ACTIVITY AND EXERCISE

1. ACTIVITY AND EXERCISE Unit VII

2. Review Body Mechanics/ safety • II. Discuss Benefits of exercise • III. Compare rehab and restoritive • IV. Discuss Effects of Immobility • V. Describe Body Alignment

3. VI. Demonstrate Skills of Activity and Exercise Ambulate Walk with Cane Walk with Walker Wheelchair Transfer Wheelchair Transport Wheelchair Transfer (2 Person) Mechanical Lift Supine Position Placement Side-lying Position Placement Move up in Bed Move up in Bed with Lift Sheet Passive Range of Motion/ Shoulder and Elbow Passive Range of Motion Hip and Knee Support stocking application

4. Review Body Mechanics • A. Body mechanics is using muscles of the body correctly to make the best use of • strength to lift or move objects. • 1. Nursing Assistants must keep alert at • all times to the principles of good body mechanics when transferring • residents or assisting them with activity. • 2. Refer to Unit II for additional information on body mechanics.

5. Discuss Benefits of Exercise • Define Exercise – exercise is physical activity or a series of specific movements designed to strengthen the body or parts of the body. • Benefits of Exercise • 1. Physical activity or exercise is important for all ages. • 2. Improves circulation and the functioning of all body systems. • 3. Keeps resident mobile, more independent and mentally alert.

6. Discuss Benefits of Exercise (Cont.) • C. Discuss the Importance of Rest and Sleep • with Activity and Exercise. • Adequate rest and sleep promotes • improved strength and endurance • and successful results with exercise • activities. • Plan rest times as a part of the resident’s daily activity. • Plan resident’s night time routine to promote a restful night’s sleep.

7. Describe Principles of Rehabilitation • Define rehabilitation • Process of treatment and education that leads the disabled person to attain maximum function and a sense of well being. Residents having strokes or broken hips may have rehabilitation therapy

8. Describe Principles of Rehabilitation (Cont.) • Define rehabilitation (Cont.) • Involves physicians as well as physical • therapists, occupational therapists and • speech therapists. 2. The nursing department participates in the plan of treatment and education. 3. Nursing Assistants participate in rehabilitation by following the resident’s plan of care. 4. Principles of rehabilitation include prevention, maintenance and restoration.

9. Describe Principles of Rehabilitation (Cont.) • Define Restorative Care • Process of assisting a person to help himself/herself to maintain his/her highest level of physical and mental ability. Residents experiencing general aging limitations will benefit from restorative care.

10. Describe Principles of Rehabilitation (Cont.) • Define Restorative Care (Cont.) • Consult resident’s care plan for individualized care. • Encourage resident self help with ADL’s by using adaptive equipment such as long handled shoe horn or grippers when suggested by Occupational Therapist on care plan. 3. Focus on resident’s abilities. 4. Encourage active range of motion.

11. Describe Principles of Rehabilitation (Cont.) • Define Restorative Care (Cont.) • Encourage to do part of bathing, dressing, grooming and other ADL’s. Provide passive range of motion when indicated on care plan. 6. Encourage resident to be as independent as possible if consistent with the care plan.

12. Describe Principles of Rehabilitation (Cont.) • Describe Progressive Mobilization • A process that builds on activity steps which to increase the resident’s abilities.

13. Discuss Effects of Immobility • Immobility affects the resident’s physical and psycho-social needs. Inactivity leads to deterioration and complications in all body systems. • A. Physical effects of immobility • 1. Circulatory • a. Blood vessels may tend to pool, causing blood clots. • b. Poor blood flow may cause edema (swelling) in tissues. • c. Increases work load for the heart. • d. Decreases functioning in all body systems.

14. Discuss Effects of Immobility (Cont.) • 2. Respiratory • a. More difficult for lungs to expand. • b. Tendency toward respiratory infections. • 3. Urinary • a. Without gravity, urine tends to be retained in the bladder, causing infections of the urinary tract (UTI). • 4. Digestive • a. Loss of appetite. • b. Inactivity leads to constipation.

15. Discuss Effects of Immobility (Cont.) • 5. Musculo-skeletal • a.Calcium loss is increased when stress (activity) is not placed on bones; leads to risk for fractures. • b. Contractures (shortening and tightening) of muscles occurs in muscles that are not used. • 6. Integumentary (skin) • a. Pressure ulcers involving skin and deeper tissue develop quickly on the resident who does not have frequent position changes.

16. Discuss Effects of Immobility (Cont.) • B. Mental effects from immobility • 1. Inactivity leads to loss of self esteem, low self concept, poor body image, and increased dependence on others. • 2. Inactivity can lead to depression. • C. Social effects from immobility • 1. Lack of social activity or stimulation leads to withdrawal, isolation or loneliness.

17. Describe Body Alignment • The correct positioning of the resident’s body is referred to as body alignment. Body alignment means positioning the resident in good posture, whether in a sitting or lying position. It is the position where the body is most comfortable and body systems function the best.

18. Describe Body Alignment (Cont.) A. Sitting 1. In Bed (Fowler’s position) • Resident is lying on his/her back. With head and knees elevated. • Make certain resident’s hips are at bend of bed. • May be necessary to move resident up in bed at intervals. • Use pillows to assist if consistent with care plan.

19. Describe Body Alignment (Cont.) • Sitting (Cont.) • In a chair • a. Feet should be flat on floor or foot stool. • b. Hip and knees at right ankles. • c. Buttocks should rest firmly against back of chair. • d. Spine should be straight (natural curve) against back of chair. • e. Head should be directly over shoulders • f. Support elbows on armrests. • g. May be necessary to position some residents with pillows to maintain good alignment.

20. Describe Body Alignment (Cont.) B. Lying • Supine Position (lying on back) • a. A small pillow under the resident’s head usually allows for better alignment than a large pillow. • b. A footboard helps to keep the feet in proper alignment and prevents footdrop.

21. Describe Body Alignment (Cont.) B. Lying (Cont.) • Side Lying Position (lateral position) • a. Pillows support upper arm and leg. • b. Position upper leg so weight does not rest on lower leg. • c. A pillow placed lengthwise is used to support the resident’s back and maintain the position.

22. Describe Body Alignment (Cont.) B. Lying (Cont.) 3. Prone Position • Use this position for residents only if directed to do so by nurse or care plan. • Turn the resident’s head to one side when lying prone. • The resident’s feet may be placed in space between mattress and foot of bed to keep in good alignment.

23. Describe Body Alignment (Cont.) B. Lying (Cont.) • Use positioning devices if indicated. • a. Pillows • b. Cushions

24. Describe Body Alignment (Cont.) • C. Guidelines for Moving and Lifting Residents • 1. Plan your moves • a. Consult resident’s care plan. • b. Ask for assistance if needed. • Organize equipment. • c. Explain procedure to resident, making certain he/she understands what is to be done.

25. Describe Body Alignment (Cont.) • C. Guidelines for Moving and Lifting Residents (Cont.) • 2. Use lifting devices if indicated. • a. Lift sheets. • b. Mechanical lifts. • c. At least two people are required when using a mechanical lift.

26. Describe Body Alignment (Cont.) • C. Guidelines for Moving and Lifting Residents (Cont.) • 3. Position bed at proper height • a. In low position when transferring resident in or out of bed. • b. At working level when moving or changing position of resident in bed.

27. Describe Body Alignment (Cont.) • D. Safety Reminders • Use brakes on equipment such as beds, • wheelchairs and lifts. 2. Always check to make sure equipment used for lifting or moving residents is in proper working condition. 3. When transferring a resident to another surface, move resident toward his/her stronger side.

28. Describe Body Alignment (Cont.) • D. Safety Reminders (Cont.) 4. Support resident’s weaker side when transferring a. Residents having had a stroke will have hemiplegia (paralysis) on half (left or right) side of the body. 5. Be alert to tubing safety. 6. Make certain all surfaces are stable. 7. Have resident wear non-skid shoes.

29. Describe Body Alignment (Cont.) • D. Safety Reminders (Cont.) 8. Apply artificial limbs and braces correctly. 9. Do not lift under arms of resident; this can cause Shoulder dislocation. 10. Support body parts when turning resident. 11. Transport residents with care; approach corners slowly and observe for cross traffic.

30. Describe Body Alignment (Cont.) • D. Safety Reminders (Cont.) 12. Observe and report any change in resident condition. a. Dizziness, unsteadiness, ability to complete or manage activity. b. Signs of skin irritation. c. Resident’s comments.

31. Describe Body Alignment (Cont.) • E. Psychosocial Influences • 1. Allow resident to assist as much as possible if consistent with care plan. • 2. Encourage resident if able, to be “in charge” of transfer. • a. Ask resident to count (1,2,3, move). • b. Offer choices to resident, such as where to be transported to or when to be transferred.

32. Describe Body Alignment (Cont.) • Psychosocial Influences (Cont.) • 3. Be aware the inability to move about • freely is a great loss of the resident’s independence. • 4. Be alert to the resident’s fears, such as falling or being left alone.

33. Use of TED Hose • TED hose are elastic stockings used to promote circulation back to the heart. • TED hose are also called anti embolism stockings. ( To prevent blood clots) • TED hose are put on residents in am before getting up and removed at night. • TED hose are physician ordered. Check care plan.

34. Home Health Aide Unit VII

35. Discuss Assisting with Activity and Exercise • in the Client’s Home • A. Review principles of rehabilitation and restorative care. • B. Review safety in the client’s home.

36. Discuss Assisting with Activity and Exercisein the Client’s Home (Cont.) • C. Identify special considerations with activity in the client’s home. • 1. Choose a safe supportive chair.a. A low to the floor, soft chair or a reclining type chair is difficult to get out of, especially if client is weak. • b. A chair with arms is easier for client to push out of chair. • c. Should provide the most independence.

37. Discuss Assisting with Activity and Exercise in the Client’s Home (Cont.) C. Identify special considerations with activity in the client’s home (Cont.) • Plan Transfers • a. There is no one immediately available to assist if a problem occurs. • b. Position chairs to prevent chairs from sliding and to provide safe transfers. • c. Do a “walk through” by yourself to see that the plan will work. • d. Instruct the client carefully so he/she understands the plan. • e. Concentrate on what you are doing.

38. Discuss Assisting with Activity and Exercise in the Client’s Home (Cont.) C. Identify special considerations with activity in the client’s home (Cont.) • Review mechanical lift procedure and follow agency policy. • 4. Assist with rehabilitation activities as directed. • a. Home health agency may have or contract for physical therapy services. • b. Follow care plan. • c. Report activities or concerns to supervisor.

39. II. Describe Sleep and Rest Needs of Child

40. Sleep and Rest Needs of Child • A. Sleep is necessary for the rapid growth of infants and children. • Maintain child’s routine or plan routine with supervisor. • Newborns usually sleep 20 out of 24 hours and are awake mostly to eat.

41. Sleep and Rest Needs of Child • Infants usually have morning and afternoon naps. • Toddlers and preschoolers need 12 hours of sleep a day. Some take a nap or have a rest time to look at books or other quiet activity. • A child confined to bed for medical reasons need to have play activity included as part of the routine.

42. Appropriate activities for Infants, children, toddlers • Infants – colorful mobiles, rattles, stuffed animals • Toddlers – finger paints, blocks, coloring, singing, read books, educational toys, play dough. • Children – puppets, books, board games, music, TV, pretend play.