UNIVERSITY OF LA SALETTE, INC.

SANTIAGO CITY
COLLEGE OF NURSING, PUBLIC HEALTH & MIDWIFERY

NCM 103 – FUNDAMENTALS OF NURSING PRACTICE

LEARNING MODULE
Prepared by: MELISSA D. SARMIENTO, RN, RM, MSN

ACTIVITY AND EXERCISE

 The coordinated efforts of the musculoskeletal and nervous systems maintain balance, posture, and body alignment during
lifting, bending, moving, and performing activities of daily living (ADLs).
 Proper balance, posture, and body alignment reduce the risk of injury to the musculoskeletal system and facilitate body
movements, allowing physical mobility without muscle strain and excessive use of muscle energy

Overview of exercise and activity:

Body alignment
 Relationship of one body part to another
Body balance
 low center of gravity is balanced over a wide, stable base of support and a vertical line falls from the center of gravity
through the base of support.
 enhanced by posture
Coordinated body movement
 A result of weight, center of gravity, and balance
 When an object is lifted, the lifter must overcome the weight of the object and be aware of its center of gravity
Friction
 Force that occurs in a direction to oppose movement
 It increases a patient's risk for skin and tissue damage and potential pressure ulcers
 To reduce friction, you need to decrease the surface area of the object.
Exercise and activity
 Exercise is physical activity used to condition the body, improve health, and maintain fitness.
 Sometimes exercise is also a therapeutic measure.
 A patient’s individualized exercise program depends on the patient’s activity tolerance or the type and amount of exercise
or activity that the patient is able to perform.
 Regular physical activity and exercise enhance functioning of all body systems, including cardiopulmonary functioning,
musculoskeletal fitness, weight control, and psychological well-being.

Three Categories of Exercise

 Isotonic exercises cause muscle contraction and change in muscle length (isotonic contraction).
 enhance circulatory and respiratory functioning; increase muscle mass, tone, and strength; and promote osteoblastic
activity (activity by bone-forming cells), thus combating osteoporosis.
 Isometric exercises involve tightening or tensing muscles without moving body parts (isometric contraction).
 ideal for patients who do not tolerate increased activity.
 A patient who is immobilized in bed can perform isometric exercises.
 Resistive isometric exercises are those in which the individual contracts the muscle while pushing against a stationary
object or resisting the movement of an object.
 Resistive isometric exercises are those in which the individual contracts the muscle while pushing against a stationary
object or resisting the movement of an object.

Regulation of Movement
 Coordinated body movement involves the integrated functioning of the skeletal, muscular, and nervous systems. Because
these three systems cooperate so closely in mechanical support of the body, they are often considered as a single
functional unit.
 The skeletal system provides support, protection, movement, mineral storage, and blood cell formation.
 Joints are the connections between bones.
 Ligaments bind joints and connect bones and cartilage.
 Tendons connect muscles to bones.
 Cartilage is nonvascular supportive tissue that acts as a shock absorber between articulating bones.
 Coordination and regulation of different muscle groups depend on muscle tone and activity of antagonistic, synergistic,
and antigravity muscles. Muscle tone, or tonus, is the normal state of balanced muscle tension.
 Antagonistic muscles cause movement at the joint. During movement, the active mover muscle contracts while its
antagonist relaxes.
 Synergistic muscles contract to accomplish the same movement.
 Antigravity muscles stabilize joints. These muscles continuously oppose the effect of gravity on the body and permit a
person to maintain an upright or sitting posture.
  The nervous system regulates movement and posture.
 Proprioception is awareness of the position of the body and its parts.
 Balance is controlled by the cerebellum and inner ear.

Principles of Transfer and Positioning Techniques

 Using principles of safe patient transfer and positioning during routine activities decreases work effort and places less strain
on musculoskeletal structures
 As a nurse you will teach colleagues and patients' families how to transfer or position patients properly
 When moving a patient, knowledge of safe transfer and positioning is crucial.

Pathological influences on body alignment mobility, and activity:

 Congenital defects
 Disorders of bones, joints, and muscles
 Central nervous system damage
 Musculoskeletal trauma

Nursing Knowledge Base

 Comprehensive safe patient-handling programs
 Ergonomics assessment protocol
 Patient assessment criteria
 Algorithms for patient handling and movement
 Special equipment
 Back injury resource nurses
 After-action reviews
 No-lift policy
 Safe patient handling
 Transfer techniques

Factors Influencing Activity and Exercise

1. Developmental changes
 Infants through school-age children
 Adolescence
 Young to middle-age adults
 Older adults
2. Behavioral aspects
 Patients are more likely to incorporate an exercise program if those around them are supportive
3. Environmental issues
 Work site
 Schools
 Community
4. Cultural and ethnic influences
5. Family and social support

Nursing Process
I. Assessment
 Thoroughly assess:
o Body alignment and posture with the patient standing, sitting, or lying down
o Normal physiological changes
o Deviations related to poor posture, trauma, muscle damage, or nerve dysfunction
o Patients’ learning needs
 Through the patient’s eyes
o Assess patient expectations concerning activity and exercise
 Standing

 Head: erect, midline

 o Body: symmetrical
o Spine: straight with normal curvatures
o Abdomen: tucked
o Knees: slightly flexed
o Feet: pointed forward and slightly apart
o Arms: at sides
 Sitting
o Head: erect
o Neck and vertebral column: in straight alignment
o Body weight: distributed on buttocks and thighs
o Thighs: parallel and in a horizontal plane
o Feet: supported on the floor
o Forearms: supported on the armrest, in the lap, or on a table in front of the chair
 Recumbent position
o Vertebrae: in straight alignment without observable curves
 Mobility
o Gait
o Exercise
 Activity tolerance

II. Nursing Diagnosis

 Activity intolerance
 Ineffective coping
 Impaired gas exchange
 Risk for injury
 Impaired bed mobility
 Impaired physical mobility
 Acute or chronic pain

III. Planning
 Goals and outcomes
 Goal: improve or maintain the patient’s motor function and independence
 Setting priorities
 Take into account the patient’s most immediate needs
 Teamwork and collaboration
 Physical and occupational therapists
 Discharge planning

IV. Implementation
 Health promotion
 Teach patients to calculate maximum heart rate.
 Body mechanics
 Acute care
 Musculoskeletal system
 Joint mobility
 Walking
 Helping a patient to walk
 Assess patient’s ability to walk safely
 Evaluate environment for safety
 Assist patient to sitting position, dangle patient’s legs over the side of the bed 1 to 2 minutes before
standing
 Some patients experience orthostatic hypotension (i.e., a drop in blood pressure that occurs when they
change from a horizontal to a vertical position)
 Provide support at the waist so the patient’s center of gravity remains midline (gait belt)
 Assisting patient who has a fainting (syncope) episode or begins to fall
 A. Stand with feet apart to provide a broad base of support.
B. Extend one leg and let patient slide against it to the floor.
C Bend knees to lower body as patient slides to the floor.
 Restorative and continuing care
 Implement strategies to assist patient with ADLs

Assistive Devices for Walking

I. Walkers
 a lightweight, movable device that stands about waist high and consists of a metal frame with handgrips, four
widely placed sturdy legs, and one open side
 Because it has a wide base of support, the walker provides great stability and security during walking.
 A walker can be used by a patient who is weak or has problems with balance.
 Walkers with wheels
 useful for patients who have difficulty lifting and advancing the walker as they walk because of limited
balance or endurance. Disadvantage is that the walker can roll forward when weight is applied.
 measure walkers by having patients relax their arms at the side of their body and stand up straight. The top of
the walker should line up with the crease on the inside of the wrist
 Elbows should be flexed about 15 to 30 degrees when standing inside the walker, with hands on the handgrips.
 A walker requires a patient to lift the device up and forward. Teach patients how to use walkers safely and avoid
risk of falling.
 The patient holds the handgrips on the upper bars, takes a step, moves the walker forward, and takes another
step.

II. Canes
 are lightweight, easily movable devices made of wood or metal.
 provide less support than a walker and are less stable.
 A person's cane length is equal to the distance between the greater trochanter and the floor

Two common types of canes

 Single straight-legged cane
 is more common and is used to support and balance a patient with decreased leg strength
 Quad cane
 provides the most support and is used when there is partial or complete leg paralysis or some hemiplegia.
 You teach the patient the same three steps that are used with the straight-legged cane.

Using Canes
 Keep cane on stronger side of the body
 Place cane forward 6 to 10 inches, keeping body weight on both legs
 Weaker leg is moved forward, divide weight between cane and stronger leg
 Stronger leg is advanced past cane; divide weight between cane and weaker leg

III. Crutches
 a wooden or metal staff
 often needed to increase mobility.
 Begin crutch instruction with guidelines for safe use
 The use of crutches is often temporary (e.g., after ligament damage to the knee). However, some patients with
paralysis of the lower extremities need them permanently.
The two types of crutches
 Double adjustable or forearm crutch
 has a handgrip and a metal band that fits around the patient's forearm.
 The metal band and the handgrip are adjusted to fit the patient's height.
 Axillary wooden or metal crutch
 most common
 has a padded curved surface at the top, which fits under the axilla. A handgrip in the form of a crossbar is
held at the level of the palms to support the body

Measuring for crutches

 When crutches are fitted, ensure that the length of the crutch is two to three finger widths from the axilla and
position the tips approximately 2 inches lateral and 4 to 6 inches anterior to the front of the patient's shoes
 Determine correct position of the handgrips with the patient upright, supporting weight by the handgrips with
the elbows slightly flexed at 20 to 25 degrees.
 Elbow flexion may be verified with a goniometer

Crutch Walking on Stairs: Ascending Stairs

A. Weight is placed on crutch.
B. Weight is transferred from crutches to unaffected leg on stairs.
C. Crutches are aligned with unaffected leg on stairs.

Crutch Walking on Stairs: Descending Stairs

A. Body weight is on unaffected leg.
B. Body weight is transferred to crutches.
C. Unaffected leg is aligned on stairs with crutches.
Sitting in a chair
A. Both crutches are held in one hand. Patient transfers weight to crutches and unaffected leg.
B. Patient grasps arm of chair with free hand and begins to lower herself into chair.
C. Patient completely lowers herself into chair.

 Restoration of Activity and Chronic Illness

 Nurses design care plans to increase activity and exercise in patients with specific disease conditions and
chronic illnesses such as CHD, hypertension, COPD, and diabetes mellitus.

V. Evaluation
 Through the patient’s eyes
 Are the patient’s expectations being met?
 Patient outcomes
 Reassess the patient for signs of improved activity and exercise tolerance.
 Make comparisons with baseline measures
 Compare actual outcomes with expected outcomes.