posture, mobility and ambulation

8/14/2019 Posture, Mobility and Ambulation

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Posture, mobility andambulation

Ella Yu (VL)


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Posture, mobility and ambulation

(Kozier, Activity and Exercise )

Describe four basic elements of normal

movement

Differentiate isotonic, isometric, isokinetic,aerobic and anaerobic exercise

Compare the effects of exercise and

immobility on body systems

Identify factors influencing a persons body

alignment and activity


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Posture, mobility and

ambulation

Assess activity- exercise pattern, alignment,mobility capabilities and limitations, activitytolerance and potential problems related to

immobilityDevelop nursing diagnoses, outcomes and

interventions related to activity, exercise andmobility problems

Use proper body mechanics whenpositioning, moving, lifting, and ambulatingclients


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Posture, mobility and

ambulation

Mobility The ability to move freely, easily, rhythmically,

and purposefully in the environment

Is vital for independence Mental well-being

Effectiveness of body functioning

Self esteem and body image


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Normal Movement

Alignment and posture Line of gravity (an imaginary vertical line drawn

through the bodys center of gravity)

Center of gravity (the point at which all of the bodymass is centered)

Base of support ( the foundation on which thebody rests)

Proper alignment minimize the strain on the joints,muscles, tendon and ligament and support theinternal organs


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Figure 42.38 A, Balance is maintained when the line of gravity falls close to the base of support. B, Balance isprecarious when the line of gravity falls at the edge of the base of support. C, Balance cannot be maintained whenthe line of gravity falls outside the base of support.


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Which one is correct posture?


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Normal movement

Joint mobility Flexor muscles are stronger than the extensor muscles Inactive- the joints are pulled into a flexed (bent) position Range of Motion (ROM)- maximum movement that is possible for that joint

Balance Vestibular apparatus Brain stem Proprioception- awareness of the posture, movement and changes in equilibrium and

the knowledge of position, weight and the resistance of objects in relation to the body Coordinated movement

Cerebral cortex- initiates voluntary motor activity Cerebellum- coordinates the motor activity. When it is injured, movements become

clumsy and uncoordinated

Basal ganglia- maintain the position


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Joint Movements

Flexion

Extension

Hyperextension

Abduction

Adduction

Rotation

Circumduction (move ina circle)

Eversion (laterally)

Inversion (medially)

Pronation (palm up)

Supination (palm down)


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Exercise

The National Institutes of Health (NIH)

Physical activity: bodily movement produced

by skeletal muscles that requires energy

expenditure and produces progressive health

benefits

Exercise: a type of activity defined as a

planned, structured, and repetitive bodilymovement done to improve or maintain one

or more components of physical fitness


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Types of exercise

Isotonic (dynamic) exercises Muscle shortens to produce muscle contraction

and active movement

Increase muscle tone, mass and strength Maintain joint flexibility and circulation Increase heart rate and cardiac output Running, walking, swimming ADLs and ROM exercises Isotonic bed exercises- using a trapeze to lift the

body off to bed


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Exercises

Isometric (Static or setting) exercises Change in muscle tension No change in muscle length, muscle or joint

movement Exerting pressure against a solid object Cast or traction Extending the legs, tensing the thigh muscles and

press the knee against the bed-quadriceps (or quad)set

Moderate increase in heart rate and cardiac output No appreciable increase in blood flow


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Exercises

Isokinetics (resistive) exercises Muscle contraction or tension against resistance

Isotonic or isometric

E.g. lifting weights to strength the pectorals

(Chest muscle)


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Exercises

Aerobic exercises The activity during which the amount of oxygen

taken in the body is greater than that used to

perform the activity Large muscle groups, performed continuously

and are rhythmic

Walking, jogging, running, swimming, skating

Improve cardiovascular conditioning and physical

fitness


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Measurement of the intensity

1. Maximum heart rate:

(220- current age) X 60-85%

at least 60% of the maximum heart rate is the

recommended intensity


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2. Talk test Keeps most people at 60% of maximum heart rate

or more

When exercising, the person should be able tocarry on a conversation even with some labored

breathing.

Exercise intensity should be increased if the

person can carry on an unlimited unlaboreddiscussion


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of exercise

3. Borg scale of perceived exertion

somewhat hard- 75% of maximum heart rate

Measures how difficult the exercise feels to the person in terms of heart and lung

exertion

6 Very, very light 13 Somewhat hard

(75%)7 14

8 Very light(40%)

15 Hard9 16

10 Fairly light 17 Very hard

11 18

12 19, 20 Very, very hard (100%)


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Exercises

Anaerobic exercises Activity in which cannot draw out enough

oxygen from the bloodstream

Anaerobic pathways are used to provide

additional energy for a short time

Endurance training for athletes such as

weight lifting and sprinting


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Guidelines and minimal

requirements for physical activity

Frequency and duration Aerobic: cumulative 30 minutes or more daily of moderately intensity

Stretching: should be added onto that minimum requirement so that

all parts of the body are stretched each day

Strength training: add onto these minimum requirements so that allmuscle groups are addressed at least three times a week, with a day

of rest after training

Types and safety Please refer to textbook Kozier


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Benefits of Exercise

Musculoskeletal System Size, shape and tone, strength of muscle

Muscle hypertrophy (enlarge)

Increase joint flexibility and range of motion

balance between osteoblast (bone -building cells)

and osteoclasts (bone-resorption and breakdown

cells)


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Cardiovascular system Increase heart rate Strength of heart muscle contraction Increase cardiac output- 30L/ min

Increase blood supply to heart and muscle Level of HDL cholesterol, stress reduction

Respiratory system Increase ventilation and oxygen intake (20 times) More toxins are eliminated Emotional stability, problem solving Prevent pooling of the secretions in bronchi and

bronchioles


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Metabolic System Increase metabolic rate (20 times) Increase production of body heat and waste

products and calorie use Reduce level of serum triglycerides and

cholesterol Enhances the effectiveness of the insulin

Gastrointestinal System Improve appetite Increase peristalsis


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Immune system Lymph fluid from tissue into lymph capillaries

Improve lymph nodes circulation

Natural killer cell, circulating T- cell and cytokines

function- increase resistance to viral infection,

prevent formation of the malignant cells

How about strenous exercise?Urinary system Prevent stasis of urine


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Psychoneurologic system Produce a sense of well-being Improve self-concept

Enhance the quality of sleep Increase levels of metabolites for

neurotransmitters such as norepinephrine andserotonin

Exercise releases endogenous opioids andincrease level of endorphins

Increase oxygen level to brain- euphoria


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Cognitive function Strengthen and build neuronal connections

Brain Gym- easy, cross-lateral movement that

enhance right and left- brain integration thusimproving mood. Learning, problem solving and

performance

The contralateral movements have been shown to

help individual with attention deficit disorder

(ADD), Attention deficit/ hyperactivity disorder

(ADHD), learning disorders and mood disorders


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Spiritual Health Yoga- style exercise- enhance mind- body spirit

The emphasis of breathing- sooth the

cardiorespiratory and nervous system

Walking a labyrinth (a circular mandala)- induce a

meditative state, decrease heart and respiratory

rate, lowering blood pressure and decrease

chronic pain and insomnia


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Walking a labyrinth

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Factors affecting body


Growth and development 1 to 5 years old- gross and fine motor skills refine

6 to 12 years old- the best

Adolescence- awkwardness

20-40years old- pregnancy

Older adult- osteoporosis, fracture

F t ff ti b d


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Factors affecting body


Physical health

Mental health

NutritionPersonal values and attitudes

External factors

Prescribed limitation Bed rest


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Effects of immobility

Musculoskeletal System Disuse osteoporosis- bone demineralize when

there is no stress of weight-bearing, bones

become spongy and fracture easily Disuse atrophy- muscle decrease in size

Contractures- permanent shortening of the

muscle leads to joints immobility and deformity

Stiffness and pain in joints- ankylosing of the

collagen


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Cardiovascular system Diminshed cardiac reserve- tachycardia with

minimal exertion

Increase use of valsalva maneuver- holding thebreath and straining against a closed glottis,

pressure on the large vein and decrease blood

flow to heart and coronary vessels

Orthostatic (postural) hypotension-

vasoconstriction of the lower half of the body


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Cardiovascular system Venous vasodilation and stasis- poor contractility of the

skeletal muscle and incompetent valves

Dependent edema- insufficient venous pressure, blood isforced to interstitial spaces (sacrum, heels)

Thrombus formation

thrombophlebitis: impaired venous return to the heart,

hypercoagulability of the blood and injury to the vessel

walls Embolus: an object move from its place of origin, causing

obstruction to circulation


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Respiratory system Decreased respiratory movement

Pooling of respiratory secretions

Atelectasis- decreased surfactant and blockage of

a bronchiole cause the collapse of a lobe or an

entire lung

Hypostatic pneumonia


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Metabolic system Decreased metabolic rate

Negative nitrogen balance: protein synthesis

(anabolism) < protein breakdown (catabolism),increase excretion of nitrogen

Anorexia: loss of appetite

Negative calcium balance


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Urinary system Urinary stasis- decrease gravity, decrease in

muscle tone

Renal calculi- calcium salts precipitate out ascrystals to form renal calculi

Urinary retention and urinary incontinence

Urinary tract infection


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Gastrointestinal system Constipation

Integumentary system Reduced skin turgor

Skin breakdown

Psychoneurologic system

Decrease self-esteem


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Using body mechanics

The efficient , coordinated and safe use of

the body to move objects and carry out the

activities of daily living

Lifting

Pulling and pushing

Pivoting- turn without twisting of the spine

Preventing back injury


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Positioning of the clients

Fowlers position

Orthopneic position

Dorsal recumbent positionProne position

Lateral position

Sims position



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(please read textbook before the

lab.) Turning the client in the bed

Logrolling the client Why and how we use logrolling?

Transferring between bed and chair

Wheelchair safety

Providing passive range of motion exercise

Low-Fowlers (semi-Fowlers position)(supported).


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Sitting with an overbed table across the lapFacilitates respiratory by allowing maximum chest expansionHelps in inhaling problem/ exhaling problem?

Dorsal recumbent position.


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Lateral position (supported).


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Sims position (supported).


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Moving a client up in bed.


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Moving a client to a lateral position.


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Logrolling

Turn the clients whose body must at all times be kept in

straight alignment (like a log).E.g. spinal injuryTwo nurses/ three nurses

Cervical injury- maintain head and neck alignment


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Logrolling


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Logrolling

Assisting a client to a sitting position on the edge of the bed.


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A i i li i i i i h d f h b d


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Assisting a client to a sitting position on the edge of the bed

Controlling Postural HypotensionRest with the head of the bed

elevatedBe aware the times after the heavy

meals or after hypotensive

medicationNever bend down quickly

Wear elastic stocking/ rockingchair

Hot bath/ valsalva maneuverArise from bed in three stages:

Sit up in bed for 1 minutes

Sit on the side of the bed withthe legs dangling for 1 minutesStand with holding

nonmovable objects for 1

minutes


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Supporting a limb above and below the joint for passive exercise.


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Passive ROM Exercises

Should be systematic, three

repetitions

Twice daily

Use a firm, comfortable grip

and good supports of limbs

smoothly., slowly and

rhythmically

Avoid fast movement- will

cause spasticity and rigidity

Avoid forcing

Firm pressure and stop

temporarily if necessary

Assisting the client to ambulate


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Assisting the client to ambulate

(please read before the lab.)

To provide a safe condition for the client to walk with

whatever support is needed

Using mechanical aids for walking Canes

Walker

Crutches

the tripod position: the crutches are placed about 15cm in front of

the feet and out laterally about 15 cm, creating a wide base of

support Please read the client teaching in using canes, alkers and

crutches


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The wheelchair is placed parallel to the bed as close to the bed as possible. Note the placement of thenurses feet mirrors that of the clients feet.


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Using a transfer (walking) belt.


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Elena Dorfman

Figure 42.67 Lowering a fainting client to the floor.


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Elena Dorfman


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The swing-to crutch gait.


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The swing-through crutch gait.


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The four-point alternate crutch gait.


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Teaching: Client Care: Using Crutches


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A, standard walker; B, A two-wheeled walker.


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Elena Dorfman Elena Dorfman

The three-point alternate crutch gait.


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The two-point alternate crutch gait.


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Teaching: Client Care: Using Walkers


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Teaching: Wellness Care: Preventing Back Injuries


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Safe Use of Stretchers


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posture, mobility and ambulation

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