Types of EXERCISE

A. According to muscle contraction

1. Isotonic (dynamic) Exercise- those that shorten muscle to produce
contraction and active movement.

Ex. Running, walking, swimming, cycling , lifting the buttocks off the bed by
pushing with the hands against the mattress

2. Isometric (static or setting) exercises- those in which there is muscle

contraction without moving the joint.
EX. squeezing a towel or pillow between the knees.
3. Isokinetic (resistive) exercises- involve muscle contraction or tension against
resistance; they can either be isotonic or isometric. During these exercises, the
person moves (isotonic) or tenses (Isometric) against resistance.
Ex. Lifting weights to increase size and strength of the pectoralis muscles.
 BODY MECHANICS
The efficient, coordinated and safe use of body to carry out activities of daily
living.
Tips for stability:
1. Broaden the base of support
2. Adjust height of work area
Tips to avoid injury:
1. Ask for help when needed.
2. Face direction of work.
3. Use smooth and continuous movements rather than sharp, sudden and
uncontrolled movement.
4. Contract abdominal and gluteal muscle to stabilize pelvis. Assume a starting
point (for movement, direction and position).
5. Use strong leg muscle when lifting, pushing or pulling.
6. Examine the surroundings for potential obstacles to the desired movement.
Tips for use of less energy (conserve energy)

1. Balance parts appropriately.

2. Reduce friction.
3. Use rhythmic movements at normal speed.
4. Hold object close to body.
5. Push or pull rather than lift!
6. Use mechanical devise.
7. Breathe normally (exhale through the mouth on exertion).
COUGHING
- Single most effective measure to control respiratory secretions upward.
1. Splint incision, if any, with pillow.
2. Patient to take a deep breath, hold for 3 seconds, and cough deeply two or
three times. (more effective than single coughing.)
3. Perform 2 to 3 hours post-operatively.
DEEP BREATHING
To expand the alveoli and mobilizes secretions.
1. Place client in fowlers or sitting position (allows full expansion of the lungs
and relieves pressure by diaphragm).
2. Place client's hands (palm) along the lower rib cage to feel diaphragm
movement.
3. Inhale fully through the nose, hold for 2 to 3 seconds (nasal breathing filters,
warms and humidifies air).
4. Exhale slowly through the mouth (slow exhalation stimulates coughing and
prevents hyperventilation)
SUCTIONING
1. Use appropriate catheter size: F 5-8 (infants) F8 10 (children) and F 12-18 for (adult)
2. Position client in fowlers (for those with intact gag reflex), side lying for unconscious) to
prevent aspiration
3. Adjust pressure: 50-75 mmHg in infants and children; 100-120 mmHg in adults
4. Pre-oxygenate client (hyper inflate with manual resuscitation bag, or by asking the
client to take several deep breaths prior, or by adjusting oxygen flow to higher rate)
5. Lubricate catheter tip by immersing in cup of saline solution
6 Insert the catheter through during inspiration (when epiglottis is open), without exerting
suction yet (open port), until you feel resistance.
7. Retract catheter by 1 cm before exerting suction.
8. Exert suction by closing the open port, withdrawing catheter in rotating motion with 5
to 10 seconds only.
9. Hyperoxygenate for a full minute between subsequent suctioning. Encourage deep
breathing.
Chest Physiotherapy
Purpose:
-To help clear excessive bronchial secretions from airways by shaking mucus
from the walls of the airways and draining them from the lungs.

PERCUSSION
VIBRATION
POSTURAL DRAINAGE
1. Percussion (Clapping) – a forceful striking of the skin with cupped hands.
It can mechanically dislodge tenacious secretions from bronchial walls.

• Explain the procedure and encourage the client to breathe slowly and
deeply.
• Place the client in a comfortable sitting or side lying position.
• Cover area with gown or towel.
• Cup hands, alternately flex and extend wrists rapidly to percuss the
affected lung segments for 1 to 2 minutes; 3-5 minutes for extra thick
secretions.
2. VIBRATION (shaking) - a series of vigorous quivering produced by hands that
are placed flat against the client's chest wall. It is done to loosen mucous
secretions. Vigorous or high- frequency quivering over the chest wall and used
alternately with or after percussion.
• Explain procedure to the client and position comfortably.
• Encourage client to breathe slowly and deeply.
• Place hands one on top of the other with palms down.
• During exhalation, tense hand and arm and using mostly the heel of the
hand, vibrate or shake hands against the client's chest.
• Stop vibrating when the client inhales.
• After each vibration, encourage the client to cough and expectorate.
• Vibrate 5 times over each lung segment.
3. Postural drainage- expulsion of secretions from various lung segment by gravity.
This involves placing in different positions so that area of lung congestion will be in
vertical position with the bronchus, facilitates drainage of respiratory tract
secretions by gravity
• Explain procedure to the client.
• Position the client so that the head is lower than the chest (in prone or side-
lying position).
• Place sputum container and wipes within the client's reach.
• Do percussion and vibration for 5 minutes and allow 5 minutes for drainage.
• Encourage client to cough and expectorate.
• Instruct client to turn to the other side then to supine position, and repeat the
procedure.
• Assist the client to a sitting position, and offer mouth care.
• Document observations.
Points to remember in PVD
• The best time to do postural drainage treatment is before meals, in the
morning upon awakening and at bedtime.
• Do not perform postural drainage immediately after meals because it may
cause vomiting. thereby aspiration.
• Provide good oral hygiene alter the procedure to remove unpalatable taste
of the mucous secretions.
• Contraindicated to clients who are unstable, asthmatic, pregnant with
tuberculosis, or to clients who produce more than 30 ml of sputum per day.
Steam Inhalation

Purpose:
- To liquefy mucous secretions
- To warm and humidify inspired air
- To relieve edema of airways
- To administer medications
Points to remember:
- It is dependent midwifery function.
- Heat application requires physician's order.
- Place client in semi-fowler's position for maximum inhalation of steam.
- Place the spout 12-18 inches away from the client's nose or adjust the distance
as necessary.
- To be effective, render steam inhalation for 15-20 minutes.
- Instruct client to perform deep breathing and coughing exercises to facilitate
expectoration.
 OXYGEN THERAPY
Oxygen - dry, odorless, colorless, tasteless and combustible (not flammable)
gas; contained in green tank

Purpose:
• To reverse hypoxemia
• To improve tissue oxygenation
• Decrease work of breathing in dyspneic clients
• Decrease myocardial workload
FORMS of oxygen therapy and corresponding O2 concentration:

• Nasal Canulla: 24-45% at 1-6 LPM

• Simple 0xygen mask: 40-60 % at 5-8 LPM
• Venturi mask: 24-50% (more accurate) at 4-10 LPM
• Partial Rebreather Mask: 60-90% at 6-10 LPM
• Non-rebreather Mask: 95-100% at 10-15 LPM
PROCEDURE:
1. Assess signs and symptoms of hypoxemia. This is an indication of the need for
oxygen therapy.
2. Check doctor's order.
3. Position patient, preferably semi-fowler‘s.
4. Open source of oxygen before insertion device. This is to check for
malfunctioning of the device.
5. Regulate oxygen flow accurately. Excessive administration of oxygen can
cause oxygen toxicity.
6. Place a "NO SMOKING" sign at the bedside. Oxygen greatly accelerates
combustion and could cause a fire from small spark.
7. Avoid use of oil, greases, alcohol and ether near the client receiving the
oxygen. These may further support combustion.
8. Check electrical appliances before use. Small spark may cause a fire if there is
leakage of oxygen.
9. Avoid materials that generate static electricity, such as wool en blankets and
synthetic fabrics. Use cotton blankets.
10. Humidify oxygen. Place sterile water into the oxygen humidifier to prevent
dryness and irritation of mucous membrane in the airways.
11. Provide good oronasal hygiene to prevent dryness and irritation of mucus
membrane.
12. Lubricate nares with water soluble lubricant to soothe the mucous
membrane. Do not use oil. Oil ignites when exposed to compressed oxygen.
13. Assess effectiveness of oxygen therapy. Check VS, especially RR; note quality
of respiration; evaluate ABG or oxygen saturation by pulse oximetry.
14. Make relevant documentation
End…