2Review Body Mechanics/ safety II. Discuss Benefits of exerciseIII. Compare rehab and restoritiveIV. Discuss Effects of ImmobilityV. Describe Body Alignment
3VI. Demonstrate Skills of Activity and Exercise Ambulate Walk with CaneWalk with WalkerWheelchair TransferWheelchair Transport(2 Person)Mechanical LiftSupine Position PlacementSide-lying Position PlacementMove up in BedMove up in Bed with LiftSheetPassive Range of Motion/Shoulder and ElbowPassive Range of MotionHip and KneeSupport stocking application
4Review Body MechanicsA. Body mechanics is using muscles of the body correctly to make the best use ofstrength to lift or move objects.1. Nursing Assistants must keep alert atall times to the principles of good body mechanics when transferringresidents or assisting them with activity.2. Refer to Unit II for additional information on body mechanics.
5Discuss Benefits of Exercise Define Exercise – exercise is physical activity or a series of specific movements designed to strengthen the body or parts of the body.Benefits of Exercise1. Physical activity or exercise is important for all ages.2. Improves circulation and the functioning of all body systems.3. Keeps resident mobile, more independent and mentally alert.
6Discuss Benefits of Exercise (Cont.) C. Discuss the Importance of Rest and Sleepwith Activity and Exercise.Adequate rest and sleep promotesimproved strength and enduranceand successful results with exerciseactivities.Plan rest times as a part of the resident’s daily activity.Plan resident’s night time routine to promote a restful night’s sleep.
7Describe Principles of Rehabilitation Define rehabilitationProcess of treatment and education that leads the disabled person to attain maximum function and a sense of well being. Residents having strokes or broken hips may have rehabilitation therapy
8Describe Principles of Rehabilitation (Cont.) Define rehabilitation (Cont.)Involves physicians as well as physicaltherapists, occupational therapists andspeech therapists.2. The nursing department participates in the plan of treatment and education.3. Nursing Assistants participatein rehabilitation by following the resident’s plan of care.4. Principles of rehabilitation includeprevention, maintenance and restoration.
9Describe Principles of Rehabilitation (Cont.) Define Restorative CareProcess of assisting a person to help himself/herself to maintain his/her highest level of physical and mental ability. Residents experiencing general aging limitations will benefit from restorative care.
10Describe Principles of Rehabilitation (Cont.) Define Restorative Care (Cont.)Consult resident’s care plan for individualized care.Encourage resident self help with ADL’s by using adaptive equipment such as long handled shoe horn or grippers when suggested by Occupational Therapist on care plan.3. Focus on resident’s abilities.4. Encourage active range of motion.
11Describe Principles of Rehabilitation (Cont.) Define Restorative Care (Cont.)Encourage to do part of bathing, dressing, grooming and other ADL’s. Provide passive range of motion when indicated on care plan.6. Encourage resident to be as independent as possible if consistent with the care plan.
12Describe Principles of Rehabilitation (Cont.) Describe Progressive MobilizationA process that builds on activity steps which to increase the resident’s abilities.
13Discuss Effects of Immobility Immobility affects the resident’s physical and psycho-social needs. Inactivity leads to deterioration and complications in all body systems.A. Physical effects of immobility1. Circulatorya. Blood vessels may tend to pool, causing blood clots.b. Poor blood flow may cause edema (swelling) in tissues.c. Increases work load for the heart.d. Decreases functioning in all body systems.
14Discuss Effects of Immobility (Cont.) 2. Respiratory a. More difficult for lungs to expand.b. Tendency toward respiratory infections.3. Urinarya. Without gravity, urine tends to be retained in the bladder, causing infections of the urinary tract (UTI).4. Digestivea. Loss of appetite.b. Inactivity leads to constipation.
15Discuss Effects of Immobility (Cont.) 5. Musculo-skeletal a. Calcium loss is increased when stress (activity) is not placed on bones; leads to risk for fractures.b. Contractures (shortening and tightening) of muscles occurs in muscles that are not used.6. Integumentary (skin)a. Pressure ulcers involving skin and deeper tissue develop quickly on the resident who does not have frequent position changes.
16Discuss Effects of Immobility (Cont.) B. Mental effects from immobility1. Inactivity leads to loss of self esteem, low self concept, poor body image, and increased dependence on others.2. Inactivity can lead to depression.C. Social effects from immobility1. Lack of social activity or stimulation leads to withdrawal, isolation or loneliness.Discuss Effects of Immobility (Cont.)
17Describe Body Alignment The correct positioning of the resident’s body is referred to as body alignment. Body alignment means positioning the resident in good posture, whether in a sitting or lying position. It is the position where the body is most comfortable and body systems function the best.
18Describe Body Alignment (Cont.) A. Sitting1. In Bed (Fowler’s position)Resident is lying on his/her back. With head and knees elevated.Make certain resident’s hips are at bend of bed.May be necessary to move resident up in bed at intervals.Use pillows to assist if consistent with care plan.
19Describe Body Alignment (Cont.) Sitting (Cont.)In a chaira. Feet should be flat on floor or foot stool.b. Hip and knees at right ankles.c. Buttocks should rest firmly against back of chair.d. Spine should be straight (natural curve) against back of chair.e. Head should be directly over shouldersf. Support elbows on armrests.g. May be necessary to position some residents with pillows to maintain good alignment.
20Describe Body Alignment (Cont.) B. LyingSupine Position (lying on back)a. A small pillow under the resident’s head usually allows for better alignment than a large pillow.b. A footboard helps to keep the feet in proper alignment and prevents footdrop.
21Describe Body Alignment (Cont.) B. Lying (Cont.)Side Lying Position (lateral position)a. Pillows support upper arm and leg.b. Position upper leg so weight does not rest on lower leg.c. A pillow placed lengthwise is used to support the resident’s back and maintain the position.
22Describe Body Alignment (Cont.) B. Lying (Cont.)3. Prone PositionUse this position for residents only if directed to do so by nurse or care plan.Turn the resident’s head to one side when lying prone.The resident’s feet may be placed in space between mattress and foot of bed to keep in good alignment.
23Describe Body Alignment (Cont.) B. Lying (Cont.)Use positioning devices if indicated.a. Pillowsb. Cushions
24Describe Body Alignment (Cont.) C. Guidelines for Moving and Lifting Residents1. Plan your movesa. Consult resident’s care plan.b. Ask for assistance if needed.Organize equipment.c. Explain procedure to resident, making certain he/she understands what is to be done.
25Describe Body Alignment (Cont.) C. Guidelines for Moving and Lifting Residents (Cont.)2. Use lifting devices if indicated.a. Lift sheets.b. Mechanical lifts.c. At least two people are required when using a mechanical lift.
26Describe Body Alignment (Cont.) C. Guidelines for Moving and Lifting Residents (Cont.)3. Position bed at proper heighta. In low position when transferring resident in or out of bed.b. At working level when moving or changing position of resident in bed.
27Describe Body Alignment (Cont.) D. Safety Reminders Use brakes on equipment such as beds,wheelchairs and lifts.2. Always check to make sure equipmentused for lifting or moving residents isin proper working condition.3. When transferring a resident toanother surface, move resident towardhis/her stronger side.
28Describe Body Alignment (Cont.) D. Safety Reminders (Cont.) 4. Support resident’s weaker side when transferringa. Residents having had a stroke will have hemiplegia (paralysis) on half (left or right) side of the body.5. Be alert to tubing safety.6. Make certain all surfaces are stable.7. Have resident wear non-skid shoes.
29Describe Body Alignment (Cont.) D. Safety Reminders (Cont.) 8. Apply artificial limbs and braces correctly.9. Do not lift under arms of resident; this can cause Shoulder dislocation.10. Support body parts when turning resident.11. Transport residents with care; approach corners slowly and observe for cross traffic.
30Describe Body Alignment (Cont.) D. Safety Reminders (Cont.) 12. Observe and report any change in resident condition.a. Dizziness, unsteadiness, ability to complete or manage activity.b. Signs of skin irritation.c. Resident’s comments.
31Describe Body Alignment (Cont.) E. Psychosocial Influences 1. Allow resident to assist as much as possible if consistent with care plan.2. Encourage resident if able, to be “in charge” of transfer.a. Ask resident to count (1,2,3, move).b. Offer choices to resident, such as where to be transported to or when to be transferred.
32Describe Body Alignment (Cont.) Psychosocial Influences (Cont.)3. Be aware the inability to move aboutfreely is a great loss of the resident’s independence.4. Be alert to the resident’s fears, such as falling or being left alone.
33Use of TED HoseTED hose are elastic stockings used to promote circulation back to the heart.TED hose are also called anti embolism stockings. ( To prevent blood clots)TED hose are put on residents in am before getting up and removed at night.TED hose are physician ordered. Check care plan.
35Discuss Assisting with Activity and Exercise in the Client’s HomeA. Review principles of rehabilitation and restorative care.B. Review safety in the client’s home.
36C. Identify special considerations with activity in the client’s home. Discuss Assisting with Activity and Exercisein the Client’s Home (Cont.)C. Identify special considerations with activity in the client’s home.1. Choose a safe supportive chair. a. A low to the floor, soft chair or a reclining type chair is difficult to get out of, especially if client is weak.b. A chair with arms is easier for client to push out of chair.c. Should provide the most independence.
37Discuss Assisting with Activity and Exercise in the Client’s Home (Cont.) C. Identify special considerations with activity in the client’s home (Cont.)Plan Transfersa. There is no one immediately available to assist if a problem occurs.b. Position chairs to prevent chairs from sliding and to provide safe transfers.c. Do a “walk through” by yourself to see that the plan will work.d. Instruct the client carefully so he/she understands the plan.e. Concentrate on what you are doing.
38Discuss Assisting with Activity and Exercise in the Client’s Home (Cont.) C. Identify special considerations with activity in the client’s home (Cont.)Review mechanical lift procedure and follow agency policy.4. Assist with rehabilitation activities as directed.a. Home health agency may have or contract for physical therapy services.b. Follow care plan.c. Report activities or concerns to supervisor.
40Sleep and Rest Needs of Child A. Sleep is necessary for the rapid growth of infants and children.Maintain child’s routine or plan routine with supervisor.Newborns usually sleep 20 out of 24 hours and are awake mostly to eat.
41Sleep and Rest Needs of Child Infants usually have morning and afternoon naps.Toddlers and preschoolers need 12 hours of sleep a day. Some take a nap or have a rest time to look at books or other quiet activity.A child confined to bed for medical reasons need to have play activity included as part of the routine.