Let’s Get Moving!

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