Concept of Nursing Care in Patients with Activities and Exercise

Activities and Exercise

Assessment

Assessment on the problem of meeting the needs of activities and exercise are as follows:

1. Current nursing history. This assessment includes the patient's reasons for causing impaired activity and exercise needs.
2. Nursing history of diseases that have been suffered. This assessment relates to the fulfillment of activity needs.
3. Ability of motor function. Assessment of motor function, among others, on the right and left hands and feet to assess the presence or absence of weakness, strength, or spastic.
4. Activity capability. This assessment is to assess the ability to move to a tilted position, sitting, standing, getting up, and moving without assistance.
5. Ability range of motion. This assessment is performed on areas such as the shoulders, elbows, arms, pelvis, and legs.
6. Changes in activity intolerance. Assessment of activity intolerance related to changes in the respiratory system, including: breath sounds, blood gas analysis, thoracic wall movement, presence of mucus, productive cough followed by heat, and pain during respiration. While related to changes in the cardiovascular system, such as pulse and blood pressure, peripheral circulation disorders, the presence of thrombus, and changes in vital signs after doing activities or changing positions.
7. Muscle strength and coordination disorders. Muscle strength can be assessed bilaterally or not.
8. Physiological changes. Assessment of psychological changes caused by activity and activity disorders, including changes in behavior, increased emotions, changes in coping mechanisms, and others.

Nursing Diagnosis that may appear according to NANDA

1. Impaired Physical Mobility related to loss of bone structural integrity due to fracture, and pain.
2. Acute pain related to physical injury.
3. Self-care Deficit: toileting, bathing, dressing/grooming, feeding related to musculoskeletal disorders, and weakness.

Nursing Interventions

1	Impaired Physical Mobility Definition: A limitation in independent, purposeful physical movement of the body or of one or more extremities Defining Characteristics: Postural instability during performance of routine activities of daily living (ADLs);  limited ability to perform gross motor skills;  limited ability to perform fine motor skills;  uncoordinated or jerky movements;  limited range of motion;  difficulty turning;  decreased reaction time;  movement-induced shortness of breath;  gait changes (e.g., decreased walking speed, difficulty initiating gait, small steps, shuffles feet, exaggerated lateral postural sway);  engages in substitutions for movement (e.g., increased attention to other's activity, controlling behavior, focus on preillness/predisability);  slowed movement;  movement-induced tremor	NOC : v Mobility Level v Self care : ADLs v Transfer performance Outcomes: Clients increase in physical activity Understand the purpose of increasing activity Verbalize feelings to increase strength and mobility Demonstrate the use of assistive devices for mobilization (walker)	NICs : Exercise therapy: ambulation Monitoring vital signs before / after exercise and see the patient's response during exercise. Teach the patient or other health care provider about ambulation techniques. Assess the patient's ability to mobilize. Train patients in meeting the needs of ADLs independently according to ability. Accompany and assist patients during mobilization and help meet the needs of ADLs. Provide assistive devices if the client requires. Teach the patient how to change positions and provide assistance if needed.
2	Acute pain Definition Pain is whatever the experiencing person says it is, existing whenever the person says it does (McCaffery, 1968); an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain) sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of <6 months (NANDA) Defining Characteristics: Report verbally or non-verbally Facts from observation Protective movement Cautious behavior Sleep disturbances (glazed eyes, looking tired, difficult or chaotic movements, grinning) Narrowed focus (decreased perception of time, impaired thought processes, decreased interaction with people and the environment) Changes in appetite and drinking Related factors: Injury agent (biological, chemical, physical, psychological)	NOC : v Pain Levels, v Pain control, v Comfort level Outcomes : Able to control pain (know the cause of pain, able to use non-pharmacological techniques to reduce pain, seek help) Reports that pain is reduced by using pain management Able to recognize pain (scale, intensity, frequency and signs of pain) Expressing a sense of comfort after the pain is reduced Vital signs within normal range	NICs : Pain Management Perform a comprehensive pain assessment including location, characteristics, duration, frequency, quality and precipitation factors Observe nonverbal reactions to discomfort Use therapeutic communication techniques to know the patient's pain experience Evaluation of past pain experiences Evaluate with patient and other healthcare team about past pain control ineffectiveness Help patients and families find and find support Reduce pain precipitation factor Teach about non-pharmacological techniques Evaluate the effectiveness of pain control Increase rest Collaborate with the doctor if there are complaints and pain measures don't work Monitor patient acceptance of pain management
3.	Self-care Deficit Definition  When an individual is very unable to meet their own self-care requisites, a "self-care deficit" occurs. It is the job of the Registered Nurse to determine these deficits, and define a support modality. Self-care deficit nursing theory is a grand nursing theory that was developed between 1959 and 2001 by Dorothea Orem. It is also known as the Orem model of nursing. It is particularly used in rehabilitation and primary care settings where the patient is encouraged to be as independent as possible. Self-Care Deficit Bathing/Hygiene; Dressing/Grooming; Feeding; Toileting Defining Characteristics: Inability to feed self independently Inability to dress self independently Inability to bathe and groom self independently Inability to perform toileting tasks independently Inability to transfer from bed to wheelchair Inability to ambulate independently Inability to perform miscellaneous common tasks such as telephoning and writing	NOC: ADL self care Outcomes: Clients are able to eat independently, change clothes, toilet, bathe, take care of themselves, maintain personal hygiene and maintain oral hygiene	NICs: Self-care Assistance Monitor the client's ability to perform ADL independently. Monitor the client's need for tools to perform ADL. Provide personal equipment needed by the client (such as deodorant, toothpaste, and soap). Assist the client in performing ADL until the client is able to do it independently. Encourage the client to perform daily activities according to his level of ability. Encourage the client to be independent, but help the client if the client cannot do it alone. Teach the family to encourage the client's independence, and only help if the client is unable to do it himself. Perform regular self-care.

Reference :

Johnson, Marion, Maas, Meridean, and Moorhead, Sue. 2000. Nursing Outcomes Classification (NOC) second edition. USA: Mosby.

McCloskey, Joanne and Bulecheck, Gloria M. 1996. Nursing Intervention Classification second edition. USA: Mosby.

North American Nursing Diagnosis Association. NANDA nursing diagnoses: definitions and classification 2007-2008. Philadelphia: The association.

Tag : Nursing Care Plan