Prof. Dr. Nursalam,M.Nurs (Hons) Disampaikan oleh: Candra Panji Asmoro Activity and Exercise Prof. Dr. Nursalam,M.Nurs (Hons) Disampaikan oleh: Candra Panji Asmoro

An activity –exercise pattern refers to a person's routine of exercise, activity, leisure, and recreation. It includes: Activities of daily living (ADL) that require energy expenditure such as hygiene, cooking , shopping, eating , working. Type, quality, and quantity of exercises, including sports.

Ligaments; jaringan berserat keras yang mengikat sendi yg menghubungkan tulang & tulang rawan (cartilage)

Tendon; kuat, fleksibel, jaringan elastik berserat yg menghubungkan otot ke tulang.

Cartilage; jaringan ikat nonvaskular yg ditemukan di persendian juga seperti di hidung, telinga, dada, trakea & laring

Physiology of Movement The following physiology of movement is:  Skeletal system; tulang dan tulang rawan yang melindungi organ kita dan yg memungkinkan kita untuk bisa bergerak. The function of this system include: Menjaga postur tubuh Melindungi struktur halus dan lunak dari tubuh misal otak, jantung, & sumsum tulang belakang Media penghubung dari otot tendon dan ligamen Media penyimpanan garam2 mineral yg dibutuhkan tubuh dan lemak. Menghasilkan sel darah  

Muscular system; mendukung fungsi bagi tubuh melalui contraction Motion Maintenance of posture Heat production The 3 types of muscles are 1) Skeletal 2) Cardiac 3) Smooth or visceral muscles. Muscles have two different points of attachments: The attachment of a muscle to the more stationary bone is called the Point of Origin. The attachment to the more movable bone is the Point of Insertion  

Nervous System; the nerve impulses stimulate muscles to contract. Body Mechanics; is the efficient use of the body as a machine and as a mean of locomotion, correct body mechanics lead to health promotion and illness prevention so the responsibility of the nurse to apply the body mechanics and to teach others .  

Types of Joint Movement Flexion: decreases the angle of the joint" bending the elbow" Extension: Increasing the angle of the joint " straightening the arm at the elbow" Hyperextension: further extension or straightening of a joint " bending the head backward" Abduction: movement of the bone away from the midline of the body Adduction: movement of the bone toward the midline of the body Rotation: movement of the bone around its central axis

Circumduction: movement of the distal part of the bone in a circle while the proximal end remains fixed. Eversion: Turning the sole of the foot outward by moving the ankle joint Inversion: Turning the sole of the foot inward by moving the ankle joint. Pronation: moving the bones of the forearm so that the palm of the hand faces downward when held in front of the body. Supination: moving the bones of the forearm so that the palm of the hand faces upward when held in front of the body.

Exercise Is a type of physical activity defined as a planned, structured, and repetitive bodily movement performed to improve or maintain one or more components of physical fitness.

Types of exercise: Exercise can be classified according to the type of muscle contraction to:- Isotonic exercise; di mana otot lebih memendek untuk menghasilkan kontraksi otot dan gerakan aktif. contoh; berlari, berenang, berjalan. Peningkatan massa otot, irama dan kekuatan, meningkatkan fungsi jantung dan pernapasan dan peredaran darah.

Isometric exercise; terdapat kontraksi otot tanpa adanya pergerakan sendi. Misalnya, menekan sebuah bantal diantara kedua kaki. Latihan seperti ini sgt berguna utk penguatan otot abdomen, paha, & otot gluteal sehingga perawat bisa menerapkan kedua jenis exercise ini pada pasien di RS.

Isokinetic exercises; latihan yg menekankan adanya kontraksi otot dgn pergerakan, termasuk juga seperti contoh gambar yakni latihan rehabilitasi untuk cedera lutut & kaki.

OR exercise can be classified according to the source of energy to:- Aerobic exercise adalah latihan dimana jumlah oksigen yang diambil dalam tubuh lebih besar dari yang digunakan untuk melakukan aktivitas. Contoh berjalan, berlari.  

Anaerobic exercise kegiatan latihan dimana individu menahan napas utk bisa melakukan sebuah latihan, bertujuan utk dpt memberikan tambahan energi yg singkat melalui pembakaran anaerob. Contoh seperti pada gambar di bawah.

Faktor yg mempengaruhi “body alignment and activity” Growth and development; terlebih berdasar pd usia orang, mk perawat harus akrab dgn perbedaan perkembangan neuromuskular klien dlm rangka memfasilitasi koping. Physical health; karena masalah pd sistem muskuloskeletal & saraf bisa memiliki pengaruh negatif pada body alignment dan gerakan. Mental health; pergerakan cenderung melamban dlm keadaan depresi berat. Lifestyle variables; seperti misalnya latihan, makanan, merokok, pekerjaan, budaya. Attitude and values; misal seperti renang, fitness, & byk pertimbangan lain dari individu yg sekiranya mempengaruhi pemilihan seseorang utk memilih jenis aktiviitas/latihannya.

Fatigue and stress; stres kronis dapat menguras energi sehingga tubuh merasa kelelahan External factors; lingkungan yg mempunyai efek/pengaruh, kelembaban, dukungan teman, kurang waktu istirahat, lingkungan yg tidak aman. Nutrition; antara nutrisi yg kurang ataupun yg lebih dapat mempengaruhi body alignment and mobility.  

Effects of exercise on major body system Musculoskeletal system Increased muscle efficiency' strength and flexibility Increased coordination, stability, gait and posture Increased efficiency of nerve impulses transmission Improve range of motion Maintained bone density and strength

Cardiovascular system; Meet the demands for oxygen Increase blood flow Increase efficiency of the heart Decreased blood pressure Increased blood flow to all body parts Improved heart rate, improved circulation, and self – reported stress reduction Decreased cholesterol level

Respiratory system; work together with the cardiovascular system Increase oxygen available to the muscle Increase depth, rate of gas exchange, rate of CO2 excretion Improved pulmonary functioning Decreasing breathing effort and risk of infection.

GI system; exercises lead to Increased intestinal tone, facilitating peristalsis Improve digestion and elimination Improve the appetite

Metabolic system; exercise elevates the metabolic rate, thus increasing the production of body heat and waste products and calorie use. Increased efficiency of metabolic system Increased efficiency of body temperature regulation Reduce level of serum triglycerides and cholesterol.

Urinary system; regular exercise increase blood circulation including improved blood flow to the kidneys which allows the kidneys to maintain the body's fluid balance and acid-base balance more efficiently and to excrete body waste.  

Skin; regular exercise increase circulation which lead to promote good health Psychosocial outlook; regular exercise have psychological effects such as increase energy, improve sleep, body image, improve self-concepts and increase positive health behaviors, improve general well being.  

Effects of immobility on major body system Musculoskeletal system Disuse osteoporosis; demineralization process, known as osteoporosis, tulang menjadi seperti spons dan kemungkinan lama-kelamaan dpt rusak dan fraktur dgn mudah.

Disuse atrophy; atrophy in muscles losing most of their strength and normal function. Contractures; when the muscle fibers are not able to shorten and lengthen (permanent shortening of the muscle) forms limiting joint mobility. Proses ini pd akhirnya bs melibatkan tendon, ligamen, dan kapsul sendi.

Cardiovascular system Orthostatic hypotension; is a common result of immobilization. The blood pools in the lower extremities, and central blood pressure drops. Cerebral perfusion is seriously compromised, and the person feels dizzy or light headed and may even faint.

Venous vasodilation and stasis; otot rangka tidak berkontraksi adekuat, otot menjadi atropi, sehingga vena tidak bisa mengalirkan darah kembali ke jantung melawan gravitasi. Retensi darah di vaskuler kaki menyebabkan vasodilatasi dan pembengkakan.

Dependent edema; bila tekanan vena cukup besar, beberapa volume darah keluar dari vaskuler menuju ruang interstitial yg mengelilingi vaskuler shg menyebabkan edema. Thrombus formation

3. Respiratory system Decreased respiratory movement; in immobile client, ventilation of the lungs is passively altered. Rongga dada tertekan oleh alas tidur dan membatasi ekspansi dada. Organ dalam perut menekan diafragma, shg membatasi gerak paru-paru dan mempersempit lapang paru utk bernapas.

Pooling of respiratory secretions; sekresi dari saluran napas dpt diatasi dgn perubahan posisi tubuh dan batuk efektif. Imobilisasi memungkinkan sekret menumpuk oleh karena gravitasi, mengganggu difusi normal dari O2 dan CO2 dlm alveoli.

Atelectasis; kolaps dari lobus atau dr seluruh paru, bila ventilasi menurun, retensi sekret mgkn akan terakumulasi. Pada lansia yg imobilisasi mempunyai risiko tinggi terjadi atelektasis.

Pneumonia; sekret yang terakumulasi bisa mjd media yg baik utk pertumbuhan bakteri. Dengan kondisi tsb, infeksi pernapasan atas dpt berkembang dgn cepat mjd infeksi yg parah pd saluran pernapassan bagian bawah.

Metabolic system Decreased metabolic rate; pd klien yg immobile, laju metabolisme basal dan motilitas GI tract dan sekresi berbagai kelenjar pencernaan menurun sesuai kebutuhan energi dari tubuh yg menurun. Anorexia; loss of appetite occurs because of the decreased metabolic rate and the increased catabolism yg menyertai immobilitas.

5. Urinary system Urinary stasis; in a mobile person, gravitasi memainkan peran penting dalam pengosongan ginjal dan kandung kemih. When the person remains in a bed, gravitasi menghambat pengosongan urine dari ginjal dan kandung kemih, sehingga pengosongan mjd terganggu dan stasis urin setelah beberapa hari istirahat.

Urinary retention, which is accumulation of urine in the bladder, bladder distention, and memungkinkan inkontinensia urin (involuntary urination). The decreased muscle tone of the urinary bladder inhibits its ability to empty completely. Urinary infection, static urine memberikan excellent medium for bacterial growth

6.Gastrointestinal system Constipation is a frequent problem for immobilized people because of decreased peristalsis and colon motility.

7. Integumentary system Reduced skin turgor. Skin turgor is an abnormality in the skin's ability to change shape and return to normal (elasticity). The skin can atrophy as a result of prolonged immobility. Skin breakdown. Normal blood circulation depend on muscle activity. Immobility menghambat circulation and mengurangi the supply of nutrients to specific areas. As a result skin breakdown and formation of pressure ulcers can occur.

8. Psychoneurologic system Lower the person’s self –esteem Increased risk of depression Decreased social interaction

NURSING MANAGEMENT Assessing Nursing History Physical examination Body Alignment Appearance and movement of joints Capabilities and limitation for movement Muscle mass and strength Activity tolerance Problems related to immobility

Nursing Diagnosis Nursing diagnoses related to mobility focus primarily on activity and mobility levels, and the psychosocial impact that perubahan in mobility dpt trjd pd a client and the client’s family. Common NANDA nursing diagnoses related to the physical adaptations or risks resulting from altered mobility include:

• Activity Intolerance related to bed rest and immobility, generalized weakness, lifestyle, and imbalance between oxygen supply and demand. • Impaired Physical Mobility related to intolerance to activity or decreased strength and endurance, pain, perceptual or cognitive impairment, neuromuscular impairment, musculoskeletal impairment, and depression or severe anxiety.

• Self-Care Deficits related to inability to wash body or body parts, inability to obtain or get to water source, activity intolerance, decreased strength and endurance, pain, and impaired transfer ability • Ineffective Health Maintenance related to lack of or significant alteration in communication skills (written, nonverbal)

• Risk for Falls related to impaired mobility • Risk for Falls related to impaired mobility. Alterations in family and social processes may also result from immobility and inactivity. Gangguan aktivitas dan mobilitas menyebabkan penurunan kemampuan untuk melakukan hbungan sosial, pendidikan, dan peran keluarga.

There are often changes in the client’s perception of role There are often changes in the client’s perception of role. Disturbed Body Image and Situational Low Self-Esteem can result from: 1. Changes in physical abilities 2. Changes in family responsibilities 3. Lack of knowledge regarding rehabilitation  Fear (of falling) Ineffective coping Low self esteem Powerlessness  

Planning Implementing Nursing strategies to maintain or promote body alignment and mobility involve positioning clients appropriately, moving and turning clients in bed, transferring clients, providing ROM exercises, ambulating clients with or without mechanical aids.  

Techniques to prevent back stress: Membiasakan postur tubuh tegak dan sesuai body allignment Menggunakan jaringan otot yg terpanjang dan terkuat dari lengan dan kaki utk membantu memberikan kekuatan yg diperlukan utk kegiatan berat. Gunakan korset & sabuk pengaman utk menstabilkan panggul & melindungi organ dalam perut ketika stopping, reaching, lifting or pulling

Use the weight of the body as a kekuatan utk menarik atau mendorong dgn gerakan tubuh condong ke arah depan atau ke belakang Bekerja semaksimal mgkn utk sesuatu yg akan diangkat atau dipindahkan. Flex the knees, put on the internal girdle and come down to an object that is to be lifted. Merenggangkan kaki utk memberikan area dukungan yg luas utk meningkatkan stabilitas tubuh.