Activity

Elements of Normal Movement

  • Proper Body alignment

  • Joint mobility

  • Balance

  • Coordinated movement

Types of Activity

  • Active Exercise/Isotonic: Patient does movement to promote joint flexibility, muscle strength, bone growth, and improve bodily systems. Examples: walking, swimming, ADL's.

  • Isometric Exercise: Involve muscle tension changes without joint movement (e.g., quadriceps setting). Maintains muscle strength/tone; useful for patients in casts/traction.

  • Resistive Isometric Exercise: Muscle contraction against resistance (e.g., lifting buttocks off bed, pushing against footboard).

  • Isokinetic Exercises: Muscle contraction against movable resistance (e.g., weight lifting).

Effects of Activity/Immobility

  • Oxygen Needs: Activity increases venous return, cardiac output, heart muscle tone, and respiratory muscle strength. Immobility leads to orthostatic hypotension, increased cardiac workload, risk of thrombus, respiratory secretions accumulation, hypostatic pneumonia, and atelectasis.

  • Food & Water Needs: Activity improves GI tone, appetite, and anabolism. Immobility causes anorexia, dyspepsia, catabolism, and negative nitrogen balance.

  • Sleep/Rest/Activity: Activity promotes sound sleep, maintains joint strength/flexibility, and promotes bone Ca^{+}$ into bones. Immobility causes irritability, insomnia, stiff/painful joints, muscle atrophy, joint contractures, Ca^{+}$ loss from bones, and joint ankyloses.

  • Elimination Needs: Activity reduces urinary stasis and constipation. Immobility can lead to kidney stones, urinary incontinence/UTI, constipation, impaction, and diarrhea.

Purposes of Good Body Mechanics

  • Reduces effort exerted by nurse and patient.

  • Conserves nurse and patient energy.

  • Prevents muscle fatigue for nurse and patient.

  • Prevents injury to nurse and patient (back injury is #1 for nurses).

Factors Affecting Stability

  • Base of support

  • Center of gravity

  • Line of gravity

Physical Forces Influencing Mobility

  • Friction

  • Gravity

  • Leverage

  • Momentum

Principles for Reducing Friction & Using Leverage

  • Reduce friction by ensuring a clean, smooth, dry surface and decreasing surface area contact (e.g., pull sheet, bend patient's knees, cross arms).

  • Use leverage: Flexors are stronger than extensors, PULL rather than push. Stabilize body against stationary objects. Elevate bed to working level. Pivot on the balls of your feet.

  • Use gravity: Pull patient toward you.

  • Use momentum: Face direction of movement, use fluid motion, move slowly and rhythmically.

Levels of Physical Mobility (Functional Level 0-4)

  • 0: Independent

  • 1: Requires equipment or device

  • 2: Requires help from another person (assistance, supervision, or teaching)

  • 3: Requires help from another person and equipment or device

  • 4: Dependent and does not participate in movement

Rules Regarding Patient Activity

  1. Assess patient's abilities.

  2. Assess and implement doctor's order.

  3. Know your own ability and limits.

  4. Use appropriate, well-maintained equipment.

Types of Range of Motion (ROM)

  1. Active: Patient moves joints through full range.

  2. Active Assistive: Patient moves joints with nurse's assistance.

  3. Passive: Nurse performs entire movement.

Rules of ROM

  1. Systematically move each joint through all possible ranges.

  2. Exercise one joint motion at a time, stabilizing joints above and below.

  3. Assess for joint pain; stop at resistance.

  4. Perform slowly, rhythmically, and smoothly.

  5. Complete ROM BID (twice daily).

  6. Exercise each joint motion 3-5 times.

  7. Use correct body mechanics for nurse and patient.

  8. Position bed at appropriate height.

  9. Expose only the limb being exercised.

  10. SUPPORT JOINTS DURING PASSIVE ROM to prevent injury.

Guidelines for Preventive Positioning

  1. Change full body position at least Q2Hrs.

  2. Position each joint systematically.

  3. Place each joint in a different position with each change.

  4. Position only weakened/paralyzed joints.

  5. Position joints in positions other than flexion.

  6. Assess body alignment after positioning.

Positioning Techniques & Devices

  • Fowler's: Head of bed elevated (High Fowler's 90^{\circ}, Semi/Low Fowler's 15-45^{\circ}).

  • Supine, Lateral, Prone.

  • Splints/Orthoses, Hand Rolls: Maintain alignment of wrist, hand, fingers.

  • Trochanter Roll: Prevents external rotation of the hip.

  • Foot Board/Protective Boots: Prevent foot drop.

Legal Implications of Physical Restraints

  • Protective devices limiting physical activity.

  • Violate Patient's Bill of Rights (right to care free of unnecessary restraints).

  • Purpose: Prevent patient from injuring self or others.

  • Order Required: MD order, renewed every 24 hours for verbal orders.

  • Documentation: Must document need, assessment, removal (Q2hr), toileting, fluids, ROM, repositioning, and patient response.

  • Appropriate use: Must not restrict respirations/circulation, apply with appropriate knot to a stable area (bed frame, not side rail).

  • Restraint-Free Philosophy: Used only after all alternatives (e.g., bed alarms, 1:1 supervision) are tried and unsuccessful. Nursing homes typically avoid. Risk of injury remains.