Fundamental Nursing Skills and Concepts

1. Fundamental Nursing Skills and Concepts Chapter 24 Page 506

2. Chapter 24 THERAPEUTIC EXERCISE Page 506

3. Exercise • Purposeful physical activity • Box 24-1 benefits of physical exercise, pg. 507

4. Fitness • Capacity to exercise • Impairment to fitness: sedentary lifestyle, health problems, compromised muscle and skeletal function, obesity, advanced age, smoking, and high blood pressure • Before a client begins an exercise program: assess his or her fitness level • Assessment techniques: Measure body composition, evaluate trends in vital signs, perform fitness tests

5. Assessment Techniques • BODY COMPOSITION-Amount of body tissue that is lean versus the amount of fat • Assessment of body composition: height, weight, body-mass index, skin fold thickness, mid-arm circumference • Vital signs, reflect a persons physical status, elevations while resting are signs that the person may have life-threatening cardiovascular symptoms during exercise

6. Assessment Techniques • Assessment of vital signs: temperature, pulse rate, respiratory rate, and blood pressure • Fitness tests: Measure current level of fitness and safe exercise

7. Assessment Techniques • Assessment of fitness tests: Electrocardiogram and Ambulatory electrocardiogram

8. Assessment Techniques • Stress electrocardiogram- electrical conduction through the heart during maximal activity and is performed in an acute care facility or outpatient clinic. 1st patient walks on a flat treadmill, progresses in speed and angle of incline, continually being monitored for heart rate and rhythum, B/P, breathing and symptoms of chest pain or dizziness. • Ambulatory electrocardiogram- (aka Holter monitor), a continuous recording of heart rate and rhythm during normal activity for 24 hour period. Client should not shower or swim. Monitor should not get wet. Avoid magnets, metal detectors, electric blankets and high-voltage areas.

9. TARGET HEART RATE • The goal of the heart rate during exercise. • It is determined by first calculating the person’s maximum heart rate • Maximum heart rate is calculated by subtracting a person’s age from 220.

10. TYPES OF EXERCISES • Fitness exercise: physical activity performed by healthy adults • Fitness exercise develops and maintains cardiorespiratory function, muscular strength, and endurance • Two categories of fitness exercises: ISOTONIC AND ISOMETRIC

11. ISOTONIC EXERCISE • Activity that involves movement and work • Example of isotonic exercise: AEROBIC EXERCISE • Promotes cardiorespiratory conditioning and increase in lean muscle mass • Isotonic exercise should be at the target heart rate

12. Isometric exercise • Consists of stationary exercises generally performed against a resistive force. • Examples- body building, weight lifting, contracting and relaxing muscle groups while sitting or standing. • Isometric exercises-increase muscle mass, strength, and tone and define muscle groups. • Improve blood circulation, but do not promote cardio-respiratory function.

13. THERAPEUTIC EXERCISE • Activity performed by people with health risks or being treated for an existing health problem • Prevent health-related complications to restore lost functions

14. THERAPEUTIC ACTIVITY THAT THE CLIENT PERFORMS INPENDENTLY Example: Following a mastectomy squeezing a ball THERAPEUTIC ACTIVITY THAT THE CLIENT PERFORMS WITH ASSISTANCE OF ANOTHER WHEN THE CLIENT CANNOT MOVE ONE OR MORE PARTS OF THE BODY Example: Paralyzed client requires the nurse to move the client’s legs to maintain muscle tone and flexibility ACTIVE VERSUS PASSIVE EXERCISES

15. Range of motion • Exercises in which joints are moved in the directions that the normal joint permits. Could be performed by the patient their-self which would be known as active exercise. • The exercises could be done by someone else and these are known as passive exercises. • A continuous passive motion machine, as seen on page 511 & 523, could also do the exercises passively. The degree of flexion, and cycles per minute are increased until the prescribed levels are reached. • Why perform ROM? Page 510b

16. RANGE-OF-MOTION EXERCISES • To assess joint flexibility before initiating an exercise program • To maintain joint mobility and flexibility in inactive clients • To prevent ankylosis (permanent loss of joint movement) • To stretch joints before performing more strenuous activities • To evaluate the client’s response to a therapeutic exercise program • Page 511 nurse guidelines 24-1

17. NURSING IMPLICATIONS: NURSING DIAGNOSES • Impaired Physical Mobility • Risk for Disuse Syndrome • Unilateral Neglect • Risk for Delayed Surgical Recovery • Activity Intolerance

18. GERONTOLOGICAL CONSIDERATIONS • Older adults need to balance physical activity with rest • Older adults need to increase noncaffeinated and nonalcoholic beverages before and during physical activity • Encourage adults to join organizations and social clubs • Encourage mall walking • Encourage swimming or exercising in water • Exercise and walk in non-skid shoes • Encourage families and caregivers of adults with cognitive impairment to participate in physical activity

19. Skills • 24-1 Performing Range-of-Motion exercises • 24-2 Using a Continuous Passive Motion machine