FUNDAMENTALS

OF NURSING:
PHYSICAL ACTIVITY &
MOBILITY
Kurnia Rachmawati
Introduction
• People often define their health and physical fitness by
their activity
• The effectiveness of body functioning depend largely
on their mobility status.
• Motion is essential for proper functioning of bones and
muscles.
• The ability to move without pain also influences self-
esteem and body image.
• For those with impaired mobility, movement must be
fostered to the full extent of capability to facilitate a
satisfying life.
NORMAL MOVEMENT
• Normal movement and stability are the result of:
- intact musculoskeletal system
- intact nervous system
- intact inner ear structures à equilibrium
• It involves four basic elements:
1. body alignment (posture)
2. joint mobility
3. Balance
4. coordinated movement.
NORMAL MOVEMENT
1. Alignment and Posture
• Proper body alignment and
posture bring body parts into
position in a manner that
promotes optimal balance and
maximal body function whether
the client is standing, sitting, or
lying down.
• A person maintains balance as
long as the line of gravity (an
imaginary vertical line drawn
through the body’s center of
gravity) passes through the
center of gravity (the point at
which all of the body’s mass is
centered) and the base of
support (the foundation on which
the body rests).
NORMAL MOVEMENT
2. Joint Mobility
• Joints are the functional units of
the musculoskeletal system.
• The bones of the skeleton
articulate at the joints, and most
of the skeletal muscles attach to
the two bones at the joint.
• The range of motion (ROM) of a
joint is the maximum movement
that is possible for that joint.
• Joint range of motion varies from
individual to individual and is
determined by genetic makeup,
developmental patterns, the
presence or absence of disease,
and the amount of physical
activity in which the person
normally engages
NORMAL MOVEMENT
3. Balance
• The mechanisms involved in maintaining balance
and posture are complex:
• informational inputs from the labyrinth (inner ear),
• vision (vestibulo-ocular input),
• stretch receptors of muscles and tendons
(vestibulospinal input).
• Proprioception is the term used to describe
awareness of posture, movement, and changes in
equilibrium and the knowledge of position, weight,
and resistance of objects in relation to the body.
NORMAL MOVEMENT
4. Coordinated Movement
• Balanced, smooth, purposeful movement is the
result of proper functioning of the cerebral cortex,
cerebellum, and basal ganglia.
• The cerebral cortex initiates voluntary motor
activity
• the cerebellum coordinates the motor activities of
movement
• the basal ganglia maintain posture.
FACTORS AFFECTING BODY
ALIGNMENT AND ACTIVITY
• Growth and Development
• Nutrition
• Personal Values and Attitudes
• External Factors (temperature, humidity, water,
recreational facility, safety)
• Prescribed Limitations à bedrest is a therapeutic
intervention that achieves:
• Rest for client’s who are exhausted
• Decreases body’s O2 consumption
• Reduces pain and discomfort
• To reverse effects of gravity-abdominal hernia
Exercises
Types of Exercises:

• Isotonic (dynamic) exercises are those in which the muscle

shortens to produce muscle contraction and active
movement. Most physical conditioning exercises—running,
walking, swimming, cycling, and other such activities—are
isotonic, as are ADLs and active ROM exercises (those
initiated by the client).
• Isometric (static or setting) exercises are those in which
muscle contraction occurs without moving the joint (muscle
length does not change). These exercises involve exerting
pressure against a solid object and are useful for
strengthening abdominal, gluteal, and quadriceps muscles
used in ambulation; for maintaining strength in immobilized
muscles in casts or traction; and for endurance training.
Exercises
• Isokinetic (resistive) exercises involve muscle
contraction or tension against resistance. During
isokinetic exercises, the person tenses (isometric)
against resistance. Special machines or devices provide
the resistance to the movement. These exercises are
used in physical conditioning and are often done to
build up certain muscle groups
• Aerobic is activity during which the amount of oxygen
taken into the body is greater than that used to
perform the activity. improve cardiovascular
conditioning and physical fitness.
• Anaerobic is used to provide additional energy for a
short time. This type of exercise is used in endurance
training for athletes such as weight lifting and sprinting.
Exercise
Benefits of Exercise
• Improves cardiovascular health
• Increases muscle tone and flexibility
• Enhances immune system
• Promotes weight loss
• Decreases stress/increases overall feeling
of well-being
 Immobility effects
Cardiovascular Changes
• Orthostatic hypotension due
to prolonged bed rest. Drop
of 15 mm Hg or more in
systolic BP with position
change
• Decrease circulating volume,
pooling of blood in lower
extremities(edema),
• Due to stasis >>> risk
thrombus formation
 Immobility effects
NI Cardiovascular
• Increase activity slowly but progressively
• Avoid crossing legs, pressure behind knee
• Encourage antiembolic leg exercises q 2 hours,
other isometric exercises
• Gradually raise client noting BP, HR, assess
dizziness/lightheadedness
 Immobility effects
Respiratory Changes
• Decrease in lung expansion,
generalized respiratory
muscle weakness, and stasis
of secretions
• Decreased hemoglobin levels
• Atelectasis --collapse of
alveoli resulting in decrease
of 02 / C02 exchange
• Hypostatic pneumonia–
inflammation of the lung
from stasis or pooling of
secretions
 Immobility effects

NI Respiratory
• Change of position q 1 – 2 hr which allows
elastic recoil property of lungs and clears
dependent lung secretions

• Cough and deep breath q 2 hr, incentive

spirometry, chest physiotherapy

• Fluids to 3000 ml / 24 h to thin secretions

 Immobility effects
Gastrointestinal Changes

• Decrease in appetite, peristalsis, constipation

• NI:
• High fiber foods, fluids to 3000 ml/24hr
• Small frequent foods of choice
• Monitor bowel sounds q shift
• Monitor bowel patterns 24 hours
• Stool softeners daily as ordered
 Immobility effects
Musculoskeletal Changes
• Muscle atrophy
• Loss of strength and
decreased endurance
• Joint contractures
• Decreased stability or
balance
• Disuse osteoporosis, a
disorder characterized by
bone reabsorption-
results from impaired
calcium metabolism
 Immobility effects
NI Musculoskeletal
• Frequent ROM: active, passive, active assist q 4
hours

• Develop an individualized progressive exercise

program

• Isometric and isotonic exercises q 4 hours

 Immobility effects
Renal Changes
• Urine formed by the kidney
must enter the bladder
against gravity due to
recumbent position
• Ureters insufficient to
overcome gravity, renal
pelvis may fill with urine-
urinary stasis which
increases risk for UTI & renal
calculi
• Renal calculi-calcium stones
lodged in in renal pelvis and
pass through ureters
 Immobility effects
NI Renal
• Position change q 1-2 hours
• Position 30 degrees of higher to enhance
gravitational forces required for normal urine flow
through kidney, ureters, bladder
• I & O q 8 hours
• Fluids to 3000 ml 24 hours
• RD for diet plan r/t calcium intake
 Immobility effects
Psychosocial Changes
• Increase isolation, passive behavior, changes in
sleep/wake cycles, stressors, sensory
deprivation/overload

• Decrease in self-identity, self-esteem, coping

strategies
 Immobility effects
NI Psychosocial
• Anticipate changes-provide routine and informal
socialization—interact with staff q 1-2 hours
• Place in room with others
• Encourage family and friends to visit-space
• Activity and recreational consult
• Schedule nursing cares from 10pm-7am to
minimize interruptions
 Immobility effects
Developmental Changes
• Increase in dependence
• Regression in development

• NI: care should stimulate client mentally, focus on

activities that promote cognitive awareness, allow
client to make care decisions, allow to be as
independent as condition permits
 Immobility effects
Impaired Skin Integrity
related to Immobility
• Previously called: a
decubitus ulcer
• A pressure sore
• A pressure ulcer
• A bedsore
• is a wound caused by
unrelieved pressure that
damages underlying tissue
 Immobility effects
• Pressure ulcers is a wound
caused by unrelieved pressure
that damages underlying tissue.
• The pressure interferes with the
tissue blood supply, leading to
vascular compromise, tissue
anoxia, and cell death
• Tend to be located over bony
prominences: *elbows,
posterior calf, *sacrum/coccyx
ischial tuberosities, trochanter,
lateral malleous, *heel, lateral
edge of foot also: ears, occiput,
great toe region
POSITIONING CLIENTS
• Positioning a client in good body alignment and
changing the position regularly (every 2 hours) and
systematically are essential aspects of nursing
practice
• Performed by the nurse:
• For certain procedures or surgeries.
• To protect the client body from injury.
• to maintain muscle tone.
• To prevent complications
POSITIONING CLIENTS
Fowler’s Position
• Semi-Fowler’s position is
when the head and trunk are
raised 15 to 45 degrees. This
position is sometimes called
low Fowler’s and typically
means 30 degrees
• High-Fowler’s position, the
head and trunk are raised
60¡ to 90¡,and most often
means the client is sitting
upright at a right angle to the
bed
POSITIONING CLIENTS
Orthopneic Position
• In the orthopneic position,
the client sits either in bed
or on the side of the bed
with an overbed table
across the lap
• This position facilitates
respiration by allowing
maximum chest expansion.
POSITIONING CLIENTS
Dorsal Recumbent Position
• In the dorsal recumbent
(back-lying) position, the
client’s head and shoulders
are slightly elevated on a
small pillow.
• In some agencies, the
terms dorsal recumbent
and supine are used
interchangeably; strictly
speaking, however, in the
supine or dorsal position
the head and shoulders are
not elevated.
POSITIONING CLIENTS
Prone Position
• In the prone position, the
client lies on the
abdomen with the head
turned to one side
• The prone position also
promotes drainage from
the mouth and is
especially useful for
unconscious clients or
those clients recovering
from surgery of the
mouth or throat
POSITIONING CLIENTS
Lateral Position
• In the lateral (side-lying)
position, the client lies on
one side of the body.
• The lateral position is
good for resting and
sleeping clients.
• The lateral position helps
to relieve pressure on the
sacrum and heels in
people who sit for much
of the day
POSITIONING CLIENTS
Sims’ Position
• In Sims’ (semiprone)
position, the client assumes a
posture halfway between the
lateral and the prone
positions.
• Sims’ position may be used
for unconscious clients
because it facilitates drainage
from the mouth and
prevents aspiration of fluids.
• It is also used for paralyzed
clients because it reduces
pressure over the sacrum
and greater trochanter of the
hip
POSITIONING CLIENTS
• Support devices
AMBULATING CLIENTS
• Ambulation (the act of walking) is a function that most people
take for granted.
• When clients are ill they are often confined to bed and are thus
nonambulatory.
• The longer clients are in bed, the more difficulty they have
walking.
• Even 1 or 2 days of bed rest can make a client feel weak,
unsteady, and shaky when first getting out of bed
• The nurse can assist clients to prepare for ambulation by helping
them become as independent as possible while in bed.
• Nurses should encourage clients to perform ADLs, maintain good
body alignment, and carry out active ROM exercises to the
maximum degree possible yet within the limitations imposed by
their illness and recovery program.
AMBULATING CLIENTS
• Preambulatory Exercises
• Clients who have been in bed for long periods often
need to perform muscle tone exercises to strengthen
the muscles used for walking before attempting to walk
• Providing passive ROM exercise
• Assisting Clients to Ambulate
• Clients who have been immobilized for even a few days
may require assistance with ambulation. The amount of
assistance will depend on the client’s condition,
including age, health status, and length of immobility
AMBULATING CLIENTS
AMBULATING CLIENTS
Using Mechanical Aids for Walking
1. Walk with a Cane
2. Walk with a Walker
3. Wheelchair
USING BODY MECHANIC
• Body mechanics is the term used to describe the
efficient, coordinated, and safe use of the body to
move objects and carry out the ADLs.
• When a person moves, the center of gravity shifts
continuously in the direction of the moving body parts.
• Balance depends on the interrelationship of the center
of gravity, the line of gravity, and the base of support.
• The closer the line of gravity is to the center of the base
of support, the greater the person’s stability
• The broader the base of support and the lower the
center of gravity, the greater the stability and balance
USING BODY MECHANIC
USING BODY MECHANIC
• Until recently, nurses believed that “correct” body
mechanics would facilitate the safe and efficient
use of appropriate muscle groups to maintain
balance, reduce the energy required, reduce
fatigue, and decrease the risk of injury for both
nurses and clients, especially During transferring,
lifting, and repositioning
• In reality, more than 30 years of evidence show
that: Educating nurses in body mechanics alone will
not prevent job-related injuries.
USING BODY MECHANIC
• In the field of nursing, work-related musculoskeletal
disorders (MSDs), such as back and shoulder injuries,
persist as the leading and most costly occupational
health problem
• Manually moving and lifting clients often cause MSDs.
• Increasingly, health care facilities are focusing on “no
lift” policies for their employees, and 35 pounds of
client weight should be the maximum a nurse should
attempt.
• The long-term benefits of using the proper equipment
(e.g.,mechanical lifts) far outweigh the costs related to
injuries.
USING BODY MECHANIC
• When the client is not able to move independently
or assist with moving, the preferred method is for
two or more nurses to move or turn the client and
use assistive equipment.
• Appropriate assistance reduces the risk of muscle
strain and body injury to both the client and nurse,
and is likely to protect the dignity and comfort of
the client.
USING BODY MECHANIC
Lifting, Pulling, Pushing
• It is important to remember
that nurses should not lift
more than 35 pounds (15,8
kg) without assistance from
proper equipment and/or
other individuals.
• Types of assistive
equipment include mobile-
powered or mechanical
lifts, ceiling-mounted lifts,
sit-to-stand powered lifts,
friction-reducing devices,
and transfer chairs
Reference for further study
• Berman, Audrey, Barbara Kozier, and Glenora Lea
Erb. Kozier And Erb's Fundamentals Of Nursing.
Frenchs Forest, N.S.W.: Pearson Australia, 2012.
Print.