RNSG 1115 Chapter 34 Activity

Physiology of Movement/Activity

• human body is designed to be mobile

• mobility is essential to activities of daily living (ADL’s)

• mobility is necessary for healthy function

• mobility is vital part of independence and well-being

Role of the Skeletal System in Movement

• supports the soft tissues of the body

• protects crucial components (organs) of the body

• furnishes surfaces for the attachment of muscles, tendons, and ligaments

• provides storage areas for minerals and fat

• produces blood cells (hematopoiesis)

Skeletal System Features:

• bones

• joints

• connective tissues

Bones:

• rigid, structured, specific and distinct form

• long, short, flat irregular

Joints:

• where bones articulate

• allow for movement, flexibility, protection, and padding where bone meets bone or articulate

Connective Tissues:

connect bones and muscles

Ligaments:

bone to bone

Tendons:

muscle to bone

Cartilage:

hard, non-vascular

Bones Classified by Shape:

• long bones

• short bones

• flat bones

• irregular bones

Long Bones:

upper and lower extremities

Short Bones:

wrist and ankle

Flat Bones:

ribs and skull bones

Irregular Bones:

spinal column and jaw

Types of Joints:

• ball-and-socket

• condyloid

• gliding

• hinge

• pivot

• saddle

3 types of muscles in the muscular system:

• cardiac

• skeletal

• smooth

Role of the Muscular System:

• produces heat (energy) for movement

• soft protection, flexibility, and equilibrium for posture

• coordination of gross and fine motor movements

• synchronize pump action and mobility

• provides for volitional, automatic, and reflexive responses

Role of Nervous System:

• the skeletal and muscular systems rely upon a functioning nervous system

• the afferent nervous system conveys information from receptors to the CNS

• neurons conduct impulses from one part of the body to another

• information is processed by the CNS leading to a response

• the efferent system conveys a response from the CNS to skeletal muscles via the somatic nervous system

Skeletal System:

support, form, structure, joint movement, protection, mineral storage, blood cell production

Muscular System:

heat production and maintenance (energy), gross and fine movement, efficiency, coordination and flexibility

Nervous System:

communication of all senses between different parts of the body (position, balance, visual, auditory, spatial, proprioception)

Body Alignment or Posture:

alignment of body parts that permits optimal musculoskeletal balance and optimal that means NO undue strain on the joints, muscles, tendons or ligaments while balance is maintained

Balance:

• body is in correct alignment

• balance occurs when the center of gravity is close to its base of support, and the object has a wide base of support

Coordinated Body Movement:

• the ability of muscles to work together for purposeful movement

• using stronger muscle groups rather than weaker ones, and taking advantage of the body’s natural levers and fulcrums facilities the action of lifting, carrying, pushing, pulling and moving objects

Postural Reflexes:

a group of reflexes (automatic) that maintain body position and equilibrium, whether at rest or during movement

Factors Affecting Movement:

• developmental considerations

• physical health

• mental health

• lifestyle

• attitude and values

• fatigue and stress

• external factors

Developmental Considerations:

knowing variations of activities based on developmental levels/age

Physical Health:

problems with/in any body system involved in movement will impact patients ability to move

Mental Health:

body processes, such as, posture, energy level, emotionless behavior can be affected by depression

Lifestyle:

choice of being active or sedentary based on type of work, leisure choices, and culture

Attitude and values:

what’s taught growing up continues into adulthood

Fatigue and Stress:

chronic stress can deplete the body’s energy

External Factors:

weather conditions, fiscal resources, living in high crime areas

Types of Exercise: Muscle Contraction

• isotonic

• isometric

• isokinetic

Types of Exercise: Body Movement

• aerobic exercise

• stretching exercise

• strength and endurance exercises

Effects of Exercise: Benefits

• cardiovascular

• respiratory

• musculoskeletal

• metabolic

• gastrointestinal

• urinary

• skin

• psychosocial

Effects of Exercise: Risks

• precipitation of a cardiac event

• orthopedic discomfort

Effects of Exercise: Cardiovascular Benefit

helps to meet oxygen demands

Effects of Exercise: Respiratory Benefit

leads to improved pulmonary function

Effects of Exercise: Musculoskeletal Benefit

improves efficiency of metabolism

Effects of Exercise: Gastrointestinal Benefit

improves digestion and elimination

Effects of Exercise: Urinary Benefit

increases blood circulation with improved blood flow to kidneys

Effects of Exercise: Skin Benefit

nourishes the skin

Effects of Exercise: Psychosocial Benefit

increased energy, appearance, improves sleep, self-concept and health behaviors

Effects of Exercise: Precipitation of a Cardiac Event Risk

more prevalent for people with known risk (diabetics, renal disease, or cardiovascular disease)

Effects of Exercise: Orthopedic Discomfort and Disability Risk

irritation in bones, tendons, ligaments

If the patient isn’t experiencing any mobility or activity problems:

• identify personal benefits of regular exercise

• list support systems that will reinforce exercise efforts

• follow a program or regular physical exercise that improves cardiovascular function, endurance, flexibility and strength

If the patient is at risk for mobility or activity problems:

• demonstrate correct body alignment

• demonstrate full ROM in joints

• demonstrate adequate muscle mass, tone and strength to perform ADLs

For patients who are immobile:

• be free from alterations in skin integrity

• show signs of adequate circulation

• maintain muscle mass, tone and strength

Ergonomics:

includes proper body movement in daily activities, the prevention and correction of problems associated with posture, and the enhancement or coordination and endurance

Body Mechanics:

use of the body as a machine; the use of the body in an efficient way to avoid injury, particularly as it relates to lifting, repositioning, and movement

Variables leading to back injury:

• uncoordinated lifts

• manual lifting and transferring of patients without assistive devices

• lifting when fatigued or after recent back injury recovery

• repetitive movements such as lifting, transferring, and repositioning of patients

• standing for long periods of time

• transferring/repositioning cooperative/uncooperative or confused patients

Equipment and Assistive Devices:

• gait belts

• stand-assist and repositioning aids

• lateral-assist devices

• friction reducing sheets

• mechanical-lateral assist devices

• transfer chairs

• powered stand assist and repositioning lifts

• powered full-body lifts

Fowler’s Position:

head of the bed elevated to a 45-60 degree angle

this position promotes cardiac and respiratory functioning

Supine or Dorsal Recumbent:

the patient is lying flat on their back and their head and shoulder slightly elevated with a pillow

Side-Lying or Lateral Position

the patient lies on their side and the main weight of the body is on the lateral aspect of the lower scapula and lower ilium. This position relieves pressure on the scapula, sacrum, and heels

Prone Position

patient lies on the abdomen with the head turned to the side

Sim’s Position:

patient is again side-lying but the lower arm is behind the patient and the upper arm is flexed at the shoulder and the elbow

body weight is on the anterior aspects of the humerus, clavicle, and ileum

Graduated Compression Stockings:

available in knee high or thigh-high lengths that requires measuring the leg for proper fit

Pneumatic Compression Devices:

also known as SCD (sequential compression devices) that are composed of an air pump, connecting tubes, and extremity sleeves

Turning the Patient in Bed:

nurses must use knowledge about correct alignment and move patient from back onto side, back onto abdomen, and from abdomen onto the back

Moving a Patient Up in Bed:

nurses should assess whether patient can assist or if equipment is needed to move patient

some of the friction-reducing devices, trapezes, draw sheets, are all possible solutions to assistance

Active Range of Motion:

patient independently moves joints

Passive Range of Motion:

nurse moves joints for patients who are unable

Quadriceps and Gluteal Setting Drills:

isometric

extension and flexion of legs

Pushups:

strengthens the shoulder and arms

can be done sitting in bed by pushing hands down on the mattress in order to lift hips off the bed, if the mattress is not too soft

can also be done in prone position

Dangling:

when the patient sits on the edge of the bed with legs and feet over the side of the bed for a few minutes

this helps prepare patient for getting out of the bed as well

helps with lightheadedness and hypotension

Mechanical Aids for Walking

• walkers

• canes

• braces

• crutches

Walkers and Canes:

• walkers offer security and support

• improve patient balance

• increases the base of support

• canes widen the base of support

• increase balance

Axillary Crutches:

temporary restrictions on ambulation

Forearm Crutches:

long-term restrictions on ambulation

Braces support…

weakened leg muscles