Module 13

Module 13: Activity and Exercise

Activity and Exercise Overview

• Focus on critical aspects related to:
    * Immobility
    * Hygiene
    * Oxygenation

Nature of Movement

• Body Mechanics
    - Definition: Coordinated efforts of the musculoskeletal and nervous systems that facilitate bodily movement.
    - Alignment and Balance: Refers to posture and body alignment, ensuring stability.
    - Key Components:
      * Gravity: The force exerted on the body due to its mass.
      * Weight: Related to mass and gravity, causing stress on body structures.
      * Friction: The force that opposes movement between surfaces in contact.

Pathological Influences on Mobility

• Postural Abnormalities: Deviations from normal posture can affect mobility and overall health.

• Muscle Abnormalities: Conditions affecting muscle structure and function impact movement.

• Damage to CNS: Central nervous system injuries can impair movement and coordination.

• Musculoskeletal Trauma: Injuries to bones, muscles, or joints hinder mobility.

Assessment of Body Posture

Standing Posture

• Head: Erect and midline

• Body: Symmetrical; balance maintained

• Spine: Straight with normal curvatures

• Abdomen: Tucked in

• Knees: Slightly flexed for balance

• Feet: Pointed forward, slightly apart for stability

• Arms: Positioned at the sides for alignment

Sitting Posture

• Head: Erect, looking straight

• Neck and Vertebral Column: Straight alignment

• Body Weight Distribution: On buttocks and thighs equally

• Thighs: Parallel and horizontal

• Feet: Flat on the floor for support

• Forearms: Supported on table, lap, or armrest for comfort

Effects of Immobility

Metabolic Changes

• Calcium Absorption: Vitamin D and other nutrients affect metabolic processes.

• GI Function: May be impaired leading to constipation or digestion issues.

Respiratory Complications

• Atelectasis: Collapse of lung tissue from inactivity.

• Hypostatic Pneumonia: Infection resulting from poor ventilation and secretions.

Cardiovascular Changes

• Orthostatic Hypotension: Drop in blood pressure upon standing causing dizziness.

• Thrombus Formation: Increased risk of blood clots in immobile patients.

Musculoskeletal Changes

• Loss of Endurance and Muscle Mass: Results from lack of movement.

• Decreased Stability and Balance: Impacts the ability to stand or walk safely.

Muscular Effects

• Muscle Atrophy: Decreasing muscle size due to disuse.

Skeletal Effects

• Impaired Calcium Absorption: Leads to weakened bones and increased fracture risk.

• Joint Abnormalities: Stiffness and reduced range of motion can occur.

Urinary Changes

• Urinary Stasis: Reduced urinary flow leading to risk for UTIs.

• Renal Calculi: Increased likelihood of kidney stones due to inactivity.

Integumentary Effects

• Pressure Ulcers: Skin breakdown from prolonged pressure.

• Ischemia: Reduced blood flow leading to tissue damage.

Range of Motion (ROM)

• Contractures: Develop in joints not moved periodically through their full range of motion (ROM).
    - Affected areas include: neck, shoulder, elbow, forearm, wrist, fingers, thumb, hip, knee, ankle, foot, and toes.

Assessment of Mobility

• Key indicators:
    * Gait (how a person walks)
    * Exercise capacity
    * Activity tolerance
    * Body alignment

Prioritize Hypotheses Related to Mobility

• Impaired physical mobility

• Risk for disuse syndrome

• Ineffective airway clearance

• Ineffective coping mechanisms

• Impaired urinary elimination

• Social isolation factors

• Risk for impaired skin integrity

Implementation Strategies

Metabolic Support

• Diet: High protein and high-calorie intake emphasized.

• Supplements: Vitamin B and C recommended to support recovery.

Respiratory Management

• Coughing Techniques: Encourage deep breathing and effective coughing.

• Chest Physiotherapy: Helps mobilize lung secretions.

Cardiovascular Care

• Address Orthostatic Hypotension: Gradual position changes to mitigate risk.

• Reduce Cardiac Workload: Through controlled activity.

• Prevent Thrombus Formation: Use of sequential compression devices (SCDs), thromboembolic disease (TED) stockings, and leg exercises.

Musculoskeletal System Care

• Prevent Muscle Atrophy: Regular movement and exercises to maintain musculature.

• Avoid Joint Contractures: Ensuring regular change of position.

Integumentary System Care

• Repositioning Schedule: Every 1 to 2 hours to prevent pressure ulcers.

• Skin Care Protocols: Regular assessments and treatments to preserve skin integrity.

Elimination System

• Hydration: Ensuring adequate fluid intake.

• Diet: Promoting a diet high in fluids, fruits, vegetables, and fiber to support urinary elimination.

Addressing Patient Needs

• Psychosocial Changes: Recognize and adapt care for emotional support.

• Developmental Changes: Tailor care strategies to individual patient development stages.

• Positioning Devices: Use of aids to support patient mobility and comfort.

Oxygenation Management

Hypotheses to Address

• Impaired gas exchange

• Impaired airway clearance

• Activity intolerance

• Acute chest pain

• Ineffective tissue perfusion

Acute Care Actions for Oxygenation

• Dyspnea Management: Strategies to alleviate breathing difficulties.

• Airway Maintenance: Ensuring clear respiratory pathways.

• Mobilization of Pulmonary Secretions: Techniques to help expel mucus.

• Ambulation: Encouraging patient movement to enhance lung function.

• Positioning: Optimizing positions that facilitate breathing.

• Incentive Spirometry: Devices to encourage deep, lung-filling breaths.

• Artificial Airways: Use as needed to maintain airway patency.

• Suctioning: Techniques to clear the airway.

Oxygen Therapy

Safety Precautions

• Following guidelines for safe oxygen use.

• Monitoring oxygen supply regularly to ensure adequate levels.

Delivery Devices

• Nasal Cannula: Primary device used for low-flow oxygen therapy.

• Face Masks: For higher concentrations of oxygen delivery.

Health Promotion

• Encourage understanding of oxygen therapy and its benefits.