Chapter 23: Body Mechanics, Positioning, & Moving

What is a metal frame that attaches to bed and forms a shell over the client's lower legs to keep bed linen off the feet and/or legs.. and is also often used for clients with burns, injuries, painful joint disease, and fractures of the leg?

Bed Cradle

What is the term for a permanent dysfunctional position caused by a shortening of the calf muscles and a lengthening of the opposing muscles on the anterior leg?

Foot drop

The following characteristics describe which good posture position? *Head & neck muscles centered between shoulders *Arms, hips, & knees are slightly flexed *Trunk is straight & hips are level *Legs are parallel *Feet at right angles to legs

Lying Down

What is an example of Pressure Reducing Devices?

Mattress overlays

What device assists in moving heavy clients or clients with very limited ability to actively participate in repositioning/transferring?

Mechanical Lift

When is caregiver assistance not needed for positioning a patient?

When the patient is fully able to position himself/herself

What is a Roller sheet/Slider sheet used for?

*Extremely helpful for care of patient *For lifting patient, sheet should be held close to sides of patient

What do proper body mechanics help do?

*Increase muscle effectiveness *Reduce fatigue *Avoids repetitive strain injuries

Why is Foot drop debilitating?

It hinders ambulation by preventing the ability to place the heal on the floor

What is a bed board?

A rigid structure placed under a mattress (plywood) used for providing additional skeletal support

What defines a good mattress vs a bad mattress?

*A comfortable, supportive mattress is firm but flexible to permit good body alignment *An unsupportive mattress promotes an unnatural curvature of the spine

What is a purpose of an adjustable bed?

*A high position facilitates performance of nursing care *Raised HOB promotes drainage of the lungs' upper lobes *A low position enables patient to get in & out of bed safely

What are 5 types of Positioning Devices?

*Adjustable bed *Mattress *Bed board *Pillows *Roller sheet/Slider sheet

What are the 2 pros for Lateral Position?

*Comfort *Foot drop is of less concern

What are the 3 pros for Lateral Oblique Position?

*Comfort *Produces less pressure on the hip than a strictly lateral position *Reduces potential for skin breakdown.

What are the 3 pros for supine position?

*Comfort for patient *Visualization of surgical sites *Easier to provide care

What are the 2 cons for Sims' Position?

*Difficult to communicate *Does not allow eating

What are the 3 pros for Fowler's Position?

*Easier for client to eat, talk, and look around. *Good for lung expansion *3 variations

What are the 3 variations for Fowler's Position?

*Low Fowler's - HOB up to 30 degrees *Mid-Fowler's - HOB 30-45 degrees *High-Fowler's - HOB 45 - 90 degrees

What is the con to a Lateral Oblique Position?

*Only if left in this position for too long

What are cons of Supine position?

*Prolonged pressure on coccyx & heels causing deep tissue injury (DTI) *Foot drop

What are the 3 pros for Prone Position?

*Reduces pressure on posterior sites *Recruits healthy lung tissue in critically ill patients with ARDS (acute respiratory distress syndrome) *Stretches trunk, extremities and hip muscles

What are examples of 2 Protective Devices on a bed?

*Side rails *Bed Cradle

What are the 2 pros for Trendelenburg Position?

*Slight Trendelenburg position may help keep the client from sliding down toward the foot of the bed *Reverse Trendelenburg has bed tilted with HOB up and no or decreased angle at hip. Used for certain procedures and treatments.

What are characteristic of Trendelenburg Position?

*The head is lower than the feet

What is the con for Fowler's Position?

*Too long in this position promotes pressure ulcers in coccyx area

What are the 3 cons for Prone Position?

*Uncomfortable for MOST patients and especially if they have anterior surgery sites *Communication is difficult *Unable to eat

What is the con for Lateral Position?

*Unless upper shoulder and arm are supported, they may rotate forward and interfere with breathing

What are some examples of ergonomics recommendations that may be helpful in a nursing environment?

*Using assistive devices to lift or transport heavy items or patients. *Positioning equipment no more than 20 to 30 degrees away, about an arm's length, to avoid reaching ot twisting trunk or neck *Working under nonglare lighting

What are the 2 pros for Sims' Position?

*Utilized for examination of and procedures involving the rectum and vagina *Modified right and left Sims' position comfortable if condition permits

How often must an inactive client be repositioned?

At least every 2 hours

What is the efficient use of the musculoskeletal system?

Body Mechanics

What should the nurse ask first before positioning a patient?

Can the patient assist?

Which mattress overlay provides minimal pressure reduction and are recommended for comfort only?

Egg-crate foam mattresses

What is a specialty field of engineering science devoted to promoting comfort, performance, & health in the workplace?

Ergonomics

T/F: Body mechanics alone will necessarily reduce musculoskeletal injuries.

FALSE Body mechanics ALONE will NOT necessarily reduce musculoskeletal injuries.

T/F: When a patient is partially able to assist with positioning, only 1 caregiver is needed

FALSE Rationale: *If patient is <200 lbs, 2-3 caregivers are needed *If patient is >200 lbs, at least 3 caregivers are needed

T/F: There is no need to engage patient to explain plan PRIOR to transferring, moving, lifting.

FALSE Rationale: Caregiver must always engage patient & explain what procedures or actions are to be performed. This increases understanding, allays fears, and promotes cooperation.

What does poor posture often result in?

Muscle spasms

How do Trochanter rolls help the patient?

Prevent legs from turning outward

What aids clients in moving about in (repositioning) and in getting out of bed (OOB)?

Side rails

The following characteristics describe which good posture position? *The butt & upper thighs become the base of support *Both feet rest on the floor *The knees are bent without knee posterior touching anything (this avoids interfering with distal circulation)

Sitting

The following characteristics describe which good posture position? *Keep feet parallel at right angles to the lower legs *Distribute base equally on both feet *Bend knees slightly to avoid straining joints *Maintain hips at an even level *Pull in butt & hold abdomen up and in to keep spine properly aligned *Hold chest up slightly forward and extend or stretch waist *Keep shoulders even & centered above the hips

Standing

T/F: An assistive device is needed if any caregiver is required to lift more than 35 pounds of any one part of a client's weight

TRUE

T/F: The nurse should always allow patient to assist as much as physically and safely capable when being turned or moved.

TRUE

How do Foot boards, boots, and foot splints help patients?

They all aid to protect and keep feet in functional position

How are Transfer Aids/ Devices useful?

They are helpful for decreasing the potential for injury to caregivers and clients.

How are pillows used as positioning devices?

Used to support and elevate a body part.

What are the consequences of inactivity collectively referred to?

disuse syndrome

What is disuse syndrome?

signs and symptoms that result from inactivity

What is Ergonomics used for?

to improve the design of the work environment & equipment for preserving the integrity of the body

How does a Trapeze help the patient?

•Assists clients with good upper strength and weak lower trunk/extremity strength. •Promotes activity and strength building exercise

What are 4 types of Mattress Overlays?

•Foam and gel mattresses •Static air mattress •Alternating air mattress •Water mattress

What are 10 examples of signs & symptoms of Disuse Syndrome?

•Loss of muscle mass •Poor posture •Contractures •Thrombus •Atelectasis (collapsed alveoli) •Urinary Tract Infections •Calculi (stone) formation •Constipation/Fecal impaction -Sleep pattern disturbances -Pressure sores

How do Hand rolls help the patient?

•Prevent contractures •Must be moved regularly to facilitate movement and exercise (passive vs. active)

What are the 6 common positions?

•Supine Position •Lateral Position •Lateral Oblique Position •Prone Position •Sims' Position •Fowler's Position

What are 3 examples of transferring Devices/Aids?

•Transfer handle •Transfer belt •Transfer boards

What are 5 examples of assistive positioning devices?

•Trochanter rolls •Hand rolls •Prevents contractures •Foot boards, boots, and foot splints •Trapeze

What are the steps tp position a client?

•Unfasten drainage tubes from the bed linen •Turn the client as a complete unit to avoid twisting the spine •Place the client in good alignment with joints slightly flexed •Replace pillows and positioning devices •Support the limbs in a functional position •Use elevation to relieve swelling or promote comfort •Provide skin care after repositioning