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NSFN (Study Unit 1)

Study Unit Context

  • Module: NSFN121 – Need for Activity and Exercise

  • Academic Year: 2025

  • Lecturer: Sr O. Ngami (NWU®)

Learning Outcomes

Outcomes Related to Activity

  • Define all core concepts linked to human activity.

  • Describe the four basic elements of normal movement.

  • Analyse factors that influence alignment and activity.

  • Identify every joint movement & full range of motion (ROM) in sketches.

Outcomes Related to Exercise

  • Describe exercise types that enhance health/well-being.

  • Explain evidence-based guidelines & minimum requirements for physical activity.

  • Summarise mental and physical benefits of exercise.

  • Explain multisystem effects of immobility.

  • Formulate a complete nursing care plan for clients with mobility disorders.

  • Design an appropriate discharge plan for a client hospitalised owing to immobility.

Key Concepts & Terminology

(Use consistently during history-taking, documentation & client education.)

  • Line of gravity, centre of gravity, base of support

  • Range of motion (ROM)

  • Proprioception, activity tolerance

  • Muscle-contraction modalities → isotonic, isometric, isokinetic

  • Energy systems → aerobic, anaerobic

  • Clinical/pathological terms → hypertrophy, osteoporosis, foot-drop, ankylosis, orthostatic hypotension, thrombophlebitis, vital capacity, urinary stasis, urinary reflux

Normal Movement

  • Requires intact:

    • Musculoskeletal system

    • Nervous system

    • Inner-ear (labyrinth) structures for equilibrium

  • Movement depends on coordinated muscle activity + neurological integration.

  • Four foundational elements:

    1. Body alignment (posture)

    2. Joint mobility

    3. Balance

    4. Coordinated movement

Mobility – Definition & Psychosocial Angle

  • Ability to move freely, easily, rhythmically & purposefully in one’s environment.

  • Vital for independent living, self-esteem, body image & social role performance.

  • Observation cues:

    • Stomach ache → person flexes trunk, guards abdomen.

    • Stress/depression → slumped posture, slow movements, poor eye contact.

    • Neurological/orthopaedic impairments → paralysis, amputations, need for assistive devices, altered gait.

Alignment & Posture Basics

  • Optimal alignment → maximal balance & physiological efficiency (standing, sitting, lying).

  • Principle: balance maintained as long as the line of gravity passes through the centre of gravity and falls within the base of support.

  • Common postural patterns (refer Berman 2022, Fig. 44-1):

    • Correct posture

    • Hollow back (lordosis)

    • Flat back

    • Slumping (kyphosis)

    • Military posture

    • Rounded shoulders

    • High shoulder/high hip

    • Head tilt

    • Scoliosis (lateral curvature)

Joint Mobility & ROM

  • Joint = point where two or more bones articulate.

  • Range of Motion (ROM): maximal quantity of movement possible at a specific joint.

    • Varies by individual; affected by age, disease, activity level, tissue elasticity, pain, etc.

Named Joint Movements (master for physical assessment & education)

  • Flexion / Extension / Hyperextension

  • Abduction / Adduction

  • Rotation (internal & external)

  • Circumduction

  • Eversion / Inversion

  • Pronation / Supination

Balance & Proprioception

  • Sensory inputs:

    • Labyrinth (inner ear) → vestibular input

    • Vision → vestibulo-ocular input

    • Stretch receptors in muscles/tendons → vestibulospinal input

  • Proprioception = conscious & unconscious awareness of posture, movement, equilibrium + object position/weight/resistance relative to body.

  • Organs of balance illustrated in slides (semicircular canals, utricle, saccule).

Exercise – Definition & Classifications

  • Exercise = repeated active contraction & relaxation of muscles to improve/maintain fitness and health.

By Type of Muscle Contraction

  1. Isotonic (dynamic): muscle shortens ⇒ joint movement & active ROM. Eg. walking, swimming.

  2. Isometric (static): muscle tension without visible joint movement. Eg. quad-sets, plank.

  3. Isokinetic (resistive): muscle contracts against constant resistance at a fixed velocity (specialised equipment).

By Predominant Energy System

  1. Aerobic: \text{O}2 supply > \text{O}2 demand; prolonged moderate intensity; improves cardiovascular fitness.
    • Examples → brisk walking, swimming, running, cycling, jump-rope, heavy cleaning, gardening.

  2. Anaerobic: \text{O}_2 supply < muscular demand; energy from anaerobic glycolysis (short bursts).
    • Examples → sprints, weight-lifting, isometrics, plyometrics, interval training.

Minimal Requirements & Safe-Exercise Assessment

  • Comprehensive nursing assessment (Table – Kozier p.1045 & Berman 2022:1123):

    • Nursing history – lifestyle, motivation, past injuries, chronic diseases.

    • Physical exam – alignment, gait, posture, joint appearance & ROM, muscle mass/strength, cardio-resp reserve.

    • Capabilities & limitations – mobility aids, pain, cognitive status.

    • Energy level / activity tolerance (vital signs pre- & post-activity).

    • Safety checks – footwear, environment, equipment, balance support.

    • Determine preferred frequency, duration, type (aerobic/stretch/strength), progression.

  • Motivational teaching tool: cartoon “What fits your busy schedule better, exercising one hour a day or being dead 24 hours a day?”

Benefits of Regular Exercise (System-By-System)

1. Musculoskeletal System

  • Muscle hypertrophy (↑ size & strength).

  • ↑ joint flexibility, stability, ROM.

  • ↑ bone density (counteracts osteoporosis) & tensile strength (Wolff’s law).

2. Cardiovascular System

  • ↓ risk of stroke & cardiovascular disease.

  • Modulates stress response, ↓ catecholamine surge.

  • ↑ coronary blood flow & collateral circulation.

  • Strengthens myocardium (↑ stroke volume ⇒ ↓ resting heart rate).

  • ↓ blood pressure; ↑ peripheral circulation & oxygen uptake \left(\text{VO}_2\text{max}\uparrow\right).

3. Respiratory System

  • ↑ gas exchange surface efficiency.

  • ↑ respiratory muscle strength/ endurance.

  • Facilitates secretion clearance → ↓ infection risk.

4. Gastro-Intestinal System

  • Stimulates appetite & peristalsis.

  • Prevents constipation; normalises bowel pattern.

5. Metabolic / Endocrine System

  • ↑ basal metabolic rate (BMR).

  • ↑ utilisation of triglycerides & fatty acids ⇒ weight management.

  • Stabilises blood glucose via ↑ insulin sensitivity.

6. Urinary System

  • ↑ renal blood flow → efficient waste elimination.

  • Prevents bladder stasis → ↓ urinary tract infection risk.

7. Immune System

  • Enhanced lymphatic drainage → ↑ pathogen destruction & foreign particle removal.

  • REST remains essential for immune recovery after intense activity.

8. Psycho-Neurologic System

  • Elevates mood (endorphin release), ↓ anxiety & stress.

  • Improves sleep quality.

9. Cognitive Function

  • Enhances decision-making, problem-solving, sustained attention, academic/work performance.

10. Spiritual Health

  • Integrates body-mind-spirit (e.g., yoga, mindful running) → inner balance & connection with environment.

Factors Influencing Body Alignment & Activity

  • Growth & development stage (infant – older adult).

  • Physical health status (musculoskeletal, neurological, cardiopulmonary, pain, fatigue).

  • Mental & emotional status (motivation, depression, anxiety, cognition).

  • Lifestyle & occupation (sedentary work vs manual labour).

  • Value & cultural beliefs regarding exercise.

  • Environmental issues (weather, safety, facilities, financial means).

  • Prescribed limitations (casting, traction, bed rest, medical devices).

Effects of Immobility (Highlight for Care Planning)

  • Musculoskeletal → atrophy, contractures, foot-drop, bone demineralisation.

  • Cardiovascular → orthostatic hypotension, ↑ heart rate, venous stasis, thrombophlebitis.

  • Respiratory → ↓ vital capacity, atelectasis, pneumonia.

  • Gastrointestinal → decreased appetite, slowed gastric motility, constipation.

  • Metabolic → negative nitrogen balance, hypercalcaemia, insulin resistance.

  • Urinary → stasis, calculi, reflux, infection.

  • Integumentary → pressure injuries.

  • Psycho-neurologic → mood disturbance, sensory deprivation.

Nursing Process – Activity & Exercise

1. Assessment

  • Gather data listed under “Minimal Requirements & Safe-Exercise Assessment”.

2. Nursing Diagnosis (NANDA examples)

  • Impaired Physical Mobility

    • Related to: pain, joint degeneration (arthritis), neuromuscular impairment, prescribed bed rest.

    • As evidenced by: verbal reports of pain, limited ROM, facial grimacing, difficulty turning in bed.

  • Activity Intolerance

  • Risk for Disuse Syndrome

  • Sedentary Lifestyle

Three-Part Diagnostic Statement Template

  1. Problem (label) – Pain

  2. Aetiology – related to degeneration of joints

  3. Evidence – as manifested by client reporting pain, guarded movement, inability to perform ADLs

3. Planning – Outcomes (SMART)

  • Client will ambulate safely with walker 30\,\text{m} twice daily by day 3 of admission.

  • Client’s heart rate will return to baseline within 3 minutes post-exercise within one week.

4. Intervention (examples)

  • Assist with ROM exercises 3\times per day; progress to active ROM.

  • Apply gait belt & educate on proper body mechanics.

  • Collaborate with physiotherapy for graded strengthening programme.

  • Provide analgesia 30 min pre-activity.

5. Evaluation

  • Compare achieved performance (distance ambulated, vitals, pain score) to expected outcomes; revise plan accordingly.

Nursing Care Plan Template (repeat for each problem)

Assessment → Diagnosis → Outcome → Intervention → Evaluation

Discharge Planning for Previously Immobile Client

  • Provide written & verbal home exercise regimen (frequency, intensity, duration).

  • Arrange community/physio follow-up appointments.

  • Teach safe transfer techniques, use of assistive devices, environmental modifications (rails, non-slip mats).

  • Educate on signs of complications (DVT, pressure injuries).

  • Encourage gradual increase in activity tolerance; include caregivers in teaching.

Ethical, Philosophical & Practical Implications

  • Autonomy: clients must set personally meaningful activity goals.

  • Justice: access to safe places & equipment promotes health equity.

  • Non-maleficence: avoid exercise prescriptions that exceed tolerance, cause injury.

  • Long-term view: investment of 1\,\text{h} daily exercise vs risk of premature mortality (cartoon metaphor).

    • Practical counselling tool to overcome “lack-of-time” barrier.

Reference Pointers (Consult for Visuals & Detail)

  • Berman, A. (2022). Skills in Clinical Nursing – Fig. 44-1 (posture), p.1110 (joint movements), p.1123 (assessment interview).

  • Kozier, B. et al. – Table on exercise assessment (p.1045).

Quick Mnemonics

  • ROM Movements: Fat Elephants Have A Really Cool Evening In Paris, Si!
    F-Flexion, E-Extension, H-Hyperextension, A-Abduction, R-Rotation, C-Circumduction, E-Eversion, I-Inversion, P-Pronation, S-Supination.

  • Benefits of Exercise – Systems: My Clever Room Grows More Useful If People Can Stretch.
    M-Musculoskeletal, C-Cardio, R-Respiratory, G-Gastro-intestinal, M-Metabolic, U-Urinary, I-Immune, P-Psycho-neurologic, C-Cognitive, S-Spiritual.

End of Study Unit 1 – Review Questions

  • Define proprioception & explain its importance for balance.

  • Differentiate isotonic, isometric, isokinetic exercises with one client example each.

  • List at least four cardiovascular benefits of regular aerobic exercise.

  • Formulate a complete nursing diagnostic statement for a client with arthritis-related mobility limitation.

  • Discuss three major complications of prolonged immobility and evidence-based nursing interventions to prevent them.

“Movement is a medicine for creating change in a person’s physical, emotional, and mental states.” – Carol Welch