Chapter 38: Activity and Exercise in Nursing Care

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Okay picture this.

You're a nurse, the alarm just went off, and bam, before you've even had that first sip of coffee, you're already in motion.

Every shift is this intricate dance of recovery and well -being.

Every patient transfer, every gentle nudge towards activity, it's all part of ensuring they get better.

It's demanding, it's dynamic, and it demands that you are informed, precise, and above all safe.

Absolutely.

Think about it.

Every small move, every transfer, it's not just about the patient's comfort, it's about your safety too, isn't it?

Definitely.

It's a high -stakes environment where understanding these fundamentals of movement and mobility is truly life -changing for everyone involved.

And that's why we're here today on the deep dive.

We're taking a deep dive into those critical concepts, activity and exercise in nursing care, drawing directly from the foundational knowledge and fundamentals of nursing, by Potter, Perry, Stockard, and Hall.

Yeah, a cornerstone text.

Our mission for this deep dive is to extract the most important nuggets of knowledge and insight, offering you a shortcut to being truly well -informed about patient mobility, safe handling, and promoting health through activity.

We're not just talking theory here though.

We're emphasizing practical application in real -world healthcare settings, you know, hospitals, home care connecting these key nursing concepts directly to NCLE -X competencies.

Get ready for some aha moments that will hopefully not only surprise you, but also empower your practice.

So let's unpack this.

Before we even talk about how to help patients move, we have to graph the incredible complexity of how the human body moves in the first place.

This isn't just academic.

It's fundamental to ensuring both your patient's safety and, just as crucially, your own.

It's the bedrock, really.

When we think about why activity matters, the American Heart Association really broadens our perspective, doesn't it?

It does.

It's far more than just physical fitness.

Regular physical activity elevates mood, boosts energy, helps us manage stress, promotes better sleep, and even improves self -image.

Yeah, holistic benefits.

Exactly.

These are holistic benefits that touch every aspect of a patient's life.

And, frankly, a nurse's practice, too.

And the nature of that movement is fascinatingly complex.

Let's start with body mechanics.

This is the coordinated effort of our musculoskeletal and nervous systems.

You know, historically, nurses suffered debilitating back injuries from improper lifting.

Oh, absolutely.

A huge problem.

But today, we rely on evidence -based understanding of body alignment,

balance, gravity, and friction to ensure safety during transfers, ambulation, and fall prevention.

Building on that, body alignment and balance are totally intertwined.

Alignment is the proper positioning of joints, tendons, ligaments, and muscles, whether you're standing, sitting, or lying down.

Oh, right, getting everything lined up.

Yeah.

Good alignment reduces strain and conserves energy.

Balance, then, means your center of gravity is stable.

What's crucial for nurses is recognizing that disease, injury, pain, age, or even medications can significantly compromise a patient's balance.

That's a lot of factors.

And then we have the physical forces at play.

Gravity and friction.

Gravity, of course, is always pulling downward.

Patients fall if their center of gravity becomes unbalanced.

Friction, that force -opposing movement, is critical to understand, too.

A specific type called shear happens when skin stays put.

But the underlying bone moves.

Think about a patient sliding down in bed.

Oh, that's a big one.

Shear can cause serious skin injuries, even pressure injuries, if we're not careful.

Exactly.

That's precisely why modern nursing increasingly relies on ergonomic assistive devices like full -body slings.

These devices mechanically lift a patient completely off the surface, preventing both friction and shear injury.

Protecting the patient's skin.

Yep, and safeguarding healthcare staff from injury.

It's a win -win, really.

Okay, here's where it truly gets interesting.

The intricate dance between all the systems that regulate movement.

Our skeletal system is the body's supporting framework.

The scaffolding.

Yeah.

It provides shape, helps us move, protects our organs.

Its strength comes from minerals like calcium,

but its flexibility changes with age.

Think about a flexible newborn versus an older adult with increased risk of bone loss, like osteoporosis.

Big difference.

And then we have the joints, where bones connect.

Think about the incredible variety here, from fixed joints in your skull that allow basically no movement to joints in your spine that offer a tiny bit of give, all the way to the amazing freely movable joints like your elbow or knee.

The synovial joints.

Exactly, the synovial ones.

For nurses, understanding the spectrum isn't just anatomy.

It's about predicting what a patient can and can't do safely, and how much strain we might be putting on them during care.

Supporting all of these are the ligaments, tendons, and cartilage.

Ligaments are those strong, flexible bands that bind joints together and connect bones, ensuring stability.

Tendons connect muscle to bone, the Achilles tendon in your heel, for instance.

That's a powerhouse.

It really is.

And cartilage is that smooth, supportive tissue that cushions bones in your joints, acting like a shock absorber between the bones.

So important.

But for actual movement, we need muscle.

Our skeletal muscles contract when stimulated by nerve impulses.

What's vital for us, as nurses,

is knowing how muscles respond to activity or the lack of it.

Right.

Muscles shrink from inactivity, what we call disuse atrophy.

You see that a lot with bed rest.

But they grow stronger with active use, through hypertrophy.

And there's that unconscious stretch reflex.

If you suddenly put weight in your hand, your arm muscles automatically contract more strongly to counteract the stretch.

Like a protective mechanism.

Exactly.

It's an involuntary protective thing.

Muscles have different ways of contracting, too, right?

Isotonic, or dynamic contraction, causes actual body movement.

This includes concentric tension, where the muscle shortens, like when a patient pulls up on an overhead trapeze.

And eccentric tension, where the muscle lengthens to control movement, like when they slowly lower themselves using that trapeze, controlling the descent.

Gotcha.

And the other type.

Then there's isometric or static contraction.

This increases muscle tension without visible movement.

Imagine tightening your quadriceps muscles while sitting.

Okay, so you're tensing, but nothing's really moving.

Precisely.

Even though you don't see movement, energy expenditure increases.

This is a key point for nurses.

These exercises can be contraindicated for patients with certain conditions, like a recent heart attack or COPD, because they increase the heart's workload.

Ah, good point.

Something to watch out for.

Definitely.

What's fascinating is how muscles work in these orchestrated groups.

Yeah, it's like a team effort.

There's a prime mover doing the main work, an antagonist relaxing to allow that movement.

The opposing muscle.

Right.

And then synergists and fixators stabilizing everything else, making the movement smooth and controlled.

For nurses, recognizing this coordinated action helps us identify when a patient's movement isn't quite right, which often points to a problem we need to investigate.

Okay.

And all this muscle action contributes to posture and muscle tone.

Our muscles are constantly working sort of subtly to counteract gravity and maintain our posture.

Poor posture makes muscles work harder, leading to fatigue.

Makes sense.

And muscle tone, or tonus, is that normal, balanced tension in our muscles.

It's maintained by just everyday activities, ADLs, but unfortunately decreases significantly with prolonged bed rest.

Which is why early mobility is so critical in hospitals.

Exactly.

Get them moving as soon as it's safe.

And finally, the nervous system's role in proprioception and balance control is vital.

Proprioception is our muscle sense, our awareness of body position and movement, even without looking.

Yeah, like, close your eyes.

You still know where your arm is, right?

Right.

That sense, along with input from the inner ear, the cerebellum for coordination and vision, all helps us maintain balance.

For us as nurses, achieving proper balance and alignment means widening your base of support, bringing your center of gravity lower and closer, and bending your knees when lifting or moving.

Basic body mechanics for us protects you and the patient.

Absolutely.

It's fundamental self -preservation in this job.

Okay, so this raises an important question.

How do we apply all this, you know, science knowledge to protect both our patients and ourselves in the busy healthcare environment?

Yeah, the practical side.

This section is all about safe patient handling and mobility, or SPHM.

The challenge is very real, isn't it?

Nurses are frequently exposed to overexertion and physical injury, especially those awful back injuries, from manually moving patients.

Oh, it's a huge risk factor.

Lifting from the floor, lifting with extended arms, twisting your trunk while lifting these are classic high -risk moves.

That's why evidence -based safe patient handling and mobility, SPHM, is so crucial.

SPHM means standardized methods for handling, moving, and mobilizing patients based on their individual characteristics and condition.

Standardized, okay.

And it's guided by ergonomics, essentially designing the work task and the environment to best suit the worker's capabilities, not forcing the worker to adapt to bad design.

That makes so much sense.

What do these comprehensive SPHM programs actually look like?

Well, they're multifaceted.

They use standardized assessment tools, like the banner mobility assessment tool, the BMAT, to quickly figure out a patient's mobility level.

They involve ergonomics assessments of patient rooms and the whole healthcare environment.

They use clinical algorithms, sort of decision trees, to choose the right equipment and the right number of staff for each handling task.

So it's not guesswork?

No, it shouldn't be.

Having the right equipment like ceiling lifts or portable lifting devices with slings is non -negotiable.

Plus, these programs often rely on unit peer leaders who are trained as SPHM experts, regular safety huddles to share information, and a minimal lift policy as a core principle.

Minimal lift.

I like the sound of that.

Me too.

The benefits are profound.

SPHM significantly reduces over -exertion injuries for healthcare providers and dramatically improves patient outcomes, fewer falls, fewer skin tears, fewer pressure injuries.

Wow.

So these are best practices that genuinely make a huge difference.

They really do.

So what are the golden rules, then?

The non -negotiables from Box 38 .1 for safely moving our patients.

Okay.

Key principles.

First, if a patient can't assist significantly, you must use mechanical lifts and lift teams.

Period.

Right.

Don't be a hero.

Exactly.

For us nurses,

a wider base of support means more stability.

Lowering your center of gravity increases stability.

Keep your line of gravity passing through your base of support for equilibrium.

Always face the direction of movement, no twisting your spine.

Divide the work between your arms and legs to reduce back strain.

Remember, leveraging, rolling, turning, or pivoting takes less effort than lifting straight up.

And reducing friction, like using a slide sheet, always makes moving easier.

Okay.

That's practical.

And Table 38 .4 gives tips specifically for preventing lift injuries for us.

Yes.

Super important.

Arrange for adequate help.

Use those lift teams.

Use patient handling equipment, adjustable beds, lifts, slide sheets.

Encourage the patient to help as much as they safely can.

It promotes their independence and reduces your workload.

Good point.

Get close to the patient.

Tighten your abdominal muscles and keep your back, neck, pelvis, and feet aligned.

No twisting.

Bend at your knees.

Keep your feet wide apart for stability.

Use your arms and legs.

They're stronger than your back.

Use the big muscles.

Right.

Slide the patient whenever possible instead of lifting less effort, less shearing.

Coordinate your efforts with any helpers.

Count to three.

And really, manual lifting should be the absolute last resort when no other option works.

Okay.

Solid advice.

So understanding mechanics and safety is one thing, but effective nursing care also means understanding the individual patient.

What factors really influence their ability and willingness to be active?

That's the holistic view.

Exactly.

First, developmental changes profoundly impact movement.

Think about infants gaining independence as their spine develops, or adolescents experiencing those sporadic growth spurts, which can actually lead to temporary awkwardness and affect coordination for a bit.

Yeah, I remember that phase.

And middle -aged adults.

Generally, they should have full musculoskeletal function, but they commonly face multiple

MCCs like arthritis, diabetes, heart disease, hypertension, even depression.

These create significant barriers to exercise.

And older adults often experience progressive bone mass loss, like osteoporosis, making bones weaker and increasing fracture risk.

They might walk slower, take smaller steps, affecting balance, and often develop a fear of falling.

That fear could be paralyzing.

It can.

But here's the crucial point.

Physical exercise can significantly improve endurance, coordination, and reduce fall risk in this population.

It's never too late to gain benefits.

That's encouraging.

Right.

What about their mindset, behavior, and readiness to exercise?

Absolutely key.

Intrinsic motivation is that inner drive, the satisfaction someone gets from activity itself.

But often, people aren't there yet.

To understand where a patient is, nurses often use the trans -theoretical model, or TTM.

It outlines six stages of readiness for change.

Okay, let's break those down.

First, pre -contemplation.

They're not even thinking about changing in the next six months.

Might be unaware of the problem or just feel demoralized.

Stay true.

Contemplation.

They're aware of the need to change, maybe thinking about acting within six months.

But they lack real commitment.

They're weighing the pros and cons.

Okay.

Then, preparation.

Yeah.

They've decided to take action in the immediate future, like the next month.

Often they have a concrete plan, like buying an exercise bike or joining a health club.

They're getting ready.

Next is action.

Right.

They've made specific, overt lifestyle changes within the past six months.

They're actively doing the new behavior.

And finally, maintenance.

Yep.

They've sustained the desired behavior for over six months and are actively working to prevent relapse, integrating it into their life.

Understanding these stages directly guides our interventions, helps us meet the patient You can't use an action strategy on someone in pre -contemplation.

Exactly.

It just won't work.

And a person's lifestyle obviously plays a huge role.

We see barriers like time constraints due to work or family.

Established routines can make it easier to add exercise.

But breaking old, inactive habits is really tough.

It is.

Cultural background is also critical, as Box 38 .3 points out.

While activity benefits everyone, there are cultural differences.

For instance, data shows inactivity is more common among certain demographics, women,

Hispanics, non -Hispanic blacks, those with lower education.

Interesting.

And some cultures might view old age as a time for rest, not exercise.

So it's essential for nurses to provide culturally sensitive and appropriate interventions and support.

Having providers from similar backgrounds can really help.

Good point.

What about environmental issues?

Big impact.

At home and work, things like employers offering activity opportunities or having space for stationary bike matter.

Weather obviously influences outdoor activity.

And for kids, schools are critical for instilling lifetime fitness habits, especially with rising childhood obesity rates.

Community support, like accessible walking trails or tracks, is vital, too.

As nurses, we often assess these available resources when talking to patients.

And then there's family and social support, which can be a powerful motivator, right?

Huge.

Studies show people are more physically active when they have family support, like using buddy systems for walking.

And parental support for children's physical activity is absolutely crucial for forming healthy habits early on.

OK, let's bring this together with a case scenario.

We've got Mrs.

Smith, a 52 -year -old overweight housewife recently diagnosed with Type 2 diabetes.

And she also has a history of controlled heart failure.

She feels tired, says things like, I just feel like a blob.

I know I have to do something.

I guess I have to start exercising.

Beth, her nurse practitioner, needs to figure out how to help.

Mrs.

Smith reports walking maybe once or twice a week, gets short of breath on hills, and has some knee pain.

Seems pretty typical, unfortunately.

But she says she enjoys walking, especially with her husband.

And she's even considering a Pilates class.

OK, some positive signs there.

Enjoyment is key.

So how do we, as nurses, gather the right information now to create a truly patient -centered plan for someone like Mrs.

Smith?

This leads us to the assessment phase of the nursing process.

Exactly.

And it has to start through the patient size.

Your ability to provide patient -centered care really hinges on assessing their willingness and readiness.

So asking them directly.

Yeah.

Ask about their expectations, their values, concerns, their beliefs about exercise.

Discuss their perceptions of what's acceptable activity in relation to symptoms like pain or fatigue, because those can be huge barriers.

Right.

And that leads directly to assessing their readiness to exercise.

Crucial.

Using that trans -theoretical model, you'd ask questions like, what exercises do you enjoy most?

How much do you normally exercise?

How confident are you, maybe on a scale of 1 to 10, in being able to perform the recommended exercises?

Their answers help you pinpoint their stage of change.

Pre -contemplation, contemplation, preparation, action, or maintenance.

And that directly guides your interventions, tells you what approach might actually work.

A thorough assessment also has to include exploring cultural and socioeconomic factors.

Absolutely.

This requires building trust to discuss cultural beliefs about exercise, and also to figure out their socioeconomic resources.

Do they have access to community facilities, safe places to walk outside?

Do they feel like they have time?

Practical stuff.

Very practical.

And always determine if social support is available from family or friends, because that accountability often makes a big difference in sticking with a plan.

OK, then comes the physical health assessment, the hands -on part.

Right.

First, body alignment.

Assess their alignment standing, sitting, and lying down.

Look for any deviations from normal, considering their age and development, and identify potential issues like trauma, muscle damage, or nerve problems.

Next, assess mobility.

The book mentions five key components here.

Yes.

First, sitting.

Can the patient sit upright safely on the side of the bed or in a chair?

This basic ability affects so much of their self -care.

OK, then standing.

And don't just rely on what they say they can do.

If it's safe, have them attempt to stand using an assistive device if needed.

The BMAT tool asks, can they raise their buttocks off the bed and hold for a count of five?

That gives you a real indication of their balance and mobility.

Good objective measure.

Then range of motion or ROM.

Yep.

Observe their joints as they move them, or as you move them passively.

Look for stiffness, swelling, pain, or limited or unequal movement.

These can indicate inflammation, fluid, nerve issues, or even contractures starting to form.

Number four is gait.

Their manner or style of walking.

Watch their speed, stride length, balance.

Ask them to walk across the room, turn, and come back.

Maybe try heel -to -toe walking if they're stable enough while you provide support.

This is a direct assessment of fall risk.

And finally, exercise pattern.

Yeah.

Ask about their current routine.

What kind of activity do they do?

How often?

How intense?

How long?

Compare their habits to recommended guidelines.

Like the American Heart Association's 150 minutes of moderate intensity aerobic activity per week for adults.

See where the gaps are.

And the last piece of the physical assessment is activity tolerance.

This is the type and amount of exercise a person can handle without undue exertion or injury.

Observe patients after activity like walking down the hall or bathing for signs of fatigue, weakness, or shortness of breath.

What vital signs do you check?

Assess their heart rate and blood pressure response, comparing it to their baseline before the activity.

Discussing how to calculate and use a target heart rate can also be a good measure of whether they're getting adequate exercise training intensity.

Okay.

Let's apply this to Mrs.

Smith.

Beth's assessment reveals Mrs.

Smith feels always tired and like a blob, doing less outside stuff.

Her heart rate actually decreased after walking from 84 to 78, and her BP was unchanged.

Blunted response.

Could be the heart failure or deconditioning.

She reports feeling a bit short of breath and knee pain, ache if I walk too far.

Beth's cardiopulmonary assessment confirms a mild ventricular gallop, likely due to the heart failure.

Okay.

Mrs.

Smith says, I like to get out and walk, but I have little time, but also walking actually makes me feel pretty good.

She worries about how exercise affects her heart, but doesn't know about its effect on blood glucose.

Lots of cues there, ambivalence, some physical limitations, knowledge deficit about diabetes.

Exactly.

Based on these cues, Beth identifies nursing diagnoses of fatigue,

activity intolerance related to that shortness of breath, the heart rate response, gallop, and her reported fatigue,

and potentially readiness for enhanced health management or ability to perform health maintenance.

Makes sense.

She wants to do something but has barriers.

Right.

Now that we've thoroughly assessed, what's fascinating here is how we synthesize this information to plan and implement effective patient -centered interventions.

Okay.

So, planning and outcomes identification.

The goal here is patient -centered outcomes.

This means you partner with the patient like Beth, with Mrs.

Smith, to set realistic achievable goals that promote functional status and independence.

So what kind of outcomes did they set for Mrs.

Smith?

They collaborated and set these.

Mrs.

Smith will participate in a planned moderate exercise program weekly.

She'll aim to demonstrate a 20 -pound weight loss in three months and report no shortness of breath following a one -mile walk in one month.

Beth plans to use an exercise log to track progress with her.

Specific and measurable.

Good.

And prioritizing care is crucial clinical judgment, isn't it?

Absolutely.

Is the patient comfortable enough right now for exercise or does acute pain mean we need to wait?

When is the best time for patient education when they're alert and willing to learn?

And you always need vigilance to prevent complications, especially when delegating related tasks like ambulation assistance.

Right.

And teamwork and collaboration are key.

Definitely.

Sound clinical judgment means using all available resources.

Collaborate with physicians or nurse practitioners for activity limits and guidelines.

Physical therapists are the experts in specific exercises and gait training.

Occupational therapists help with adaptive devices for ADLs.

And discharge planning needs to start early to ensure continuity of care after they leave your setting.

OK, let's move to implementation health promotion.

How do we encourage patients like Mrs.

Smith?

Well, Box 38 .8 outlines the physical activity guidelines for Americans.

As nurses, our core message is move more, sit less.

General guidelines for adults are 150 -300 minutes of moderate intensity aerobic activity per week, plus muscle strengthening activities on two or more days.

And special considerations for older adults.

Yes, include balance training and always adapt recommendations based on their chronic conditions and abilities.

Makes sense.

And Box 38 .9 talks about creating patient -centered exercise programs.

Right.

This involves teaching patients how to tailor their own program.

A key part is calculating a target heart rate.

The basic formula is 220 minus age to get maximum heart rate, then aim for 60 -90 % of that max.

Start low for beginners, right?

Definitely start low, especially for beginners or those with activity intolerance like Mrs.

Smith.

And always, always include 5 -10 minute warm -up and cool -down periods.

Prepares the body, aids recovery, prevents injury.

So for Mrs.

Smith, how did Beth apply this?

OK, Beth calculated Mrs.

Smith's target heart rate.

220 minus 52 equals 168 max.

60 % of 168 is roughly 100 beats per minute.

So Beth sets an initial target goal of 100 BPM to start.

She outlines a gradual progression for walking, maybe starting with 20 minutes three times a week.

Very mindful of Mrs.

Smith's heart failure and current deconditioning.

Beth teaches her how to take her pulse at the carotid artery during and after walking.

Empowering her.

Exactly.

Recognizing the teaching session was getting long, Beth also smartly schedules a separate appointment with a dietician for Mrs.

Smith to learn about the DSH diet plan and encourages her to include her husband in walks for that crucial social support.

Great integrated approach.

What about different types of exercise?

We encourage a mix.

Aerobic exercise for endurance, brisk walking, swimming, biking,

resistance training to increase strength and endurance weights, resistance bands, or even functional ADLs like pushing a vacuum cleaner.

Things people do anyway.

Balance exercises, especially vital for older adults to decrease fall risk things like standing on one foot, heel to toe walking, and flexibility exercises to improve joint range of motion and lessen muscle tightness stretching, tai chi, yoga, pilates.

Mrs.

Smith mentioned pilates, so that's something to explore.

Shifting gears to implementation acute care.

Preventing deconditioning in the hospital is a huge nursing priority.

Massive.

Early mobility protocols like those mentioned in box 38 .11 and 38 .12 are critical.

These are interprofessional programs involving nurses, PTs, OTs, doctors, and they've been shown to reduce delirium, improve muscle strength, and increase independent functional status after discharge.

So how do they work?

Patients progress systematically,

maybe starting with passive or active assistive range of motion in bed, then moving to sitting on the edge of the bed, transferring to a chair, and finally progressive ambulation, all with close monitoring of vital signs and oxygenation.

And you mentioned pain management.

Yes, giving analgesics maybe 30 minutes before planned activity can significantly improve tolerance and participation.

Good tip.

What about patients who can't ambulate yet?

For them, isotonic and isometric exercises are safe options.

With isometrics, the patient actively tightens a muscle group, like pushing their side down into the mattress holds for about 10 seconds, then relaxes.

It helps maintain muscle mass, tone, strength, and increases circulation locally.

And isotonic?

Isotonic ROM exercises involve actually moving the joints through their range, like doing

Your role is to support the patient, ensure they're doing it correctly, and watch for any problems like pain or fatigue.

Okay, now let's talk about assisting with ambulation.

For patients who can walk, maybe for the first time after surgery or illness, but without assist devices yet.

Box 38 .11 again.

Right.

A step -by -step approach is crucial for safety.

First, preparation.

Assess their strength, coordination, vital signs, and balance before you even get them up.

Ensure the environment is safe, clear path, dry floor, maybe have a chair nearby for rest.

You might need assistance from another caregiver.

Okay, and dangling.

Yes.

Before standing, have the patient dangle their legs over the side of the bed for 1 -2 minutes.

This allows their circulation to equilibrate and helps prevent a sudden drop in blood pressure when they stand up that's orthospatic hypotension, or OH.

Explain OH again.

It's a drop in systolic blood pressure of at least 20 millimilla bilici or diastolic of at least 10 millimilla Hg within 3 minutes of rising from lying or sitting to standing.

High -risk patients include those who've been immobilized, older adults, and those with certain chronic illnesses or on specific meds.

What are the symptoms?

Dizziness, lightheadedness, maybe pallor, sometimes even fainting.

If dizziness persists while dangling, don't proceed.

Help them lie back down safely.

There is also neurogenic orthostatic hypotension where the BP drops, but the heart rate doesn't compensate much.

Okay.

What about using a gait belt?

For patients who can bear weight but might be unsteady, a gait belt provides crucial support at the waist.

You apply it snugly around their waist.

Usually below the belly button, you should be able to fit two fingers between the belt and the patient.

Make sure it's not over ivy lines or incisions.

And how do you hold it?

Hold it with your palms facing up, usually grasping from underneath.

Crucially, remember, it's for stability and control, not for lifting or carrying the patient's weight.

Big distinction.

Okay, the scary moment.

How to support a falling patient.

Figure 38 .9.

Your instinct is to catch them.

But that's how you get injured.

The recommended technique, often taught by physical therapists, is different.

Assume a wide base of support yourself, one foot in front of the other.

Extend one leg towards the patient, let them slide against your leg, and gently lower them

Making sure to protect their head as best you can.

So you control the fall rather than stopping it abruptly.

Exactly.

Prioritize your own safety while minimizing harm to the patient.

Okay, moving on to implementation, restorative, and continuing care, focusing on assistive devices.

Yes.

Nurses often collaborate with physical therapists to teach patients the proper use of canes, walkers, and crutches.

These devices can be fantastic for reducing fall risk, decreasing pain, and improving balance.

But they can actually increase fall risk if used incorrectly.

So proper teaching is vital.

Let's start with walkers.

Figure 38 .0.

Walkers are lightweight, usually waist -high metal frames.

Proper use.

Hold the hand grips.

Take a step into the walker.

Move the walker forward a comfortable distance, then step again.

Caution patients not to lean way over it or try to use it on stairs.

What about walkers with wheels?

They're an option for people with limited endurance or balance issues.

Easier to maneuver.

But the downside is they can roll forward unexpectedly if the person isn't careful or leans too heavily.

Okay.

Next,

canes.

Figure 38 .11.

They offer less support.

Yes.

Less support than walkers.

Two main types.

The single straight -legged cane should be measured so the top is at the level of the greater trochanter, that bony bump on your hip.

The patient holds the cane on their stronger side.

Stronger side.

That seems counterintuitive.

It does, but think about it.

You move the cane forward about 6 -10 inches, then you move the weaker leg forward to the cane, then you advance the stronger leg past the cane.

This way, the cane and the weaker leg share the weight and you always have two points of support on the floor.

Ah.

Okay, that makes sense.

And the quad cane.

The quad cane has four feet at the base, offering more support.

It's often used for patients with one -sided weakness, maybe after a stroke.

You use the same three steps as the straight cane.

Cane, weak leg, strong leg.

Got it.

Now crutches.

Often used for short -term injuries, but sometimes long -term too.

Right.

Measurement is critical.

For standard axillary crutches, the top pad should be 2 -3 finger -whips, about 1 .52 inches, below the axilla when the patient stands straight.

The hand grip should be positioned so the elbow is flexed about 15 -30 degrees.

And the big safety point.

Emphasize, emphasize, emphasize.

The axillary armpits should not bear the body weight.

All the weight should be on the hands and arms.

Pressure on the axillary can damage nerves.

Okay, super important.

Box 38 .13 covers crutch safety.

Reinforce not leaning on the axillary.

Use only crutches fitted specifically for them.

Routinely inspect the rubber tips, they should be dry and securely attached.

Check for any structural damage to the crutch itself.

Makes sense.

What about actually walking with them?

The crutch gaits?

First, they need to learn the basic tripod position.

Crutches are placed about 6 inches in front and 6 inches to the side of each foot.

This gives a wide, stable base of support.

Then there are 4 standard gaits, depending on how much weight they can bear.

The 4 -point alternating gait requires weight bearing on both legs.

It goes right crutch, then left foot, then left crutch, then right foot.

Slow, stable, always 3 points of support on the floor.

Okay, what if they can only bear weight on one foot?

That's the 3 -point alternating gait, 38 .15B.

The patient bears all weight on the one strong foot.

They move both crutches forward together, then swing the uninvolved leg forward.

The affected leg doesn't touch the ground initially, or only lightly for balance later on.

Got it.

What about the 2 -point gait?

The 2 -point gait, 38 .15C, requires at least partial weight bearing on each foot.

It's faster.

You move one crutch and the opposite leg forward at the same time.

So right crutch and left leg move together, then left crutch and right leg move together.

More natural walking pattern.

And the swing -through gait?

The swing -through gait is often used by people with paraplegia or significant leg weakness.

Often requires bracing.

They move both crutches forward, then swing both legs forward, landing past the crutches.

Needs good upper body strength.

Wow.

Lots of options.

What about stairs?

That seems tricky.

It is.

Figures 38 .17 and 38 .18 show how.

Safety imbalance or paramount.

Ascending, going up.

The patient stands at the bottom, holds the handrail if available, strong leg next to railing.

They transfer body weight to the crutch and step up with the stronger leg first, up with the good.

Then they bring the affected leg and the crutch up to that step.

The nurse stays behind them, holding the gait belt.

Okay, up with the good.

How about descending?

Descending, going down.

Patient stands at the top, again holds handrail if possible.

This time affected leg might be closer to railing.

They lower the crutch to the step below, then move the affected leg down, down with the bad.

Finally, they bring the strong leg down.

The nurse stands in front and slightly below, holding the gait belt.

Always make sure the crutch tips are fully on the stair tread.

Down with the bad.

Good mnemonic.

And sitting in a chair, figure 38 .12.

Patient positions themselves at the front edge of the chair.

They hold both crutches in the hand on their stronger side, or opposite the affected leg if only one is affected.

They support their weight on the unaffected leg and the crutches, reach back with their free hand to grasp the chair armrest and lower themselves slowly.

Reverse the process to stand up.

Okay, practice definitely makes perfect there.

Lastly in this section, activity and chronic illness.

Exercise is therapeutic, right?

Absolutely.

For coronary artery disease, CAD, regular moderate intensity aerobic exercise actually reduces the risk of sudden cardiac death and heart attack by improving blood flow to the heart muscle.

Cardiac rehab programs are fantastic.

What about hypertension?

Exercise consistently lowers both systolic and diastolic blood pressure, typically a reduction of 5 -7 mmL.

Low to moderate intensity aerobic exercise seems most effective.

And COPD.

People might be scared to exercise if they get short of breath.

That's a huge barrier.

But pulmonary rehabilitation programs significantly improve health -related quality of life, respiratory muscle strength, and exercise capacity.

They teach patients how to manage dyspnoea with exertion.

That's great.

And diabetes mellitus.

We know Mrs.

Smith has type 2.

Exercise is crucial.

For type 1, moderate to high levels of aerobic activity, improve fitness, decrease insulin resistance, and improve lipid levels.

For type 2, like Mrs.

Smith, regular exercise reduces HbA1c levels, triglycerides, blood pressure, and insulin resistance.

It could genuinely help control her diabetes and maybe even reduce her need for...

How do we know if our plan worked?

It's how we determine if interventions are effective and if the patient's condition is improving.

And again, it starts through the patient's eyes.

Always.

The patient is the ultimate judge of how effective and beneficial the plan feels for them.

Ask questions like, how well did you tolerate walking today and is that what you expected?

Or you've been walking regularly for a month now, how has it made you feel?

This continuous evaluation allows for necessary adjustments to the plan.

Right.

And then we look at the objective patient outcomes.

Sound clinical judgment means comparing the patient's baseline measures.

Mobility, activity tolerance like pulse, blood pressure, strength, their self -reported fatigue, even psychological well -being with the expected outcomes we set, and any established standards for improvement like reaching that target heart rate.

And observing function.

Yes.

Observe their ability to perform ADLs.

Are they more independent?

Are they moving more easily?

Be attentive to even subtle changes and ensure clear communication with other health care providers for consistent evaluation across the team.

Okay, let's circle back one last time to Mrs.

Smith's follow -up.

What happened?

Three weeks after her initial visit, Beth calls Mrs.

Smith.

Mrs.

Smith reports she's feeling good about using her exercise diary.

She walked twice the first week, about 20 minutes each time, feeling comfortable.

Good start.

The second week, she walked three days for a total of 90 minutes.

She pushed herself a bit and felt a little short of breath, with her pulse reaching 105 BPM mid -walk.

But importantly, she knew to slow down and stop just as Beth had taught her.

Excellent self -management.

Yes.

This week, she walked once so far for 25 minutes, with her pulse staying around 96 BPM.

She also shares that walking with her husband has been great for them, gives them quality time to talk.

And she reports good progress with the DHI plan after seeing the dietitian.

What a truly fantastic outcome for her.

That really shows progress.

It really does.

It shows how critical that personalized holistic approach is.

It's not just about treating symptoms, but really empowering patients to live healthier lives through activity and informed choices.

So today, we took a really deep dive into activity and exercise in nursing.

From the intricate science of movement and those crucial, safe patient handling techniques,

all the way through the comprehensive nursing process assessment, planning, implementation, and evaluation.

Remember, as you apply this,

your nuanced understanding of each patient's unique physiological, developmental, behavioral, cultural, and environmental factors will truly transform your care.

Absolutely.

So the provocative thought for you today is, how will your enhanced understanding of these principles empower you to not just assist patients with movement, but to truly motivate them towards a healthier, more active life?

Something to think about.

Yeah.

Thank you so much for joining us on this deep dive.

We're the Last Minute Lecture Team, and we're so glad you're part of our learning community.

Keep exploring, keep questioning, and keep making a difference out there.