FUNDAMENTALS OF
NURSING
ACTIVITY, MOBILITY AND
EXERCISE
ACTIVITY, MOBILITY AND
EXERCISE
1. Body Alignment – geometric
arrangement of body parts in relation
to each other
● Line of gravity
● Center of gravity
● Base of support
ACTIVITY, MOBILITY AND
EXERCISE
Body Mechanics – efficient, coordinated and safe
use of the body to produce motion and maintain
balance during activity
Principles:
1. Line of gravity passes through the base of
support
2. The wider the base of support and the lower the
center of gravity, the greater the stability
3. Objects that are close to center of gravity are
moved with least effort
4. The closer the line of gravity to center of base of
support, the greater its stability
ACTIVITY, MOBILITY AND
EXERCISE
1. Body Alignment
a. Stance – a manner in which a person
stands
b. Sitting alignment – popliteal space
from the edge of chair : 1 inch away
2. Gait – walk
» Pace – number of steps taken/min:
(70 – 100 steps/minute);
elderly (40 steps/min)
ACTIVITY, MOBILITY AND
EXERCISE
4. Muscle strength and endurance:
● Bent – knee sit up
● Women for 1 minute: 20 – 25/min
● Men for 2 minutes: 50 – 60/min
5. Joint flexibility
● Touch toes several times:
1- 3 inches in front of toes
ACTIVITY, MOBILITY AND
EXERCISE
Pressure sores – reddened areas, sore, ulcers of
skin occurring over bony prominences. Due to
interruption of blood circulation to tissue,
resulting in localized ischemia
Stages:
I – non blanchable erythema of intact skin
II – partial thickness skin loss (epidermis and
dermis).
III – full thickness skin loss (subcutaneous
tissue); ulcer as deep crater
IV – full thickness with extensive destruction,
necrosis (muscle, bone)
Four Stages of Pressure Ulcer
Formation
A B
C D
ACTIVITY, MOBILITY AND
EXERCISE
Measures to prevent and treat pressure
sores:
1. Wrinkle – free bed or egg crate
mattress
2. Turn to sides q 15 – 2 hours
3. Meticulous hygiene, skin kept clean
and dry
4. ROM exercises
ACTIVITY, MOBILITY AND
EXERCISE
PROTECTIVE DEVICES:
1. Handrolls or rubber balls
● to prevent clawhand deformity
2. Trochanter rolls –
● hips to upper third of thigh
3. Footboard
4. Wedge Pillow
ACTIVITY, MOBILITY AND
EXERCISE
TYPES OF EXERCISE:
According to type of muscle contraction:
a. Isotonic – (dynamic)
● change in MUSCLE LENGTH AND
TENSION
● Ex. walking, running, ADL
ACTIVITY, MOBILITY AND
EXERCISE
b. Isometric – (static)
● change in MUSCLE TENSION
ONLY; alternate tension & relaxation of
group of muscles
a. Quadriceps setting – thigh muscles
b. Gluteal - buttocks
c. Kegel’s – pubococcygeal muscles
ACTIVITY, MOBILITY AND
EXERCISE
c. Isokinetic – (resistive)
● MUSCLE CONTRACTION AND
JOINT MOVEMENT
● Ex. lifting weights
ACTIVITY, MOBILITY AND
EXERCISE
1. Active ROM
» done by the client
2. Passive ROM
» done by health care provider
3. Active – Resistive
» done by client against a weight or force
4. Active – Assistive
» done by stronger arm and leg to weaker arm
and leg
ACTIVITY, MOBILITY AND
EXERCISE
During ambulation:
priority is to prevent what condition?
TRANSFERRING CLIENT FROM BED TO
STRETCHER, WHEELCHAIR:
● Lock the wheels of bed, stretcher, wheelchair
● Stretcher and wheelchair parallel to bed
* WHEN ENTERING ELEVATOR, WHICH
SHOULD GO FIRST? HEAD OR LOWER
BODY?
ASSISTING CLIENT TO AMBULATE:
Nurse: behind the weaker side of
the client.
(moderately weak)
Nurse: behind the stronger side
of the client. (very weak)
ACTIVITY, MOBILITY AND
EXERCISE
Mechanical Aids for walking:
1. Canes:
a. Straight legged
b. Tripod or crab cane
c. Quad Cane
• Length should permit the elbow to be
slightly flexed
• Distance that the cane should be positioned
(side and front) : 15 CM (6 INCHES)
AMBULATION AIDS:
A. CANES:
= on the stronger side of the body.
= rubber tips: to prevent slipping.
= for maximum support: cane forward,
next affected leg, then stronger leg.
= as pt becomes stronger: move cane
and weak leg at the same time.
REMEMBER: COAL
C = CANE, OPPOSITE, AFFECTED, LEG
WALKERS:
= for maximum support: move
walker, then right, then left leg.
= one leg is weaker: move walker
and the weak leg, then
stronger leg.
REMEMBER: [Link]
MOVE WALKER WITH WEAKER LEG
ACTIVITY, MOBILITY AND
EXERCISE
2. Walker
● Move the walker ahead about 15 cm (6 inches)
● For maximum support;
a. right foot up to the walker, then left foot up to
the right foot
● If one leg is weaker:
a. move walker and weak leg ahead together
about 15 cm (6 in), then move the stronger leg
ACTIVITY, MOBILITY AND
EXERCISE
3. Crutches:
Methods of measuring crutch length:
1. Supine: anterior fold of axilla to heel of
foot + 2.5 cm (1 in)
2. Standing: position the crutch: shoulder
rest of the crutch is 1 – 2 inches below
the axilla
» Angle of elbow flexion = 30 degrees
CRUTCHES
CRUTCHES
Correct fit:
= STAND STRAIGHT, ARMPIT TO FLOOR
= DEDUCT 5 CM/ 2 INCHES OR 3 FINGERS
= HANDGRIP: SLIGHTLY ABOVE WRIST
LEVEL
= ELBOW 30 DEGREES FLEXION
= IF pt in supine, measure from axillary fold
to heel of foot
= ADD 1 inch
4 point gait
= the safest, very slow.
= client can bear weight on both legs.
= tripod, R crutch, L foot, L crutch, L foot.
3 point gait
= pt bears entire weight on the unaffected leg.
= tripod, both crutches with bad leg, good leg.
2 point gait
= requires partial weight bearing on both legs.
= L crutch with R foot, L foot with R crutch.
DIFFERENCE:
SWING TO AND SWING THROUGH
Swing to
= with paralysis of legs and hips.
= swing to the crutches
Swing through
= swing beyond the crutches.
ACTIVITY, MOBILITY AND
EXERCISE
Going up and down stairs:
“Good leg goes to heaven”
“Bad leg goes to hell”