chapter 48 Moving and postioning clients

Dangling

648 footstool or the floor. This helps the client who has been in u to prepare to sit in a chair and eventually, to walk. Be person to sit in the bed for a few minutes careful: Allow the before assisting him or her out of bed. (It may be neces- Sary to raise the head of the bed.) The client may experience light-headedness or weakness due to a temporary fall in blood pressure (orthostatic or postural hypotension). It is important to understand the client's limitations. He or she may only be strong enough to dangle and then lie down again. In Practice: Nursing Procedure 48-5 discusses the steps for dangling.

Concept Mastery Actions During a Client Fall

Actions During a Client Fall If a client you are assisting to ambulate starts to fall and grabs your neck for support, lower your head to escape the client's grip on your neck. Gently lower the client to the floor, to avoid injury. Your neck will not support the weight of a falling client. Injury to the client and/or to your neck is very likely to occur.

suspine

Back-lying, legs extended or slightly bent. Arms up or down. Small pillow allowed. May be uncomfort- able for client with back problem. uses are general examinations of chst, abdomen, pelvic area

Nursing Alert

Be sure to request assistance to move clients. Use a mechanical lift, "Hover- Matt," or other device, and make sure you know how to safely operate this equipment. 1o ot

Dorsiflexion

Bending a body part toward the dorsum (backward), as in moving the foot so the toes are pulled toward the knee and thus facing backward.

lantar flexion

Bending the foot so that the toes are pointed downward.

sims

COMMENTS USES Side-lying (usually left side), upper Rectal examination; proce- knee flexed sharply, bottom arm dures such as colonoscopy behind body. Small pillow allowed or enema. under head. Pillow may be placed under top leg. Difficult for client with arthritis or leg injuries.

Principles underlying Correct body mechanics invovle

Center of gravity base of support and Line of gravity

knee-chest

Client on knees with chest resting on Rectal or vaginal examination; bed. Arms above head or to the treatment to bring retro- straight up and down; lower legs side; head turned to side. Thighs flexed uterus into normal position. flat on bed. Client may become dizzy; do not leave alone.

lateral semi-prone

Client positioned for extende rest periods. for support. Comfortable for longer Sims' Pillow placed under top leg front of client, not as extreme as Side-lying, bottom arm behind or in time than prone.

orthopenic

Client sitting fully upright; shown Facilitates breathing in cli- here leaning on overbed table, ent with severe cardiac or arms outstretched, head held respiratory disorders. Can up or turned to side on pillows. be used for an extended (Sometimes called "high Fowler" length of time. position.)

What are common positions

Commonly used positions are supine (dorsal recum- bent-lying on the back), prone (on the abdomen), Sims' (semi-prone-on the side [usually the left]-with the upper knee flexed), Fowler's (on the back, with the head elevated), knee-chest or genupectoral (on the knees, with the chest rest- ing on the bed), dorsal lithotomy (on the back, with feet in be modified by bending the knees and placing the feet flat on stirrups), and lateral (on the side). The supine position may the bed. Trendelenburg's (head-down-with the head lower than the feet)-is used to treat shock, by promoting cerebral blood flow, and for some portions of postural drainage, to help drain secretions from particular segments of the lungs. Reverse Trendelenburg position may be used to enhance tube feeding and as an emergency procedure to help stop bleeding in a head injury

Conditioning and Strengthening Exercises

Conditioning and Strengthening Exercises Conditioning and strengthening exercises prepare the cli- ent's body for action. The client pulls up on the trapeze, performs isometric exercises, dangles, sits in a chair, and practices standing next to the side of the bed, As the client performs these actions, he or she is encouraged to practice correct posture: head up, chest out, back straight, and abdo- men in. Encourage the client to press the feet down on a footstool while sitting, to regain the feeling of standing.

Continuous Passive Motion

Continuous Passive Motion A mechanical device, the continuous passive motion (CPM) machine, may provide continuous motion to a specific joint, usually the knee or hip (Fig. 48-8). CPM machines are often used after joint replacement or arthroscopic joint repair. This machine automatically moves the client's leg, promoting joint mobility, and speeding rehabilitation. The nurse must carefully explain the action and purpose of the machine, to avoid client anxiety. Some discomfort may also occur. The electric CPM machine has a padded rack for the extremity and the physical therapist or healthcare provider sets the machine's parameters (limits), including the num- ber of movements per minute (speed) and the degree of joint flexion. The client's leg is secured in the rack, with the knee joint back far enough to allow flexing, without rubbing the skin. Be sure the call light is placed within the client's reach and the client is instructed to call if there is pain. It is often helpful to give a PRN (as needed) pain medication approximately 15 minutes before the inter- mittent CPM treatment begins, to relieve pain and allow greater joint movement during the treatment. In some cases, a client will return from surgery with the CPM machine already in place and moving. Many providers order CPM around the clock; others order the machine on are gradually only at night. The degree of flexion and speed of the CPM increased, per orders, helping build joint that some providers do it does not promote healing and may increase not prescribe CPM, believing strength and mobility. (Be aware inflammation.)

Helping the Mobile Client out of Bed

Helping the Mobile Client out of Bed Clients who are weak from long periods of bedrest or who are unsteady because of illness require assistance from bed. Take care to ensure that the client has a secure sense of bal- ance before helping him or her out of bed. In Practice: Nurs- ing Procedure 48-6 discusses the steps in helping the mobile client out of bed.

Crutch-Walking Gaits

Crutch-Walking Gaits sible crutch-walking The client should use all museles and joints as much as gait or "style of walking" (Fig. 48-14). The client's strength and abilities are guides to the best pos- determine the preferred gait for each client. possible. A healthcare provider and physical therapist will client is partially weight-bearing "point.") The client and on the contralateral walking than the others, and the client can speed up the shifts the weight to them. This gait is faster and more like crutch and leg forward together and (opposite side) crutch. The client puts his or her body weight on one leg ered one "point." The other crutch and on both legs. (A crutch • In two-point gait, the and the opposite leg are consid- leg are the second then brings the other ing the weight on the unaffected leg, while supporting the bearing leg and both crutches forward together, balanc- non-weight-bearing. The person moves the non-weight- weight. (Each is considered a "point.") The other leg is In three-point gait, each crutch and only strength; and when a client is learning to walk again. ing spinal cord injury; when both legs have about the same gait as muscle power improves. This gait is used follow- one leg support the weight-bearing leg. Steps should be of equal length weight on the crutches. He or she then steps forward with and timed so no pauses occur. This gait is best when one leg is disabled and the other is strong enough to bear all of the client's weight. This gait keeps weight off the weak leg. (Sometimes the client may place a small amount of weight on the weak leg, if partial weight-bearing is allowed.) This gait is one means of strengthening the weak leg, without endangering the client. In four-point gait, each crutch and each leg move sepa- rately. (Each of the four "points" supports weight.) The client places one crutch forward, and then advances the contralateral foot; he or she then brings the second crutch forward, and the other foot follows. Rhythmic, short, and equal steps are important. Counting helps develop rhythm: one, right crutch forward; two, advance left foot; three, left crutch forward; four, advance right foot. This gait is easi- est and safest to use (the client always has three points of support). The client must be able to bring each leg forward and clear the floor with each foot. Those who are partially paralyzed, have fractures of both legs, or have arthritis often can safely use this gait. • In swing-through or tripod gait, the client stands on the strong leg, moves both crutches forward the same dis- tance, rests his or her weight on the palms, and swings forward slightly ahead of the crutches. The client then rests the weight again on the good leg and balances for the next step. Because this gait is fast, the client should learn to balance before attempting it. This gait is often used fol- lowing a fracture, when no weight-bearing is allowed on one leg. It also is used following amputation, when the

Flexion

Decreasing the angle between two bones or bending a part on itself, as in bending the leg at the hip.

JOINT MOBILITY AND RANGE himu OF MOTION

Every body joint has a specific, but limited, opening closing motion, its range of motion (ROM). Chapter 47 intr duces this concept (see Figs. 47-18 and 47-19). The limit a joint's range is between the points of resistance at whid the joint will neither open nor close any further. Generall all people have a similar ROM for major joints. Factors su as body development, genetics, presence/absence of dise or deformity, and amount of exercise obtained determ individual differences. The musculoskeletal system and movements are introduced in Chapter 18; Table 48-2 revie

prone

Examination of spine, back. On abdomen, head to side. Arms pillow or folded towel may be may cause neck strain and/ above head or beside body. (Small (Long time in this position placed under shoulder toward or headache.) which head is turned.) Difficult for pregnant woman, obese client, or client with abdominal incision or breathing problem.

Supporting the Client in a Sitting Position in Bed

Fowler Position raised (see Table a variation of the supine position, The most commonly 48-1). In semi-Fowler's or low Fowler' with the head of the bed used position, the Fowler position, is overbed table, or change position, per the provider's order. A client may sit up for a short time to eat meals, work at the degrees. In high High Fowler position is sometimes Fowler's, the head of the bed is the head of the bed is raised about 30 to 45 raised to nearly vertical. referred to as orthopneic

reverse trendelenburg

Head higher than feet. To facilitate tube feedings, Place pillow between client's feet and emergency treatment in footboard of bed. severe bleeding, head injury.

tredelenburg head down postion

Head lower than feet. (May be simu- Treatment of shock, promot- lated using pillows under feet in ing venous return. emergency.) Place pillow between client's head and headboard of bed.

NUASING CARE GUIDELINES 48-2 Client to Walk Assisting the

IN PRACTICE NUASING CARE GUIDELINES 48-2 Client to Walk Assisting the is If the client is fully mobile: • One nurse can assist. • Have the client wear nonslip shoes with wide heels or firm slippers. • Use a transfer belt for safety. • Position yourself to the side and slightly behind the client. If the client is more unsteady: • Two assistants are required (see Fig. 48-10A). Often, one is a family member. • Hold the client's arms and support the lower arms and hands. If the client needs firm support: • Two assistants are required. The assistants grasp each other's arms behind the client's back (see Fig. 48-10B). • The client is asked to put his or her arms around the shoulders of the assistants. Remember, in any case, if the client becomes faint and is going to fall, you can safely ease him or her to the floor, avoiding injury (see Fig. 48-9).

Extension

Increasing the angle between two bones, as in straightening the arm.

Hyperextension

Increasing the angle of an extremity beyond normal, as in bending the head back to look at the ceiling or bending the fingers back.

Key Concept

Key Concept When the client gets up to walk, it is important that he or she wear sturdy shoes or slippers, with nonslippery soles. They should fit well and have low, broad heels. The client should not wear slipper socks unless abso- lutely necessary, and never without gripper soles. (These factors help prevent falls. Slipper socks provide no arch support; extended use may cause serious damage to the feet, arches, and hips. The client may also step on something sharp and be injured.) Good arch support is important. (This helps prevent conditions such as sciatica-pain along the sciatic nerve in the thigh and leg and plantar fascitis, an inflammation of the fascia in the foot.)

Supination

Inversion. Turing the palm upward.

Evaluating Fall Risk

It is everyone's duty in the healthcare facility to prevent client falls; a formal fall-risk evaluation is done on admis- sion and throughout the client's stay. In the acute care facil- ity, this evaluation is done twice a day; in long-term care, at least daily. Those walking or who have clients who have difficulty moving or had a recent fall are particularly vul- nerable. Chapter 39 contains a discussion of fall-risk criteria (see Box 39-1). Although the formal Fall-Risk Assessment is done by RN, the LPN/LVN plays a vital role in observ- ing and reporting observations. All nurses are expected to assist and move clients in such a way as to prevent falling. Clients at risk for falling are often identified by special slippers (yellow), a yellow name band, and a special sign attached to the door of the room (see Fig. 39-1). Guidelines for fall prevention are given to clients on admission. These guidelines include: calling for assistance, realizing that some medications and physical disorders cause dizziness, getting up slowly, and wearing proper footwear when up. Clients are reminded to use their glasses and hearing aids, never to try to climb over siderails, and to use handrails when needed. Family members may be encouraged to stay with high-risk clients and to make sure the client has a nurse call signal. A bed alarm may be needed, to warn staff if the client tries to get up (see Fig. 48-22) (Ridgeview Medical Center, 2013).

Why is it important to explain to the client the reasons for a position change and how it will be done

It is important to explain to the client the reasons for a position change and how it will be done. The knowledge- able client is more likely to maintain the new position. If the client can help, explain how. The client's cooperation will assist the nurse and give the client some exercise, increase independence and self-esteem, and instill feeling of con- trol. Sometimes, turning the client is an important part of treatment and the provider specifically orders Some conditions limit turning the client, such as the presence of traction or an unstabilized fracture. Otherwise, turning is encouraged. In some cases, the client is turned only to wash or rub the back; assess skin condition, wounds, or dressings; or change bed linens. Some clients may not be allowed or are not able to turn and must remain supine. In this case, the client may be instructed to do isometric exercises,

Key Concept

It is important to give meticulous skin care to the person who must remain on the back. If the wash and gently massage the back person can use the trapeze, the nurse can with the hand held flat. This heløsl prevent skin breakdown. In other situations, a special bed is used (see Chapter 49).

Key Concept

Key Concept It is important to use a transfer belt whenever assisting an unsteady, weak, dizzy, faint, or partially paralyzed person to walk. Preventing falls is a primary nursing function.

Describe line of gravity

Line of Gravity Draw an imaginary vertical line through the top of the head. the center of gravity, and the base of support. This becomes the line of gravity, or gravital plane (Fig. 48-2). Gravitational pull runs from the top of the head to the feet. For highest efficiency, this line should be straight from the top of the head to the base of support, with equal weight on each side. Therefore, if a person stands with the back straight and the head erect, the line of gravity will be approximately through the center of the body.

lumbar puncture

Lying on right side, knees and head Lumbar puncture for exami- flexed as sharply as possible; back exposed. Held in position by anesthesia, specific drug nation of spinal fluid, spina healthcare worker. administration

What is the only way to truly prevent nursing staff from being injured

Mechanical lift assistance equipment is the only way to truly prevent nursing staff from being injured correct procedures including mechanical lift help prevent nursing injuries

Abduction

Moving a body part away from the midline of the body.

Adduction

Moving a body part toward the midline of the body.

Rotation

Moving a bone on a longitudinal axis (horizontally), as in shaking the head no, or moving in a circle from the waist.

Circumduction

Moving an extremity in circles; the extremity draws a cone, with the joint as the apex of the cone-as in swinging arms in circles.

Retraction

Moving backward or back into anatomic position.

Protract on

Moving forward or anteriorly, as in jutting out the jaw.

Nursing Alert

Nursing Alert Do not force joint movement when doing PROM exercises. If the client complains of pain, stop and check with your supervisor.

Nursing Alert

Nursing Alert It is important to remember that the wheeled walker is more difficult to use, because it does not stay in one place as easily. The client a must be carefully taught to lean on this walker before shifting his or her weight, to prevent the walker from rolling away, causing a fall.

Nursing Alert

Nursing Alert Leaning on crutches in the axillae can cause a serious disorder (brachial paralysis, crutch palsy). To prevent this condition, the hands-not the axillae-should bear the weight of the client's body.

৯I, O The Client in Danger of Falling

O The Client in Danger of Falling If a client feels faint, try to assist the person to sit. If it is not pos- sible to assist the client into a chair or bed, carefully guide him or her to the floor (Fig. 48-9). If the client is sitting, lower the head as close to the lap as possible. If the client is on the floor, assist him or her to lie down. If help is not readily available, elevate the client's feet (see Nursing Care Guidelines 43-1).

Body Alignment with the Client on the Back (Supine Position)

Often clients prefer to lie on their backs most of the time, the supine or dorsal recumbent position. (They may return from side-lying to the back if they not properly supported on the side.) When a client prefers this position, use pillows to support the head, neck, arms, and hands, and a footboard to under the knees, and a pad is placed under the ankles to pre- is needed to support the head and neck. A knee roll is placed must be flatter than the upper part of the body, only one pillow organs to function, without being restricted. If the client's trunk support feet. This position allows digestive and respiratory ing later deformities rolling a bath blanket or by using commercially prepared rolls. (Fig. 48-7). Trochanter rolls are made by the legs, to keep the legs and feet from rotating outward, caus- back for some time, trochanter rolls are placed on each side of upright in this case. When the immobile client is to lie on the vent pressure on the heels. The footboard will be more nearly

Turning the Client to a Side-Lying Position

Proper body alignment is always important when turning a client. When a person is to remain in the side-lying position,

eversion

Turning the foot so the sole faces away from the other foot. (Both illustrations here show the right foot.)

Pronation

Turning the hand so the palm faces downward or backward.

modified standing

Standing, with chest, head, and arms Prostate examination. on table.

fowlers

Supine, with head raised. Promotes drainage; assists Semi-Fowler's (30-45 degrees)3; with breathing; preparation high Fowler's (nearly vertical); for dangling or walking. often called orthopneic position, if required continuously. Knees elevated slightly Watch for dizziness or faintness.

lithotomy (dorsal lithotomy

Supine, with legs separated, knees Pelvic or perineal acutely flexed, hips at end of exam- examination. ination table, and feet in stirrups.

Turning and Moving Clients

THIOL As a nurse, you will be required to turn and move clients regularly, without endangering either the client or yourself.

The Logroll Turn

The Logroll Turn The logroll turn is a method of turning the client that keeps the body in straight alignment (like a tree log) and may be used for linen changes, change of body position, or to give back care. This helps relieve pressure areas over bony promi nences and generally adds to the client's comfort. The logrl turn is used for clients with spinal cord injuries or who have had back surgery. Because the goal is to turn the client's body as one intact unit, this method helps prevent further injurie to the back or spine. Two or three nurses are required to tun the client in logroll fashion. (Only in an emergency, such as the client is vomiting, can one nurse perform this procedure The logroll turn is used only with specific provider's orden and special in-service education. This turn is introduced in li Practice: Nursing Procedure 48-2.

Positioning for Examinations and Treatments

The client often must assume a special position as part of a treatment or test, an examination, or to obtain specimens. Because nurses assist clients into many and will see other positions used, it is important to know of these positions how to assist the client and to place necessary drapes.

Key Concept

The client's body alignment when lying down should be approximately the same as if the person were standing. If in doubt about moving any client, ask for assistance.

Prone

The person may be positioned on the stomach (prone) for short periods, to provide variety (see Table 48-1). The full because having the head turned to the side can strain the neck prone position, however, is uncomfortable for extended times, and cause headache. The Semi-Prone Position are supported with pillows. (Usually, pillows are not needed more on the stomach than on the side. The upper arm and le be placed behind the client, rather than in front, and the client dure 48-1. The major difference is that the bottom arm may back-lying, roll the person as in In Practice: Nursing Proce- position. To place a client into a semi-prone position from on the stomach and breathing is easier than in the full prone and side-lying positions. It is more comfortable than lying The semi-prone (lateral) position is a variation of the prone behind the person.) The semi-prone position is similar to the Sims position, but not as extreme. (See Table 48-1.)

Inversion

Turning a body part so that it faces medially or inside, such as turning the ankle so that the sole of the foot faces the opposite foot.

Use of the Transfer Belt

Use of the Transfer Belt The nurse can provide support to the weak or unsteady person by using a transfer belt (also called a gait belt). This belt is a sturdy webbed belt with a buckle, easily secured around the client's waist. Explain to the client that the belt provides safety and protection for both client and nurse. In Practice: Nursing Procedure 48-4 discusses use of a transfer belt.

Describe base of support

ai bed Base of Support A person's feet provide the base of support. The feet should be spread sidewise when lifting, to give side-to-side stability. One foot is placed slightly in front of the other, for back-to-front stability. The weight is distributed evenly between both feet, with the knees flexed slightly, to absorb jolts. The feet are moved to turn an object being moved. (Do not twist the body.) iqardƆ i bonuioig

Nursing Alert

alone. Use a transfer belt or mechanical lift, if there is any are not sure whether you can transfer a client Always request assistance if vo question,

Two less commonly used positions

are the modified standing position (standing bending over forward), and the lumbar puncture position. Special positioning is shown in Table 48-1. (Chapter 57 illus- trates positioning for male and female urinary catheterization. Chapter 47 described physical examination in more detail.) The following measures are carried out before draping the client for examination: • A signed release is obtained, if necessary. indicated. Rationale: This helps the person feel more • The client is asked to empty the bladder, unless contra-

Moving and positioning the clients

function, relieve pressure, stimulate respiration and circu- lation, provide diversion, and enhance self-esteem. Clients are also assisted into specific positions for examinations and treatments.

Position the client

goals. Immobility including: pressure wounds, blood clots, constipation, muscle can contribute to a number of disorders, even though they are reluctant, accomprishes several positive Encouraging clients to move in bed, get out of bed, or walk, weakness and atrophy ics and use mechanical devices, when necessary, to lift and or your clients, it is important to practice good body mechan- vent complications (Fig. 48-4). To prevent injuries to yourself regain mobility, you promote self-care practices and help pre- disorders, and depression. By assisting clients to maintain or pneumonia, joint deformities, urinary move clients or objects (Fig. 48-5).

Special beds

hoga and provide back operate to relieve pressure support. Infrequently, the client who cannot turn is placed in a circle bed, which rotates the client from head to toe, or on a Stryker (wedge) turning frame, which rotates the client from side to side. More commonly, the client is placed in a rotat- ing or oscillating bed (e.g., the Roto-Rest), a flotation bed,

Describe the center of gravity

is in the pelvic area when lifting an object been at the knees and hips and keep the backstreet by doing so the center of gravity remains over the feet giving extra stability it is easier to maintain balance

JOINT MOBILITY AND RANGE OF MOTION sd liw

obivur nilds brov basic joint movements. Ligaments, muscles, and tendons connected to bones control joint movement; injuries/disor- ders of these structures often cause limited joint movement tion (shortening) and pain. Every major joint (e.g., neck, shoulder, elbow, conditions such as hypostatic in order to prevent joint deformities. The most serious defor- mity is a contracture, the continuous, permanent contrac- of muscles. (Exercise also helps prevent pneumonia, thrombophlebitis, difficulties, skin breakdown, urinary impactions, and depression.) Attentive and care can help minimize these problems for wrist, finger/thumb, hip, knee, ankle, and toe) must move footdrop, circulatory regularly to prevent stiffness and deformities, For healthy, disorders, fecal active people, this exercise occurs normally in everyday life. frequent nursing assist clients to exercise all joints-several times daily- may be limited or impaired. To avoid abnormalities, nurses For the ill or immobilized person, however, joint movement the immobile client. through ROM exercises responsibility for managing client ROM exercise programs, Nursing and physical/occupational therapy share the

Crutch Adjustment

of sturdy rubber that fits snugly. A large vacuum tip is a neces- sity, because it provides a firm base of support and prevents sliding. Ice grips are also available for slippery conditions. To adjust crutches: • Place the bottom of each crutch about 6 in (15 cm) from the outside of the client's feet. The top of the crutch should be two to three finger widths below the client's axil- lae when his or her elbows are flexed approximately 30 degrees (Fig. 48-13B). Adjust the hand bar so that the client can extend the arm almost completely when leaning on the palms. Even if crutches are the correct total length, the position of the hand bar may need to be adjusted. If crutches are short- ened by more than 1 in, the position of the hand bar will most likely also need to be changed. Crutches that fit properly and are used correctly are com- fortable and do not create pressure under the arms. Rubber pads may be on the tops of the crutches to protect clothing. In many cases, the rubber pads are removed, to discourage clients from leaning on the tops of the crutches. The crutch tip is made

Helping a Client Move Bed to Chair

or mechanics as well. paralyzed, a mechanical lift is required. Use proper bo Helping a Client Move From Bed to Chair Some clients have difficulty moving (transferring) from bed to chair or back again, because of weakness or paralysis (inability to move a part of the body). The nurse can assist the mobile client, but if the client requires lifting, mechani- cal lift should be used, In Practice: Nursing Procedure 48-6 outlines steps for assisting a mobile client to move from bed to chair or wheelchair. If a client is quite unsteady, heavy,

The following measures are carried out before draping the client for examination:

relaxed and helps the examiner to better palpate the area being examined. (In some cases, a full bladder aids in the examination.) • A urine specimen is collected, as ordered. • The client is encouraged to defecate before most examina- tions, particularly a rectal examination. • The client is provided with an examination gown and/or bath towel to cover the chest and perineal area. • bath blanket or sheet is provided for warmth and pri- vacy. In some cases, a small pillow is provided. • The examination procedure is fully explained. • The body is draped appropriately for client privacy and examiner's access. Appropriate lighting is provided. Necessary equipment and supplies are prepared. • The nurse remains during the examination. The examiner and nurse wash or sanitize their hands before and after any examination. • Gloves are worn in many cases. • Other personal protective equipment is worn when needed. • The nurse observes, in order to document the procedure, maintain client safety and confidentiality, provide client reassurance, and answer questions. It is important that the nurse understand the examination, to anticipate untoward events and accurately answer questions. • After the examination, the nurse assists in disposing of equipment and supplies and readying the examination room for the next examination.

Crutches

stability. The platform crutch (Fig. 48-12C) is used in a simi- lar manner. Another type of crutch is called a rocker crutch. This crutch has the two bars extending straight down to the floor, connected by a rounded end or rocker. The rocker end contains a rubber pad, to prevent slipping. This crutch gives more support, because it stays in contact with the floor while the client rocks on the crutch and swings the weight through.

Body Alignment

when lifting walking or performing any activity, proper body alignment is essential to maintain balance

USING MOBILITY DEVICES

stand up alone, a client reminder device or protective device is required for the use of most protective devices (discussed may be needed, to prevent him or her from falling. An order later in this chapter). Check on the client frequently, because he or she may become faint or may have pain. Carefully assist the client back into bed. Be sure to lock the wheels of the wheelchair for each transfer. Sometimes, the celient will be moved in a wheelchair to another area for examinations or tests. In Practice: Nursing Procedure 48-7 describes skills in pushing a wheelchair. (Many of these skills are also used when pushing a wheeled stretcher [a litter or gurney], used for moving pcople who cannot sit or walk.) Canes and Walkers Wheelchairs A wheelchair is often used to move clients who cannot walk or who should be spared fatigue as much as possible (see In Practice: Nursing Procedure 48-6). After the client is in the is to stay alone, secure the call signal within easy reach. If the wheelchair, make sure he or she is comfortable. If the client client is unable to remain seated upright or may attempt to

Helping the Client to Walk

the serious complications of immobility possible after surgery or serious illness. This helps preve Clients are usually encouraged to be up walking as soon (see Fig. 48-4) If the client feels dizzy or light-headed: provides guidelines on assisting the client to walk. ing (Fig. 48-10). In Practice: Nursing Care Guidelines 4 many cases, the person needs some support, to prevent fill • Use a transfer belt the first time the client gets out of be and each time after that, if needed. Remember: the goal to keep the client safe and injury-free. • Help steady the person while he or she sits on the si of the bed. Return to the supine position (lying down)a soon as possible. • If the client is in a chair, have him or her bend over at waist and lower the head. If walking with a client who feels faint, help him or he to lean against a wall and bend over. If this does n help, and you are alone, ease him or her to the floor (se Fig. 48-9).

Passive Range of Motion

therapist moves the client's joints and assists in assuming various positions. (If the client moves himself or herself, this is active range of motion [AROM].) In Practice: Nursing Procedure 48-3 gives information for providing PROM exer- cises. The physical therapist may draw up an exercise plan for a specific client and orient the client. Nurses help carry out this plan, particularly if exercises are repeated several times a day. Occupational therapy also provides exercises, often for smaller muscle groups.

Preventing Deformities

to functionally use the hand. (Without this procedure, the muscles would pull the hand into a tight fist.) When the client is in bed, the knees are supported in a comfortable position. A slanting footboard (at about the same angle as if the person were standing) is comfortable and prevents footdrop Footdrop is a contracture deformity in which the foot remains in a plantarflexed posi- tion (see Fig. 49-3). This deformity prevents the heel from being placed on ground, impeding walking. (The same sort of deformity can occur if very high heels heels are worn con- stantly.) The mattress may slip to the foot of the bed when the head of the bed is raised. Maintaining proper body alignment becomes difficult. To avoid this, place a pillow or rolled blan- ket between the edge of the mattress and the foot of the bed. prepU mechanics situations prevention Preventing Deformities hands supported in an open position, to prevent Any client who does not move the hands must have their contractures (permanently shortened muscles). A hand roll is placed in keep the fingers both the client's hand roll can be keep the thumb out in a hands, to support the wrists, grasping position bent slightly, and hand roll. By using a hand cloth or small towel, or by (Fig. 48-6). The roll, the client will later be able using a commercially prepared made by rolling a wash-

ing Weight-Bearing Restrictions

totally weight-bearing on one or both legs. Crutches are bearing). In other cases, the client cannot put any weight on an injured leg or hip (non-weight- may be partially or weight-bearing if a fracture is not totally immobilized or is their underlying reasons. (Usually, a leg is considered non- sure. It is important for the nurse to explain restrictions and also used to support full-weight-bearing as a safety mea- not healing well.) The primary provider determines how much weight the cli- ent can safely bear on the legs. In some cases, the client

what is body mechanics

use of the safest and most efficient methods of moving and lifting is called body mechanics this means applying mechanical principles of movement to the human body

Preparation for Crutch-Walking

weight to go up and down stairs. Documentation of all client teach- the ing is vital.

The Orthopneic Position

with one or two pillows on top of the table. The client leans forward across the table with the arms on (or beside) the pillows and rests his or her head on the pillows. Pillows can also be placed behind the client's back, for additional sup- port (see Table 48-1). In the alternative orthopneic position, the client sits up straight, with arms supported by pillows. Positions Some clients with The Orthopneic Position cardiac or respiratory conditions need to ease breathing (orthopnea). This breathing and is achieved by placing the overbed orthopneic sit upright continuously, position facilitates table across the bed or in front of a chair

Basic principles of body mechanics

• It is easier to pull, push, or roll an object than it is to lift it. The movement should be smooth and continuous, rather than jerky. • Often less energy or force is required to keep an object moving than it is to start and stop it. • It takes less effort to lift an object if the nurse works as close to it as possible. Use the strong leg and arm muscles as much as possible. Use back muscles, which are not as strong, as little as possible. Avoid reaching. • The nurse rocks backward or forward on the feet and with his or her body as a force for pulling or pushing.

Positioning the Client for Comfort

• Maintain functional client body alignment. (Alignment is similar whether in bed or standing.) • Maintain safety. • Reassure the client, to promote comfort and cooperation. • Properly handle the client's body, to prevent pain or injury. gobloo • Follow proper body mechanics and standard precautions, to protect nurse and client. • Use mechanical lifts or other devices whenever possible. • Obtain assistance if needed. • Follow specific provider's orders. • Remember: a specific order is needed for a client to be out of bed. • Do not use equipment such as splints, traction, or lift- ing equipment without specific in-service education. • Make sure the client is comfortable and has the nurse signal cord available after positioning. NOTE: Special turning and positioning systems are available to help prevent nurse injuries.