NCM 101

FUNDAMENTALS OF
NURSING PRACTICE

CLINICAL INSTRUCTOR:
IVY M. MANCERA, RN, MSN
Basic Interventions to
Maintain Client Mobility
and Exercise
Four Basic Elements of Normal Movement
• Body alignment (posture)
• Joint mobility
• Balance
• Coordinated movement
 Body Alignment/Posture

• Brings body parts into

position that promotes
optimal balance and body
function
• Person maintains balance as
long as line of gravity passes
through center of gravity and
base of support
 Joint Mobility
• ROM is maximum
movement possible
for joint
• ROM varies and
determined by:
• Genetic makeup
• Developmental
patterns
• Presence or absence
of disease
• Physical activity
Elbow Flexion/Extension
Elbow Pronation
and Supination
Foot Dorsiflexion/Extension
Ankle Inversion/Eversion
Hand Opposition
Humerus Adduction / Abduction
 Humerus
Circumduction
 Balance
• Smooth, purposeful
movement
• Result of proper
functioning of:
• Cerebral cortex
• Initiates voluntary
movement
• Cerebellum
• Coordinates motor
activity
• Basal ganglia
• Maintains posture
 Coordinated Movement
• Complex
mechanisms
• Proprioception
• Awareness of
posture, movement,
changes in
equilibrium
• Knowledge of
position, weight,
resistance of objects
in relation to body
 Isotonic (Dynamic) Exercise
• Muscle shortens to
produce muscle
contraction and active
movement
• Increase muscle tone,
mass, and strength
• Maintain joint
flexibility and
circulation
• HR quicken and CO
increase
 Isometric (Static or Setting) Exercise
• Muscle contraction without
moving the joint (muscle
length does not change)
• Involve exerting pressure
against a solid object
• Produce a mild increase in
HR and CO
• No apparent increase in
blood flow to other parts of
the body
 Isokinetic (Resistive) Exercise
• Muscle contraction or
tension against resistance
• Can either be isotonic or
isometric
• Person moves (isotonic) or
tenses (isometric) against
resistance
• An increase in blood
pressure and blood flow to
muscles occurs
 Aerobic Exercise
• Activity during which
the amount of oxygen
taken in the body is
greater than that
used to perform the
activity
• Improve
cardiovascular
conditioning and
physical fitness
 Anaerobic Exercise
• Activity in which the
muscles cannot draw
enough oxygen from
the bloodstream
• Anaerobic pathways
are used to provide
additional energy for
a short time
• Used in endurance
training for athletes
 Effect on Musculoskeletal System
• Exercise • Immobility
• Maintain size, • Disuse osteoporosis
shape, tone, and • bone loss that results from not enough
strength of muscles stress or pressure on the bones
(including the heart • Disuse atrophy
muscle) • body will start to break muscles down,
• Nourish joints which causes them to decrease in size
and strength
• Increase joint
flexibility, stability, • Contractures
and ROM • chronic loss of joint mobility caused by
structural changes in non-bony tissue,
• Maintain bone including muscles, ligaments, and
density (fragility) tendons
and strength • Stiffness and pain in the joints
 Effects on the Cardiovascular System
• Exercise • Immobility
• Increases • Diminished cardiac reserve
HR, strength • inability to increase cardiac output to meet the
of metabolic requirements during exercise
contraction, • Increased use of the Valsalva maneuver
and blood • Valsalva maneuver is a forceful strain that may
supply to the slow the heart when it's beating too fast
heart and • Orthostatic hypotension
muscles • low blood pressure that happens when you
• Mediates stand up from sitting or lying down
harmful • Venous vasodilation and stasis
effects of • Thrombus formation
stress • Dependent edema
 Leg Veins

Active Inactive
Person Person
 Effect on the Respiratory System
• Exercise • Immobility
• Increase • Decreased respiratory movement
ventilation and • Pooling of respiratory secretions
oxygen intake • Atelectasis
improving gas • a complete or partial collapse of the
exchange entire lung or area (lobe) of the lung
• Prevents pooling of • Hypostatic pneumonia
secretions in the • occurs primarily in old people or those
bronchi and debilitated by disease who remain
bronchioles recumbent in the same position for
long periods
Atelectasis
 Effects on the Metabolic/
Endocrine System
• Exercise • Immobility
• Elevates the metabolic rate • Decreased metabolic rate
• Basal Metabolic Rate is the
number of calories required to • Anorexia
keep your body functioning at rest • lack or loss of appetite for
food
• Decreases serum triglycerides
(a type of fat (lipid) found in • Negative calcium
your blood) and cholesterol (a balance
waxy substance found in your • occurs when dietary intake
blood) is insufficient to cover
losses, despite mechanisms
• Stabilizes blood sugar and to conserve body calcium
make cells more responsive to
insulin
 Effects on the GI System
• Exercise • Immobility
• Improves the appetite • Constipation
• Increases GI tract tone
• Facilitates peristalsis
 Effect on the Urinary System
• Exercise • Immobility
• Promotes blood flow • Urinary stasis
to the kidneys • Stoppage of the flow of urine at
causing body wastes any part of the urinary tract
to be excreted more • Renal calculi
effectively • kidney stones
• Prevents stasis • Urinary retention
(stagnation) of urine • a condition in which you cannot
in the bladder empty all the urine from your
bladder
• Urinary infection
 Effect on the Immune System
• Exercise
• Pumps lymph fluid from
tissues into lymph capillaries
and vessels
• Increases circulation through
lymph nodes
• Strenuous exercise may
reduce immune function
• Leaving window of opportunity
for infection during recovery
phase
 Effect on the Psychoneurologic System
• Exercise • Immobility
• Elevates mood • Decline in mood elevating
• Dopamine also known substances
as the “feel-good” • Perception of time intervals
hormone
deteriorates
• can be obtained from
• Time perception is a
protein-rich foods
fundamental element of human
• Relieves stress and awareness
anxiety • Problem-solving and decision-
• Improves quality of making abilities may deteriorate
sleep for most • Loss of control over events can
individuals cause anxiety
 Effect on Cognitive Function
• Exercise
• Positive effects on
decision-making and
problem solving
processes, planning,
and paying attention
• Induces cells in the
brain to strengthen
and build neuronal
connections
 Other Effects of Exercise and
Immobility
• Evidence that certain
types of exercise
increase spiritual
health
• Immobility causes
reduced skin turgor
and skin breakdown
 Factors Affecting Body Alignment,
Mobility and Daily Activity Level
• Growth and development
• Nutrition, personal values
and attitudes
• External factors
• i.e., Temperature, humidity,
availability of recreational
facilities, safety of the
neighborhood
• Prescribed limitations
• i.e., Casts, braces, traction,
activity restrictions including
bed rest
 Assessment of Activity and Exercise
• Nursing History
• Physical Examination:
• Body alignment
• Gait
• a person's manner of walking
• Appearance and movement
of joints
• Capabilities and limitations
for movement
• Muscle mass and strength
• Activity tolerance
• Problems related to
immobility
 NANDA Nursing Diagnoses
• For activity and
exercise problems
• Activity Intolerance
• Risk for Activity
Intolerance
• Impaired Physical
Mobility
• Sedentary Lifestyle
• Risk for Disuse
Syndrome
 NANDA Nursing Diagnoses
• The mobility
problem becomes
the etiology:
• Fear (of falling)
• Ineffective Coping
• Low Self-Esteem
• Powerlessness
• Risk for Falls
• Self-Care Deficit
 NANDA Nursing Diagnoses
• Prolonged immobility:
• Ineffective Airway
Clearance
• Risk for Infection
• Risk for Injury
• Risk for Disturbed
Sleep Pattern
• Risk for Situational
Low Self-Esteem
 Examples of Desired Outcomes

• Activity tolerance • Mobility

• Body positioning • Respiratory status
• Bowel elimination • Ventilation and gas
• Fall prevention behavior exchange
• Immobility consequences • Self-care
both physiological and • Sleep
psychocognitive • Stress level
• Joint movement • Weight control
 Overall Goals for Problems
Related to Mobility or Activity
• Increased tolerance for physical activity
• Restored or improved capability to ambulate and/or participate
in ADLs (activities of daily living)
• Absence of injury from falling or improper use of body
mechanics
• Enhanced physical fitness
• Absence of any complications associated with immobility
• Improved social, emotional, and intellectual well-being
 Safe Practice for Positioning, Moving,
Lifting, Ambulating Clients
• Correct body
mechanics required
for nurse to prevent
injury
• Body mechanics
refers to the way you
hold your body when
you move around
• Correct body alignment
for the client also so
that undue stress is not
placed on the
musculoskeletal system
 General Guidelines for Moving and
Lifting
• Before moving, assess
• If indicated, use pain relief
modalities
• Prepare any needed
assistive devices
• Be alert to the effects of any
medications
• Obtain required assistance
• Explain the procedure to the
client
 General Guidelines for Transferring a
Client
• Plan what to do and how to do it
• Obtain essential equipment before
starting
• Remove obstacles
• Explain transfer to client and
assistive personnel
• Support or hold client rather than
equipment
• Explain what client should do
• Make written plan, including client’s
tolerance
Safe Practice for Positioning, Moving,
Lifting, Ambulating Clients
 General Guidelines for Ambulating
• Assess the amount of assistance the
client will require
• Assess for signs and symptoms of
orthostatic hypotension
• Prepare client for ambulation
• Apply transfer or walking belt
• Physically support client
• Obtain assistance to follow with
wheelchair or assist with physical
support
• Teach client to correctly use
mechanical aids
 Thank you!
This ends our topic on
Mobility and Exercise

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Basic Interventions to Maintain
Client Nutrition & Elimination