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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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Measurement of the intensity
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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Measurement of the intensity
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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Benefits of Exercise
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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Benefits of Exercise
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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Benefits of Exercise
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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Benefits of Exercise
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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Benefits of Exercise
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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Benefits of Exercise
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
F t ff ti b d
http://hk.wrs.yahoo.com/_ylt=A8tU32svT9FJqSEATQu.ygt./SIG=13begpeu1/EXP=1238540463/**http%3A//www.maislabyrinth-eutingen.de/news/files/2004_07_08_22_29/Maislabyrinth_2004.jpg8/14/2019 Posture, Mobility and Ambulation
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Factors affecting body
alignment and activity
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
alignment and activity
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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Effects of immobility
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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Effects of immobility
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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Effects of immobility
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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Effects of immobility
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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Effects of immobility
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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Effects of immobility
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
Positioning of the clients
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Positioning of the clients
(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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