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Describe four basic elements of normal movement.
Concepts for Lecture
1. Body movement requires coordinated muscle activity and neurologic
2. Proper body alignment and posture bring body parts into position in
a manner that promotes optimal balance and maximal body function
3. Range of motion (ROM) of a joint is the maximum movement that is
possible for that joint. ROM varies from individual to individual and
4. The mechanisms involved in maintaining balance and posture are
complex and involve informational inputs from the labyrinth (inner
5.
Balanced, smooth, purposeful movement is the result of proper function-
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Concepts for Lecture
1. Isotonic (dynamic) exercises are those in which the muscle shortens
to produce muscle contraction and active movement. Isotonic exer-
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HAPTER
44
ACTIVITY AND EXERCISE
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CTIVITIES
• Review the anatomy related to coordinated mus-
cle activity and neurologic integration required
for body movement.
•
Have the students play ROM charades. Place a
description of a ROM of a joint on a card.
Have a student demonstrate the ROM and ask
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2. Isometric (static or setting) exercises are those in which there is
muscle contraction without moving the joint (muscle length does not
3. Isokinetic (resistive) exercises involve muscle contraction or tension
against resistance. Thus, they can be either isotonic or isometric.
4. Aerobic exercise is activity during which the amount of oxygen tak-
5.
Anaerobic exercise involves activity in which the muscles cannot draw
enough oxygen from the bloodstream, and anaerobic pathways are used
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Compare the effects of exercise and immobility on body systems.
Concepts for Lecture
1. The effects of exercise on the musculoskeletal system include
maintenance of the size, shape, tone, and strength of muscles (in-
cluding the heart muscle). Because joints lack a discrete blood sup-
2. The effects of adequate moderate–intensity exercise on the cardio-
vascular system include increases in the heart rate, the strength of the
3. The effects of exercise on the respiratory system include an increase
in ventilation and oxygen intake during exercise, thereby improving
gas exchange. Adequate exercise also prevents pooling of secretions
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•
Divide the students into groups and assign
each a body system. Have each group develop
a pamphlet for adult clients and families, pre-
senting the effect of exercise and the negative
effect of immobility on each system. Repro-
duce the pamphlets and share with the class.
4. The effects of exercise on the metabolic/endocrine system include
elevation of the metabolic rate, thus increasing the production of
5. The effects of exercise on the gastrointestinal system include im-
6. The effects of exercise on the urinary system include promotion of
blood flow to the kidneys, causing body wastes to be excreted more
7. The effects of exercise on the immune system include more efficient
pumping of lymph fluid from tissues into lymph capillaries and ves-
8. According to a strong and growing body of evidence, the effects of
exercise on the psychoneurologic system include elevating mood and
9. Current research supports the positive effects of exercise on cogni-
10. There is evidence that a program of Pilates, yoga–style exercise, and
slow walking a labyrinth (circular mandala) improves spiritual health
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Identify factors influencing a person’s body alignment and activity.
Concepts for Lecture
1. A number of factors can affect an individual’s body alignment, mo-
bility, and daily activity level. These include growth and develop-
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• Have the students provide examples of how
nurses can help individuals adapt to or change
factors influencing body alignment and activity.
•
Show pictures of clients from various age
groups and have the students identify body
alignment characteristics of each age group.
CHAPTER 44 / Activity and Exercise 315
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Concepts for Lecture
1. Assessment relative to a client’s activity and exercise should be rou-
tinely addressed. It should include a nursing history and a physical
examination of body alignment, gait, appearance and movement of
joints, capabilities and limitations for movement, muscle mass and
strength, activity tolerance, problems related to immobility, and
physical fitness.
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Develop nursing diagnoses and outcomes related to activity, exercise, and
mobility problems.
Concepts for Lecture
1. Mobility problems may be appropriate as the diagnostic label or as
the etiology for other nursing diagnoses.
NANDA includes the following nursing diagnostic labels for ac-
2. NANDA diagnoses in which the mobility problem becomes the eti-
3. When problems associated with prolonged immobility arise, many
other diagnoses may be necessary. Examples include, but are not
4. When planning for desired outcomes, NOC labels that pertain to
exercise and activity can be helpful. These include the following: ac-
tivity tolerance; anxiety level and self-control; body image; body po-
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UGGESTIONS FOR
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•
Demonstrate how to assess body alignment,
gait, ROM, muscle mass, strength, and activi-
ty tolerance. Have the students practice this
assessment.
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UGGESTIONS FOR
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CTIVITIES
•
Assign students to assess their assigned cli-
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• Have the students review the definitions, defin-
ing characteristics, etiology, or risk factors for
the NANDA diagnoses related to activity and
mobility.
•
Provide the students with a case study. Ask
them to identify nursing diagnoses and the da-
ta that support these diagnoses.
ty, if appropriate. Share these with the class.
5.
The goals established will vary according to the diagnosis and defining
characteristics related to each individual. Examples of overall goals for
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Use safe practices when positioning, moving, transferring, and ambulating
clients.
Concepts for Lecture
1. When a nurse assists a person to move, correct body mechanics need
2. Actions and rationales applicable to moving and lifting clients in-
clude the following:
• Before moving a client, assess the degree of exertion permitted,
ability to move the client.
• If indicated, use pain relief modalities or medication prior to mov-
ing the client.
3. Refer to the text and the Skill Checklists included on the
Student DVD–ROM:
4. General guidelines for transferring client include: plan what to do
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UGGESTIONS FOR
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• Using manikins or fellow students, have the
students practice all of the above skills in the
nursing laboratory.
•
Have the students practice positioning the
manikins in the above positions with special
emphasis on preventing pressure points and
maintaining body alignment.
•
Have students practice assisting a falling or
fainting client.
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UGGESTIONS FOR
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taining body alignment (e.g., foot splints, hand
splints).
CHAPTER 44 / Activity and Exercise 317
equipment; during the transfer, explain step by step what the client
5. General guidelines for ambulating the client include: assess the
amount of assistance the client will require; assess for signs and
symptoms of postural (orthostatic) hypotension and return the client
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Compare and contrast active, passive, and active-assistive range–of-motion
(ROM) exercises.
Concepts for Lecture
1. Active ROM exercises are isotonic exercises in which the client
moves each joint in the body through its complete range of move-
2. During passive ROM exercises
,
another person moves each of the cli-
ent’s joints through its complete range of movement, maximally stretch-
3.
During active-assistive ROM exercises, the client uses a stronger, opposite
arm or leg to move each of the joints of a limb incapable of active motion.
The client learns to support and move the weak arm or leg with the strong
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Describe client teaching for clients who use mechanical aids for walking.
Concepts for Lecture
1. When teaching the client to use a cane, include the following points:
• Hold the cane with the hand on the stronger side of the body to
provide maximum support and appropriate body alignment when
walking.
318 CHAPTER 44 / Activity and Exercise
• Position the tip of a standard cane (and the nearest tip of other
canes) about 15 cm (6 in.) to the side and 15 cm (6 in.) in front of
the near foot, so that the elbow is slightly flexed.
2. When teaching the client to use a walker, include the following
points:
• When maximum support is required, move the walker ahead about
15 cm (6 in.) while your body weight is borne by both legs, then
3. When teaching the client to use crutches, include the following
points:
• Follow the plan of exercises developed for you to strengthen your
arm muscles before beginning crutch walking.
• Have a health care professional establish the correct length for
your crutches and the correct placement of the handpieces.
CHAPTER 44 / Activity and Exercise 319
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Verbalize the steps used in:
a. Moving a client up in bed
b. Turning a client to the lateral or prone position in bed
c. Logrolling a client
Concepts for Lecture
ESSENTIAL/
CRITICAL
ELEMENT?
COMPETENCY
DEMONSTRATED?
Yes
No
320 CHAPTER 44 / Activity and Exercise
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 44–2: TURNING A CLIENT TO THE LATERAL OR
PRONE POSITION IN BED
COMPETENCY
DEMONSTRATED?
Yes
No
2. Explained steps to client before beginning.
tion control procedures.
4. Provided for client privacy.
5. Positioned self and client appropriately before performing the
move, with the other person(s) positioned on the opposite side
of the bed.
a. Adjusted the head of the bed to as low as the client can tolerate.
b. Raised the height of the bed appropriate for own safety (at
c. Locked the wheels on the bed.
client’s head and repositioned the client’s legs appropriately.
CHAPTER 44 / Activity and Exercise 321
f. Placed the client’s near ankle and foot across the far ankle
e. While standing on the side of the bed nearest the client,
placed the client’s near arm across the chest. Abducted the
6. Rolled the client to the lateral position. The other person(s)
standing on the opposite side of the bed helped roll the client.
a. Placed one hand on the client’s hip and the other hand on the
client’s shoulder.
a. Instead of abducting far arm, kept the client’s arm alongside
b. Rolled the client completely onto his or her abdomen.
ESSENTIAL/
CRITICAL
ELEMENT?
COMPETENCY
DEMONSTRATED?
Yes
No
b. This person reached over the client and grasped the far
322 CHAPTER 44 / Activity and Exercise
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 44–4: ASSISTING THE CLIENT TO SIT ON THE
SIDE OF THE BED (DANGLING)
COMPETENCY
DEMONSTRATED?
Yes
No
1. Introduced self and verified client’s identity.
2. Explained procedure to client.
tion control procedures.
4. Provided for client privacy.
5. Positioned self and client appropriately before performing the
move.
a. Assisted client to a lateral position facing self.
b. Raised head of bed slowly to its highest position.
c. Positioned the client’s feet and lower legs at the edge of the
6. Moved the client to a sitting position.
b. Tightened gluteal, abdominal, leg, and arm muscles.
c. Pivoted on balls of feet in desired direction facing foot of
d. Kept supporting client until client was well balanced and
a. Placed one arm around the client’s shoulders and other arm
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 44–5: TRANSFERRING BETWEEN BED AND CHAIR
COMPETENCY
DEMONSTRATED?
Yes
No
1. Introduced self and verified client’s identity.
2. Explained procedure to client.
3. Gathered appropriate equipment.
4. Performed hand hygiene and observed how results will be used.
5. Provided for client privacy.
6. Positioned equipment appropriately:
a. Lowered bed to its lowest position. Locked the wheels of the
CHAPTER 44 / Activity and Exercise 323
client to move toward his or her stronger side. Locked the
wheels of the wheelchair and raised the footplate.
b. Placed wheelchair parallel to the bed as close to the bed as
7. Prepared and assessed the client:
a. Assisted client to a sitting position on the side of the bed.
b. Assessed client for orthostatic hypotension before moving
client.
c. Assisted client in putting on bathrobe and nonskid slippers
or shoes.
8. Gave explicit instructions to the client. Asked the client to do the
following:
placed on the floor.
b. Lean forward slightly from the hips.
c. Place the foot of the stronger leg beneath the edge of the bed
and put the other foot forward.
d. Place your hands on the bed surface so you can push while
standing.
a. Move forward and sit on the edge of the bed with the feet
9. Positioned self correctly:
b. Leaned trunk forward from hips. Flexed hips, knees, and an-
kles. Assumed broad stance, placing one foot forward and
a. Stood directly in front of client and to the side requiring the
10. Assisted client to stand and moved together toward the wheel-
chair.
the mattress.
ent forward (toward own center of gravity) into a standing
c. Supported the client in an upright standing position for a few
moments.
d. Together with the client, pivoted on foot farthest from the
chair, or took a few steps toward the wheelchair.
a. Counted to three or gave the verbal instructions of “Ready,
Steady, Stand,” and asked the client to push down against
11. Assisted the client to sit.
a. Moved the wheelchair forward or had the client back up to
the wheelchair and place legs against seat.
b. Made sure the wheelchair brakes were on.
c. Had the client reach back and feel/hold the arms of the
wheelchair.
back.
e. Tightened grasp on gait belt and tightened gluteal, ab-
dominal, leg, and arm muscles.
f. Had the client sit down while bent own knees/hips and low-
ered the client onto the wheelchair seat.
12. Ensured client safety.
a. Asked the client to push back into the wheelchair seat.
b. Removed the gait/transfer belt.
c. Lowered the footplates and placed the client’s feet on them.
Variation: Angling the Wheelchair
a. Placed wheelchair at a 45-degree angle to bed.
Variation: Transferring with a Belt and Two Nurses
client and with the other hand supported the client’s elbows.
the wheelchair seat.
a. Positioned selves on both sides of the client, facing the same
direction as the client. Flexed hips, knees, and ankles.
Variation: Transferring a Client with an Injured Lower Extremity
a. Made sure movement occurred toward the client’s unaffect-
ed (strong) side.
Variation: Using a Sliding Board
board to help them move without nursing assistance.
ESSENTIAL/
CRITICAL
ELEMENT?
SKILL 44–6: TRANSFERRING BETWEEN BED AND
STRETCHER
COMPETENCY
DEMONSTRATED?
Yes
No
1. Introduced self and verified client’s identity.
2. Explained procedure to client.
3. Gathered appropriate equipment.
5. Provided for client privacy.
6. Adjusted the client’s bed in preparation for the transfer:
a. Lowered the head of the bed as low as tolerated by the cli-
ent.
b. Placed friction-reducing device under the client.
the surface of the stretcher.
d. Ensured the wheels on the bed were locked.
e. Placed the stretcher parallel to the bed next to the client and
locked the stretcher wheels.
f. Filled the gap between the bed and stretcher loosely with
bath blankets (optional).
c. Raised the bed so that it was slightly higher (i.e., ½ in.) than
7. Transferred the client securely to the stretcher.
client to do so and stood by for safety.
b. If the client was partially able or not able to transfer:
a. If the client could transfer independently, encouraged the
CHAPTER 44 / Activity and Exercise 325
• The second and third caregivers were at the side of the
stretcher, one positioned between the client’s shoulder and
c. Made the client comfortable, unlocked the stretcher wheels,
and moved the stretcher away from the bed.
d. Immediately raised the stretcher side rails and/or fastened
the safety straps across the chest.
Variation: Using a Transfer Board
to the stretcher.
a. Turned the client to a lateral position away from self, posi-
ESSENTIAL/
CRITICAL
ELEMENT?
COMPETENCY
DEMONSTRATED?
Yes
No
326 CHAPTER 44 / Activity and Exercise
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Recognize when it is appropriate to delegate aspects of moving, transferring,
and ambulating a client to unlicensed assistive personnel.
Concepts for Lecture
1. The skills of moving, turning, and transferring clients in bed can be
delegated to unlicensed assistive personnel (UAP). The nurse should
that require assessment and intervention by the nurse.
2.
Ambulation of clients is frequently delegated to UAP. However, the
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Demonstrate appropriate documentation and reporting of moving, transfer-
ring, and ambulating a client.
Concepts for Lecture
1. After moving the client, determine and document the client’s comfort
2. Record time and change of position moved from and position moved to,
3. When assisting the client with transferring, document relevant in-
4.
When assisting the client with ambulation, document distance and dura-
tion of ambulation in the client record using forms or checklists supple-