1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 26 Exercise and Activity

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  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  Affects mental well-being  Deconditioning is the loss of muscle strength from inactivity. Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  To help promote exercise and activity, you need to understand:  Bedrest  How to prevent complications from bedrest  How to help with exercise  The person’s care plan and your assignment sheet tell you the activities allowed. Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Bedrest  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 (some ADL [activities of daily living] allowed)  Bedrest with commode privileges  Bedrest with bathroom privileges (bedrest with BRP) Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Complications of bedrest involve every system and include:  Pressure ulcers  Constipation and fecal impaction  Urinary tract infections and renal calculi  Blood clots (thrombi)  Pneumonia  Contractures  Muscle atrophy  Orthostatic hypotension (postural hypotension)  Syncope Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Good nursing care prevents complications from bedrest.  The care plan includes: 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

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Exercise helps prevent:  Contractures  Muscle atrophy  Other complications of bedrest  A trapeze is used for exercises to strengthen arm muscles.  The trapeze is also used to move up and turn in bed. Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Range-of-Motion Exercises  Active range-of-motion (ROM) exercises are done by the person.  With passive range-of-motion exercises, someone moves the joints through their range of motion.  With active-assistive range-of-motion 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.  OBRA and the CMS require an assessment and care planning process focused on a person’s range of motion: preventing loss of ROM, increasing ROM, preventing further loss of ROM. Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Ambulation (The Act of Walking)  Some people need help walking.  Some become strong enough to walk alone.  Others will always need help.  After bedrest, activity increases slowly and in steps.  To achieve the goal of walking:  Contractures and muscle atrophy must be prevented.  Proper positioning and exercises are needed during bedrest. Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  When helping the person to walk:  Follow the care plan.  Use a gait (transfer) belt if the person is weak or unsteady.  The person uses hand rails along the wall.  Check the person for orthostatic hypotension. Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Walking aids support the body.  The need may be temporary or permanent.  The type ordered depends on: The person’s condition The person’s condition The amount of support needed The amount of support needed The type of disability The type of disability  Crutches are used when the person cannot use one leg or when one or both legs need to gain strength. Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Follow these safety measures when crutches are used: Check the crutch tips. Check the crutch tips. Check crutches for flaws. Check crutches for flaws. Tighten all bolts. Tighten all bolts. Street shoes are worn. Street shoes are worn. Clothes must fit well. Clothes must 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 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Canes are used for weakness on one side of the body. They help provide balance and support.They help provide balance and support. Single-tip and four-point (quad) canes are common.Single-tip and four-point (quad) canes are common. A cane is held on the strong side of the body.A cane is held on the strong side of the body.  A walker is a four-point walking aid. It gives more support than a cane.It gives more support than a cane. There are many kinds of walkers.There are many kinds of walkers. Baskets, pouches, and trays attach to the walker.Baskets, pouches, and trays attach to the walker. Slide 13

14. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Braces support weak body parts. They prevent or correct deformities or prevent joint movement.They prevent or correct deformities or prevent joint movement. They are applied over the ankle, knee, or back.They are applied over the ankle, knee, or back. You need to keep the skin and bony points under braces clean and dry.You need to keep the skin and bony points under braces clean and dry. You need to report redness, signs of skin breakdown, and complaints of pain or discomfort at once.You need to report redness, signs of skin breakdown, and complaints of pain or discomfort at once. Slide 14

15. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Recreational Activities  OBRA requires activity programs for residents.  A good activity program improves a person’s quality of life.  Activities must meet each person’s interests and physical, mental, and psychosocial needs. Slide 15

16. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  You assist residents with exercise and activity.  You must protect the rights to privacy and personal choice.  The person’s body is not exposed.  Choices are allowed whenever safe and possible. Slide 16