The Virtues of

Activity

The Evils of
Immobility
Chapter 29
Dr. Jon Christensen
 The Virtues of
Activity
 Makes the heart stronger and more efficient in maintaining
CO, Cardiac reserve is enhanced. ↓ fatigue
 Better gas exchange in the alveoli. Increased vital capacity
 Stronger bones and muscles enhancing movement and
balance Reduces risk of osteoporosis and OA
 ↑ insulin sensitivity at the cellular level decreasing risk of
diabetes
 Strengthens immune function
 Enhances mood and coping abilities
 ↓ pain, stress, inflammation, and anxiety
 Enhances sleep
 Assists in maintaining healthy body weight
 Reduces risk for many diseases and disorders: HTN; Stroke;
CAD
 See Box 29-3
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 Concepts
 Mobility
 Fitness
 Physical activity
 Exercise
 The musculoskeletal & nervous system work in
concert to allow for mobility and movement
 The autonomic nervous system innervates
involuntary muscles.
 The somatic nervous system innervates
voluntary skeletal muscles

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 Body Mechanics
1. Body alignment
2. Balance
3. Coordination
4. Joint mobility
 Active & passive ROM (Note: Do not
memorize Table 29-2)

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 Body Mechanics
 Nurses suffer back injury at a high
rate
 Some nurses are forced to leave the
profession
 OSHA regulations state that lifting is
a technical skill
 Only lift objects weighing 50 or less
 With handles!
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 Body Mechanics: Avoiding
Injury
 Use proper alignment.
 Have a wide base of support.
 Avoid bending and twisting.
 Squat to lift.
 Keep objects close to body when lifting.
 Raise beds when giving care.
 Push versus lift.
 Get help and use appropriate resources

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 Types of Exercise
 Isometric
 Isotonic
 Isokinetic
 Aerobic
 Anaerobic
 What is the best type of exercise?

Weights; aerobic; flexibility?
 There are some risks associated with
exercise
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 Mobility – Risk Factors
 Developmental stage – focus on older adults
 Physical health: COPD, CAD, Fatigue
 Environmental factors
 Congenital abnormalities
 Musculoskeletal problems
 Bone integrity: Osteoporosis & Osteomyelitis
 Problems affecting joint mobility
 RA, OA, Gout

 Problems affecting the central nervous system –

CVA, trauma, MS, MG

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 Evils of
Immobility
Musculoskeletal: Atrophy; Wasting; CV: Venous stasis; ↓ Cardiac
Contractures; Frozen & stiff joints reserve; Edema; Risk for
thrombosis & DVT; Orthostatic
hypotension
Lungs: ↓ ventilation; Pulmonary Metabolism: ↓ energy; ↓
edema (pooling of secretions); metabolic rate; ↓ muscle mass;
Atelectasis; Risk for pneumonia Stress response; Calcium
resorption & excetion; Risk for
fractures
Urinary: ↑ calcium levels; Risk for Psychosocial: Mood; ↓ cognition; ↓
renal calculi; Urinary retention; motivation for self care and ADLs
Risk for infection
GI: ↓ peristalsis; Constipation; Skin: Pressure injury
Paralytic ileus; ↓ appetite; Muscle
catabolized
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 Assessment
 Focused nursing history
 Focused physical assessment
 BMI
 Joint function – ROM & alignment
 Gait
 Muscle strength
 Activity tolerance
 Pain & Inflammation
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 Nursing Diagnoses
 Activity Intolerance
 Impaired Physical Mobility
 Risk for Disuse Syndrome
 Sedentary Lifestyle

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 Implementation: Acute
Care

 Metabolic  Musculoskeletal system


High-protein, high-calorie diet 
Prevent muscle atrophy and
with vitamin B and C joint contractures - ROM
supplements.  Integumentary system
 Respiratory 
Reposition every 1 to 2

Cough and deep breathe or use hours.
spirometer every 2 hours. 
Provide skin care.

Provide chest physiotherapy.  Elimination system
 Cardiovascular 
Provide adequate

Reducing orthostatic hypotension hydration.

SCDs, thromboembolic disease

Serve a diet rich in fluids,
(TED), hose, and leg exercises fruits, vegetables, and
fiber.

Reducing cardiac workload
 Psychosocial changes

Preventing thrombus formation

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 Implementation: Health
Promotion
 Promote exercise – see box 29-5 for
suggestions on how
 Bone health in patients with osteoporosis
 Calcium/Vit. D
 Weight-bearing exercise
 Avoid steroids
 Prevention of falls
 Incorporate overhead trapeze, footboard,
splints
 Assist with ambulation
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 Prevention: Immobile
patients are at risk for
everything!
 EARLY AMBULATION!!! Get OOB
 CV
 Prevent orthostasis
 DVT: TEDS, SCD
 Respiratory
 Cough & deep breathe
 GI: Fluids & fiber; Upright to toilet
 GU: Adequate fluids; Upright to toilet
 Musculoskeletal: Positioning; ROM
 Skin: Positioning; Hydration; avoid friction, shear, moisture
 Psychological wellbeing: Active; Social; Independent
 Provide assistive devices for ambulation

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 Range of Motion
Types Terms
Flexion
Active


 Extension
 Passive  Hyperextension
 Rotation
 Assistive  Internal

 Continuous –  External

i.e. CPM
 Abduction
 Adduction
machine  Pronation/supination
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 Principles of ROM
 1. Verify MD orders

 2. Make patient as active a participant

as possible

 3. Do not exceed pain threshold

 4. Put joints through full ROM

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 Positioning Patients

 Fowler’s

 Lateral

 Prone

 Sims’

 Supine
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