Posture, mobility and

ambulation
Ella Yu (VL)
Posture, mobility and ambulation
(Kozier, Activity and Exercise )
 Describe four basic elements of normal
movement
 Differentiate isotonic, isometric, isokinetic,
aerobic and anaerobic exercise
 Compare the effects of exercise and
immobility on body systems
 Identify factors influencing a person’s body
alignment and activity
Posture, mobility and
ambulation
 Assess activity- exercise pattern, alignment,
mobility capabilities and limitations, activity
tolerance and potential problems related to
immobility
 Develop nursing diagnoses, outcomes and
interventions related to activity, exercise and
mobility problems
 Use proper body mechanics when
positioning, moving, lifting, and ambulating
clients
Posture, mobility and
ambulation
 Activity- exercise pattern
 Person’s routine of exercise, activity, leisure and
recreation
1. Activities of daily living (ADL)
2. The type, the quality and the quantity of the
exercise, including sports
Posture, mobility and
ambulation
 Mobility
 The ability to move freely, easily, rhythmically,
and purposefully in the environment
 Is vital for independence
 Mental well-being
 Effectiveness of body functioning
 Self esteem and body image
Normal Movement
 Alignment and posture
 Line of gravity (an imaginary vertical line drawn
through the body’s center of gravity)
 Center of gravity (the point at which all of the body
mass is centered)
 Base of support ( the foundation on which the
body rests)
 Proper alignment minimize the strain on the joints,
muscles, tendon and ligament and support the
internal organs
Figure 42.38 A, Balance is maintained when the line of gravity falls close to the base of support. B, Balance is
precarious when the line of gravity falls at the edge of the base of support. C, Balance cannot be maintained when
the line of gravity falls outside the base of support.
Which one is correct posture?
Normal movement
 Joint mobility
 Flexor muscles are stronger than the extensor muscles
 Inactive- the joints are pulled into a flexed (bent) position
 Range of Motion (ROM)- maximum movement that is possible for that joint
 Balance
 Vestibular apparatus
 Brain stem
 Proprioception- awareness of the posture, movement and changes in equilibrium and
the knowledge of position, weight and the resistance of objects in relation to the body
 Coordinated movement
 Cerebral cortex- initiates voluntary motor activity
 Cerebellum- coordinates the motor activity. When it is injured, movements become
clumsy and uncoordinated
 Basal ganglia- maintain the position
Joint Movements
 Flexion  Eversion (laterally)
 Extension  Inversion (medially)
 Hyperextension  Pronation (palm up)
 Abduction  Supination (palm down)
 Adduction
 Rotation
 Circumduction (move in
a circle)
Exercise
 The National Institutes of Health (NIH)
 Physical activity: bodily movement produced
by skeletal muscles that requires energy
expenditure and produces progressive health
benefits
 Exercise: a type of activity defined as a
planned, structured, and repetitive bodily
movement done to improve or maintain one
or more components of physical fitness
Types of exercise
 Isotonic (dynamic) exercises
 Muscle shortens to produce muscle contraction
and active movement
 Increase muscle tone, mass and strength
 Maintain joint flexibility and circulation
 Increase heart rate and cardiac output
 Running, walking, swimming
 ADLs and ROM exercises
 Isotonic bed exercises- using a trapeze to lift the
body off to bed
Exercises
 Isometric (Static or setting) exercises
 Change in muscle tension
 No change in muscle length, muscle or joint
movement
 Exerting pressure against a solid object
 Cast or traction
 Extending the legs, tensing the thigh muscles and
press the knee against the bed-quadriceps (or quad)
set
 Moderate increase in heart rate and cardiac output
 No appreciable increase in blood flow
Exercises
 Isokinetics (resistive) exercises
 Muscle contraction or tension against resistance
 Isotonic or isometric
 E.g. lifting weights to strength the pectorals
(Chest muscle)
Exercises
 Aerobic exercises
 The activity during which the amount of oxygen
taken in the body is greater than that used to
perform the activity
 Large muscle groups, performed continuously
and are rhythmic
 Walking, jogging, running, swimming, skating
 Improve cardiovascular conditioning and physical
fitness
Measurement of the intensity

1. Maximum heart rate:

 (220- current age) X 60-85%
 at least 60% of the maximum heart rate is the
recommended intensity
Measurement of the intensity
2. Talk test
 Keeps most people at 60% of maximum heart rate
or more
 When exercising, the person should be able to
carry on a conversation even with some labored
breathing.
 Exercise intensity should be increased if the
person can carry on an unlimited unlabored
discussion
Measurement of the intensity
of exercise
3. Borg scale of perceived exertion
 somewhat hard- 75% of maximum heart rate

 Measures “how difficult” the exercise feels to the person in terms of heart and lung
exertion

6 Very, very light 13 Somewhat hard

7 14 (75%)

8 Very light 15 Hard

9 (40%) 16
10 Fairly light 17 Very hard
11 18
12 19, 20 Very, very hard (100%)
Exercises
 Anaerobic exercises
 Activity in which cannot draw out enough
oxygen from the bloodstream
 Anaerobic pathways are used to provide
additional energy for a short time
 Endurance training for athletes such as
weight lifting and sprinting
Guidelines and minimal
requirements for physical activity
 Frequency and duration
 Aerobic: cumulative 30 minutes or more daily of “moderately intensity”
 Stretching: should be added onto that minimum requirement so that
all parts of the body are stretched each day
 Strength training: add onto these minimum requirements so that all
muscle groups are addressed at least three times a week, with a day
of rest after training
 Types and safety
 Please refer to textbook Kozier
Benefits of Exercise
 Musculoskeletal System
 Size, shape and tone, strength of muscle
 Muscle hypertrophy (enlarge)
 Increase joint flexibility and range of motion
 balance between osteoblast (bone -building cells)
and osteoclasts (bone-resorption and breakdown
cells)
Benefits of Exercise
 Cardiovascular system
 Increase heart rate
 Strength of heart muscle contraction
 Increase cardiac output- 30L/ min
 Increase blood supply to heart and muscle
 Level of HDL cholesterol, stress reduction
 Respiratory system
 Increase ventilation and oxygen intake (20 times)
 More toxins are eliminated
 Emotional stability, problem solving
 Prevent pooling of the secretions in bronchi and
bronchioles
Benefits of Exercise
 Metabolic System
 Increase metabolic rate (20 times)
 Increase production of body heat and waste
products and calorie use
 Reduce level of serum triglycerides and
cholesterol
 Enhances the effectiveness of the insulin
 Gastrointestinal System
 Improve appetite
 Increase peristalsis
Benefits of Exercise
 Immune system
 Lymph fluid from tissue into lymph capillaries
 Improve lymph nodes circulation
 Natural killer cell, circulating T- cell and cytokines
function- increase resistance to viral infection,
prevent formation of the malignant cells
 How about strenous exercise?
 Urinary system
 Prevent stasis of urine
Benefits of Exercise
 Psychoneurologic system
 Produce a sense of well-being
 Improve self-concept
 Enhance the quality of sleep
 Increase levels of metabolites for
neurotransmitters such as norepinephrine and
serotonin
 Exercise releases endogenous opioids and
increase level of endorphins
 Increase oxygen level to brain- euphoria
Benefits of Exercise
 Cognitive function
 Strengthen and build neuronal connections
 Brain Gym- easy, cross-lateral movement that
enhance right and left- brain integration thus
improving mood. Learning, problem solving and
performance
 The contralateral movements have been shown to
help individual with attention deficit disorder
(ADD), Attention deficit/ hyperactivity disorder
(ADHD), learning disorders and mood disorders
Benefits of Exercise
 Spiritual Health
 Yoga- style exercise- enhance mind- body spirit
 The emphasis of breathing- sooth the
cardiorespiratory and nervous system
 Walking a labyrinth (a circular mandala)- induce a
meditative state, decrease heart and respiratory
rate, lowering blood pressure and decrease
chronic pain and insomnia
Walking a labyrinth
Factors affecting body
alignment and activity
 Growth and development
 1 to 5 years old- gross and fine motor skills refine
 6 to 12 years old- the best
 Adolescence- awkwardness
 20-40years old- pregnancy
 Older adult- osteoporosis, fracture
Factors affecting body
alignment and activity
 Physical health
 Mental health

 Nutrition

 Personal values and attitudes

 External factors

 Prescribed limitation
 Bed rest
Effects of immobility
 Musculoskeletal System
 Disuse osteoporosis- bone demineralize when
there is no stress of weight-bearing, bones
become spongy and fracture easily
 Disuse atrophy- muscle decrease in size
 Contractures- permanent shortening of the
muscle leads to joints immobility and deformity
 Stiffness and pain in joints- ankylosing of the
collagen
Effects of immobility
 Cardiovascular system
 Diminshed cardiac reserve- tachycardia with
minimal exertion
 Increase use of valsalva maneuver- holding the
breath and straining against a closed glottis,
pressure on the large vein and decrease blood
flow to heart and coronary vessels
 Orthostatic (postural) hypotension-
vasoconstriction of the lower half of the body
Effects of immobility
 Cardiovascular system
 Venous vasodilation and stasis- poor contractility of the
skeletal muscle and incompetent valves
 Dependent edema- insufficient venous pressure, blood is
forced to interstitial spaces (sacrum, heels)
 Thrombus formation
 thrombophlebitis: impaired venous return to the heart,
hypercoagulability of the blood and injury to the vessel
walls
 Embolus: an object move from its place of origin, causing
obstruction to circulation
Effects of immobility
 Respiratory system
 Decreased respiratory movement
 Pooling of respiratory secretions
 Atelectasis- decreased surfactant and blockage of
a bronchiole cause the collapse of a lobe or an
entire lung
 Hypostatic pneumonia
Effects of immobility
 Metabolic system
 Decreased metabolic rate
 Negative nitrogen balance: protein synthesis
(anabolism) < protein breakdown (catabolism),
increase excretion of nitrogen
 Anorexia: loss of appetite
 Negative calcium balance
Effects of immobility
 Urinary system
 Urinary stasis- decrease gravity, decrease in
muscle tone
 Renal calculi- calcium salts precipitate out as
crystals to form renal calculi
 Urinary retention and urinary incontinence
 Urinary tract infection
Effects of immobility
 Gastrointestinal system
 Constipation
 Integumentary system
 Reduced skin turgor
 Skin breakdown
 Psychoneurologic system
 Decrease self-esteem
Using body mechanics
 The efficient , coordinated and safe use of
the body to move objects and carry out the
activities of daily living
 Lifting

 Pulling and pushing

 Pivoting- turn without twisting of the spine

 Preventing back injury

Positioning of the clients
 Fowler’s position
 Orthopneic position

 Dorsal recumbent position

 Prone position

 Lateral position

 Sim’s position
Positioning of the clients
(please read textbook before the
lab.)
 Turning the client in the bed
 Logrolling the client
 Why and how we use logrolling?
 Transferringbetween bed and chair
 Wheelchair safety

 Providing passive range of motion exercise

Low-Fowler’s (semi-Fowler’s position)(supported).
•Sitting with an overbed table across the lap
•Facilitates respiratory by allowing maximum chest expansion
•Helps in inhaling problem/ exhaling problem?
Dorsal recumbent position.
Lateral position (supported).
Sim’s position (supported).
Moving a client up in bed.
Moving a client to a lateral position.
Logrolling

•Turn the clients whose body must at all times be kept in

straight alignment (like a log).
•E.g. spinal injury
•Two nurses/ three nurses
•Cervical injury- maintain head and neck alignment
Logrolling
Logrolling
Assisting a client to a sitting position on the edge of the bed.
Assisting a client to a sitting position on the edge of the bed

Controlling Postural Hypotension

•Rest with the head of the bed
elevated
•Be aware the times after the heavy
meals or after hypotensive
medication
•Never bend down quickly
•Wear elastic stocking/ rocking
chair
•Hot bath/ valsalva maneuver
•Arise from bed in three stages:
•Sit up in bed for 1 minutes
•Sit on the side of the bed with
the legs dangling for 1 minutes
•Stand with holding
nonmovable objects for 1
minutes
Supporting a limb above and below the joint for passive exercise.
Passive ROM Exercises
•Should be systematic, three
repetitions
•Twice daily
•Use a firm, comfortable grip
and good supports of limbs
•smoothly., slowly and
rhythmically
•Avoid fast movement- will
cause spasticity and rigidity
•Avoid forcing
•Firm pressure and stop
temporarily if necessary
Assisting the client to ambulate
(please read before the lab.)
 To provide a safe condition for the client to walk with
whatever support is needed
 Using mechanical aids for walking
 Canes
 Walker
 Crutches
 the tripod position: the crutches are placed about 15cm in front of
the feet and out laterally about 15 cm, creating a wide base of
support
 Please read the client teaching in using canes, alkers and
crutches
The wheelchair is placed parallel to the bed as close to the bed as possible. Note the placement of the
nurse’s feet mirrors that of the client’s feet.
Using a transfer (walking) belt.

© Elena Dorfman
Figure 42.67 Lowering a fainting client to the floor.

© Elena Dorfman
The swing-to crutch gait.
The swing-through crutch gait.
The four-point alternate crutch gait.
Teaching: Client Care: Using Crutches
A, standard walker; B, A two-wheeled walker.

©©Elena
ElenaDorfman
Dorfman
The three-point alternate crutch gait.
The two-point alternate crutch gait.
Teaching: Client Care: Using Walkers
Teaching: Wellness Care: Preventing Back Injuries
Safe Use of Stretchers