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Exercise for the Immobile Patient
The purpose of Exercise for Immobile Patients is as follows; To maintain joint mobility by putting each of the patient's joints through all possible movements to increase and/or maintain movement in each joint. To prevent contracture, atony (insufficient muscular tone), and atrophy of muscles. To stimulate circulation, preventing thrombus and embolus formation. To improve coordination. To increase tolerance for more activity. To maintain and build muscle strength. Learning Outcomes: After completng this lesson you will be able to: Identify types of exercises and range of movement techniques recommended for the immobile patient. Cite guidelines for range of motion exercises before bedtime. Understand contraindications to range of motion exercises. Cite guidelines and purpose for documenting the patient's response and progress to exercise programme. THE PURPOSES OF EXERCISE FOR THE IMMOBILE PATIENT • To maintain joint mobility is done by putting each of the patient's joints through all possible movements to increase and/or maintain movement in each joint. • To prevent contracture, atony (insufficient muscular tone), and atrophy of muscles. • To stimulate circulation, preventing thrombus and embolus formation. • To improve coordination. • To increase tolerance for more activity. • To maintain and build muscle strength. TYPES OF EXERCISES • Passive. These exercises are carried out by the nurse, without assistance from the patient. Passive exercises will not preserve muscle mass or bone mineralization because there is no voluntary contraction, lengthening of muscle, or tension on bones. • Active Assistive. These exercises are performed by the patient with assistance from the nurse. Active assistive exercises encourage normal muscle function while the nurse supports the distal joint. • Active. Active exercises are performed by the patient, without assistance, to increase muscle strength. • Resistive. These are active exercises performed by the patient by pulling or pushing against an opposing force. • Isometric. These exercises are performed by the patient by contracting and relaxing muscles while keeping the part in a fixed position. Isometric exercises are done to maintain muscle strength when a joint is immobilized. Full patient cooperation is required. TYPES OF BODY MOVEMENT Flexion. The state of being bent. The cervical spine is flexed when the chin is moved toward the chest. Extension. The state of being in a straight line. The cervical spine is extended when the head is held straight. Hyperextension. The state of exaggerated extension. The cervical spine is hyperextended when the person looks overhead, toward the ceiling. Abduction. Lateral movement of a body part away from the midline of the body. The arm is abducted when it is held away from the body. Adduction. Lateral movement of a body part toward the midline of the body. The arm is adducted when it is moved from an outstretched position toward the body. Rotation. Turning of a body part around an axis. The head is rotated when moved from side to side to indicate "no." Circumduction. Rotating an extremity in a complete circle. Circumduction is a combination of abduction, adduction, extension, and flexion. Supination. The palm or sole is rotated in an upward position Pronation. The palm or sole is rotated in a downward position. GUIDELINES FOR RANGE OF MOTION EXERCISES • Plan when range of motion exercises should be done. Plan whether exercises will be passive, active-assistive, or active. Involve the patient in planning the program of exercises and other activities because he/she will be more apt to do the exercises voluntarily. • Expect the patient's heart rate and respiratory rate to increase during exercise. • Range-of-motion exercises should be done at least twice a day. During the bath is one appropriate time. The warm bath water relaxes the muscles and decreases spasticity of the joints. Also, during the bath, areas are exposed so that the joints can be both moved and observed. Another appropriate time might be before bedtime. The joints of helpless or immobile patients should be exercised once every eight hours to prevent contracture from occurring. • Joints are exercised sequentially, starting with the neck and moving down. Put each joint needing exercise through the range of motion procedure a minimum of three times, and preferably five times. Avoid overexerting the patient; do not continue the exercises to the point that the patient develops fatigue. Some exercises may need to be delayed until the patient's condition improves. • Start gradually and move slowly using smooth and rhythmic movements appropriate for the patient's condition. • Support the extremity when giving passive exercise to the joints of the arm or leg. • Stretch the muscles and keep the joint flexible. • Move each joint until there is resistance, but never force a joint to the point of pain. • Keep friction at a minimum to avoid injuring the skin. • Return the joint to its neutral position. • Use passive exercises as required, however, encourage active exercises when the patient is able to do so. DOCUMENTATION a. Evaluation. Evaluate the patient in terms of fatigue, joint discomfort, and joint mobility. b. Record Keeping. Range of motion is often placed on a flow sheet. If a flow sheet is not used, an entry should be made in the Nursing Progress Notes using a narrative format. If there is any adverse response to the exercises, a narrative note must be made. Nursing notes should address the extent to which joints can be moved in degrees.