexibility and circulation.

isotonic exercise

During ____________, both heart rate and cardiac output quicken to increase blood flow to all parts of the body.

Isometric (static or setting) exercises

_______________ are those in which muscle contraction occurs without moving the joint (muscle length does not change).

Isometric (static or setting) exercises

- These exercises involve exerting pressure against a solid object and are useful for strengthening abdominal, gluteal, and quadriceps muscles used in ambulation;

- for maintaining strength in immobilized muscles in casts or traction;

- for endurance training.

Isometric (static or setting) exercises

- squeezing a towel or pillow between the knees while at the same time tightening the muscles in the fronts of the thighs by pressing the knees backwards and holding for several seconds

--> These are often called "quad sets."

Isometric (static or setting) exercises

produce a mild increase in heart rate and cardiac output, but no appreciable increase in blood flow to other parts of the body

Isokinetic (resistive) exercises

_________________ involve muscle contraction or tension against resistance.

isokinetic exercises

During ______________, the individual tenses (isometric) against resistance.

isokinetic exercises

- Special machines or devices provide the resistance to the movement.

- These exercises are used in physical conditioning and are often done to build up certain muscle groups.

Aerobic exercise

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

Aerobic exercise

- use large muscle groups that move repetitively

- improve cardiovascular conditioning and physical fitness.

1. Target heart rate

2. Talk test.

3. Borg scale of perceived exertion

Intensity of exercise can be measured in three ways:

- target heart rate

- The goal is to work up to and sustain a ____________ during exercise, based on the individual's age.

target heart rate

To determine _____________, first calculate the client's maximum heart rate by subtracting his or her current age in years from 220. Then obtain the target heart rate by taking 60% to 85% of the maximum. Because heart rates vary among individuals, the tests that follow are replacing this measure.

TALK TEST

- This test is easier to implement and keeps most people at 60% of maximum heart rate or more.

- When exercising, the client should experience labored breathing, yet still be able to carry on a conversation

Borg scale of perceived exertion

- This scale measures "how difficult" the exercise feels to the client in terms of heart and lung exertion.

- "Very, very hard" corresponds closely to 100% of maximum heart rate.

- "Very light" is close to 40%.

- Most people need to strive for the "somewhat hard" level (13/20), which corresponds to 75% of maximum heart rate.

Anaerobic exercise

_______________ involves activity in which the muscles cannot draw out enough oxygen from the bloodstream

--> anaerobic pathways are used to provide additional energy for a short time.

Anaerobic exercise

This type of exercise is used in endurance training for athletes such as weight lifting and sprinting.

Hatha yoga

______________, developed in ancient Hindu culture, is a series of physical exercises, breath control, and meditation that tones and strengthens the whole individual—body, mind, and spirit

yoga

The beauty of __________ is that it can be fully practiced by those who must use a wheelchair or remain in bed

Qigong

- _________ is a Chinese discipline that involves breathing and gentle movements of mostly arms and torso.

- regular practice of THIS is intended to generate as well as conserve energy to maintain health or treat illness.

- t'ai chi

- Although developed as a martial art, ________ is practiced today mostly for health promotion.

- In China, it is common to see individuals of all ages, including older adults, practicing these movement disciplines outdoors in public parks

Musculoskeletal System

The size, shape, tone, and strength of muscles (including the heart muscle) are maintained with mild exercise and increased with strenuous exercise.

Musculoskeletal System

With strenuous exercise, muscles hypertrophy (enlarge), and the efficiency of muscular contraction increases.

Musculoskeletal System

- Joints lack a discrete blood supply. It is through activity that joints receive nourishment.

- Exercise increases joint flexibility, stability, and range of motion.

Musculoskeletal System

- Bone density and strength are maintained through WEIGHT BEARING.

- The stress of weight-bearing and high-impact movement maintains a balance between OSTEOBLAST (bone-building cells) and OSTEOCLAST (bone-resorption and breakdown cells).

- 150 minutes per week ; 75 minutes per week

- Cardiovascular System

- recommending at least ____________ of moderate exercise or ____________ of vigorous exercise, or a combination of moderate and vigorous activity

- Adequate moderate-intensity exercise increases the heart rate, the strength of heart muscle contraction, and the blood supply to the heart and muscles through increased cardiac output

RESPIRATORY SYSTEM

- Ventilation

- ___________ (air circulating into and out of the lungs) and oxygen intake increase during exercise, thereby improving gas exchange

RESPIRATORY SYSTEM

More toxins are eliminated with deeper breathing, and problem-solving and emotional stability are enhanced due to increased oxygen to the brain.

Gastrointestinal System

Exercise improves the appetite and increases gastrointestinal tract tone, facilitating peristalsis.

Gastrointestinal System

Activities such as rowing, swimming, walking, and sit-ups work the abdominal muscles and can help relieve constipation.

Endocrine System and Metabolism

Exercise elevates the metabolic rate, thus increasing the production of body heat and waste products and calorie use.

Endocrine System and Metabolism

Exercise elevates the metabolic rate, thus increasing the production of body heat and waste products and calorie use.

Endocrine System and Metabolism

Exercise increases the use of triglycerides and fatty acids, resulting in a reduced level of serum triglycerides, glycosylated hemoglobin A1C (HbA1C) levels, and cholesterol.

Urinary System

With adequate exercise, which promotes efficient blood flow, the body excretes wastes more effectively.

Urinary System

- stasis

In addition, ________ (stagnation) of urine in the bladder is usually prevented, which in turn decreases the risk for urinary tract infections (UTIs).

Immune System

As respiratory and musculoskeletal effort increase with exercise and as gravity is enlisted with postural changes, lymph fluid is more efficiently pumped from tissues into lymph capillaries and vessels throughout the body

Immune System

Circulation through lymph nodes where destruction of pathogens and removal of foreign antigens can occur is also improved when doing exercises

relaxation response (RR)

_______________, first described by Dr. Herbert Benson, is beneficial for counteracting some of the harmful effects of stress on the body and mind.

- Disuse osteoporosis

- osteoporosis

- Without the stress of weightbearing activity, the bones demineralize.

- They are depleted chiefly of calcium, which gives the bones strength and density.

- Regardless of the amount of calcium in an individual's diet, the demineralization process, known as ___________, continues with immobility.

--> The bones become spongy and may gradually deform and fracture easily.

Disuse atrophy

Unused muscles _________ (decrease in size), losing most of their strength and normal function.

contracture

When the muscle fibers are not able to shorten and lengthen, eventually a _____________ (permanent shortening of the muscle) forms, limiting joint mobility

ankylosed

Without movement, the collagen (connective) tissues at the joint become ___________ (permanently immobile).

Valsalva maneuver

- ___________ refers to holding the breath and straining against a closed glottis.

--> For example, clients tend to hold their breath when attempting to move up in a bed or sit on a bedpan. This builds up sufficient pressure on the large veins in the thorax to interfere with the return blood flow to the heart and coronary arteries. When the client exhales and the glottis again opens, pressure is suddenly released, and a surge of blood flows to the heart.

Orthostatic hypotension

- ______________ is a common result of immobilization.

--> Under normal conditions, sympathetic nervous system activity causes automatic vasoconstriction in the blood vessels in the lower half of the body when a mobile client changes from a horizontal to a vertical posture.

- thrombophlebitis

- Three factors collectively predispose a client to the formation of a ____________ (a clot that is loosely attached to an inflamed vein wall):

--> impaired venous return to the heart

--> hypercoagulability of the blood (sometimes caused by medications such as oral contraceptives)

--> injury to a vessel wall.

- thrombus

- embolus

__________ (clot) is particularly dangerous if it breaks loose from the vein wall to enter the general circulation as an ___________ (an object that has moved from its place of origin, causing obstruction to circulation elsewhere).

anorexia

Loss of appetite (____________) occurs because of the decreased metabolic rate and the increased catabolism that accompany immobility.

Body mechanics

__________ is the term used to describe the efficient, coordinated, and safe use of the body to move objects and carry out the ADLs.

BODY BALANCE

_____________ can be greatly enhanced by

(a) widening the base of support and

(b) lowering the center of gravity, bringing it closer to the base of support.

--> Spreading the feet farther apart widens the base of support.

--> Flexing the hips and knees until achieving a squatting position lowers the center of gravity.

--> The importance of these alterations cannot be overemphasized for nurses