1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 24 Exercise and Activity

2. Slide 2 Copyright © 2007, 2003 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 every body system Affects mental well-being Affects mental well-being  Deconditioning is the loss of muscle strength from inactivity.

3. Slide 3 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  To help promote exercise and activity, you need to understand: Bedrest Bedrest How to prevent complications from bedrest How to prevent complications from bedrest How to help with exercise How to help with exercise

4. Slide 4 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  BEDREST  Generally bedrest is ordered to: Reduce physical activity Reduce physical activity Reduce pain Reduce pain Encourage rest Encourage rest Regain strength Regain strength Promote healing Promote healing  These types of bedrest are common: Strict bedrest Strict bedrest Bedrest Bedrest Bedrest with commode privileges Bedrest with commode privileges Bedrest with bathroom privileges (bedrest with BRP) Bedrest with bathroom privileges (bedrest with BRP)

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The person’s care plan and your assignment sheet tell you the activities allowed.  Complications of bedrest involve every system and include: Pressure ulcers Pressure ulcers Constipation and fecal impaction Constipation and fecal impaction Urinary tract infections and renal calculi Urinary tract infections and renal calculi Blood clots (thrombi) Blood clots (thrombi) Pneumonia Pneumonia Contractures Contractures Muscle atrophy Muscle atrophy Orthostatic hypotension (postural hypotension) Orthostatic hypotension (postural hypotension)

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Good nursing care prevents complications from bedrest. The care plan includes: The care plan includes:  Good alignment  Range-of-motion exercises  Frequent position changes  Supportive devices are often used. Bed boards Bed boards Foot boards Foot boards Trochanter rolls Trochanter rolls Hip abduction wedges Hip abduction wedges Hand rolls or handgrips Hand rolls or handgrips Splints Splints Bed cradles Bed cradles

15. Slide 15 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Exercise helps prevent: Contractures Contractures Muscle atrophy Muscle atrophy Other complications of bedrest 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. The trapeze is also used to move up and turn in bed.

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  RANGE-OF-MOTION EXERCISES  Active range-of-motion 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.  OBRA requires an assessment and care planning process to prevent unnecessary loss in a person’s range of motion.

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

19. Slide 19 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

20. Slide 20 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

22. Slide 22 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  AMBULATION  Some people need help walking. Some become strong enough to walk alone. Some become strong enough to walk alone. Others will always need help. 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. Contractures and muscle atrophy must be prevented. Proper positioning and exercises are needed during bedrest. Proper positioning and exercises are needed during bedrest.

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  When helping the person to walk: Follow the care plan. Follow the care plan. Use a gait (transfer) belt if the person is weak or unsteady. Use a gait (transfer) belt if the person is weak or unsteady. The person uses hand rails along the wall. The person uses hand rails along the wall. Check the person for orthostatic hypotension. Check the person for orthostatic hypotension.

27. Slide 27 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Walking aids support the body. The need may be temporary or permanent. The need may be temporary or permanent. The type ordered depends on: The type ordered depends on:  The person’s condition  The amount of support needed  The type of disability Crutches are used when the person cannot use one leg or when one or both legs need to gain strength. Crutches are used when the person cannot use one leg or when one or both legs need to gain strength.

28. Slide 28 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Follow these safety measures when crutches are used: Follow these safety measures when crutches are used:  Check the crutch tips.  Check crutches for flaws.  Tighten all bolts.  Street shoes are worn.  Clothes must fit well.  Practice safety rules to prevent falls.  Keep crutches within the person’s reach.  Know which crutch gait the person uses.

29. Slide 29 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Canes are used for weakness on one side of the body. 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 is a four-point walking aid. A walker is a four-point walking aid.  It gives more support than a cane.  There are many kinds of walkers.  Baskets, pouches, and trays attach to the walker. Braces support weak body parts. Braces support weak body parts.  They prevent or correct deformities or prevent joint movement.  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 report redness, signs of skin breakdown, and complaints of pain or discomfort at once.

30. Slide 30 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.

34. Slide 34 Copyright © 2007, 2003 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.

35. Slide 35 Copyright © 2007, 2003 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. The person’s body is not exposed. Choices are allowed whenever safe and possible. Choices are allowed whenever safe and possible.