CLIENT TEACHING Controlling Postural...

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CLIENT TEACHING Controlling Postural Hypotension Rest with the head of the bed elevated 8 to 12 inches. This posi- tion makes the position change on rising less severe. Avoid sudden changes in position. Arise from bed in three stages: a. Sit up in bed for 1 minute. b. Sit on the side of the bed with legs dangling for 1 minute. c. Stand with care, holding onto the edge of the bed or another nonmovable object for 1 minute. Never bend down all the way to the floor or stand up too quickly after stooping. Postpone activities such as shaving and hair grooming for at least 1 hour after rising. Wear elastic stockings at night to inhibit venous pooling in the legs. Be aware that the symptoms of hypotension are most severe at the following times: a. 30 to 60 minutes after a heavy meal b. 1 to 2 hours after taking an antihypertension medication Get out of a hot bath very slowly, because high temperatures can lead to venous pooling. Use a rocking chair to improve circulation in the lower extremities. Even mild leg conditioning can strengthen muscle tone and en- hance circulation. Refrain from any strenuous activity that results in holding the breath and bearing down. This Valsalva maneuver slows the heart rate, leading to subsequent lowering of blood pressure.

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1148 UNIT X / Promoting Physiologic Health

RESEARCH NOTE What Effect Does Mind-Body Exercise Have on Cognition and Quality of Life?

Researchers wanted to explore if there might be benefits ofmind–body exercise techniques such as yoga because such modali-ties involve an active attentional or mindfulness component. A total of135 healthy men and women 65 to 85 years of age were randomlyassigned to 6 months of one of the following: hatha yoga class(once/week with independent home practice), walking exercise class(once/week with independent home practice), or a wait-list controlgroup. The researchers collected before and after assessments of cog-nitive measures, mood states, fatigue, health-related quality of life, andphysical measures. Results indicated no effects from either of the ac-tive interventions on cognitive function (possibly due to the high base-line level of cognitive functioning in this group of participants). Theyoga intervention produced significant improvements in physicalmeasures (strength and flexibility) as well as quality of life measures

related to well-being, energy, and fatigue as compared to walking ex-ercise and wait-list controls.

IMPLICATIONSThis study, and others like it, highlights benefits of mind–body types ofexercise for improving physical functioning and mood in older adults.While the participants in this study did not show improvement in cogni-tive function, a strong body of evidence supports the use of exercise forimproving cognitive function (Freeman, 2004). Nurses can recommendyoga as a tool for maintaining and improving health in older adults.

Note: From Alternative Therapies in Health and Medicine, by B. Oken, D. Zajdel,S. Kishiyama. Copyright 2006 by Innovision Communications. Reproduced withpermission of Innovision Communications in the format Textbook via CopyrightClearance Center.

had surgery, is elderly, or has been immobilized for a longer timewill feel more pronounced weakness. The potential problems ofimmobility are far less likely to occur when clients become ambu-latory as soon as possible. The nurse can assist clients to preparefor ambulation by helping them become as independent as possi-ble while in bed. Nurses should encourage clients to performADLs, maintain good body alignment, and carry out active ROMexercises to the maximum degree possible yet within the limita-tions imposed by their illness and recovery program.

PREAMBULATORY EXERCISES. Clients who have been in bed forlong periods often need a plan of muscle tone exercises tostrengthen the muscles used for walking before attempting to walk.One of the most important muscle groups is the quadricepsfemoris, which extends the knee and flexes the thigh. This group isalso important for elevating the legs, for example, for walking up-stairs. These exercises are frequently called quadriceps drills orsets. To strengthen these muscles, the client consciously tensesthem, drawing the kneecap upward and inward. The client pushesthe popliteal space of the knee against the bed surface, relaxing theheels on the bed surface (Figure 44-56 ■). On the count of 1, themuscles are tensed; they are held during the counts of 2, 3, 4; andthey are relaxed at the count of 5. The exercise should be donewithin the client’s tolerance, that is, without fatiguing the muscles.Carried out several times an hour during waking hours, this simpleexercise significantly strengthens the muscles used for walking.

ASSISTING CLIENTS TO AMBULATE. Clients who have beenimmobilized for even a few days may require assistance withambulation. The amount of assistance will depend on theclient’s condition, including age, health status, and length ofinactivity. Assistance may mean walking alongside the clientwhile providing physical support (see Skill 44-7) or providinginstruction to the client about the use of assistive devices suchas a cane, walker, or crutches.

Some clients experience postural (orthostatic) hypotensionon assuming a vertical position from a lying position and mayneed information about ways to control this problem (see ClientTeaching). The client may exhibit some or all of the followingsymptoms: pallor, diaphoresis, nausea, tachycardia, and dizzi-ness. If any of these are present, the client should be assisted toa supine position in bed and closely assessed.

Figure 44-56 ■ Tensing the quadriceps femoris muscles beforeambulation.

CLIENT TEACHING Controlling Postural Hypotension

■ Rest with the head of the bed elevated 8 to 12 inches. This posi-tion makes the position change on rising less severe.

■ Avoid sudden changes in position. Arise from bed in three stages:a. Sit up in bed for 1 minute.b. Sit on the side of the bed with legs dangling for 1 minute.c. Stand with care, holding onto the edge of the bed or another

nonmovable object for 1 minute.■ Never bend down all the way to the floor or stand up too quickly

after stooping.■ Postpone activities such as shaving and hair grooming for at least

1 hour after rising.■ Wear elastic stockings at night to inhibit venous pooling in the legs.

■ Be aware that the symptoms of hypotension are most severe atthe following times:a. 30 to 60 minutes after a heavy mealb. 1 to 2 hours after taking an antihypertension medication

■ Get out of a hot bath very slowly, because high temperatures canlead to venous pooling.

■ Use a rocking chair to improve circulation in the lower extremities.Even mild leg conditioning can strengthen muscle tone and en-hance circulation.

■ Refrain from any strenuous activity that results in holding thebreath and bearing down. This Valsalva maneuver slows the heartrate, leading to subsequent lowering of blood pressure.

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