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Chapter 38
Activity and Exercise
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Scientific Knowledge Base
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Overview of exercise and activity:
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Body alignment
• Relationship of one body part to another
Body balance
• Achieved by low center of gravity; enhanced by posture
Coordinated body movement
• A result of weight, center of gravity, and balance
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Scientific Knowledge Base (cont’d)

Overview of exercise and activity:
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Friction
• Force that occurs in a direction to oppose movement
Exercise and activity
• A patient’s individualized exercise program depends on
the patient’s activity tolerance or the type and amount
of exercise or activity that the patient is able to perform.
• Isotonic exercises
• Isometric exercises
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Case Study
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Mr. Indelicato is a 72-year-old African
American who is hospitalized for surgery on
his right knee. He relates the problem with his
knee to previous sports injuries. He first
sought medical advice and treatment 6 years
ago.
He has tried various treatments, including
physical therapy, rest, and pain medication.
His only preoperative medication is ibuprofen
600 mg every 6 to 8 hours. He and his wife
are very active.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Marilyn Sweeney is a 40-year-old nursing
student. She has just finished rotating
through a general surgical unit and is
spending the remaining 6 weeks in the
orthopedic/rehabilitation division of the
agency. Her assignment is to follow the
patient through his surgery and rehabilitation.
As Marilyn prepares to assess Mr. Indelicato,
she reviews anatomy and physiology related
to the musculoskeletal system and exercise
physiology.
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Regulation of Movement
Skeletal
system
Muscles
concerned
with
movement
Joints
Ligaments,
tendons,
cartilage
Skeletal
muscle
Muscles
concerned
with posture
Muscle
groups
Nervous
system
Proprioception
Balance
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Factors Influencing Activity
and Exercise

Developmental changes
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Infants through school-aged children
 Adolescence
 Young to middle adults
 Older adults

Behavioral aspects
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Patients are more likely to incorporate an exercise
program if those around them are supportive.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Factors Influencing Activity
and Exercise (cont’d)
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Environmental issues
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Work site
Schools
Community
Cultural and ethnic influences
Family and social support
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Nursing Process
Assessment
Diagnosis
Planning
Implementation
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Evaluation
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Assessment: Standing
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Assessment: Sitting

Sitting
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Head is erect.
 Neck and vertebral column are in straight
alignment.
 Body weight is distributed on the buttocks and
thighs.
 Thighs are parallel and horizontal.
 Feet are supported on the floor.
 Forearms are supported on the armrest, in the lap,
or on a table in front of the chair.
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Assessment

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Recumbent position
Mobility
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Range of motion
 Gait
 Exercise

Activity tolerance
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Case Study (cont’d)
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Mr. Indelicato is hesitant to ambulate or use his
continuous positive motion machine. He rates his
pain as 6 to 7 on a scale of 0 to 10 and is using a
patient-controlled analgesia (PCA) pump.
His degree of knee flexion is now 70 degrees. He is
able to ambulate 10 feet with a walker. He further
describes his muscle strength in his right leg as
feeling weak and tired after walking a short distance.
Marilyn observes Mr. Indelicato using the walker
incorrectly.
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Nursing Diagnosis
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Activity intolerance
Ineffective coping
Impaired gas exchange
Risk for injury
Impaired physical mobility
Imbalanced nutrition: more than body
requirements
Acute or chronic pain
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Planning

Goals and outcomes
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Participates in prescribed physical activity while
maintaining appropriate heart rate, blood
pressure, and breathing rate
 Verbalizes an understanding of the need to
gradually increase activity based on tolerance and
symptoms
 Expresses understanding of balancing rest and
activity
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
Setting priorities
Teamwork and collaboration
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Case Study (cont’d)
Mr. Indelicato will attain
a tolerable level of pain
during ambulation.
Mr. Indelicato’s pain will be a 2 to 3
on a scale of 0 to 10 during
ambulation.
Mr. Indelicato will gain
optimal functioning of
the right knee with
independent, purposeful
movement.
Mr. Indelicato will ambulate 50 to
75 feet with the aid of a walker
without reports of increasing
fatigue.
Mr. Indelicato will gain a minimum
of 90-degree flexion in the right
knee by the time of discharge.
Mr. Indelicato will
Mr. Indelicato will perform a return
demonstrate proper use demonstration of proper use of a
of a walker while
walker.
ambulating.
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Implementation
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Health promotion
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Acute care
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Teach patients to calculate maximum heart rate.
Body mechanics
Musculoskeletal system
Joint mobility
Walking
Restorative and continuing care
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Controlled Fall
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Case Study (cont’d)
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Marilyn wants to help Mr. Indelicato with
ambulation and strength training. To
implement her plan of care, she:
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Encourages Mr. Indelicato to use PCA pump
before ambulation
Explains why he should sit in bed and dangle his
legs before standing to ambulate
Establishes realistic increments for Mr. Indelicato
to increase walking distance during ambulation
Talks with him about exercise tolerance
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Principles of Transfer
and Positioning Techniques
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When moving a patient, knowledge of safe
transfer and positioning is crucial.
Pathological influences on body alignment
and mobility:
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Congenital defects
Disorders of bones, joints, and muscles
Central nervous system damage
Musculoskeletal trauma
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)

As part of the teaching process, Marilyn
consults with a physical therapist on proper
use of the walker. She and the physical
therapist instruct Mr. Indelicato and family
caregivers on the proper use of a walker, and
Marilyn provides written material that
reinforces these verbal instructions.
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Assistive Devices for Walking
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Walkers
Canes
Crutches
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Measuring for crutches
 Crutch gait
 Sitting in a chair with crutches
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Assistive Devices for Walking
(cont’d)
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Measuring for Crutches
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Measuring for Crutches (cont’d)
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Crutch Gait
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Ascending Stairs
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Descending Stairs
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Sitting in a Chair
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Implementation
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Restoration of activity and chronic illness
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Coronary heart disease
 Hypertension
 Chronic obstructive pulmonary disease
 Diabetes mellitus
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Evaluation
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Patient outcomes
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Reassess the patient for signs of improved activity
and exercise tolerance.
Ask for the patient’s perception of activity and
exercise status after interventions.
Ask if the patient’s expectations are being met.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Marilyn evaluates how effective her plan of care
has been. She asks Mr. Indelicato to rate the
level of pain from 0 to 10, observes his range of
motion and use of the continuous passive motion
(CPM) machine, and observes his ambulation
with a walker.
Mr. Indelicato rates his pain as a 3 and is able to
perform range of motion (ROM) and use the
CPM machine. He has a steady gait with the aid
of the walker.
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Quick Quiz!
1. A patient with a long history of arthritis
complains of sensitivity and warmth in the
knees. To determine the degree of limitation,
the nurse should assess
A. Posture.
B. Activity tolerance.
C. Body mechanics.
D. Range of joint motion.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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It has been 5 weeks since Marilyn began to
care for Mr. Indelicato. Mr Indelicato has
progressed steadily to increase both weight
bearing and range of joint motion on the
affected knee. Mr. Indelicato expected the
pain to be completely resolved on hospital
discharge and not to follow into physical
therapy.
Marilyn and the physical therapist worked
with Mr. Indelicato and his orthopedic
surgeon to identify pain control measures.
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