ACTIVITY CH.

33

NUR 231 Fundamental Nursing

Skills

Ball State University

Pam Brelage, MS, RN

Ch. 33 Objectives
1. Id e n t i f y va r i a b l e s t h a t i n fl u e n c e b o d y a l i g n m e n t a n d m o b i l i t y

2. D e sc r i b e t h e e ff e c t s o f e x e r c i s e a n d i m m o b i l i ty o n m a j o r b o d y
systems

3. A s s e s s b o d y a l i g n m e n t , m o b i l i t y, a n d a c t i v i t y to l e ra n c e

4. D e ve l o p n u r s i n g d i a g n o s e s t h a t c o r r e c t l y i d e n t i f y m o b i l i t y
p r o b l e m s t h a t c a n b e m a n a g e d w i t h n u r s i n g i n t e r ve n t i o n s

5. U s e s a fe p a t i e n t h a n d l i n g a n d m o ve m e n t t e c h n i q u e s w h e n
p o s i t i o n i n g , m ov i n g , l i f t i n g , a n d a m b u l a t i n g p a t i e n t s
PHYSIOLOGY
OF MOVEMENT
Purposeful, coordinated
movement of the body
and maintenance of
alignment require
integrated functioning of
the musculoskeletal and
nervous systems.
Skeletal System
Supports soft tissues

Protects vital organs

Provides points of attachment for muscles, tendons, and ligaments

Stores minerals and fat

Produces red blood cells

Muscular System
Typ es :

• Ske le ta l

• Ca r di a c

• Smoo th /V is c era l

Funct i on:

• Mot i on

• Ma i nte na nc e of p os tur e

• Sup p or t

• H e at p r od uct i on
Nervous
System
Neurons conduct
impulses between
diff erent par ts of the
body thereby moving
the muscular and
skeletal systems.
Normal Movement
and Alignment

Body Alignment or
Posture

Balance

Coordinated Body
Movement

Postural Refl exes

Factors Affecting Movement and Alignment

Developmental Physical
Mental Health Lifestyle
Considerations Health

Attitude and Fatigue and External

Values Stress Factors
Problems Aff ecting Physical
Health
M u s c u l a r, s k e l e t a l , o r n e r v o u s s y s t e m p r o b l e m s

• Bone formation or muscle development

• Joint mobility

• Tr a u m a t o t h e m u s c u l o s k e l e t a l s y s t e m

• Central nervous system

Other body systems problems

Types of Exercise
Exercise is divided into two major types

1. Type of muscle contraction occurring

during the exercise

2. Type of body movement occurring, and the

health benefi ts achieved
Exercise Type by
Muscle Contraction

Isotonic exercise: Involves muscle shortening

and active movement.

Isometric exercise: Involves muscle

contraction without shor tening.

Isokinetic exercise: Involves muscle

contractions with resistance.
EFFECTS OF EXERCISE AND
IMMOBILITY ON MAJOR BODY SYSTEMS

Cardiovascul Respiratory Musculoskel Metabolic

ar system system etal system Processes

Gastrointesti Urinary Skin Psychosocial

nal system system Outlook
Eff ects of Exercise and Immobility on
the Body

Cardiovascular system

Respirator y system

Gastrointestinal system

Urinar y system
Eff ects of Exercise and Immobility on
the Body cont’d

Musculoskeletal system

Metabolic processes

Integumentar y system

Psychosocial outlook
The Nursing Process for Activity:
Assessing
Nursing History
• Daily activity level
• Endurance
• Exercise and fitness goals
• Mobility problems
• Physical or mental health
alterations that affect mobility
• External factors that affect
mobility
Physical Assessment
• General ease of movement
• Gait and posture
• Alignment
• Joint structure and function
• Muscle mass, tone, and strength
• Endurance
The Nursing Process for Activity:

Diagnosing (Problem)

Re c o g n i z i n g c u e s t h a t i n d i c a t e b o t h p o t e n t i a l a n d
actual problems is essential when analyzing data
a b o u t a p a t i e n t ’s m o b i l i t y s t a t u s .

E x a m p l e s o f N u r s i n g d i a g n o s e s r e l a t e d t o m o b i l i ty :

• A c t i v i t y I n to l e ra n c e

• S e l f- C a r e D e fi c i t

• R i s k fo r I n j u r y

• R i s k fo r C o n s t i p a t i o n
The Nursing Process for Activity:

Planning
Individualize the outcomes.

What is the plan for this specifi c patient?

• If no mobility problems = outcomes promote

physical fi tness

• If at high risk for mobility problem = address

the outcome to that specifi c issue

• If patient is immobile = outcomes are directed

at preventing complications related to
inactivity
The Nursing Process for Activity:

Implementing

Incorporate ergonomics and safe

patient handling and moving
strategies
The Nursing Process for Activity:

Evaluating

Evaluate the eff ectiveness of the plan that

was designed to either enhance, maintain, or
regain mobility and fi tness.
Apply Ergonomics to Prevent Injury

Ergonomics vs. Patient Care Ergonomics

Nurses are at a high risk of patient care injuries

• Nurses routinely lift, carr y, push, pull, and move objects and
people

• Musculoskeletal disorders plague the nursing profession

Include patient assessment criteria for safety – Assess your patient

Apply Ergonomics to Prevent Injury

• Use proper posture

• U s e l o n g e s t a n d s t r o n g e s t m u s c l e s t o p r ov i d e p o w e r

• Wo r k c l o s e l y t o o b j e c t s t h a t n e e d t o b e l i f t e d o r m o v e d

• Av o i d t w i s t i n g t h e b o d y

• Use body weight as a force for pushing and pulling

• Slide /roll /push /pull an object instead of lifting when

able

• Spread feet to widen base

• Ta k e b r e a k s a n d b r e a k u p h e a v y l o a d s i n t o s m a l l e r l o a d s
Ensure Safe Patient Handling
and Movement
Safe patient transfers

Equipment and assistive devices

Gait belts

Stand-assist and repositioning aids

Lateral-assist devices

Friction-reducing sheets

Transfer chairs

Powered full body lif ts

Positioning Patients in Bed
Common devices to promote correct alignment:

Fo a m w e d g e s a n d p i l l o w s

Mattresses

Ad j u s t a b l e b e d s

Tra p e z e b a r

Tr o c h a n t e r r o l l s

Splints

S i d e ra i l s

* P r e v e n t Fo o t D r o p – u s e e q u i p m e n t a n d t e n t b e d d i n g
Patient
Positioning
Prone position Side lying/lateral

Fowler’s positioning:
High- Fowler’s
Semi-Fowler’s
Low-Fowler’s Sims’ position Supine
Graduated compression
stockings and Pneumatic
compression devices

TED hose

Sequential devices
Assisting the patient
to reposition

Tu r n i n g t h e p a t i e n t i n b e d

M ov i n g t h e p a t i e n t u p i n b e d

M ov i n g p a t i e n t f r o m b e d t o s t r e t c h e r

M ov i n g p a t i e n t f r o m b e d t o c h a i r

A s s i s t i n g w i t h ra n g e o f m o t i o n e x e r c i s e s

Helping patient ambulate

Assisting with
Ambulation
• Physical conditioning of
patient

• Using a one nurse or two

nurse assist

• Using appropriate mechanical

aids:

• Wa l k e r

• Cane

• Braces

• Crutches
"He who has health has
hope, and he who has
hope has ever ything."
~Arabian proverb
Test Prep
(Example NCLEX question)

Th e nu rse wri tes a c lien t problem of “a ctivity intolera nc e” for a clien t diagnosed
w ith an emi a. Wh ic h int er ven tions should th e nu rse im plem en t? Select all that
ap ply.

1. Pac e ac ti vi ties ac cording to tolera nce.

2. P rovi de s upplem ents h igh in iron a nd vita mins.

3. Admi ni st er pac ked red blood cells.

4. Moni tor vi ta l signs ever y 4 h ou rs.

5. Assi st wi th persona l c are as n eeded.

Test Prep
(Example NCLEX question)

Test-taking Hint

Read the stem closely and choose only interventions that directly aff ect
activity.
 T H E N U R S E W R I T E S A C L I E N T P R O B L E M O F “A C T I V I T Y I N T O L E R A N C E ”
FOR A CLIENT DIAGNOSED WITH ANEMIA. WHICH INTERVENTIONS
S H O U L D T H E N U R S E I M P L E M E N T ? S E L E C T A L L T H AT A P P LY.

1. P a c e a c t i v i t i e s a c c o r d i n g t o t o l e r a n c e .

2. P r o v i d e s u p p l e m e n t s h i g h i n i r o n a n d v i t a m i n s .

3. A d m i n i s t e r p a c k e d r e d b l o o d c e l l s .

4. M o n i t o r v i t a l s i g n s e v e r y 4 h o u r s .

Test Prep 5. A s s i s t w i t h p e r s o n a l c a r e a s n e e d e d .

(Example NCLEX
question)
1. T h e c l i e n t ’ s p r o b l e m i s a c t i v i t y i n t o l e r a n c e , a n d t h e p a c i n g o f
a c t i v i t i e s d i r e c t l y a ff e c t s t h e d i a g n o s i s .

2. T h i s i s a n a p p r o p r i a t e i n t e r v e n t i o n f o r i r o n o r v i t a m i n d e fi c i e n c y, b u t
not for activity intolerance.

3. T h i s m a y b e d o n e b u t n o t s p e c i fi c a l l y f o r t h i s d i a g n o s i s .

4. T h i s w o u l d n o t h e l p a c t i v i t y i n t o l e r a n c e .

5. A s s i s t i n g t h e c l i e n t w i t h p e r s o n a l c a r e a n d a m b u l a t i o n w i l l a d d r e s s
activity intolerance.
References

D oher ty, C. (2021) Med -Sur g Success: NCLEX-Styl e Q& A Revi ew,(4 t h Ed ) . F.A. D avi s

Taylo r, C., Lynn, & Bar t l et t (2019). Fundament al s of Nurs i ng:

The ar t and science of p erson-cent ered nur s i ng care (9 t h ed.). Wol ters K luwer
Heal t h, I nc.