Activity/Exercise/Immobility/Sleep

Why is physical activity important?

• improves mood/atitude

• Enables physical fitness

• Promotes better sleep quality

• Boosts energy

Scientific knowledge base

• nature and movement — body mechanics

• Alignment and balance — body alignment

• Gravity and friction — unsteady patients fall if center of gravity becomes unbalanced, friction opposes movement

Body mechanics

• Coordinated use of muscles, bones, and nervous system

• Maintains balance, posture, alignment, prevents injury and supports safe patient handling

Principles of good body mechanics

• keep wide base of support

• Bend at the knees, not waist

• Hold objects close to body

• Maintain neutral spine

• Tighten abdominal muscles

• Push not pull

• Face direction of movement

Nursing implications for body mechanics

• assess environment before moving

• Use assistive devices

• Encourage patient participation

• Teach proper techniques

• Practice strengthening exercises

Skeletal system is made of

Joints, ligaments, tendons, cartilage

Why is skeletal muscle important?

Those muscles are concerned with movement

How does the nervous system contribute to movement?

It ensures balance and alignment

What are some pathological influences on alignment/immobility?

• congenital defects

• Bone/joint/muscle disorders

• Obesity

What is isotonic contraction?

• muscle contracts with joint movement

• Muscle changes length (shortens or lengthens)

• Promotes strength and CV fitness

• Ex: walking/swimming

What is concentric contraction?

• type of isotonic contraction

• Muscle shortens under tension

• Ex. Bicep curls

What is eccentric contraction?

• type of isotonic contraction

• Muscle lengthens under tension

• Ex. Biceps uncurling

What is isometric contraction?

• muscle contracts without joint movement

• Muscle length stays the same

• Build strength for immobilized patients without moving

• Ideal for rehab

• Ex. Planks, gluteal squeezes

What is the purpose of proper positioning?

• promotes comfort, lung expansion, circulation

• Prevents pressure injuries, pneumonia, etc

• Maintains body alignment and joint mobility

What is Fowler’s position and what is it best for?

• head of bed 45-60 degrees

• Lung expansion, post-op

What is semi-Fowler’s position and what is it best for?

• head of bed 30-45 degrees

• Feeding, comfort, lower aspiration risk

What is high Fowler’s position and what is it best for?

• head of bed 60-90 degrees

• Respiratory distress, eating, NG tube insertion

What is supine position and what is it best for?

• lying flat on back

• Resting, post-op care

What is prone position and what is it best for?

• lying face down

• Improves oxygenation in ARDS, not for spinal issues

What is lateral position and what is it best for?

• lying on the side with support

• Prevents pressure ulcers on the back/sacrum

What is Sims position and what is it best for?

• halfway between lateral and prone

• Rectal exams, enemas, unconscious patient drainage

What is trendelenburg position and what is it best for?

• head down, feet up

• Promotes venous return, used in hypotension

What is reverse trendelenburg position and what is it best for?

• Head up, feet down

• Promotes gastric emptying, prevents reflux

What is orthopenic position and what is it best for?

• sitting upright, leaning forward

• Maximizes chest expansion, COPD patients

What is dorsal recumbent position and what is it best for?

• supine with knees flexed

• Vaginal exams, peri-care

What is lithotomy position and what is it best for?

• supine, legs raised in stirrups

• Pelvic exams, childbirth

What are some factors influencing activity and exercise?

• developmental changes: aging

• Cultural background

• Environment: work, school

• Support systems

What is SPHM?

• safe patient handling and mobility

• Part of the nursing knowledge base

Nursing process for exercise/mobility (ADPIE)

• assessment: comprehensive health history, readiness, observe posture

• Diagnosis: tolerance, injury risk, impaired mobility, pain

• Planning: set goals to maintain/improve function

• Implementation: health promotion, ROM

• Evaluation: were goals met, adjust plan as needed

What is range of motion?

• movement of a joint through its full natural range

• Maintains joint flexibility and muscle strength

• Prevents stiffness

• Promotes circulation

What is active ROM?

patient moved joint independently

What is passive ROM?

Caregiver moves the joints

What is active-assisted ROM?

Patient participates with assistance

What is flexion?

Bending (elbow, knee)

What is extension?

Straitening a joint

What is abduction?

Away from the midline

What is adduction?

Toward midline

What is rotation?

Turning along axis (neck)

What is circumduction?

Circular motion (shoulder)

Crutch measurement and safety

• height: 2-3 fingers or 1-1.5 inch below axilla

• Hand grips: elbow flexed 20-25 degrees

• Check rubber tips

Why do you want to avoid pressure on the axilla when using crutches?

It can cause brachial plexus injury (nerve damage)

What is the tripod position for crutches?

• used for standing stability

• Crutches placed about 6inch in front and to the side of each foot

How to sit with crutches

• back up to chair

• Hold both crutches to one side

• Use free hand to grasp chair

• Lower into sear

How to stand with crutches

• hold both crutches on one side

• Push off chair with opposite hand

• Find balance

Four point gait with crutches

• move right crutch, then left foot, then left crutch, then right foot

• For those with weakness or poor coordination in both legs and can bear weight

Three point gait with crutches

• move both crutches and the affected leg forward, then unaffected leg

• For those who cannot bear weight on one leg

Two point gait with crutches

• move one crutch and the opposite foot together

• For those who can bear partial weight on both legs and have good balance

Swing to gait with crutches

• move both crutches forward together, then swing both legs forward to land NEXT TO crutches

• For those with lower body paralysis or severe leg weakness

Swing through gait with crutches

• move both crutches forward together, then swing both legs forward PAST the crutches

• For those with strong arms and core, weakness in both legs

Cane measurement

• height: handle level with greater trochanter (top of femur)

• Elbow flexed 15-25 degrees

• Hold in opposite hand of affected leg

Ambulating with a cane

• place 6-10 inches forward

• Move weak leg to cane

• Move stronger leg past cane

Walker measurement

• height: top aligns with wrist crease when arms hang

• Elbow flexed 15-30 degrees

Walker use

• pick up/roll walker 6-8 inches forward

• Ensure all four legs on ground before stepping

• Step with weaker leg then stronger leg

How does the metabolic system affect immobility?

• endocrine changes

• Altered calcium absorption

• Altered GI function

How does the respiratory system affect immobility?

• hypostatic pneumonia

• Atelectasis (partial or complete collapse of lung)

How does the cardiovascular system affect immobility?

• orthostatic hypotension

• Thrombus formation (blood clot)

How does the musculoskeletal system affect immobility?

• loss of endurance and muscle mass

• Decreased stability and balance

How does the urinary system affect immobility?

• urinary stasis (urine stops flowing)

• Renal calculi (kidney stones)

What is the function of sleep?

• restores biological processes

• Protein synthesis and cell division for tissue renewal occur

Dreams

• occur in NREM and REM

• Aid in learning, memory, and stress adaptation

Factors affecting sleep

• physical illness

• Medications

• Emotional stress

• Environment

• Lifestyle

What is circadian rhythm?

24-hour internal biological clock that regulates sleep-wake patterns

What is the circadian rhythm controlled by?

The suprachiasmatic nucleus (SCN) in the hypothalamus

What are the primary cues for circadian rhythm?

Light and darkness synchronize rhythm

What influences the circadian rhythm?

• sleep-wake cycle

• Body temp

• Hormone secretion

• Blood pressure

What can disrupt circadian rhythm?

• night shifts

• Jet lag

• Hospitalization

NREM stages

• 75-80% of sleep

• Stage one: light sleep, easily woken

• Stage two: deeper sleep, body temp drops, heart rate slows

• Stage three: deepest sleep (slow-wave), tissue repair, growth hormone released

REM stages

• 20-25% of sleep

• Vivid dreaming, memory processing, brain activity increase

• Rapid eye movement with muscle Antonia

• Critical for memory, learning, and emotional processing

• Duration increases with each cycle through the night

How long does a sleep cycle last?

90-110 minutes and repeats 4-6 times a night

How many hours of sleep do neonates need?

16 hours

How many hours of sleep do infants need?

15 hours with naps

How many hours of sleep do toddlers need?

12 hours with nap

How many hours of sleep do preschoolers need?

12 hours

How many hours of sleep do school-aged kids need?

9-12 hours

How many hours of sleep do adolescents need?

8-10 hours

How many hours of sleep do young adults need?

6-8.5 hours

How many hours of sleep do middle adults need?

7-9 hours

How many hours of sleep do older adults need?

Varies, sleep difficulties increase with age

Visual analog scale (VAS) for sleep

• patient marks a point on a 10cm line best sleep to worst sleep possible

• Quick bedside check

• Subjective, numeric position on the line

Numerical rating scale (NRS) for sleep

• on a 0-10 scale how would you rate your sleep

• 0= worst, 10=best

Pittsburgh sleep quality index (PSQI) for sleep

• Comprehensive tool evaluating sleep quality over the past month

• Used in research and long-term care

• Global score >5 = poor sleep quality

Epworth Sleepiness scale (ESS) for sleep

• rates likelihood of dozing off in 8 common situations

• Screens for excessive daytime sleepiness/sleep apnea

• Higher scores = more sleepiness