18, 20, 39

Implementation Positioning Basically, changing position accomplishes four things: (1) it provides comfort; (2) it relieves pressure on bony prominences and other parts;

(3) it helps prevent contractures, deformities, and respiratory problems; and (4) it improves circulation. It is essential to know how to correctly support and position the patient while maintaining good body mechanics.

Correct body alignment is generally called "good posture" The second reason for proper body movement is to prevent injuries

. One of the most common injuries for health care workers is lower back strain. With proper use of body mechanics, many injuries can be avoided.

A roller board consists of several roller bars between fixed end bars. The bars are enclosed in a vinyl covering that allows the bars to turn when something or someone is pulled over the top of the roller board. It works similar to a conveyor belt.

A slide board works similarly to a roller board except that it does not roll. It has a slippery surface that allows the patient on a lift sheet to be slid across it to a stretcher or to a wheelchair.

When using a lift sheet, you and preferably two assistants stand on opposite sides of a locked, flat bed at waist level. Leave a pillow under the patient's head and lower the side rails. Place pillows, if needed, between the patient's legs.

All nurses face the bed with one foot slightly in front of the other. Roll the lift sheet close to the patient's body and, on the count of 3, lift the patient to one side of the bed, keeping the body in straight alignment

Beds: A hospital mattress is usually firm and has a covering that can be cleansed easily between patients. An overlay (air or gel filled) may be used with a mattress to reduce the risk of pressure ulcers,

Always check to be certain the bed wheels are locked, unless you are moving the bed.

Patients often lie on their back when in bed. It is important to change this position frequently to prevent the problems associated with immobility. Support the head with one pillow so the neck is not hyperflexed.

Assess the patient's ability to ambulate walk and to change position independently. A physician's order is needed for a patient to be out of bed. Observe the patient walking. Is the head centered over the vertebral column? Is the gait style of walking even and unlabored?

Positioning Devices Devices used for positioning include pillows, boots or splints, footboards, cushioned boots or high-top sneakers, a trapeze bar , A), sandbags, hand rolls, trochanter rolls

B), side rails, and bed boards. Use pillows to support the body or extremities and elevate body parts. Boots or splints help to maintain dorsiflexion of the feet and may help to prevent heel pressure. Footboards and high-top sneakers are other devices used to maintain foot dorsiflexion.

wheelchair, and strengthen upper extremities. Side rails assist the patient in changing position and turning in bed.

Bed boards are boards that are placed under the home mattress to give more support to the mattress and thereby improve vertebral alignment.

should be available for each biohazard substance stored or used on the nursing unit. These sheets are consulted for recommended methods of storage, labeling, handling spills, and disposal. Everyone must comply with these guidelines

Bioterrosim and other terrorism agents: . Bioterrorism is the release of pathogenic microorganisms into a community to achieve political and/or military goals. Chemical terrorism is the use of certain compounds to cause destruction to achieve political and/or military goals.

Overview of Structure and Function of the Musculoskeletal System: •

Bone is a dense and hard type of connective tissue. There are four basic types of bones—short, long, flat, and irregular—and they are made up of compact and spongy bone.

Ligaments connect bones or cartilage to provide support and strength.

Cartilage is a fibrous connective tissue that acts as a cushion.

• Fluid collection in the lungs

Contractures, muscle cramps, and respiratory problems as complications of immobility

Remove slippers. Have patient lean against the elevated head of the bed, and assist in swinging legs up into bed, maintaining good body mechanics.

Cover the patient, raise side rail if necessary, and place call bell within reach. (Maintains privacy, and institutes safety measures.

Keep elbows and work close to your body. Work at the same level or height as the object to be moved. Remember that pulling actions require less effort than pushing or lifting.

Directly face the object or person to be moved. Keep trunk straight; do not twist when lifting or pulling. Use arms as levers when pulling the patient toward you. Lock the elbows and rock back on your heels, using the weight of your body to move the patient.

brings the patient closer to each nurse's center of gravity.

Directly face the object or person to be moved. It is much easier to move an object if you are facing in that direction

it is associated with decreased circulation of the lower extremities; check the orders. Fowler position may help the patient who had a stroke and has paresis to swallow food and secretions.

Dorsal recumbent and dorsal lithotomy positions are other variations of the supine position. In the dorsal recumbent position, patients are on their back with knees flexed and soles of the feet flat on the bed The dorsal lithotomy position is used for examining the pelvic organs

biologic agents used as weapons: Anthrax Fever, malaise, fatigue, dry cough, chest discomfort progressing to severe respiratory distress and shock. Death typically 24-36 hr after onset of severe symptoms.

Ebola virus (Filovirus) Abrupt onset of fever, headache, muscle pain, swollen lymph nodes, sore throat, nausea, vomiting, diarrhea, maculopapular rash on the trunk, petechiae, and progressive bleeding.

Rearrange the pillow under the patient's head and place any other positioning devices before lowering the bed and putting the call bell within the patient's reach. Logrolling without a lift sheet is accomplished in a similar manner.

Evenly space three nurses along one side of a locked, flat bed at waist level. One nurse supports and rolls the head, neck, and shoulder region; one supports and rolls the waist and hips; and the third supports and rolls the thighs and lower legs.

chapter 20: The environment is the total of all elements and conditions that surround us and influence our development.

Factors Affecting the Environment The same environmental factors Florence Nightingale wrote about more than a century and a half ago are still important today. Temperature, ventilation, humidity, lighting, odor, and noise all are factors that must be controlled.

If a physical therapist is not available, you must assist your patient in performing these exercises. The family or significant other can also be shown how to assist the patient with exercise.

Full range-of-motion (ROM) exercises should be performed either actively or passively several times a day. Active ROM exercises are used for the patient who independently performs activities of daily living but for some reason is immobilized or limited in activity or is unable to move

for orthostatic hypotension, dizziness, or nausea before getting the patient out of bed.

If a patient has been on prolonged bed rest, she may be strong enough to dangle for only a few minutes and then will need to lie down again.

Watch the patient's face as you perform passive ROM exercises so that you will know if you are causing pain.

If the patient is expressing pain, you are moving the joint too far.

keep loads near your center of gravity: Work at the same level or height as the object to be moved. This keeps the workload near your center of gravity. Changing bed linens is a good example of this principle.

In most institutions the bed's height is adjustable. When changing linen or moving a patient, temporarily raise the bed to waist level to keep the work near your center of gravity. Injuries are more likely to occur the farther away the work is from the center of gravity.

Obtain help whenever possible: Combining the efforts of two nurses to change a patient's position divides the work. Each nurse has less weight or fewer parts of the body to move. Sometimes it is difficult to find another person to assist you.

It is always better to wait for help than to risk injury to yourself or the patient. Encourage the patient to assist when transferring and moving if possible. Use devices such as mechanical lifts and transfer or roller boards where available.

Sims position is a variation of the side-lying position.

It is used for rectal examinations, administering enemas, and inserting suppositories or for an unconscious patient.

Muscle fiber elasticity is decreased or lost, causing decreased flexibility.

Joint motion may decrease, limiting mobility, activity, and exercise

Keep loads close to the body:

Keep your elbows and work close to your body. This keeps the workload close to your waist and center of gravity. Pick up your textbook and hold it close to your body.

Provide stability for movement:

Keep your feet about shoulders' width apart. This establishes a wide base of support and provides stability for movement.

The side-lying or lateral position is achieved by having patients rest on their side. It alleviates pressure from bony prominences on the back. The major portion of the patients' weight is on the dependent shoulder and hip.

Maintain the vertebral column in proper alignment as if they were standing. The oblique side-lying position removes pressure from the dependent shoulder and hip and is easier for patients to maintain.

Maintain the patient's privacy through draping while changing positions.

Many positions can leave a patient feeling vulnerable, and draping demonstrates respect for the patient and supports privacy.

Devices that may be used in lifting and transferring patients include mechanical lifts, lift or pull sheets, roller boards, slide boards, and transfer or gait belts. Lift sheets are often used to move and transfer a patient. Low friction sheets may be used

Mechanical lifts are discussed in Chapter 39. Lift sheets are often used to move and transfer a patient. Low friction sheets may be used

Ventilation is the process or act of supplying a building or room continuously with fresh air.

Most hospital windows cannot be opened for safety reasons and are not a source of ventilation. Fans are discouraged because air currents spread microorganisms

Humidity is the amount of moisture in the air. A range from 30% to 50% is normally comfortable. Very low humidity dries skin and respiratory passages.

Most hospitals maintain a low humidity setting to discourage the growth of microorganisms. Vaporizers or humidifiers may be ordered for a patient with a respiratory condition who requires more humidity

A sunny, cheerful room can improve a patient's spirits. Areas must have adequate lighting for tasks and to prevent accidents and injury. Ideally, your patient will be able to control the lights independently.

Odor Control Illness changes sensory perceptions. Odors that ordinarily are pleasant may make the patient feel nauseated. Health care facilities may have unpleasant odors from bedpans, urinals, wounds, and other sources

Temperature Infants and older adults may need their rooms warmer than other patients because of their poor temperature regulation. Keep room temperature between 68° and 74° F 20° and 23° C.

Operating rooms and critical care areas are kept slightly cooler to reduce the patient's metabolic demands.

In most facilities a patient at risk for falls is given a color-coded wrist or leg band to alert the staff of this increased risk.

Personal alarms sense a change in position or pressure and sound an alarm to alert caregivers that patients are attempting to get out of bed or a chair

Positioning the Patient . Raise level of bed to a comfortable working height, and raise far side rail. Promotes safety and reduces back strain.

Place hand rolls or towels in patient's hands if needed to maintain correct slightly flexed position. Promotes thumb adduction and finger flexion.

NUrsing actions to promote patient safety: Toilet the patient on a regular schedule to decrease the chance the patient will try to get out of bed unassisted

Place the high-risk or restless patient in a room close to the nurses' station so you can check on the patient often. Be certain wheelchair brakes are locked before transferring a patient into or out of it.

When transferring a patient into or out of a wheelchair, check feet and arms for positions where they will not hit the parts of the chair or the bed.

Position the footrests where they won't interfere with the feet during transfer. Many skin injuries occur when transferring patients into or out of wheelchairs.

Patients and residents of long-term care facilities who smoke should be given information on how to quit smoking. Smoking damages the lungs, blood vessels, and other vital organs and decreases the oxygen-carrying capacity of the blood.

Positive reinforcement for efforts to quit smoking is very important. Clear, consistent advice; individual or group therapy; nicotine replacement therapy; and frequent telephone contact have been shown to increase a smoking cessation program's effectiveness .

Either lift equipment or two nurses should transfer a patient to a wheelchair if the patient is unsteady, weak, or heavy check agency policy

Remember to lock the wheels on the wheelchair and the bed or stretcher before attempting to transfer a patient into a wheelchair or stretcher or onto the bed. Otherwise, the wheelchair or stretcher could roll away from you, and you and the patient could be injured.

Interior design:

Rooms are tastefully decorated. The goal is to provide a homelike environment for the patient.

Shearing is an applied force that causes a downward and forward pressure on the tissues beneath the skin.

Shearing forces occur when a patient slides down in a chair, bedclothes are pulled from beneath the patient, or the patient is slid up to the head of the bed without lifting the body.

Side-Lying Position • Neck: Avoid lateral flexion. Pressure points: Check for pressure on the ankles, knees, trochanter, ileum, and ear.

Sims Position • Hip and shoulder: Support properly to prevent internal rotation and adduction. • Pressure points: Check for pressure on the clavicle, humerus, ileum, knees, and ankles.

What are the functions of muscles for positioning and moving patients?

Skeletal muscle contraction is accomplished through the stimulation of its many muscle fibers. Contraction of skeletal muscles provides movement, stabilizes joints, produces body heat, and maintains posture.

A joint is the place of union of two or more bones in the body. Joints can be freely movable, slightly movable, or immovable. Bursae are small fluid-filled sacs that provide a cushion at friction points in freely movable joints

Skeletal muscles are striated muscles that are made of bundles of muscle fibers surrounded by a connective tissue sheath. Tendons are cords of fibrous connective tissue that connect a muscle to a bone to allow for joint movement.

noise control: The main cause of noise is people. To reduce noise, avoid long conversations on the intercom by going to the patient's room to talk. Encourage staff to limit conversations in the hallway and to speak in lowered voices.

Soft, pleasant background music may be played to mask other sounds and promote relaxation.

The prone position is when the patient is lying face down. It provides an alternative for patients who are on prolonged bed rest or are immobilized.

Spinal cord-injured patients often use this position. The position is generally not well tolerated because it is boring.

neatness: It is important to provide a neat, tidy atmosphere for your patient. Keep the unit in enough order to be safe, but not so rigid that the patient may not have possessions from home.

Straighten the patient unit after making the bed. Remove old dishes and unused equipment promptly.

Hazads: falls: The three most common factors that predispose a person to falls are impaired physical mobility, altered mental status, and sensory and/or motor deficits.

The Joint Commission 2012 National Patient Safety Goals require that every patient be assessed and periodically reassessed for risk for falling, correlating the patient's medications with increased risk for falls.

What are the functions of bones for positioning and moving patients? • Bones provide the scaffolding or framework to the body The skeleton gives the body shape and supports the internal organs and skin.

The bones provide places for the ligaments and tendons to attach, thereby allowing movement. The primary function of a joint is to provide movement and flexibility to the skeleton.

Before transferring a patient to a wheelchair, have her dangle her legs over the side of the bed first . Dangling is the term used for the patient position of sitting on the side of the bed with the legs and feet over the side.

The feet are either on the floor or supported on a footstool. Dangling is often the first step before sitting in a chair or ambulating. The purpose of this is to gradually accustom the body to the position change. While the patient is dangling, assess the patient's balance, and monitor

If the patient is not able to move independently, change the patient's position at least every 2 hours to avoid complications. Your assessment will indicate whether you can move the patient independently or you will need assistance.

The home setting must also be considered when planning care for the patient.

What changes in the system occur with aging? Bone strength and mass are lost because of mineral resorption. This may lead to osteoporosis, which is more common in women.

The loss of bone density predisposes the elderly patient to fractures. The fractures do not heal as quickly because of the decreased mineral uptake. Muscle cells are lost and replaced by fat. This leads to a loss of muscle strength and endurance. .

The knee-chest position is a variation of the prone position. The patient is face down on the bed with the head turned to one side. The chest, elbows, and knees rest on the bed, and the thighs are perpendicular to the bed

The lower legs rest flat on the bed. This is used for rectal examinations and as a method to restore the uterus to a normal position. Do not leave the patient alone in the knee-chest position

worn in a patient care setting. • Remove old, disintegrating flowers and stagnant water promptly. • Consult with your patient before using a room deodorizer or spray.

These items can help control lingering odors, but your patient may be allergic or sensitive to the deodorizer itself. You might offend the patient if you spray a deodorizer throughout the room without asking permission first.

Fowler position is an elevation of 30 to 60 degrees, and low Fowler is an elevation of 15 to 30 degrees. Unless contraindicated, the knees can be raised 10 to 15 degrees in these positions.

These positions improve cardiac output and respiration and promote urinary and bowel elimination. Do not place a patient who had abdominal surgery in a Fowler position unless ordered. Elevation of the knees above 15 degrees is contraindicated in elderly and postoperative patients because

A transfer belt or gait belt may be used to ambulate or transfer the weak or unsteady patient. It is made of a tightly webbed canvas material and is very sturdy. Place and buckle the belt around the patient's waist before having the patient stand.

Tighten it just enough to allow space for your hand to grasp it from the rear. Insert your hand into the belt from the bottom so that, if the patient falls, you will be able to support the weight.

Fire: You must know and be familiar with your institution's fire regulations. There are three basic types of fire extinguishers: A, B, and C. Type A is a water-under-pressure extinguisher that is used for paper, wood, or cloth fires.

Type B contains carbon dioxide and is used for gasoline, oil, paint, fat, and flammable liquid fires. Type C is used for electrical fires and contains carbon dioxide. The most commonly seen extinguisher is an ABC combination extinguisher that can be used on any kind of fire.

Use smooth, coordinated movements:

Use smooth, coordinated movements instead of jerking or sudden pulling motions. To coordinate effort, tell the patient and other staff members to move, lift, or pull "on the count of 3

Use your leg muscles: In positioning and transferring, use the muscles in your legs as much as possible. Instead of bending over at the waist to pick up something from the floor, bend at the knees and lower yourself until you can pick up the item without straining your back.

Use the greatest number of muscles possible when lifting or moving an object. For instance, when turning a patient in bed, flex your knees and use the muscles in your legs as well as your arms.

Guidelines for Moving and Lifting: Body Mechanics Obtain help whenever possible. Ask the patient to help if able. Bend or flex knees. Use the greatest number of muscles possible.

Use thigh, arm, or leg muscles rather than back muscles. Use a wide base of support. Keep feet about shoulders' width apart. Use smooth coordinated movement; avoid jerking or sudden pulling motions.

Common Positions and Their Variations While in bed, the patient can assume three basic positions: supine, side-lying, and prone. The supine position is when patients are resting on their back.

Variations of the supine position are Fowler, semi-Fowler, and low Fowler positions. Fowler position is arranged by elevating the head of the bed 60 to 90 degrees. Semi-

smoking:

Warn your patient not to smoke in bed. Smoking is never allowed when oxygen is in use because a spark could cause a fire. Any equipment that might cause a spark is also prohibited near oxygen

Initial symptoms of ARS are nausea, vomiting, and diarrhea. Loss of appetite, fatigue, fever, skin damage, hair loss, and potentially seizures, coma, and death are possible later effects.

You must be familiar with your institution's policies and procedures for handling victims of a terrorist attack.

When repositioning an elderly person, you must move slowly and carefully to avoid hurting the patient. Arthritis may cause the joints to be stiff and harder to move.

after positioning a patient, check the following the areas to prevent possible problems

Determine whether the patient's head is erect and centered over the shoulders. Are the buttocks in the same plane as the shoulders, and are the thighs in line with the shoulders? The patient's weight should be distributed evenly over the buttocks

and thighs. The knees should be flexed at about 90 degrees with the feet resting comfortably on the floor. Provide a footstool if the feet do not reach the floor.

bed positions: The bed is usually kept in the "low position" i.e., close to the floor

bed making: An occupied bed is made only if the patient absolutely cannot be out of bed. For example, a patient whose activity order is bed rest with bathroom privileges would have the bed made while she is using the bathroom. Bed linens should be neat, orderly, and free of

Logrolling is turning the patient as a single unit while maintaining straight body alignment at all times. Logrolling is often used for patients with injuries or surgery to the spine and for those who must avoid twisting. The linens for an occupied bed are often

changed by using the logrolling turn. Logrolling can be done either with or without a lift sheet. If a lift sheet is used, two or three people are needed to accomplish the move, depending on the patient's size It takes at least three people to logroll a patient without a lift sheet

Dispose of them in the dirty or soiled utility room. Do not throw anything that could become odorous in the patient's unit trash can. • Avoid being the source of odors yourself. Odors that linger include

cigarette smoke; strong foods, such as onions, garlic, or curry, and perspiration or body odors. Eliminate these by bathing, using unscented deodorant, wearing clean clothes, and performing oral hygiene after food or coffee breaks. Perfumes, scented lotions, or scented cosmetics should not be

The elderly have a greater risk for skin breakdown than younger patients because they have

decreased muscle mass and less moisture in their skin, and their capillaries are more fragile. Handle elderly patients carefully.

During the assessment, also observe for any muscle weakness or paralysis, and check symmetry

equality in size, form, and arrangement of parts on the opposite sides of a plane; a mirror image of extremities.

Privacy Privacy is essential for a patient's well-being. Always knock gently and identify yourself before entering the room. In multiple-patient rooms, close the curtain around the patient

for personal tasks such as using a bedpan and bathing. Post a sign on the door informing others of such tasks to discourage them from entering the room

Trochanter rolls prevent external rotation of the hips and legs when a patient is lying in a supine position. Sandbags immobilize an extremity, provide support, and maintain correct body alignment. Hand rolls and splints for the hands and wrists

help to prevent contractures of the hands, promote thumb adduction, keep the fingers slightly flexed, and prevent dorsiflexion of the wrist. A trapeze bar allows a patient to adjust position by raising the trunk and buttocks off the bed. The patient may use it to move up in bed, transfer from bed to

Elderly patients often have some arthritic joints. Ask the patient about this before beginning the exercises; medicate for pain as needed.

instruct the caregiver with the home patient on how to do the exercises, and leave a written schedule form for tracking performance.

A biohazard is defined as a biologic agent, chemical, or condition (such as unsecure laboratory procedures) that can be harmful to a person's health. The Occupational Safety and Health Administration (OSHA) classifies materials in the work environment according to the degree

of hazard to health that they impose. OSHA publishes specific guidelines for labeling, handling, cleaning spills, and disposing of these materials. Mercury is an example of a biohazard, as are blood and most body fluids. A material safety data sheet (MSDS)

The elderly may need to be reeducated on how and what they may safely lift. As the body ages, there is a change in body posture and center of gravity and usually a decrease in muscle mass. Items that could be lifted safely during youth

often cannot be lifted safely in the later years. Consider whether the elderly person has a spinal deformity or osteoporosis when determining how much weight is safe to lift.

When assessing the standing patient's body alignment, begin by noting the head position in relation to the rest of the body. Is the head centered and erect? Are the shoulders and hips parallel? Are the knees and ankles slightly flexed and

parallel to the hips and shoulders? Do the arms hang comfortably at the patient's side? Are the feet slightly apart to provide a base of support?

burns: Burn prevention includes protecting the patient from accidental thermal injury and the threat of fire. Thermal injuries may be caused by either hot or cold materials. A person who has diabetes, impaired circulation, or

paralysis or who is taking medications that alter mental awareness is more easily burned than a healthy person.

keep your trunk straight when lifting or pulling. Avoid twisting. Instead, if turning is needed,

pivot turn or change direction with your feet while remaining in a fixed place. Pivoting prevents twisting, which can lead to back strain and injury.

Pressure ulcers, also known as decubitus ulcers or bedsores, occur from pressure on the skin. This pressure causes a local area of tissue necrosis local death of tissue from disease or injury. Most often the area of pressure occurs between a bony

prominence and an external surface. Besides pressure, the other main factor in the development of pressure ulcers is a shearing force.

Principles of Body Movement for Nurses Kinesiology also called body mechanics is the study of the movement of body parts. There are two main reasons why the use of good body movement is important for you and your patient. The first

reason is that the body functions best when it is in correct anatomic position or alignment arrangement in a straight line, bringing a line into order.

Pull and Pivot Pulling actions require less effort than pushing or lifting. Whenever possible, use pulling motions. When transferring a patient to a stretcher, two nurses should stand on the far

side of the stretcher to pull the patient toward them onto the stretcher. This movement is easier than pushing because it

Supine Position • Feet: Maintain the feet in dorsiflexion; you may need to use a positioning device to decrease the chance of footdrop. • Lower back: If the patient complains of lower back pain, place a

small pillow or rolled towel under the patient's lumbar spine. • Pressure points: Check for pressure on the occiput, lumbar vertebrae, elbows, and heels

one extremity due to injury or surgery. Passive ROM exercises are performed on the patient who cannot actively move. This patient cannot contract muscles,

so muscle strengthening cannot be accomplished. All muscles over a joint are maximally stretched to achieve or maintain flexibility of the joint.

When transferring a patient: Place the chair so that it is closest to the patient's strongest side

transferring the patient to a wheel chair: Check to ensure the brakes are locked on the wheelchair. Have patient grasp both arms of the chair and push up and out of the chair to a standing position Help the patient pivot 90 degrees so her back is next to the bed

There are several types of chemical threats, including pulmonary agents, cyanide agents, nerve agents, vesicants, and incapacitating agents. Radiation is a form of energy that can come from man-made sources as

well as the sun and outer space. Some elements that release radiation, such as uranium, exist naturally in the soil.

Terrorists may use radioactive substances attached to an explosive device a "dirty bomb" to disperse radiation. The body can be protected from radiation in three basic ways: time decrease the amount of time near a source), distance increase

your distance from a source, and shielding use a barrier or shield between you and the source). Acute radiation sickness ARS develops when most or all of the body is exposed to a high dose of radiation, usually over a short time.

e RACE acronym • Rescue any patients in immediate danger by removing them from the area.

• Activate the fire alarm system. • Contain the fire by closing doors and any open windows. • Extinguish the flames with an appropriate extinguisher.

Odor Control • Reduce offensive odors by emptying and rinsing the bedpan, bedside commode, urinal, and emesis basin promptly. Change soiled linens as soon as possible.

• Dispose of used dressings, catheters, urine bags, tubing, intravenous bags, and other disposable equipment by placing in a closed plastic bag according to Standard Precautions guidelines and facility procedure.

positioning the patient: Wear gloves when moving or positioning a patient if you will be touching blood, body fluid, secretions, excretions, broken skin, mucous membranes, or contaminated items.

• For a patient who has edema or is dehydrated, turn and reposition more frequently than every 2 hours to avoid skin breakdown.

Expected outcomes are written for each nursing diagnosis. Examples related to the above nursing diagnoses are as follows: • Patient will experience no musculoskeletal injury.

• Former level of mobility will be reattained within 6 months. • Skin integrity will remain intact. Patient will not experience an injury while ambulating.

• Perform each movement a minimum of three to five times.

• Involve patients in planning their exercise program, and encourage active performance of the exercises if allowed and capability returns..

Hazards of improper alignment and positioning: • Interference with circulation, which may lead to pressure ulcers (ulcers that form from local interference with circulation)

• Muscle cramps and possible contractures resistance to stretch in damaged muscle that pulls a joint into a fixed or "frozen" position

Principles Guiding Range-of-Motion (ROM) Exercise • Move the body part to stretch the muscles and keep the joint flexible, but avoid movement to the point of discomfort.

• Perform ROM exercises of the joints of helpless or immobile patients at least twice a day, or more often if tolerated. • Support the limb above and below the joint when performing passive exercises of arms and legs.

Prone Position • Feet: Position in dorsiflexion. Sustained extension with plantar flexion is undesirable.

• Pressure points: Check for pressure on the ear, chin, hips, and knees.

Fowler and Semi-Fowler Positions • Circulation: Check to see that the lower extremities have palpable pulses, verifying that the popliteal artery is not occluded.

• Pressure points: Check for pressure on the scapula, sacrum, elbows, and heels.

Nursing Diagnosis Nursing diagnoses commonly used for problems with body movement are as follows:

• Risk for injury • Impaired physical mobility • Risk for impaired skin integrity • Impaired walking

Principes of body movement for patients: There are two basic principles for patients:

•Maintain correct anatomic position. •Change position frequently