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Let’s Get Moving!

Let’s Get Moving!. Lisa B. Flatt, RN, MSN, CHPN. The Cornerstones of Nursing Care. Maintaining mobility Supporting increased mobility Priniciples of body alignment Body mechanics Range of Motion (ROM) Positioning Transfer. Mobility Principles.

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Let’s Get Moving!

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  1. Let’s Get Moving! Lisa B. Flatt, RN, MSN, CHPN

  2. The Cornerstones of Nursing Care • Maintaining mobility • Supporting increased mobility • Priniciples of body alignment • Body mechanics • Range of Motion (ROM) • Positioning • Transfer

  3. Mobility Principles • Body alignment – ideal body position, proper anatomical position • Positioning changes depending on how/what you are doing • Ideal position: • Centered cranium (midline shoulders, facing forward) • Arms hanging at sides palms midline and fingers slightly bent • Weight is mostly on hips, knees not locked, feet slightly apart and pointed forward

  4. Body Mechanics Protection of MS system Nursing Care Plan & Implications Weight to center of gravity Lift with legs Straight back Implementation: instruct patient and family about body mechanics and safe patient handling Evaluation: return demonstration and verbalization of techniques; injury free

  5. ROM – part of every joint, nose to toes! • Active ROM: patient does self • Active-assisted ROM: patient does with assistance • Passive ROM: caregiver does all the work

  6. Influencing factors on Activity & Mobility • Age & developmental level • Preferences & patterns • Initial physical condition • Culture/spiritual/religious • Socioeconomic • Environmental • Psychological – depression • Obesity • Nutritional status • Finances • Housing (stairs) • Cardiovascular status • Educational level • Congenital or acquired postural anomalies • Vitamin D deficiencies • MS disorders • Respiratory status • CV status • Chronic Illness • Climate • Altitude • Occupation

  7. Nursing Implications • Contracture prevention - ___ROM, positioning_______ • Nursing responsibility- _teaching, turning_____ • Positioning - ___reduce pressure, promote health____ • Importance of alignment - ___decrease injury___ • Transferring - __safety, prevent injury_____ • Exercise - ____promotes health____ • Bedrest - ___evil or good depending___ • Immobility issues - _contractures, pneumonia, pressure sores, UTI, weakness, nerve damage_

  8. The Evils of Bedrest! • Encourage ROM and bed activity • Systems affected • Respiratory ___lung expansion decreases; fluids pool; decreased tolerance__ • MS __decreased strength, muscle wasting, contractures, loss of mobility_ • Cardiac __arrhythmias, decreased tone, fluids pooling, not increasing heart rate_ • Vital signs ___depressed__ • Appetite __decreases__ • GU__UTI, incontinence____ • GI_incontinence, constipation____ • Psychosocial – depression and isolation

  9. Diseases & Nursing Considerations • Osteoporosis – primarily effects___women___ who are of __asian, caucasian__descent ___thin____small boned? • Television and obesity ___more tv = less exercise = fatter__ • Athletics – social outlet – teamwork with peers –increase muscle mass • Older adults – kyphosis, gait changes, muscle tone, joint mobility • Chronic illnesses • Smoking/dipping/chewing • Sedentary lifestyle • Psychological benefits of exercise • Nutritional status

  10. Disturbed…. Oh yeah.. Immobility  • CV__diminshed cardiac reserve and muscle tone______ • Repiratory __decreases amt of air take in, lung compliance, decreased air exchange__ • Orthostatic hypotension___shift in position causes bp changes/ lowering_ • Metabolism ___slows way down…….._ • Pressure Ulcers__bad__ • Venous __stasis, stasis ulcers, blood pools, mottling, dvt__ • GI _constipation, decreased motility___ • GU__UTI, incontinence, decrease urination_ • Skin _____poor, tenting__________________ • Thrombophlebitis ___bid bad risk_________

  11. Psychological • Hopelessness • Helpless • Sensory deprivation • Sleep issues • Attention-seeking • Powerlessness • Developmental

  12. Nursing Interventions • Exercises • Positioning • Supportive devices • Transfer techniques • Prevention programs • Assistive devices • Alternative and complementary treatments • Active and passive ROM • Quadriceps-setting • Weights

  13. The lay of the land - positioning • Fowlers – HOB 45*-90* • Semi-fowlers – HOB 15*-45* • High-fowlers- HOB- 90* • Orthopneic – like high-fowlers with arms over table (ie) • Dorsal recumbent – lying on back, shoulders slightly elevated • Prone – lying flat on back • Sims’ (semi-prone) – between lateral and prone (ie enema assume the position)

  14. Are you there for me? Support! • Pillows, mattresses, bed boards, chair beds, foot boots, footboards, trochanter rolls, sand bags, handrails, restraints • Safe transfer techniques: elevate bed, get help • Mechanical aids & Safety: lifts, slider sheets, chair riser, trapeze • Wheelchairs – brakes, foot pads • Crutches (117) • 4 point gait – safest, one crutch, one foot, one crutch opposite foot • 3 point gait – both crutches and weaker leg first • 2 point gait – opposite crutch and leg • Swing through gait – crutches then body swings through • Swing to gait – body and then crutches • Canes – various kinds, depends on what is needed • Transfer belts • Bedside rails • Trapeze • Lifts

  15. Sample of Nursing Care Plan (120) • Assessment: SOB, Dyspenic when climbing stairs, Unemployed, • Diagnosis: Activity intolerance R/T sedentary lifestyle manifested by SOB on exertion. • Plan: • Pt will verbalize the need to incorporate exercise into daily activity. • Find Pt’s activity preference • Implementation: • Pt will work with PT three times/wk. Nursing staff will also walk pt twice per day working towards ambulating 100ft. • Will educate pt on benefits of exercising. • Administer Resp. Tx prior to ambulation • Evaluation: • Pt ambulated twice per day with stand by assist up to 150ft. • Verbalizes education of benefits in exercising. • RT gave Tx’s prior to ambulation.

  16. Exercise – a dirty word? • Aerobic – using air- hehe - burning calories • Weight – what we have  • Resistive (isokinetic)- pushing against • Isotonic – muscles moves • Isometric – muscle tenses • Target heart rate – 60-85% of maximum • Maximum heart rate – 220-age • Talk test – carry on a conversation without labored breathing • Borg’s scale is- perception of exertion or how difficult the exercise feels related to heart and lung exertion

  17. Complementary therapy • Chiropractic • Acupuncture • Acupressure • Therapeutic touch • Massage • Reflexology

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