NR i224 iExam i2 iStudy iGuide
Activity iand iExercise
1. Health ipromotion iandimaintenance
Encourage iptitoiengage iiniregular iexercise iprogram.iUse iholisticiapproachito imake iand ii mplementiplanitoienhance ithe ipt’sioverall
i physical i fitness. i Discuss i recommendations i & i collaborate iw/ ipt i to i design i program. i Teach i pt i to i calculate i heart i rate. i Include
i warm-up(5-10min) i & i cool-down(5-10min) i in i program.
2. Restorative iand iContinuing iCare
Implementing iactivity i& iexercise istrategies ito iassist iptiw/ iADL’s iafter iacute icare iis ino il onger ineeded. iAlso irestore i&
ipromoteioptimal ifunctioning i pts iw/ ispecific i chronic i illness i(coronary i heart i disease i-CHD, i hypertension, i COPD, i diabetes)
3. Assistive idevices ifor iwalking; iproper itechnique
Walkersi– ihold iwalker, itake ione istep, imove iwalker iforward, iand itake ianother istep. iLift idevice iup i& iforward.
Canes i– iuse ionistronger iside. iPlace icane iforward i15-25cm i(6-10in) i(keeping iweightionibothilegs),iWeakerione iforward itoimeet
i cane i (weighti on i cane i &i strong), i then istrong ileg i moves ipassed i cane i(weight i on i cane i & iweaker).
Crutch:
4point i–iweightionibothilegs.iSafestigait.iMove iRIGHT iCRUTCHiforwardi(6in), imove iLEFT iFOOTiforward ito ilevel iof iright
i crutch,imove i LEFT i CRUTCH i forward, imove i RIGHT i FOOT iforward.
3point i–iweight ion iUNAFFECTED ileg. iMove ibothicrutchesiandiweakileg iforward,imove istrongerileg.
2point i–ipartial ibearing ion iBOTH ilegs. iFaster ithani4point.iRequires imore ibalance. iMove ithe iLEFT icrutchi& iRIGHT
i footiFORWARD i together, i move i the i RIGHT i crutch i &i LEFT ifoot i forward i together.
Swingito igait i– iusing ifor iuse iw/iparalysisioniboth ilegs.iProlonged iuse iresultsiin iatrophyiof iused imuscle. iMove iboth
i crutchesitogether, i lift i weight i by i the i arms i &i swingi to i the i crutch i(at i the i level)
Swingithough igait i– imove iboth icrutches itogether, iliftibodyiweightibyithe iarmsi&iswing iforward ipassithe icrutchesi(beyondilevel)
4. Proper imeasurementifor iassistive idevices
Crutchesi–icrutch ilengthi(in isupine iposition,imeasure ifrom iaxilla idown), ithe iangle iof ielbowiflexioni30idegrees
i (goniometer),iand i the i distance ibetween i the i crutch i pad i &i the i axilla i(3 i to i 4 i fingers iwide)
Cane i– ilength iisiequal itoithe idistance ibetweenithe igreater itrochanter i(hip/legsistart) iandithe ifloor.
5. Safety iusingiassistive idevices
Crutch i– ishow ipt ihow ito iroutinely iinspect icrutch itops, isecurely iattach irubber itips, ireplace iworn itips i(to iincrease isurface
i friction ito i prevent i slipping). i Explain i tips ineed ito i remain idry i (water i decreases ifriction), i teach i how i to i dry i w/ i paper ior i cloth iif
i they ibecome i wet. i Show i pti how i to iinspect i the i structure. i Cracksiini wooden i crutches idecrease i ability i to ihold iweight i &i bents
i inialuminum i crutches i alter i body i alignment.
Walker/cane i– iinstruct ihowito iuse isafelyitoiavoidiriskiof ifalling
6. Nursing iImplicationsifor iassistive idevices
Collaborationiw/ iotherihealthicare iprofessionalsisuchias iphysical itherapist,ipromote iactivity i&iexercise ibyiteachingithe iproperiuse
i of i canes; i walkers;i or i crutches, i Dependingi oni the i assistive idevice i most i appropriate i fori the i pt’s i condition.
Oxygenation
1. Factors iAffectingiOxygenation
Physiological, idevelopment, ilifestyle i&ienvironment
Physiologicali– irespiratoryidisorders(hyperventilation, ihypoventilation, i& ihypoxia); icardio idisorder(disturbed iconduction,
i impaired i valvular ifunction, i myocardia i hypoxia, i cardiomyopathy, i peripheral i tissue i hypoxia). iAlterations i of iblood-
carryingioxygen, inot iinhaling ie noughioxygen, ii ncreased imetabolism,ialterationsiby imusculoskeletal iabnormality ior
, ineuromusculariaffect ichest iwall imovement.
Decreasedioxygenicarrying icapacity i–ianemiai& iinhaleditoxinsi(carbonimonoxide)
Hypovolemia i– ishock i& isevere idehydration,iextracellular ifluidiloss i& ireducedicirculatingibloodivolume iresultingihypoxia iinitissues.
i Body i vasoconstrict i peripheral i &i increases i heart i rate ifor iincreased i cardiac i output.
Decreased ii nspired ioxygeniconcentrationi– icausediby iupper i&lower iairwayiobstructioni(Not ienoughioxygen ito
i alveoli);ie nvironment i (highi altitudes); i hypoventilation i(drug ioverdose)
Increasedimetabolicirate i– iincreasesioxygen idemand. iincreasingicarbonidioxide ii nibodyicausesianiincrease iinirate iand idepthiof
i breathing.
Conditions ieffectingichestiwallimovement i– idecreasesiventilation;iif idiaphragmidoesinotifullyidescend iw/ibreathingitheniamount
i of i air i breathed idecreases i (lessi oxygen i to i alveoli i & i tissues)
Pregnancy i–ienlargediuterus ipushes iabdominal iorgansiup iagainst idiaphragm.i3rd itrimester, ilessiairicapacityicausing idyspnea
i &if atigue
Obesityi– ireducedilungivolume ibecause iheavyilowerithorax i& iabdomeniwhen irecumbent i(laying idown) i&isupine.
i Obstructiveisleep i apnea. i Obesity-hypoventilation isyndrome i (oxygenation i decreased i & i carbon i retained)
Musculoskeletal i– iimpairment ii n ithoracicireduces ioxygenation. iAbnormal istructures i(kyphosis,ilordosis, ior iscoliosis),
itrauma,imusculari diseases, i & i central inervous i system idiseases.
Trauma i– iflail ichesti(multiple irib ifractures). iThoracicioriupperiabdomenisurgery,iopioidsi(paini– ifurtheridecreases iresp. irate
i &ichest iexpansion)
Neuromuscular idiseasesi– iventilation iimpaired icausing iatelectasis i(lung icollapse), ihypercapnia i(excessive icarbon ii n
iblood),ihypoxemia i(low i oxygen iin iblood).
Central inervous isystem ialterations i– idisease ior itrauma ito imedulla ioblongata i(neural iregulation iof ireparation iimpaired,
i abnormal i breathing ipattern i develops) i and/ori spinal i cordi(injury i to i c3-c5 icauses i paralysisi of i phrenic i nerve, idiaphragm i doesinot
i descend).
Influencesiofichronicidisease i–ichronicilungidisease. iApidiameterichangedi(Barrel ichest) ibecause ioveruse iof iaccessory imusclei&
i airi trapping iini emphysema. i Diaphragm iflattened i & ilungs ioverdistended i(hypoxemiai and/or i hypercapnia)
2. Hyperventilation/Hypoventilation
Hyperventilation i– ilungs iremove icarbon idioxide ifaster ithan iit iis iproduced iby icellular imetabolism i(Breathing iat ifast irate,
i decreased i carbon i & ii ncreased ioxygen). iCaused iby i Severe i anxiety. i Infection, i drugs iori acid-base i imbalance. i Signs i&
i symptomsiare i rapid ibreathing, isighing i breaths, i numbness i &i tingling i of ihands/feet, i light-headedness, i and iloss i of
i consciousness.
Hypoventilation i– ialveolar iventilation iis iinadequate ito imeet ioxygen idemand iof ithe ibody ior ieliminate isufficient icarbon
i (Breathing iati ani abnormally i slow i rate, i resultsiini more i carboni in iblood). i atelectasis i(collapsed ilung). iSigns i &i symptoms
i areimental istatus i changes, i dysrhythmias, i & ipotential i cardiac i arrest. iIf iuntreated i can i lead i to i convulsions, i unconsciousness i &
i death.
3. Lifestyle iFactors iAffectingiOxygenation:iStress, iSmoking,iExercise, iStress
Nutritioni– iobesityidecreasesilung iexpansion i&iincreased iweightiincreasesitissue idemand. iMalnourishment icauses
irespiratoryimuscle iwasting i which i results iin idecreased i muscle i strength i & i respiratory i excursion. i Both i at i risk ifor i anemia. i Diets
i w/ ihigh i carbs i can i increase i carbon iload ifor i pt’s i w/ i carbon i retention. iCardioprotective inutrients i are idiets i rich i in i fiber; i whole
i grains; i fresh ifruits i & i veggies; i nuts; i antioxidants; ilean i meat, i fish i & i chicken; iomega-3 i fatty i acid. i Restricted i sodium iis i good ifor
i avoidingihypertensive i meds. i Diets i high iin i potassium iprevent i & i help iimprove i control i on i hypertension. i 2000-cal i diet i of i fruit;
i veggies; i and i low-fat i dairy ifoods i that i are i high iin i fiber, ipotassium, i calcium, i magnesium i and i low i saturated i & i total i fat i helps
i prevent i & i reduce ihypertension.
Stress i– icontinuedistress i& isevere ianxietyiincrease imetabolic irate i& ioxygen idemand. iIncrease irate i&depth iof
irespiration.iw /chronic iillness i or i acute ilife i threatening iillnesses i can’ti tolerate ioxygen i demands ifrom i anxiety.
Smokingi– iheartidisease,icopd, i&ilungicancer. iInhaledinicotine icauses ivasoconstriction iof iperipheral i& icoronaryiblood
Activity iand iExercise
1. Health ipromotion iandimaintenance
Encourage iptitoiengage iiniregular iexercise iprogram.iUse iholisticiapproachito imake iand ii mplementiplanitoienhance ithe ipt’sioverall
i physical i fitness. i Discuss i recommendations i & i collaborate iw/ ipt i to i design i program. i Teach i pt i to i calculate i heart i rate. i Include
i warm-up(5-10min) i & i cool-down(5-10min) i in i program.
2. Restorative iand iContinuing iCare
Implementing iactivity i& iexercise istrategies ito iassist iptiw/ iADL’s iafter iacute icare iis ino il onger ineeded. iAlso irestore i&
ipromoteioptimal ifunctioning i pts iw/ ispecific i chronic i illness i(coronary i heart i disease i-CHD, i hypertension, i COPD, i diabetes)
3. Assistive idevices ifor iwalking; iproper itechnique
Walkersi– ihold iwalker, itake ione istep, imove iwalker iforward, iand itake ianother istep. iLift idevice iup i& iforward.
Canes i– iuse ionistronger iside. iPlace icane iforward i15-25cm i(6-10in) i(keeping iweightionibothilegs),iWeakerione iforward itoimeet
i cane i (weighti on i cane i &i strong), i then istrong ileg i moves ipassed i cane i(weight i on i cane i & iweaker).
Crutch:
4point i–iweightionibothilegs.iSafestigait.iMove iRIGHT iCRUTCHiforwardi(6in), imove iLEFT iFOOTiforward ito ilevel iof iright
i crutch,imove i LEFT i CRUTCH i forward, imove i RIGHT i FOOT iforward.
3point i–iweight ion iUNAFFECTED ileg. iMove ibothicrutchesiandiweakileg iforward,imove istrongerileg.
2point i–ipartial ibearing ion iBOTH ilegs. iFaster ithani4point.iRequires imore ibalance. iMove ithe iLEFT icrutchi& iRIGHT
i footiFORWARD i together, i move i the i RIGHT i crutch i &i LEFT ifoot i forward i together.
Swingito igait i– iusing ifor iuse iw/iparalysisioniboth ilegs.iProlonged iuse iresultsiin iatrophyiof iused imuscle. iMove iboth
i crutchesitogether, i lift i weight i by i the i arms i &i swingi to i the i crutch i(at i the i level)
Swingithough igait i– imove iboth icrutches itogether, iliftibodyiweightibyithe iarmsi&iswing iforward ipassithe icrutchesi(beyondilevel)
4. Proper imeasurementifor iassistive idevices
Crutchesi–icrutch ilengthi(in isupine iposition,imeasure ifrom iaxilla idown), ithe iangle iof ielbowiflexioni30idegrees
i (goniometer),iand i the i distance ibetween i the i crutch i pad i &i the i axilla i(3 i to i 4 i fingers iwide)
Cane i– ilength iisiequal itoithe idistance ibetweenithe igreater itrochanter i(hip/legsistart) iandithe ifloor.
5. Safety iusingiassistive idevices
Crutch i– ishow ipt ihow ito iroutinely iinspect icrutch itops, isecurely iattach irubber itips, ireplace iworn itips i(to iincrease isurface
i friction ito i prevent i slipping). i Explain i tips ineed ito i remain idry i (water i decreases ifriction), i teach i how i to i dry i w/ i paper ior i cloth iif
i they ibecome i wet. i Show i pti how i to iinspect i the i structure. i Cracksiini wooden i crutches idecrease i ability i to ihold iweight i &i bents
i inialuminum i crutches i alter i body i alignment.
Walker/cane i– iinstruct ihowito iuse isafelyitoiavoidiriskiof ifalling
6. Nursing iImplicationsifor iassistive idevices
Collaborationiw/ iotherihealthicare iprofessionalsisuchias iphysical itherapist,ipromote iactivity i&iexercise ibyiteachingithe iproperiuse
i of i canes; i walkers;i or i crutches, i Dependingi oni the i assistive idevice i most i appropriate i fori the i pt’s i condition.
Oxygenation
1. Factors iAffectingiOxygenation
Physiological, idevelopment, ilifestyle i&ienvironment
Physiologicali– irespiratoryidisorders(hyperventilation, ihypoventilation, i& ihypoxia); icardio idisorder(disturbed iconduction,
i impaired i valvular ifunction, i myocardia i hypoxia, i cardiomyopathy, i peripheral i tissue i hypoxia). iAlterations i of iblood-
carryingioxygen, inot iinhaling ie noughioxygen, ii ncreased imetabolism,ialterationsiby imusculoskeletal iabnormality ior
, ineuromusculariaffect ichest iwall imovement.
Decreasedioxygenicarrying icapacity i–ianemiai& iinhaleditoxinsi(carbonimonoxide)
Hypovolemia i– ishock i& isevere idehydration,iextracellular ifluidiloss i& ireducedicirculatingibloodivolume iresultingihypoxia iinitissues.
i Body i vasoconstrict i peripheral i &i increases i heart i rate ifor iincreased i cardiac i output.
Decreased ii nspired ioxygeniconcentrationi– icausediby iupper i&lower iairwayiobstructioni(Not ienoughioxygen ito
i alveoli);ie nvironment i (highi altitudes); i hypoventilation i(drug ioverdose)
Increasedimetabolicirate i– iincreasesioxygen idemand. iincreasingicarbonidioxide ii nibodyicausesianiincrease iinirate iand idepthiof
i breathing.
Conditions ieffectingichestiwallimovement i– idecreasesiventilation;iif idiaphragmidoesinotifullyidescend iw/ibreathingitheniamount
i of i air i breathed idecreases i (lessi oxygen i to i alveoli i & i tissues)
Pregnancy i–ienlargediuterus ipushes iabdominal iorgansiup iagainst idiaphragm.i3rd itrimester, ilessiairicapacityicausing idyspnea
i &if atigue
Obesityi– ireducedilungivolume ibecause iheavyilowerithorax i& iabdomeniwhen irecumbent i(laying idown) i&isupine.
i Obstructiveisleep i apnea. i Obesity-hypoventilation isyndrome i (oxygenation i decreased i & i carbon i retained)
Musculoskeletal i– iimpairment ii n ithoracicireduces ioxygenation. iAbnormal istructures i(kyphosis,ilordosis, ior iscoliosis),
itrauma,imusculari diseases, i & i central inervous i system idiseases.
Trauma i– iflail ichesti(multiple irib ifractures). iThoracicioriupperiabdomenisurgery,iopioidsi(paini– ifurtheridecreases iresp. irate
i &ichest iexpansion)
Neuromuscular idiseasesi– iventilation iimpaired icausing iatelectasis i(lung icollapse), ihypercapnia i(excessive icarbon ii n
iblood),ihypoxemia i(low i oxygen iin iblood).
Central inervous isystem ialterations i– idisease ior itrauma ito imedulla ioblongata i(neural iregulation iof ireparation iimpaired,
i abnormal i breathing ipattern i develops) i and/ori spinal i cordi(injury i to i c3-c5 icauses i paralysisi of i phrenic i nerve, idiaphragm i doesinot
i descend).
Influencesiofichronicidisease i–ichronicilungidisease. iApidiameterichangedi(Barrel ichest) ibecause ioveruse iof iaccessory imusclei&
i airi trapping iini emphysema. i Diaphragm iflattened i & ilungs ioverdistended i(hypoxemiai and/or i hypercapnia)
2. Hyperventilation/Hypoventilation
Hyperventilation i– ilungs iremove icarbon idioxide ifaster ithan iit iis iproduced iby icellular imetabolism i(Breathing iat ifast irate,
i decreased i carbon i & ii ncreased ioxygen). iCaused iby i Severe i anxiety. i Infection, i drugs iori acid-base i imbalance. i Signs i&
i symptomsiare i rapid ibreathing, isighing i breaths, i numbness i &i tingling i of ihands/feet, i light-headedness, i and iloss i of
i consciousness.
Hypoventilation i– ialveolar iventilation iis iinadequate ito imeet ioxygen idemand iof ithe ibody ior ieliminate isufficient icarbon
i (Breathing iati ani abnormally i slow i rate, i resultsiini more i carboni in iblood). i atelectasis i(collapsed ilung). iSigns i &i symptoms
i areimental istatus i changes, i dysrhythmias, i & ipotential i cardiac i arrest. iIf iuntreated i can i lead i to i convulsions, i unconsciousness i &
i death.
3. Lifestyle iFactors iAffectingiOxygenation:iStress, iSmoking,iExercise, iStress
Nutritioni– iobesityidecreasesilung iexpansion i&iincreased iweightiincreasesitissue idemand. iMalnourishment icauses
irespiratoryimuscle iwasting i which i results iin idecreased i muscle i strength i & i respiratory i excursion. i Both i at i risk ifor i anemia. i Diets
i w/ ihigh i carbs i can i increase i carbon iload ifor i pt’s i w/ i carbon i retention. iCardioprotective inutrients i are idiets i rich i in i fiber; i whole
i grains; i fresh ifruits i & i veggies; i nuts; i antioxidants; ilean i meat, i fish i & i chicken; iomega-3 i fatty i acid. i Restricted i sodium iis i good ifor
i avoidingihypertensive i meds. i Diets i high iin i potassium iprevent i & i help iimprove i control i on i hypertension. i 2000-cal i diet i of i fruit;
i veggies; i and i low-fat i dairy ifoods i that i are i high iin i fiber, ipotassium, i calcium, i magnesium i and i low i saturated i & i total i fat i helps
i prevent i & i reduce ihypertension.
Stress i– icontinuedistress i& isevere ianxietyiincrease imetabolic irate i& ioxygen idemand. iIncrease irate i&depth iof
irespiration.iw /chronic iillness i or i acute ilife i threatening iillnesses i can’ti tolerate ioxygen i demands ifrom i anxiety.
Smokingi– iheartidisease,icopd, i&ilungicancer. iInhaledinicotine icauses ivasoconstriction iof iperipheral i& icoronaryiblood
