1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 26 Exercise and Activity

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2  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 Every body system Mental well-being Mental well-being

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3  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 Bedrest How to prevent complications from bedrest How to prevent complications from bedrest How to help with exercise How to help with exercise

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 4  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

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5  These types of bedrest are common: Strict bedrest Strict bedrest  Everything is done for the person. Bedrest Bedrest  Some activities of daily living (ADL) are allowed. Bedrest with commode privileges Bedrest with commode privileges Bedrest with bathroom privileges (bedrest with BRP) Bedrest with bathroom privileges (bedrest with BRP)

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6  Complications of bedrest include: Pressure ulcers Pressure ulcers Constipation and fecal impaction Constipation and fecal impaction Urinary tract infections and renal calculi (kidney stones) Urinary tract infections and renal calculi (kidney stones) Blood clots (thrombi) Blood clots (thrombi) Pneumonia (inflammation and infection of the lung) Pneumonia (inflammation and infection of the lung) Contractures Contractures Muscle atrophy Muscle atrophy Orthostatic hypotension (postural hypotension) Orthostatic hypotension (postural hypotension) Syncope (fainting) Syncope (fainting)

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7  Good nursing care prevents complications from bedrest. Good alignment Good alignment Range-of-motion exercises Range-of-motion exercises Frequent position changes Frequent position changes  These are part of the care plan.

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8  Supportive devices are often used. Bed boards prevent the mattress from sagging. Bed boards prevent the mattress from sagging. Foot boards prevent plantar flexion and serve as bed cradles. Foot boards prevent plantar flexion and serve as bed cradles. Trochanter rolls prevent the hips and legs from external rotation. Trochanter rolls prevent the hips and legs from external rotation. Hip abduction wedges keep the hips abducted. Hip abduction wedges keep the hips abducted. Handrolls or handgrips prevent contractures of the thumb, fingers, and wrist. Handrolls or handgrips prevent contractures of the thumb, fingers, and wrist. Splints keep the elbows, wrists, thumbs, fingers, ankles, and knees in normal position. Splints keep the elbows, wrists, thumbs, fingers, ankles, and knees in normal position. Bed cradles keep the weight of top linens off the feet and toes. Bed cradles keep the weight of top linens off the feet and toes.

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9  Exercise helps prevent: Contractures Contractures Muscle atrophy Muscle atrophy Other complications of bedrest Other complications of bedrest  Some exercise occurs: With ADL With ADL When turning and moving in bed without help When turning and moving in bed without help  A trapeze is used: For exercises to strengthen arm muscles For exercises to strengthen arm muscles To move up and turn in bed To move up and turn in bed

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10  RANGE-OF-MOTION EXERCISES  Range-of-motion exercises involve moving the joints through their complete range of motion. Active range-of-motion exercises are done by the person. 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 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. With active-assistive range-of-motion exercises, the person does the exercises with some help.

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 11  AMBULATION  Ambulation is the act of walking.  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.  Walking regularly helps prevent deconditioning.

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12  Walking aids Walking aids support the body. Walking aids support the body. The type ordered depends on: The type ordered depends on:  The person’s condition  The amount of support needed  The type of disability

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13  Crutches are used when the person cannot use one leg or when one or both legs need to gain strength.  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.

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14  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.

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15  Braces support weak body parts. They also prevent or correct deformities or prevent joint movement. They also prevent or correct deformities or prevent joint movement. A brace is applied over the ankle, knee, or back. 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: You need to:  Keep skin and bony points under braces clean and dry.  Report redness or signs of skin breakdown at once.  Report complaints of pain or discomfort. The care plan tells you when to apply or remove a brace. The care plan tells you when to apply or remove a brace.

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 16  RECREATIONAL ACTIVITIES  OBRA requires activity programs for residents.  Recreational activities: Are important for a person’s physical and mental well- being Are important for a person’s physical and mental well- being Exercise joints and muscles Exercise joints and muscles Stimulate circulation Stimulate circulation Are social events Are social events Are mentally stimulating Are mentally stimulating  A good activity program improves a person’s quality of life.