Fundamental Nursing Skills and Concepts

1
Fundamental Nursing Skills and Concepts

• Chapter 24
• Page 506

2
Chapter 24

• THERAPEUTIC EXERCISE
• Page 506

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Exercise

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

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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

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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

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Assessment Techniques

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

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Assessment Techniques

• Assessment of fitness tests Electrocardiogram
  and Ambulatory electrocardiogram

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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.

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TARGET HEART RATE

• The goal of the heart rate during exercise.
• It is determined by first calculating the
  persons maximum heart rate
• Maximum heart rate is calculated by subtracting a
  persons age from 220.

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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

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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

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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.

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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

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ACTIVE VERSUS PASSIVE EXERCISES

• 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 clients legs to maintain muscle tone
  and flexibility

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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

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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 clients response to a
  therapeutic exercise program
• Page 511 nurse guidelines 24-1

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NURSING IMPLICATIONS NURSING DIAGNOSES

• Impaired Physical Mobility
• Risk for Disuse Syndrome
• Unilateral Neglect
• Risk for Delayed Surgical Recovery
• Activity Intolerance

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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

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Skills

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