1. AUGUST 20, 2013
© FUNDAMENTALS OF NURSING 5TH EDITION

2.  can be described as energetic
action or as being in a state of
movement.

3.  Good body mechanics is the
efficient, coordinated, and safe use of the
body to produce motion and maintain
balance during activity.
 Three basic elements of body mechanics:
BODY ALIGNMENT (POSTURE), BALANCE
(STABILITY), and COORDINATED BODY
MOVEMENT.

4.  Body Alignment: the geometric
arrangement of body parts in relation
to each other.
 Balance: a state of equipoise
(equilibrium) in which opposing forces
counteract each other.
 Coordinated Body Movement:
Integrated functioning of the
musculoskeletal and nervous system
as well as joint mobility.

5.  Joint: functioning unit of the musculoskeletal
system.
 Bones articulate at the joints
 Skeletal muscles attach to two bone at the
joint
 When a person is inactive, the joints are
pulled into a flexed position.
 Synovial Joint: freely movable
 Range of Motion: maximum movement that is
possible for the joint.

6.  Poor standing and sitting posture,
overweight, pregnancy and constant use of
high-heeled shoes may produce an
exaggerated curvature of the lumbar spine,
called lordosis.

7.  Lifting: When a person lifts or carries an
object, the weight of the object becomes part
of the person’s body weight.
 Pulling and Pushing: When pulling or pushing
an object, a person maintains balance with
least effort when the base of support is
enlarged in the direction in which the
movement is to be produced or opposed.
 Pivoting: technique in which the body is
turned in a way that avoids twisting of the
spine.

8.  Growth and Development
 Physical Health
 Mental Health
 Nutrition
 Lifestyle
 Personal Values
 Fatigue and Stress
 External Factors

9.  Musculoskeletal System
◦ Problem Related to Immobility: Client experience a
significant decrease in muscular strength.
◦ Effects of Exercise: Maintenance of muscle strength
and tone; efficiency of muscular contraction
increases; maintain joint mobility
 Cardiovascular System
◦ Problems related to Immobility: Diminished cardiac
reserve; Orthostatic hypotension
◦ Effects of Exercise: Heart rate, blood pressure and
cardiac output increases;

10.  Respiratory System
◦ Problems related to Immobility: Decreased
respiratory movement; Pooling of respiratory
excretions; Atelectasis
◦ Effects of Exercise: Ventilation increases
 Metabolic System
◦ Problems related to Immobility: Decreased
metabolic rate; Anorexia
◦ Effects of exercise: Metabolic rate elevation;

11.  Urinary System
◦ Problems related to Immobility: Urinary stasis;
Urinary retention; Urinary Infection
◦ Effects of exercise: more efficient blood flow;
prevention of stasis.
 Gastrointestinal System
◦ Problems related to Immobility: Constipation;
decreased peristalsis and colon motility
◦ Effects of exercise: Appetite improvement;
increased GI tract tone, improved digestion and
elimination

12.  Integumentary System
◦ Problems related to Immobility: Reduced
skin turgor; skin breakdown
◦ Effects of exercise: improved blood
circulation (peripheral) and promoted
delivery of nutrients and oxygen.
 Psychoneurologic System
◦ Problems related to Immobility: Increased
dependence; lower self-esteem;
Exaggerated emotional reactions; lack of
intellectual stimulation
◦ Effects of exercise: improves tolerance to
stress; sense of relaxation; improvement of
body image; improves sleep

13.  Nursing History
 Physical Examination
◦ Body Alignment
 Stance
 Sitting Alignment
◦ Gait
◦ Joint Appearance and Movement
◦ Capabilities and Limitations of Movement
◦ Muscle Mass and Strength
◦ Activity Tolerance
◦ Physical Fitness

14.  NANDA nursing diagnoses that relate to
activity/mobility problems include: Activity
tolerance, High risk for activity
intolerance, Impaired physical mobility, &
High risk for disuse symptoms.

15.  Identifying those clients who need assistance
with body alignment and determining the
degree of assistance they need.
 Sensitive to the client’s need to function as
independently as possible yet provide
assistance when the client needs it.
 Plan to teach clients applicable skills.

16.  Maintaining good posture
 Positioning Clients
◦ Fowler’s Position
◦ Orthopneic Position
◦ Dorsal Recumbent Position
◦ Prone Position
◦ Lateral Position
◦ Sim’s Position

17.  Moving and Turning Clients in Bed
◦ Moving a client up in bed
◦ Moving a client to the side of the bed in segments
 Transferring Clients
◦ Transferring a client between a Bed and a
Wheelchair
◦ Transferring a Client between a Bed and a Stretcher
◦ Moving a Client Using a Hydraulic Lift
 Exercise
◦ Isotonic (dynamic) exercises: muscle tension is
constant and the muscle shortens to produce
muscle contraction and movement

18. ◦ Isometric (static or setting) exercises: There is a
change in muscle tension but no change in muscle
strength.
◦ Isokinetic (resistive) exercises: involve muscle
contraction and joint movement
◦ Aerobic exercise: an activity in which the amount of
oxygen taken into the body is greater than or equal
to the amount the body requires. (Anaerobic
exercise – opposite)
◦ Range of motion:
 Active ROM activities
 Passive ROM activities
 Active-assistive ROM exercises

19. ◦ Components of Physical Fitness:
 Muscle Strength and Endurance
 Cardiorespiratory Fitness
 Joint Flexibility
 Body Composition
 Ambulating Clients
◦ Ambulation: act of walking; function that most
people take for granted
 Preambulatory Exercises
 Assisting Clients to Ambulate

20.  Mechanical Aids in Walking
◦ Canes
◦ Walkers
◦ Crutches

21.  Collect date relevant to the outcome criteria
previously established by asking the client to
demonstrate specific exercises, measure
muscle size, observe client’s activity
tolerance when performing self-care
activities, measure vital signs before and after
exercise and ambulation.. Etc.

22. AUGUST 20, 2013
© FUNDAMENTALS OF NURSING 5TH EDITION

23.  Implies calmness, relaxation
without emotional stress, and
freedom from anxiety.
 Restores a person’s energy;
allowing the individual to resume
optimal functioning.

24.  Considered to be a basic human need
 It is a universal process common to all
people.
 More recently, sleep has come to be
considered a state of consciousness in which
the individual’s perception and reaction to
the environment is decreased.

25.  Circadian Rhythm
◦ Biorhythms – In humans, these are controlled from
within the body and synchronized with
environmental factors.
◦ Circadian from circa dies, “about a day”
◦ The person is awake when the physiologic and
psychologic rhythms are most active.
 Stages of Sleep
◦ Electroencephalogram (EEG) – provides a good a
picture of what occurs during sleep.

26. ◦ Two types of sleep: NREM (Non-REM) sleep and REM
(Rapid Eye Movement) sleep
◦ NREM Sleep
 Also referred to as slow-wave sleep
 Most sleep during a night is NREM sleep.
 Deep, restful sleep and brings a decrease in some
physiologic functions
 Divided into four stages: Stage I (Very light sleep);
Stage II (Light sleep); Stage III (Parasympathetic
nervous system domination); Stage IV (deep sleep)

27. ◦ REM Sleep
 25% of the sleep of a young adult.
 Most dreams take place during the REM sleep.
 Brain is highly active (paradoxical sleep)
 As the person becomes more rested through the
night, the duration of the REM sleep increases
 Sleep Cycles
◦ Stage I NREM -> Stage II NREM -> Stage III NREM
-> Stage IV NREM -> Stage III -> Stage II -> Stage I
REM

28.  Age
 Environment
 Fatigue
 Lifestyle
 Psychologic Stress
 Alcohol and Stimulants
 Diet
 Smoking
 Motivation
 Illness
 Medications

29.  Primary Sleep Disorders: the person’s
problem is the main disorder
 Secondary Sleep Disorders: sleep
disturbances caused by another clinical
disorder
 Insomnia: most common sleep disorder;
inability to obtain an adequate amount or
quality of sleep
 Hypersomnia: opposite of insomnia;
excessive sleep

30.  Narcolepsy: sudden wave of overwhelming
sleepiness that occurs during the day; “sleep
attack”; genetic defect of the CNS in which
REM sleep cannot be controlled.
 Sleep Apnea: periodic cessation of breathing
during sleep
◦ Obstructive Apnea: pharynx or oral cavity blocks
the air
◦ Central Apnea: defect in the respiratory center of
the brain
◦ Mixed Apnea: combination of Obstructive and
Central Apnea

31.  Parasomnias
◦ Somnambulism (sleepwalking)
◦ Sleeptalking
◦ Nocturnal enuresis (bedwetting)
◦ Nocturnal erections
◦ Bruxism (clenching or grinding of the teeth)
 Sleep Deprivations
◦ prolonged sleep disturbances; not a sleep disorder

32.  Sleep History
◦ Usual sleeping pattern
◦ Bedtime rituals
◦ Use of sleep medications
◦ Sleep environment
◦ Recent changes in sleep patterns or difficulties in
sleeping.
 Sleep Diary
 Physical Examination
 Diagnostic Studies
◦ Polysomnography; EEG; Electromyogram (EMG);
Electro-oculogram (EOG)

33.  NANDA nursing diagnosis given to clients
with sleeping problems: Sleep pattern
disturbance.

34.  Maintain/develop a sleeping pattern that
provides sufficient energy for daily activities.
 Interventions include reducing environmental
distractions; promoting bedtime rituals;
providing comfort measures; scheduling
nursing care to provide uninterrupted sleep
periods…etc.

35.  Creating a restful environment
 Supporting Bedtime Rituals
 Promoting Comfort and Relaxation
 Administering Sleep Medications
 Client Teaching

36.  To evaluate whether client outcomes have
been achieved, the nurse may observe the
duration of the client’s sleep, observe the
client’s signs of REM and NREM sleep
deprivation, question effectiveness of specific
interventions…etc.