MOBILITY / ACTIVITY

MOBILITY - the ability to move freely, easily, rhythmically, and purposefully in the environment, is an
essential part of living.

Body movement involves four basic elements.

1. body alignment
2. joint mobility
3. balance
4. coordinated movement.

Using Mechanical Aids for Walking

1. Cane

2. Walker

3. Crutches

• Osteoporosis is a condition in which the bones become brittle and fragile due to calcium

depletion.

• Gait – “belt like” use to transfer patient

• Romberg’s Test – use to test the balance and coordination of the patient

• Ballottement test – test the knee capabilities

EXERCISE - active contraction and relaxation of muscles

• Functional strength - ability of the body to perform work.

• Activity tolerance - type and amount of exercise.

Types of Exercise

1. Isotonic (dynamic) exercises - muscle shortens to produce muscle contraction and active

movement.

2. Isometric (static or setting) exercises - muscle contraction occurs without moving the joint.

3. Isokinetic (resistive) exercises - muscle contraction or tension against resistance.

4. Aerobic exercise - is activity during which the amount of oxygen taken into the body is

greater than that used to perform the activity.

5. Anaerobic exercise - activity in which the muscles cannot draw out enough oxygen from the

bloodstream, and anaerobic pathways are used to provide additional energy for a short time.
 Sleep & rest
Sleep is a basic human need.

• Centres located in the brain by Circadian Rhythms. “BIOLOGICAL CLOCK”

• The term Circadian is from the Latin “circa dies”, meaning “about a day”

• Reticular Activating System (RAS) located at the brain stem and Cerebral Cortex

• Sleep promoting neurons act over wake promoting neurons by releasing Gamma Amino

Butyric Acid (GABA)

• Melatonin low in daylight Cortisol high and vice versa

ENVIRONMENTAL FACTORS

• Light

• Darkness

Electroencephalogram (EEG) – identify the stages of sleep.

The stages of sleep are classified into Two stages:

1. NON-Rapid Eye Movement (NREM) sleep

2. Rapid Eye Movement (REM) sleep.

REM

• Stage usually begins about 90 minutes after sleep has begun.

• Dreaming occurs in this stage.

Function of Sleep and Rest

• Conversation of energy

• Restoration of tissues and growth

• Thermoregulation

Factors Affecting Sleep

1. Illness

2. Environment

3. Lifestyle

4. Emotional Stress
Sleep Disorders

1. DYSSOMNIAS Cause trouble falling asleep or staying asleep. Perhaps the most well-known

Dyssomnia is obstructive sleep apnea. Examples Insomnia, narcolepsy, sleep apnea.

Three Types of Apnea are:

1. Obstructive Apnea - occurs when the structures of the pharynx or oral cavity block the

flow of air.

2. Central Apnea - due to detect in the respiratory center of the brain.

3. Mixed Apnea – Combination of obstructive and central apnea.

2. PARASOMNIAS something abnormal occurs during sleep itself, or during times when the

client is falling asleep or waking up. EXAMPLE Bruxism, sleep talking and sleeping

The quality, quantity, and timing of the sleep are essentially normal.

3. DISORDERS DUE TO OTHER MEDICAL CONDITIONS

Pain Management
PHYSIOLOGY OF PAIN

Nociception - peripheral nervous system includes specialized primary sensory neurons that detect
mechanical, thermal, or chemical conditions associated with potential tissue damage.

1. TRANSDUCTION

2. TRANSMISSION

3. PERCEPTION

4. MODULATION

CONCEPTS OF PAIN

• Acute pain: Pain that is directly related to tissue injury and resolves when tissue heals.

➢ Cancer pain: Pain associated with the disease, treatment, or some other factor in individuals

with cancer.

➢ Chronic or persistent pain: Pain that persists beyond 3 to 6 months secondary to chronic

disorders or nerve malfunctions that produce ongoing pain after healing is complete.

➢ Intractable pain: A pain state (generally severe) for which no cure is possible even after

accepted medical evaluation and treatments have been implemented. The focus of treatment

turns from cure to pain reduction, functional improvement, and the enhancement of quality
of life.

➢ Neuropathic pain: Pain that is related to damaged or malfunctioning nervous tissue in the

peripheral and/or CNS.

➢ Nociceptive pain: Pain that is directly related to tissue damage. May be somatic (e.g., damage

to skin, muscle, bone) or visceral (e.g., damage to organs).

➢ Pain threshold: The least number of stimuli necessary for a person to label a sensation as pain.

➢ Pain tolerance: The most pain an individual is willing or able to tolerate before taking evasive

actions.

The following states indicate abnormal nerve functioning, and the associated cause needs to

be identified/treated (as soon as possible) before irreversible damage occurs:

➢ Allodynia: Sensation of pain from a stimulus that normally does not produce pain (e.g., light

touch).

➢ Dysesthesia: An unpleasant abnormal sensation that can be either spontaneous or evoked.

➢ Hyperalgesia: Increased sensation of pain in response to normally painful stimulus.

The following concepts are important reasons to prevent pain or treat it as soon as possible to prevent.

the amplification, spread, and persistence of pain:

➢ Sensitization: An increased sensitivity of a receptor after repeated activation by noxious

stimuli.

➢ Windup: Progressive increase in excitability and sensitivity of spinal cord neurons, leading to

persistent, increased pain.

NUTRITION
Nutrition is the sum of all the interactions between an organism.

Essential Nutrients

• macronutrients
• Micronutrients

The body's most basic nutrient is water.

Carbohydrates are macronutrients and are one of the three main ways by which our body obtains its
energy.

Protein is a macronutrient that is essential to building muscle mass.

“lipid” is another word for “fat.

URINARY ELIMINATION
INFANTS URINE

• 200 – 500 ml/day

• 20 times

• Born without urinary control

SCHOOL AGE CHILDREN

• 6 – 8 times/ day urinate

• ENURESIS – Involuntary passing of urine

• NOCTURNAL ENURESIS – bed wetting

OLDER ADULTS

• Excretory function of kidney diminishes

• Nocturnal frequency occurs

✓ DIURECTICS – Increase urine formation.

✓ DIURNAL – increase urine daytime.
✓ ENURESIS – increase urination.
✓ NOCTURNAL ENURESIS – bed wetting

Urinary Incontinence – involuntary urine leakage

4 types

1. Stress urinary incontinence

2. Urge urinary incontinence.

3. Mixed urinary incontinence

4. Overflow incontinence

FECAL ELIMINATION
• DEFECATION - “bowel movement”

• FECES - 75% water and 25% solid

The excreted waste products are referred to as feces or stools.

FECAL ELIMINATION PROBLEM

Constipation – fewer than 3 times bowel movement per week

Faecal Impaction – results from prolonged retention and accumulation of faecal material

Diarrheal – passage of liquid feces

Bowel Incontinence – loss of voluntary ability to control faecal.

Flatulence “utot” – execessive flatus in the stool or excessive gas

Oxygenation and perfusion

Oxygen, a clear, odorless gas that constitutes approximately 21% of the air we breathe.

Process of the Respiratory system

1. Pulmonary Ventilation - ventilation of the lungs is accomplished through the act of breathing.
2. Alveolar Gas Exchange - the diffusion of oxygen from the alveoli
3. Transport of Oxygen and Carbon Dioxide - transport of respiratory gases.
4. Systemic Diffusion - diffusion of oxygen and carbon dioxide

Respiratory regulation includes both neural and chemical controls to maintain the correct
concentrations of oxygen.

Incentive spirometers, also referred to as sustained maximal inspiration devices (SMIs), measure the
flow of air inhaled through the mouthpiece.

FLUIDS, ELECTROLYTES AND ACID BASE BALANCE

BODY FLUIDS COMPARTMENTS

1. Intracellular fluid compartment (ICF) –

✓ Fluid found inside the cells
✓ Promotes cellular chemical function
✓ Maintains normal body temperature
✓ Eliminates waste products from the cells

2. Extracellular fluid compartment (ECF)

✓ Fluid found outside the cells
✓ Maintains blood volume
✓ Transports gases, nutrients and other substances to the cells

FACTORS OF BODY WATER DISTRIBUTION

✓ infants, 80%
✓ males, 60%
✓ females, 50%

INTERNAL REGULATION OF BODY WATER AND ELECTROLYTES

1. Sodium and Water regulation

▪ Thirst – major control of actual fluid intake

 ▪ Kidneys – major organs controlling output

▪ ADH – retains water in the renal tubules

▪ RAAS – aldosterone retain sodium and water of the body fluids

2. Potassium Regulation

3. Calcium Regulation

✓ Vitamin D promotes calcium absorption from GIT

✓ Parathormone elevates s. Ca levels by withdrawing calcium from bones (bone resorption)
✓ Thyrocalcitonin lowers s. Ca levels by depositing Ca in the bones. bone absorption.

MOVEMENTS OF FLUIDS

Passive transport

Diffusion - transport of solutes from area of higher concentration to lower concentration

Osmosis - transport of solvent from area of lower concentration

Active transport

▪ Hydrostatic pressure - caused by the blood pressing against walls of blood vessels (pushing
force)

▪ Colloid Osmotic pressure (oncotic pressure) -pressure needed to overcome the pull of CHON.
Pull or absorb fluid from the interstitial space.

FLUID INTAKE - During periods of normal activity at moderate temperature, the average adult drinks
about 1,500 mL/day, despite the fact that they need 2,500 mL/day for normal functioning.

FLUID OUTPUT

▪ Urine

▪ Feces

Sensory Functioning
TWO CONCEPTS

Sensory reception is the process of receiving stimuli or data.

Sensory perception involves the conscious organization and translation of the data or stimuli into
meaningful information.

• Stimulus This is an agent or act that stimulates a nerve receptor.

• Impulse conduction The impulse travels along nerve pathways
• Receptor A nerve cell acts as a receptor by converting the stimulus to a nerve impulse.
• Perception, or awareness and interpretation of stimuli, takes place in the brain.

Arousal Mechanism

For the person to receive and interpret stimuli, the brain must be alert, also referred to as arousal.
STATES OF AWARENESS

1. Full consciousness
2. Disoriented
3. Confused
4. Somnolent
5. Semi-comatose
6. Coma

SENSORY ALTERATION - People become accustomed to certain sensory stimuli, and when these change
markedly an individual may experience discomfort.

Sensory deprivation is generally thought of as a decrease in or lack of meaningful stimuli.

Sensory Overload generally occurs when a person is unable to process or manage the amount or
intensity of sensory stimuli.

A sensory deficit is impaired reception, perception, or both, of one or more of the senses.

• Acute Confusion: abrupt onset of reversible disturbances of consciousness, attention, cognition,

and perception that develop over a short period of time.
• Chronic Confusion: irreversible, long-standing, and/or progressive deterioration of intellect and
personality characterized by decreased ability to interpret environmental stimuli.
• Impaired Memory: inability to remember or recall bits of information or behaviour skill

STRESS AND COPING

• Stress is a universal phenomenon.
• STRESS is a condition in which an individual experiences changes in the normal balanced state.
• STRESSORS is any event or stimulus that causes an individual to experience stress.

SOURCE OF STRESS

INTERNAL STRESSORS - originate within a person.

EXTERNAL STRESSORS - originate outside.

DEVELOPMENTAL STRESSORS - occur a predictable time throughout an individual's life.

SITUATIONAL STRESSORS - are unpredictable and may occur at any time during life.

MODELS OF STRESS

1.STIMULUS-BASED STRESS MODELS

2.RESPONSE-BASED MODELS

3.STAGE OF RESISTANCE

4.STAGE OF EXHAUSTION
GENERAL ADAPTATION SYNDROME (GAS) or stress syndrome

LOSS AND GRIEF

Loss defined as the experience of parting with an object,person,belief or relationship that one values.

TYPES OF LOSS:

1. ACTUAL LOSS: -Can be recognized by others as well as the person sustaining the loss
2. PERCEIVED LOSS -Sense of loss felt by the individual but not tangible to others.
3. ANTICIPATORY LOSS is experienced before the loss occurs.

Grief/Grieving - is a characteristic pattern of psychological and physical response experiencing after the
loss of significant person, object ,belief or relationship.

Bereavement - A common depressed reaction to the death of loved one

Mourning - A period of acceptance of loss and grief during which the person learns to deal with the loss

5 Stages of Grieving process:

DENIAL- shock, didn't happen, numb, disbelief

ANGER- guilt, resentment, sadness

ARGAINING -pining, searching, yearning.

DEPRESSION - grieving

CCEPTANCE - resolution

Types of Grief:

COMPLICATED- when a person grief is intense and on going for many week, creating an abnormal
reaction.

NORMAL GRIEF- typical reaction a person has when coping with loss

ANTICIPATORY-occurrence of grief work before loss actually occurs

DISENFRANCHISED GRIEF-grief that does not openly acknowledge, socially sanctioned or publicly
shared.

Heart-Lung Death - The traditional clinical signs of death were cessation of the apical pulse, respiration
and blood pressure.

Cerebral/Higher Brain death - Another definition of death, occurs when the higher brain center, the
cerebral cortex is irreversibly destroyed.

Post Mortem Care

RIGOR MOTIS - stiffening of the body 2-4 hours after death

ALGOR MOTIS - decrease of body temperature.

LIVOR MOTIS - discoloration of dependent areas

 SEXUALITY
✓ About sexual feelings, thoughts, attraction and behavior towards other people

✓ A diverse and personal, and is important part of who you are

The Circles of Sexuality

✓ Sexualization - Flirting media messages/images. Seduction; withholding sex; sexual harrassment;

incest; rape.

✓ Intimacy - Caring; sharing; loving or liking; risk taking; vulnerability; self-disclosure; trust

✓ Sensuality - Skin hunger aural/visual stimuli. Sexual response cycle body image, Fantasy

✓ Sexual Identity - Biological gender; gender Identity; Gender role; Sexual orientation

✓ Sexual Health & Reproduction - Sexual behavior; Anatomy & Physiology; Sexual/Reproductive
systems; Contraception/abortion; sexually transmitted infection

Sexual Orientation - Describes the predominant pattern of a person’s sexual attraction over time

Contraception - Numerous contraceptive options are available to sexually active couples today.

Site of Transmission:

➢ Genital
➢ Anal-genital
➢ Oral-genital