11/23/2010 1 Nursing 53A Judy Ontiveros, RN, MSN 11/23/2010 1 Discuss the importance of maintaining adequate daily physical activity. Describe the consequences of disuse on the major body functions. Identify and explain preventive nursing interventions for the client who is under temporary or prolonged restriction of physical activity. 11/23/2010 2 Explain the nature of sleep as a form of rest. Report the effects of sleep deprivation. Sleep as a major part of daily rest and the characteristics of sleep Explain the need for a balance between physical activity and rest. 11/23/2010 3 The gift of exercise Physical Activity | Produced by muscle contraction that increases energy expenditure Exercise | Planned, structured, repetitive | Maintain physical fitness | Functional Strength y Perform work The consequences of disuse the state in which an individual is at risk for deterioration of the body systems as the result of prescribed or unavoidable musculoskeletal inactivity 11/23/2010 4 Gift of Exercise Immobility and Its Effect Maintain size, shape, tone, and strength of muscles (including the heart muscle) Nourish joints Increase joint flexibility, stability, and ROM Maintain bone density and strength Disuse osteoporosis Disuse atrophy Contractures Stiffness and pain in the joints 11/23/2010 5 Deterioration of bones, muscles, and joints Atrophy Negative nitrogen balance Contractures Foot drop Osteoporosis 11/23/2010 6
Transcript
11/23/2010
1
Nursing 53A Judy Ontiveros, RN, MSN
11/23/2010 1
Discuss the importance of maintainingadequate daily physical activity.
Describe the consequences of disuse on themajor body functions.
Identify and explain preventive nursinginterventions for the client who is undertemporary or prolonged restriction ofphysical activity.
11/23/2010 2
Explain the nature of sleep as a form of rest.
Report the effects of sleepdeprivation.Sleep as a major part ofdaily rest and the characteristics of sleep
Explain the need for a balance between physical activity and rest.
11/23/2010 3
The gift of exercisePhysical Activity
Produced by muscle contraction that increases energy expenditure
The consequences of disusethe state in which an individual is at risk for deterioration of the body systems as the result of prescribed or unavoidable musculoskeletal inactivity
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Gift of Exercise Immobility and Its Effect
Maintain size, shape, tone, and strength of muscles (including the heart muscle) Nourish jointsIncrease joint flexibility, stability, and ROMMaintain bone density and strength
Disuse osteoporosisDisuse atrophyContracturesStiffness and pain in the joints
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Deterioration of bones, muscles, and jointsAtrophyNegative nitrogen balanceContracturesFoot dropOsteoporosis
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Effects of Immobility/Disuse
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Gift of Exercise Immobility and its Effect
Increase ventilation and oxygen intake improving gas exchangePrevents pooling of secretions in the bronchi and bronchioles
Decreased respiratory movementPooling of respiratory secretionsAtelectasisHypostatic pneumonia
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Lungs function best when uprightMetabolic need for O2 decreasesBreathing becomes shallowMuscles weakenAbility to cough is compromisedDehydrationPneumonia
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Gift of Exercise Immobility and its Effect
Increases HR, strength of contraction, and blood supply to the heart and muscles Mediates harmful effects of stress
Immobility Diminished cardiac reserveIncreased use of the Valsalva maneuverOrthostatic hypotensionVenous vasodilation and stasisDependent edemaThrombus formation
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Metabolic demands of the cell decreaseCV workload may increase
Difficult to change positionsDifficult to perform ADLsValsalva Maneuver
yellow marrow: fat, in hollow area of long bones, originates from red marrow, converts to yellow by 5 y/o, serves as a last resort for body's energy requirements
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red marrow: hematopoietic
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Gift of Exercise Immobility and It’s Effects
Elevates the metabolic rateDecreases serum triglycerides and cholesterolStabilizes blood sugar and make cells more responsive to insulin
Immobility Reduced skin turgorProlonged pressure on bony prominences
Skin Breakdownpressure ulcer
Skin damage fromshearfrictionmacerationinfection
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Exercise
Pumps lymph fluid from tissues into lymph capillaries and vesselsIncreases circulation through lymph nodesStrenuous exercise may reduce immune functionLeaving window of opportunity for infection during recovery phase
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Gift of Exercise Effects of Immobility
Elevates moodRelieves stress and anxiety Improves quality of sleep for most individuals
Decline in mood elevating substancesPerception of time intervals deterioratesProblem-solving and decision-making abilities may deteriorateLoss of control over events can cause anxiety
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Patient can lose interest in lifeLoneliness and social isolationPowerlessnessLoss of roleBehavior changesSensory deprivation/mental confusionSleep interference
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Exercise
Positive effects on decision-making and problem solving processes, planning, and paying attentionInduces cells in the brain to strengthen and build neuronal connections
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A Basic Need:
Physiological effectSafety and survivalPsychosocial effect
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MobilityEssential part of livingProtection from harmMeet basic needsIndependence
Vs vulnerability / dependency
Mental well-being / effective body functioningAll body parts function more efficientlyInfluences self-esteem and body image
Independence/usefulness/Pain = difficult coping strategiesReaction of others to infirmities
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Movement fostered to full extent of abilitySatisfying lifeEngage in competitionsFitnessCreate Art
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Body position change Proper alignmentStimulate circulationMaximize respirationsPrevent skin breakdown
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Alignment:Support above and below jointAnatomic or functionalTurn q 1 to 2 hours
Use positioning aides such as:Egg crateOver bed cradlesHeel protectorsHand rolls
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Change body positioning:Active, passive or assistive ROM for all jointsCPM machine for post op orthopedic surgery patientsFoot boardsIsometricsADL’sOOB
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Prevent skin breakdown:
BathingRemove excess moistureUse draw sheet to reduce shear Be careful with tapeGet help to move patient
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Elevate legsTED hoseSEQ
Avoid compression of leg vesselsGradual adjustment to vertical
DangleTilt table
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Encourage lung expansionMobilize secretionsDeep breathing 10X q2 hoursDrinking lots of fluids to liquefy secretions
2 -3 liters of H2O preferably per dayCough 5 x q 2 hours
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Nursing History Physical Examination:
Body alignmentGaitAppearance and movement of jointsCapabilities and limitations for movementMuscle mass and strengthActivity toleranceProblems related to immobility
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Activity toleranceBody positioningBowel eliminationFall prevention behaviorImmobility consequences both physiological and psychocognitiveJoint movement
MobilityRespiratory statusVentilation and gas exchangeSelf-careSleepStress levelWeight control
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Plan what to do and how to do itObtain essential equipment before startingRemove obstaclesExplain transfer to client and assistive personnelSupport or hold client rather than equipmentExplain what client should doMake written plan, including client’s tolerance
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SLEEP
ACTIVITY REST
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Sleep is altered state of consciousness where perception of and reaction to environment decreasedCyclic nature of sleep thought to be controlled by lower part of brain
Neurons in reticular formation integrate sensory information from PNSRelay to cerebral cortexRAS involved in sleep-wake cycle
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Affect sleep-wake cycleSerotonin
Thought to lessen response to sensory stimulationGABA
Thought to shut off activity in neurons of RASWakefulness
RAS – maintains alertness and wakefulnessRAS receives visual and sensory input and auditory pain and tactile stimuliStudies support that wakefulness results from neurons in the RAS releasing catecholamines
Acetylcholine, dopamine, noradrenalin associated with cerebral cortical arousal
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Darkness and preparing for sleep cause decrease in stimulation of RASPineal gland begins to secrete melatonin and person feels less alertDuring sleep GH secreted and cortisol inhibited
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Circadian synchronization when biological clock coincides with sleep-wake cyclePerson awake when body temp highest and asleep when body temp lowestBy 3-6 months of age have regular sleep-wake cycle
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Restores normal levels of activityRestores normal balance among parts of the nervous systemNecessary for protein synthesisPsychological well-being
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Sleep & Temperature: sleeping warm/hot interferes with insulin & glucocorticoid stabilization, role in weight loss
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Reticular Activating System
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Awake
Stage I NREM
Stage II NREM
Stage III NREM
Stage IV NREM
Repeat III
Repeat II
Stage V REM
Repeat II
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Refers to basic organization of sleepTwo types that alternate in cycles during sleep
NREMREM
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Occurs when activity in RAS inhibitedConstitutes 75% - 80% of sleepConsists of 4 stages
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Stage I Very light sleep and lasts only a few minutesFeels drowsy and relaxedEyes roll from side to sideHR and RR drop slightlyCan be readily awakened and may deny sleeping
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Stage IILight sleep lasts only about 10 to 15 minutes Body processes continue to slow downEyes are generally stillHR and RR decrease slightly Body temperature falls44% to 55% of total sleepRequires more intense stimuli to awaken
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Stage III and IVDeepest stages of sleep (delta sleep or deep sleep)HR and RR drop 20% to 30% below waking hoursDifficult to arouseNot disturbed by sensory stimuliSkeletal muscles very relaxedReflexes are diminished Snoring is likely to occurSwallowing and saliva production reducedEssential for restoring energy and releasing important growth hormones
Occurs every 90 minuteLasts 5 to 10 minutesAcetylcholine and dopamine increaseMost dreams take place Brain is highly active Brain metabolism increases as much as 20%Distinctive eye movements occur
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Voluntary muscle tone dramatically decreasedDeep tendon reflexes absentMay be difficult to arouse or may wake spontaneouslyGastric secretions increaseHR and RR often are irregular Regions of brain associated with learning, thinking, organizing information stimulated
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Sleep Cycles Physiological Changes
Stage I NREM: Light sleepFew minutes
Stage II NREM: Sound sleep 10 to 20 minutes
Stage III NREM:1st stages of deep sleep
Gradual fall in VS / metabolism
Body functions slowRelaxation progresses
Muscles completely relaxed VS decline / WNL
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Sleep cycles Physiological changes
Stage IV NREM: deepest stage of sleep 15 to 30 minutes
Stage V REM: Deep vivid dreamSleep lasts 20 minutes and cycles Q 50 to 90 minutes
Body restored / rested VS significant lower than waking hoursSleep walking Enuresis may occur
Loss of skeletal muscle tone ANS response of rapidly moving eyesFluctuating BP, HR, RR rateGastric secretions increase Mental restoration occurs
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Newborns Toddlers
AdolescentsPregnancy
Menopausal women
Elderly
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[kids & *adolescents* need sleep!]
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Sleep 16 to 18 hours a dayPeriods of 1 to 3 hours spent awakeEnter REM sleep immediately50% NREM and 50% REMSleep cycle ~ 50 minutes
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Awaken every 3 to 4 hours, eat, and then go back to sleepPeriods of wakefulness gradually increase By 6 months, most infants sleep through the night and establish a patternEstablish a pattern of daytime naps
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12 to 14 hours are recommended Most still need an afternoon nap Nighttime fears and nightmares are also common
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Preschool child (3-5 years)requires 11 to 13 hours of sleepSleep needs fluctuate in relation to activity and growth spurts
School-age child (aged 5 to 12) needs 10-11 hours of sleepMost receive less
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Require 9-10 hours of sleep each nightFew actually get that much sleepCircadian rhythms tend to shiftTendency to stay up later and wake later
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Adults7-9 hours of sleepIndividual variations
EldersTendency toward earlier bedtime and wake timesMay show an increase in disturbed sleep Need to sleep does not decrease with age
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circadian rhythm variations - 24.2 hour cycle
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IllnessEnvironmentLifestyleEmotional stressStimulants and alcoholDietSmokingMotivationMedications
Signs: reddened uvula, irritation caused by breathing with open mouth
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Helping client to relaxTeaching cognitive strategiesAdministering medicationsPreparing the environment for sleepPromoting dietary changesScheduling night time careManaging DisordersManaging symptomatology that disturbs sleepManaging bedtime agitation
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Reducing environmental distractionsPromoting bedtime ritualsProviding comfort measuresScheduling nursing care to promote uninterrupted sleepTeaching stress reduction, relaxation techniques or good sleep hygiene
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Experience sleepiness and fatigue during dayAttention and concentration deficitsReduced vigilanceDistractibilityReduced motivationFatigue, malaise, diplopia, dry mouth
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When does client usually go to sleep?Bedtime rituals?Does client snore?Can client stay away during day?Taking any prescribed or OTC medications?
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Rarely yields information unless client has obstructive sleep apneaEnlarged and reddened uvula and soft palateEnlarged adenoids and tonsils (children)Obesity (adults)Neck circumference > 17.5 inches (men)Deviated septum (occasionally)
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Altering or eliminating routines can affect sleepAdultsListening to musicReadingSoothing bathPrayingChildrenNeed to be socialized into presleep routineUsually preceded by hygienic ritual
