1. Chapter 27 Exercise and Activity Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. Exercise and Activity  Being active is important for physical and mental well-being.  Illness, surgery, injury, pain, and aging cause weakness and some activity limits.  Inactivity, whether mild or severe, affects:  Every body system  Mental well-being  Deconditioning is the loss of muscle strength from inactivity. Slide 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Exercise and Activity (cont’d)  Nurses use the nursing process to promote exercise and activity in all persons to the extent possible.  To help promote exercise and activity, you need to understand:  Bedrest  How to prevent complications from bedrest  How to help with exercise Slide 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4.  Generally, bedrest is ordered to:  Reduce physical activity.  Reduce pain.  Encourage rest.  Regain strength.  Promote healing.  These types of bedrest are common:  Strict bedrest  Bedrest with some ADL [activities of daily living] allowed  Bedrest with commode privileges  Bedrest with bathroom privileges (bedrest with BRP) Slide 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Bedrest

5.  Complications from bedrest include:  Pressure ulcers  Constipation and fecal impaction  Urinary tract infections and renal calculi (kidney stones)  Blood clots (thrombi)  Pneumonia (inflammation and infection of the lung)  Contractures  Atrophy  Orthostatic hypotension (postural hypotension)  Syncope (fainting) Slide 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Bedrest (cont’d)

6.  Good nursing care prevents complications from bedrest.  Important measures included in the care plan include Good alignment Good alignment Range-of-motion exercises Range-of-motion exercises Frequent position changes Frequent position changes  Supportive devices are often used.  Bed-boards  Foot-boards  Trochanter rolls  Hip abduction wedges  Hand rolls or hand grips  Splints  Bed cradles Slide 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Bedrest (cont’d)

7.  Exercise helps prevent:  Contractures  Muscle atrophy  Other complications from bedrest  Some exercise occurs:  With ADL  When turning and moving in bed without help  A trapeze is used:  For exercises to strengthen arm muscles  To move up and turn in bed Slide 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Bedrest (cont’d)

8. Range-of-Motion Exercises  Range-of-motion exercises (ROM) involve moving the joints through their complete range of motion. They are usually done at least 2 times a day.  Active ROM exercises are done by the person.  Passive ROM exercises—someone moves the joints through their range of motion.  Active-assistive ROM exercises—the person does the exercises with some help.  Persons on bedrest need more frequent ROM exercises; so do those who cannot walk, turn, or transfer themselves because of illness or injury. Slide 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Ambulation (Walking)  After bedrest, activity increases slowly and in steps.  First, the person sits on the side of the bed (dangles).  Sitting in a bedside chair follows.  Next, the person walks in the room and then in the hallway.  Regular walking helps prevent deconditioning.  Use a gait (transfer) belt if the person is weak or unsteady.  The person also uses hand rails along the wall.  Always check for orthostatic hypotension. Slide 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10.  Walking aids support the body.  The need may be temporary or permanent.  The type ordered depends on the: Person’s condition Person’s condition Amount of support needed Amount of support needed Type of disability Type of disability  Crutches are used when the person cannot use one leg or when one or both legs need to gain strength. Slide 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Ambulation (Walking) (cont’d)

11.  The person on crutches is at risk for falls. Follow these safety measures: Check the crutch tips. Check the crutch tips. Check crutches for flaws. Check crutches for flaws. Tighten all bolts. Tighten all bolts. Make sure the person wears street shoes with flat, non-skid soles. Make sure the person wears street shoes with flat, non-skid soles. Make sure clothes fit well. Make sure clothes fit well. Practice safety rules to prevent falls. Practice safety rules to prevent falls. Keep crutches within the person’s reach. Keep crutches within the person’s reach. Know which crutch gait the person uses. Know which crutch gait the person uses. Slide 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Ambulation (Walking) (cont’d)

12.  Canes are used for weakness on one side of the body.  They help provide balance and support.  Single-tip and four-point (quad) canes are common.  A cane is held on the strong side of the body.  A walker gives more support than a cane.  Wheeled walkers are common.  Baskets, pouches, and trays attach to the walker. Slide 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Ambulation (Walking) (cont’d)

13.  Braces support weak body parts.  They also prevent or correct deformities or prevent joint movement.  A brace is applied over the ankle, knee, or back. An ankle-foot orthosis (AFO) is placed in the shoe. An ankle-foot orthosis (AFO) is placed in the shoe.  You need to: Keep skin and bony points under braces clean and dry. Keep skin and bony points under braces clean and dry. Report redness or signs of skin breakdown at once. Report redness or signs of skin breakdown at once. Report complaints of pain or discomfort. Report complaints of pain or discomfort.  The care plan tells you when to apply and remove a brace. Slide 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Ambulation (Walking) (cont’d)