Body Mechanics and Patient Mobility (Funds)

Walker

- a four-legged device with hand grips -provides sturdy support for patients who are unable or too unstable to walk with a cane - the patient grips the device, raises it from the floor, moves it away from the body a few inches, sits it securely on the floor, and walks toward it

Center of Gravity

- a persons center of gravity is located in the pelvic area. This means approximately half the body weight is distributed above this area, half below it. Also, half the body weight is to each side. - when lifting an object, bend at the knees and hips, and keep the back straight.

Base of Support

- a persons feet provide the base of support - the wider the base of support, the more stable the object. The feet must not be too far apart, as this would cause instability - the feet are 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. The knees are flexed slightly. The feet are moved to turn the object being moved. - it is important not to twist the body.

Lateral Oblique Position

- a variation of the side lying position.

Mobility

- ability to move around freely - purposes: • exercise • express emotions • Attain basic needs • Perform recreational activities - completing activities of daily living (ADLs)

Assisting Patients With Position Changes

- ask the preferred sleeping position ld and record these on the plan of care - regardless of the patients, see that proper body alignment is maintained - provide assistive devices that will help the patient move independently; example: overhead trapeze - encourage involvement in repositioning which will promote muscle tone and circulation - use comfort devices, such as foot boards, sandbags, and pillows - place padding over heals, elbows, and other bony prominences to prevent skin breakdown - observe the patient for nonverbal signs of discomfort - assist your patient with active or passive range-of-motion exercises which help prevent contractures and stiffness - never force movement to the point of pain

Coordinated Body Movement

- every nursing activity uses the musculoskeletal system, either to stand, walk, sit or squat, carry, left, push, or pull objects. It is very important not to strain ones muscles. Do not use jerky movements. Always be prepared to lift in a safe manner.

Canadian or Lofstrand Crutches

- fit around the forearm by means of a metal cuff - has some rehabilitative advantages in that the patient has to depend more on their own muscles than on the crutches - has no axillary bar, provides less chance of crutch paralysis (axillary muscle damage)

Axillary Crutches

- fit under the upper arm - provide more adequate support - to measure for, place in a standing position, measure the length from the axilla to a point of 6 inches out from the side of the foot (heel).

Balance

- good body alignment is necessary for body balance. Poor body alignment responds to gravity and becomes unbalanced and the person is apt to fall. This is corrected by widening the base of support by spreading the feet wider apart and lower the center of gravity by flexing the hips and knees to a squatting position.

Immobility

- inability to move around freely - complications of immobility: • muscle atrophy and asthenia (muscle weakness) • contractures • osteoporosis • pressure ulcer • constipation • pneumonia, pulmonary embolism • atrophy

Principles of Body Mechanics

- involve 3 major factors 1) center of gravity 2) base of support 3) line of gravity

Lithotomy

- lying supine with hips and knees flexed and thighs abducted and rotates externally

Knee-Chest (genupectoral)

- patient kneels so that weight of body is supported by knees and chest, with abdomen raised, head turned to one side and arms flexed

Active Exercise

- performed by a person without assistance and is the preferred method of exercise

Foot drop

- permanent dysfunctional position caused by shortening of the calf muscles and lengthening of the opposing muscles on the anterior leg

Orthopneic

- position assumed by the patient sitting up in bed at 90-degree angle, resting forward supported by a pillow on the overbed table

Trendelenburg

- position in which head is low and the body and legs are in a inclineplane * if someone goes into shock, raise lower part of bed

Dorsal Recumbent

- supine position with patient lying on back, head and shoulder with extremities moderately flexed, legs may be extended

Activity and Exercise

- the actions of walking, lifting, carrying, and turning are essential components in the provision of nursing care - to reduce the risk of injury to the patient or nurse, the nurse must know and practice proper body mechanics - nurses must also promote activity and exercise because of the beneficial impact on wellness, prevention of illness, and restoration of optimal functioning

Body Mechanics

- the area of physiology for the study of muscle action and how muscles function in maintaining the posture of the body and prevention of injury during activity - includes the knowledge of how certain muscle groups are used - the musculoskeletal system must be protected to prevent injury to the patient and the nurse

Line of Gravity

- the line of gravity is an imaginary vertical line through the top of the head, the center of gravity, and the base of support

Prone Position

- the patient is lying on the abdomen

Supine position

- the patient is lying on their back

Sims position

- the patient lies on the left side with the right knee drawn up toward the chest - the left arm is positioned along the patients back and the chest and abdomen are allowed to lean forward

Passive Exercise

- the person needs some or all assistance

Ergonomics

- the science of matching workplace conditions and job demands to the capabilities of workers

Positioning the patient

- there are many reasons to change the patients position • these include promoting comfort, restoring body function, preventing deformities, relieving pressure, preventing muscle strain, stimulating proper respiration and circulation and giving nursing treatments - by assisting patients to maintain of regain mobility, you promote self-care practices and help to prevent deformities - it is important to explain to the patient why his or her position is being changed and how it will be done - the patients understanding is important because he or she will be more likely to maintain the new position • the patients assistance will save strain on the nurse, and will give the person some exercise, increase independence, self-esteem, and a feeling that he or she is helping, and instill a feeling of control

Body Alignment

- this is when the body is well aligned, and undue strain is not placed on the joints, muscles, tendons, or ligaments to maintain balance

Wheelchair and Stretchers

- use to move patients who cannot walk or who should be spared fatigue as much as possible - stretcher is used when a patient cannot sit or walk - after assisting to a wheelchair or stretcher, ensure their comfort - always remember to lock the wheels of the wheelchair or stretcher for transfer

Body Mechanics Involves 3 Basic Elements

1) body alignment 2) balance 3) coordinated body movement

Benefits of activity and exercise

1) improved cardiopulmonary function 2) improves muscle strength and stamina 3) maintains joint mobility 4) improves or maintains flexibility 5) exercise promotes the deposit and retention of calcium. Without calcium, bones become soft and brittle. 6) promotes bowel elimination 7) sleep aid 8) exercise increases the respiratory rate and depth of respirations 9) increases muscle tone, strength and size of muscles

Examples of ergonomic recommendations:

1) use assistive devices to lift or transport heavy items or patients 2) use alternative equipment for tasks that require repetitive motions such as headsets or automatic staplers 3) position equipment no more than 20-30 degrees away- about an arm length to avoid reaching or twisting the trunk or neck 4) use a chair with good back support. It should be high enough so the users feet can be placed firmly on the floor. There should be two fingers between the edge of the seat and the back of the knees. Arm rests should allow a relaxed shoulder position 5) keep elbows flexed no more than 100-110 degrees, or use wrist rests to keep the wrists in neutral position when working at a computer 6) work under non-glare lighting

What degree for low-fowlers?

15-30 degrees

What degree for mid-fowlers?

30-45 degrees

What is the standard degree for the fowlers position?

45-60 degrees

What degree for high-fowlers?

60-90 degrees

Canes

A slender, hand-held, curved stick or device meant to provide support while walking. - three basic types of canes: • standard straight-legged • tripod (which has 3 feet) • the quad (which has 4 feet) - supports balance and helps the patient walk - held on the patients strong side and is adjusted to appropriate height

Hyper extension

Angle between joints is made larger; over 180

Prone position improves ____ _____ in critically ill patients with adult respiratory syndrome.

Arterial oxygenation

Trapeze

Assistive Device

Circumduction

Circular movement

Proximal

Closest to the center

Siderails

Considered a restraint

Flexion

Decreasing angle between joints

Turning Sheet

Draw sheet

Pronation

Facing down

Supination

Facing up

Distal

Farthest from the center

Mattress

Firm but flexible

Transfer Handle

Fits between mattress and bed frame. Basically like a side rail. Assistive

Mattress Overlays

Foam; Gel. Pad put over normal mattress

Pillows

For support; relieve pressure points

Transfer Belt

Gait Belt

Bed Board

Placed under mattress for additional support

Hand Rolls

Prevent contractions; keeps hand functional

Trochanter Rolls

Prevents legs from externally rotating

Cradle

Prevents pain on lower extremities

What are two common problems associated with the supine position?

Prolonged pressure and foot drop.

What does lying in the prone position provide?

Provides good drainage from bronchioles, stretches the trunk and extremities and keeps the hips in an extended position

Fowler's Position

Semi-sitting position - there are 3 different variations

Extension

Straighten; increase angle

Crutches

Supports used to assist clients requiring aid in walking because of injury or disease in the lower extremities

Abduction

Take away from center of the body

When laying in lateral oblique position at what degree should the hip Flexion and the knee Flexion be?

The patient lies on the side with the top leg placed in 30 degrees of hip Flexion and 35 degrees knee Flexion.

Transfer Board

Thin board, transferring from bed to stretcher (sliding board)

Air-Fluidized Bed

This bed contains beads within the mattress that are blown upward with warm air. Excretions and secretions drain away from the body and throughout the beads. This prevents skin irritation from moisture. Examples are CLINITRON and FluidAir

Low-Air-Loss-Bed

This bed contains inflated air sacs inside the mattress - capillary pressure is maintained well below that which can interfere with blood flow - air is redistributed to maintain low pressure of all skin areas. - examples of low air loss beds are KinAir, Flexicair and Mediscus

Oscillating Support Bed (Rocking Bed)

This type of bed continuously rocks the patient from side to side. This relieves skin pressure and helps with respiratory secretions. Sliding is prevented by the use of foam supports. Examples are Roto Rest, Tilt and Turn, Paragon 9000.

Circular Bed

This type of bed supports the patient on a 6-7 foot anterior or posterior platform suspended across the diameter of the frame. This allows the patient to remain passively immobilized during a change in position. Patients who are dependent feel a sense of control with type of bed because they learn to make adjustments in their position

Plantar Flexion

Toes down

Dorsal flexion

Toes to nose

Adduction

Toward the center of the body

Rotate

Turning

Inversion

Turning in; just the foot

Eversion

Turning out; foot

Internal rotation

Turns in; whole leg extremities

External rotation

Turns out

Abduction Pillow

Used to keep legs abducted (total hip surgery) - prevents from crossing legs

Mechanical Lift

Used to save your back; easier on patient