Lisa B. Flatt, RN, MSN, CHPN

Let’s Get Moving!

The Cornerstones of Nursing CareMaintaining mobilitySupporting increased mobility

Priniciples of body alignmentBody mechanicsRange of Motion (ROM)PositioningTransfer

Mobility PrinciplesBody alignment – ideal body position,

proper anatomical positionPositioning changes depending on

how/what you are doingIdeal 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

Body MechanicsProtection of MS system

Nursing Care Plan & Implications

Weight to center of gravity

Lift with legsStraight back

Implementation: instruct patient and family about body mechanics and safe patient handling

Evaluation: return demonstration and verbalization of techniques; injury free

ROM – part of every joint, nose to toes!Active ROM: patient does selfActive-assisted ROM: patient does with

assistancePassive ROM: caregiver does all the work

Influencing factors on Activity & MobilityAge & developmental

levelPreferences & patternsInitial physical conditionCulture/spiritual/

religiousSocioeconomicEnvironmentalPsychological –

depressionObesityNutritional statusFinancesHousing (stairs)

Cardiovascular statusEducational levelCongenital or acquired

postural anomaliesVitamin D deficienciesMS disordersRespiratory statusCV statusChronic IllnessClimateAltitudeOccupation

Nursing ImplicationsContracture 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_

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

Diseases & Nursing ConsiderationsOsteoporosis – 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 massOlder adults – kyphosis, gait changes, muscle tone,

joint mobilityChronic illnessesSmoking/dipping/chewingSedentary lifestylePsychological benefits of exerciseNutritional status

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_________

Psychological HopelessnessHelplessSensory deprivationSleep issuesAttention-seekingPowerlessnessDevelopmental

Nursing InterventionsExercisesPositioningSupportive devicesTransfer techniquesPrevention programsAssistive devicesAlternative and complementary treatmentsActive and passive ROMQuadriceps-settingWeights

The lay of the land - positioningFowlers – 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 elevatedProne – lying flat on back Sims’ (semi-prone) – between lateral and

prone (ie enema assume the position)

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

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.

Exercise – a dirty word?Aerobic – using air- hehe - burning caloriesWeight – what we have Resistive (isokinetic)- pushing againstIsotonic – muscles movesIsometric – muscle tensesTarget heart rate – 60-85% of maximumMaximum heart rate – 220-ageTalk test – carry on a conversation without labored

breathingBorg’s scale is- perception of exertion or how difficult

the exercise feels related to heart and lung exertion

Complementary therapyChiropracticAcupunctureAcupressureTherapeutic touchMassageReflexology