0331 Exercise, Transfer & Mobility

8/19/2019 0331 Exercise, Transfer & Mobility

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Exercise, Transfers &

Ambulation


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Mobility

Mobility refers to a person’s ability to move about freely.

Immobility refers to a person’s inability to move about freely.

Mobility & immobility are the endpoints of a continuum with manydegrees of partial immobility in between.

mobility immobility

ome clients move bac! and forth, some clients remain absolute.


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Ability to Move

The ability to move & function is a function most people ta!e for granted.

The level of mobility has a significant impact on an ind.’s physiological,

psychosocial, & developmental well"being #$amilton & %yon, ''().

*hen there is an alteration in mobility, many body systems are at ris! for

impairment.

" +ardiovascular functioning – orthostatic hypotension

" ulmonary complications – pneumonia

- romote s!in brea!down, muscle atrophy etc

uch changes can lead to altered self"concept & lowered self"

esteem.


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Medical +onditions that can

Alter Mobility

ractures/sprains

0eurological conditions – spinal cord in1ury, head in1ury

2egenerative neurological conditions – Myasthenia

gravis, $untington’s chorea


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0ursing Measures

Attempt to maintain and/or restore optimal mobility as well as to decreasethe ha3ards assoc. with immobility.

" Muscle & 1oint exercises

" re4uent repositioning –

4 5 hrs" luid inta!e/fiber inta!e

6uidelines7" +hec! activity order

" 8now client’s past medical history & limitations" 9aseline vital signs are necessary

" 9ecome familiar with assistive devices


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Ma1or concern during transfer : afety of

both the client and the nurse


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;ange of Motion Exercise

#;


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;


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;


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Two urposes of ;


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+ontraindications to ;


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erform Exercises in $ead to

Toe ormat

tart with the head and move down, always do bilaterally

2o not grasp the 1oint directly

+up the 1oint gently #prevents pressure)

2o not grasp fingernail or toenail

Important 1oints – thumb, hip, !nee, an!le

;eturn to correct anatomic position

Move 1oint through movement ( times/session


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tart at the 0ec! & p. ?@

Neck Flexion – look @ the toes

Extension – look straight ahead

Hyperextension – look up @ ceiling

Lateral fexion – look straight ahead, tilt head to shoulder

Shoulder Flexion – raise arm orward o!erhead

Extension – return arm to side o "ody

#"duction – raise arm to side to position a"o!e head withpalm away rom head$

#dduction – return arm "ring across chest

%nternal rotation – el"ow fexed, rotate the shoulder "ymo!ing arm til thum" is turned inward toward the "ack&'ngers to the foor(

External rotation – el"ow fexed, mo!e arm until thum" isupward lateral to head$ &'ngers point up(

)ircumduction – mo!e arm in ull circle &arm straight out,mo!e hand as i to draw a circle$


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Elbow

El"ow Flexion – "end el"ow

Extension – straighten el"ow

Hyperextension – "end lower arm "ack as ar aspossi"le

Forearm Supination – turn lower hand so palm is up

*ronation + turn lower hand so palm is down

rist Flexion – "end wrist orward

Extension – straighten wrist &'ngers, wrist arm insame plane(

Hyperextension – "ring dorsal surace o hand asar "ack as possi"le

#"duction &radial fexion( – "ring wrist mediallytowards the thum"

#dduction &ulnar fexion( – "end wrist laterallyth


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ingers & Thumb

Fingers thum"

Flexion – "end 'ngers thum" into palm make a'st

Extension – straighten 'ngers thum"

Hyperextension – "end 'ngers as ar "ack as

possi"le#"duction – spread 'ngers apart . extend thum"laterally

#dduction – "ring 'ngers together. thum" "ackto hand

)ircumduction – mo!e 'nger.thum" in circular

motion

/pposition – touch thum" to each 'nger o samehand


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$ip

Hip Flexion – mo!e leg orward &0/1 23+453 deg(Extension – mo!e leg "ack "eside other leg

Hyperextension – mo!e leg "ackwards &0/163+-3 deg(

#"duction – mo!e leg laterally away rom "ody&0/1 63+-3 deg(

#dduction – mo!e leg "ack to medial position "eyond i possi"le &0/1 63+-3 deg(

7nee Flexion – "ring heel toward "ack o thigh &453+463 deg(

Extension – return leg to foor


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An!le

#nkle 8orsifexion – mo!e oot so toes are pointed upward*lantarfexion – mo!e oot so toes are pointeddownward

Foot %n!ersion – turn sole o oot medially &0/1 43 deg(E!ersion – turn sole o oot laterally &0/1 43 deg(

Flexion – curl toes downward &0/1 63+93 deg(

Extension – straighten toes &0/1 63+93 deg(

#"duction – spread toes apart

#dduction – "ring toes together


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pine

Spine Flexion – when standing – "end orward romthe waist

Extension – straighten up

Hyperextension –

"end "ackwardLateral fexion – "end to the side

0otation – twist rom the waist


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Types of ;


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Isometric/Isotonic Exercises

In addition to ;


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Applying Antiembolism toc!ings

#Elastic) & p. ?=5

Thromobophlebitis – the development of a thrombus or clot

along with the inflammation of the vein & may be classified as

superficial or deep.

Three elements contribute to the development of a clot.

. $ypercoagulability of the bld – clotting disorders,

dehydration, pregnancy & st B wee!s postpartum if the

woman was confined to bed, oral contraceptives.

5. Cenous wall damage – local trauma, orthopedic

surgeries, ma1or abdominal surgery, varicose veins,

arteriosclerosis

@. 9lood stasis – immobility, obesity, pregnancy


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Antiembolism stoc!ings

romote venous return by maintaining

pressure on superficial veins to prevent venous

pooling.

revent passive dilation of veins

Application of antiembolism stoc!ings #refer top. ?=( &)


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Therapeutic ositions

+hair – feet flat on floor, footrest if unable to reach floor, !nees & hipsflexed '" degrees. 9uttoc!s at bac! of the chair, spine straight, pillowsat side to prevent leaning.

owlers – supine, $


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Therapeutic positions cont.

%ithotomy – supine flex both !nees so that feetare close to hips, separate legs, feet in stirrups.tili3ed for perineal & vaginal examinations

Trendelenburg – supine, entire bed frame tilteddown with head @ deg below hori3ontal.

" ostural drainage

" Increase venous return in case of shoc!


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ositions and ses

2orsal #supine)7

F lace patient on bac! with head and shoulders are slightly elevated.

F sed for physical assessment , to provide comfort , & change position.


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ositions and ses

2orsal recumbent7

F lace patient on bac!, legs flexed and slightly rotated outward

Fsed for pelvic examination, female catheteri3ation, perinal care


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ositions and ses

emi"fowlerGs position7

F itting position with or without positioning pillow at head =("B

degree. used for eating and facilitate breathing.


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ositions and ses

$igh fowlerGs position7

F$ead & trun! are raised B"' degrees, used for some people

with heart problems or having difficulty breathing.


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ositions and ses

rone position7

F %ying flat on the abdomen, arm flexed toward head, & head

turned to one side. seful for some unconscious patients.


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9enefits of roper ositioning

Maintains body alignment & comfort

revents in1ury to musculos!eletal system, prevents

strain

rovides sensory, motor & cognitive stimulation

revents pressure sore #decubitus ulcer) & 1oint

contractures


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Transfers

Transferring is a nursing s!ill that helps the client with restricted

mobility attain/maintain mobility & independence.

9enefits of transfers

" Maintains & improves 1oint motion

" Increases strength

" romotes circulation

" ;elieves pressure on the s!in

" Improves urinary/respiratory function" Increases social activity

" Increased mental stimulation


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Transfers " afety

afety is a ma1or concern when transferring. alls are a commonha3ard. If a patient starts to fall – do not try to stop the fall, insteadassist the patient to the floor while protecting the head from in1ury.This will reduce the ris! of patient as well as staff in1ury.

+omplete a thorough nursing assessment before you move thepatient to determine if she/he has suffered any in1uries.

revention of in1ury is the !ey, be aware of the client’s motordeficit, ability to support their body weight and use effective bodymechanics & lifting techni4ues.

*hen in doubt regarding the patient’s ability"6ET AITA0+E


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0ursing rocess " Transfers

#ssessment #cti!ity orders

)lient capa"ilities

*lanning 8ecide appropriate transer techni:ue

Explain procedure to the patient

%mplementation ash hands

*osition chair ;- deg angle to "ed on clients strongerside

Lock "ed "rakes, lower "ed, raise H/< as high aspatient tolerates

Lower side rail

#ssist to sitting &lit upper "ody swing legs around(

#ssist with ro"e slippers

*osition eet on foor

=ake wide stance, "end knees, grasp patient

“4 5 6 stand”

*i!ot to chair


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0ursing rocess #cont.)

E!aluation

Of note:


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Ambulation

+lients who have been immobile even for a short time may re4uire

assistance

A client may re4uire the use of an assistive device to aid in

ambulation.

Assistive devices

" Increase stability

" upport a wea! extremity" ;educe the load on weight bearing structures> hip, !nees


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Assisting the patient

imple assist. lace arm near patient under the arm & at the elbow &

grasp pt’s hand, synchroni3e wal!ing with the pt #moveinside foot forward at same time as pt’s inside foot)

5. 6rasp pt’s left hand in nurses

’ left hand & encircle pt

’s waistwith the rt hand & synchroni3e wal!ing as above

@. sing a transfer belt #held at the waist from the rear by thebelt – helps maintain balance)

0urse to stand on the pt’s wea! side. The nurse provides

support with his/her leg to the pt’s wea!ened one if necessary.2o not allow the pt. to place their arm around your shoulder.

*al! slowly, even gait, synchroni3e your steps.


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+ane

$elps maintain balance by widening the base of support increases a pt’ssecurity.

hould be held on stronger side

" hould have rubber tip – prevent slipping

" $eight #from greater trochanter to the floor allowing ("@ deg of elbowflexion.

6ait – place cane B" inches ahead, move affected leg ahead tocane, place weight on affected leg and cane, move unaffected legahead of cane.

tand from sitting" +ane in hand opposite affected leg, grasp arm of chair & cane in other,

push to stand, gain balance


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*al!er

*ide base of support, provides great stability &security. sed for clients who are wea! or whohas problems with balance.

" atient should have at least one weight bearing leg andarm

" ic! up wal!er is more stable, wal!er with wheels easierfor pt’s who have difficulty with lifting or balance, however

can roll forward when weight is applied." $eight – upper bar of wal!er should be slightly below the

client’s waist with arms flexed ("@ deg


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*al!er #cont.)

To stand – wal!er in front of seat, push up off arms ofchair #wal!er is less stable, chair is lower pt. can pushwith more force. $ands move to wal!er one at a time.

To sit – bac! up to chair, reach bac! with one arm toarm of chair, then with the other arm and lower to chair.

6ait – wal!er ahead B"? inches, weight on arms. artialweight on affected leg first.


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+rutches

*ooden or metal staff that reaches from the ground to

/5 – 5 inches below the axilla. *hen standing tip of

crutch rests ="B inches in front & ="B inches to side of

foot.

2o not rest on top of crutches – pressure on axilla

nerves – can lead to paralysis called crutch paralysis

#numbness, tingling, muscle wea!ness)


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+rutches #cont.) & p.?('

@ point gait – able to wt. bear on one foot, full wt. on

unaffected leg then on both crutches – begin in tripod

position, move crutches & affected leg ahead, move

stronger leg forward and repeat.

= point gait – #most stable crutch wal!) weight on both

legs and both crutches – muscular wea!ness,

improves balance by providing a wide base of support,lac! of coordination, move each independently – rt

crutch"lt foot"lt crutch"rt leg


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Assisting with Ambulation

Assistive 2evices

"+anes "+rutches "*al!ers

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0331 Exercise, Transfer & Mobility

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