Ch 18 F&D - Primary Prevention, Risk Reduction, Deconditioning Flashcards Preview

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exercise dose that will maintain the patient's conditioning level and prevent deterioration


prehabilitation parameters

- intensity more important than frequency (better to complete high intensity exercise less frequently than low intensity exercise more often/frequently)
- quality over quantity
*more research for exercise prescription to prevent negative side effects of recumbency/bed rest


appropriate dosing needed to prevent "life-style related conditions" has not been determined with exception of:

ischemic heart disease can be prevented & “optimal” cardiovascular health can be achieved through moderate volume of regular physical activity at an intensity of 6 METs


what best represents the human condition

upright and mobile


what is the difference btw bed rest and deconditioning

deconditioning = cumulative affect; result of a person being sedentary and having restricted mobility (can be secondary to bedrest)


bedrest definition

physician written order that says they cannot get out of bed


physiological effects of bed rest

- CV and pulmonary deterioration occurs more quickly than MS deterioration
- Takes longer to recover from effects of bedrest than for the impairments of bedrest originally occur
- worse in older adults than younger adults
- active older adult has better physiological reserve to accommodate for illness/bedrest
- Restricted mobility is associated with clinical depression
- Additional considerations in Table 18-2 (p. 252)


mobilization and exercise ENHANCE mucociliary transport and airway clearance resulting in:

improved pulmonary function (top of hierarchy)


changes in body position assist in airway clearance to minimize pooling and stagnation of bronchial secretions resulting in:

decreased risk of atelectasis


effects of bedrest on the CV system

- Loss of fluid-volume and pressure regulating mechanism
- Decrease in plasma volume
- Diuresis
- Increased hematocrit
- Increased risk for deep vein thrombosis (DVT) – this is PREVENTABLE!


effects of bedrest on the pulmonary system

**Increased work of breathing; secondary effect of decrease lung volumes:
- dec. Functional Residual Capacity (worse in supine; improved in sitting)
- dec. Residual Volume
- dec. Forced Expiratory Volume


effects of bedrest on the MS system

- Muscle Atrophy leading to weakness, dec coordination, impaired balance
- Excessive strain on ligaments and joints (when they start to move again) leading to joint contracture
- Disuse osteoporosis (once bone loss occurs it is irreversible, so inc fx risk)
- Limited alternatives to lying in bed result in poor postural alignment, stiffness, soreness


effects of bed rest of other systems

- Orthostatic hypotension
- Inc risk for skin lesions and decubitus ulcers
- Inc renal load leading to dysrhythmia, muscle wasting, weakness, neuropathy, glucose intolerance, and reduced bone density
- dec activity of the sympathetic nervous system
- dec electrical activity in brain
- Emotional/behavioral changes
- dec reaction times
- sleep disturbance
- impaired psychomotor performance
- dec insulin sensitivity
- dec lymphatic flow and impaired immune system response
- depression


alternatives to bedrest

- creatively-designed furniture that supports normal physiological functioning. (i.e. stretcher chair, kinetic bed)
- Avoid passive positioning whenever possible!
- Active standing > passive standing
- Upright sitting > passive standing


indications for bedrest

- Minimize effects of gravity to promote healing following trauma or orthopedic surgery
- Minimize the effects of edema; can be achieved more specifically though
**Mobilizing patients and permitting bathroom privileges has been reported to be less stressful than having to use a bedpan
**disadvantages are better documented than benefits


acute effects of mobilization and exercise on cardiopulmonary system

**increased airway diameter in addition to the following increases:
- Minute alveolar ventilation
- Alveolar ventilation
- Tidal Volume
- Respiratory Rate
- Air flow rates
- Cardiac Output
- Stroke volume
- Heart rate
- Blood pressure
- Rate pressure product (HR + Systolic BP)
** hemodynamic benefits are greater in an upright position


For those with impaired venous return and myocardial contractility begin with...

moderate-intensity recumbent cycling


In those with stroke and other clotting disorders ______ levels of activity are associated with _______ in platelet activity.

moderate; minimal increases
**No evidence to support this as a risk factor in this population


role of resistance training

- prevent mechanical ventilation or aid in weaning from it (respiratory m.)
- Prevents m. atrophy
- improved aerobic exercise responses in healthy older adults
**Should be included in cardiac and pulmonary rehabilitation programs


before beginning resistance training use caution and screen for...

**caution in those with ischemic heart disease due to increased arterial wall stiffness
**Screen for risk factors before prescription of abdominal exercises due to intrathoracic pressure increases and SV decreases


acute effects of mobilization and exercise on endocrine system

- stimulation
- Increased sympathetic nerve stimulation; improves processing of sympathetic neurotransmitters
- increase catecholamines, including anti-inflammatory effects


acute effects of mobilization and exercise on CNS

- Arousal due to activation of the reticular activating system
- Parasympathetic inhibition coupled with sympathetic activation to assist with systemic responses to exercise


acute effects of mobilization and exercise on metabolic system

- Improved sensitivity to insulin
- Increased growth hormone synthesis


acute effects of mobilization and exercise on immune system

- Improves WBC production
- Dose-dependence unknown; know aerobic ex = better, but don’t know what threshold marks what amount will shift to worse than better for the immune system (what is the magic duration #/time?)
- Prolonged exhaustive exercise is associated with compromised immunity


acute effects of mobilization and exercise on psychological system

- Improved well-being and mood
- Not well utilized amongst those with mental illness


- Identify factors contributing to deficits in oxygen transport.
- Identify which parameters to monitor
- Is mobilization/exercise indicated?
- Select an appropriate mobilization to match the patients oxygen transport capacity.
- Combine body positions (especially upright).
- Set the duration according to patient response (not time).
- Repeat mobilization as often as possible according to their beneficial effects and being safely tolerated by the patient.
- Increase intensity and and/or duration to maintain optimal oxygen transport.
- Continue progression until patient is able to resume activities and full participation or when the threat to oxygen transport is minimized.

Table 18-4


preparing for mobilization

1. The patient should be physically prepared. – untangle wires, tie gown, slipper socks on, etc.
2. The patient’s medication schedule should be reviewed. – when did they receive their pain meds?
3. Equipment should be noted and positioned appropriately.
4. Move procedures and techniques should be discussed with the team before implementation.


“Show me how you get out of bed. I’ll jump in and help you when you look like you need it.”

– teaching a new way when they are already sick and immobilized is not very effective.


monitoring mobilization session

- Adapt communication needs to the learner (Cognitive, language impairment, etc.)
- Assess baseline; Laying in bed, sitting, Orthostatic hypotension
- Metabolic response to mobilization and exercise should be monitored (Beginning, during, etc.)


what to measure during mobilization session

- Heart rate
- Electrocardiogram
- Blood Pressure
- Rate Pressure Product
- Respiratory Rate
- Perceived exertion (RPE b/c HR blunted with beta-blocker)
- Breathlessness
- Pain/discomfort
- Fatigue


Long-Term Physiological Effects of Mobilization & Exercise - pulmonary system

Increased respiratory muscle strength and endurance


Long-Term Physiological Effects of Mobilization & Exercise - CV system

- Increased myocardial efficiency
- Exercise-induced bradycardia
- Decreased HR & BP
- Improved orthostatic tolerance


Long-Term Physiological Effects of Mobilization & Exercise - hematological system

- Increased number of RBC
- Optimize hematocrit and cholesterol


Long-Term Physiological Effects of Mobilization & Exercise - NM system

- Improved neuromotor control
- Improved postural control
- Improved efficiency of movement


Long-Term Physiological Effects of Mobilization & Exercise - MS system

- Improved muscle vascularization
- Increased glycogen storage capacity
- Increased biomechanical efficiency
- muscle hypertrophy
- increased strength
- endurance
- ligament tensile strength
- Maintain bone density


Long-Term Physiological Effects of Mobilization & Exercise - immunological system

increased resistance to infection


Long-Term Physiological Effects of Mobilization & Exercise - endocrine system

Increased efficiency of hormone production and degradation to support exercise


Long-Term Physiological Effects of Mobilization & Exercise - CNS

Increased sense of well-being and concentration


Long-Term Physiological Effects of Mobilization & Exercise - integumentary system

- Increased efficiency of skin as heat exchanger and sweating efficiency
- decreased skin breakdown
- improved healing