Chapter 23dsc sm,ancm,nsacndm,sdncm,n,mcsacds

8/13/2019 Chapter 23dsc sm,ancm,nsacndm,sdncm,n,mcsacds

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Nursing

Chapter 23

Body Mechanics,

Positioning and Moving

Inst.: Dr. Ashraf El - Jedi


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Inactivity leads to deterioration of health. Multiple

complications can occur among people with limitedactivity and movement.

The consequences of inactivity are collectively

referred to as disuse syndrome(signs and symptomsthat result from inactivity). Nursing care activitiessuch as positioning and moving clients reduce the

potential for disuse syndrome. Nurses can become

injured, however, if they fail to use good posture andbody mechanics while performing these activities(Table 23-1).


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This chapter describes how to position andmove clients to prevent complications

associated with inactivity. It also discusses

methods for protecting nurses from work-

related injuries. Basic terms are defined in

Table 23-2.


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Maintaining Good Posture

Posture (position of the body, or the way in

which it is held) affects a person's appearance,

stamina, and ability to use the musculoskeletal

system efficiently. Good posture, whether in a

standing, sitting, or lying position, distributes

gravity through the center of the body over a

wide base of support and is important for bothclients and nurses (Fig. 23-1).


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Figure 23-1

Good posture helps to align

gravity through the center of thebody. A wide stance provides a

stable base for support


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When a person performs work while using

poor posture, muscle spasms (sudden,

forceful, involuntary muscle contractions)

often result. They occur more often when

muscles are strained and forced to work

beyond their capacity.


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Standing

To maintain good posture in a standing position

Keep the feet parallel

Distribute weight equally on both feet

Bend the knees slightly

Maintain the hips at an even level.

Pull in the buttocks and hold the abdomen up

Hold the chest up and slightly forward Keep the shoulders even and centered above the hips.

Hold the head erect with the face forward


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Figure 23-2

A)Good standing posture( .

B)Poor standing posture(.


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Sitting

In a good sitting position (Fig. 23-3), the

buttocks and upper thighs become the base of

support. Both feet rest on the floor.


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Figure 23-3

A)Correct sitting posture

B)Incorrect sitting

posture.

(Courtesy of Lowren West,New York, NY).


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Lying Down

Good posture in a lying position looks the

same as in a standing position, except the

person is horizontal (Fig. 23-4).


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Figure 23-4

A) Correct lying posture.

B) Incorrect lying posture.

(Courtesy of Lowren West, New York, NY)


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Body Mechanics

The use of proper body mechanics (efficient

use of the musculoskeletal system) increases

muscle effectiveness, reduces fatigue, and

helps to avoid repetitive strain injuries.


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Positioning Clients

Good posture and body mechanics and assistive

devices are necessary when inactive clients require

positioning and moving. An inactive client's position

is changed to relieve pressure on bony areas of thebody, promote functional mobility (alignment that

maintains the potential for movement and

ambulation), and provide for therapeutic needs.

General principles for positioning are as follows:


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Change the inactive client's position at least every 2 hours.

Enlist the assistance of at least one other caregiver.

Raise the bed to the height of the caregiver's elbow.

Remove pillows and positioning devices.

Unfasten drainage tubes from the bed linen.

Turn the client as a complete unit to avoid twisting thespine.

Place the client in good alignment with joints slightlyflexed.

Replace pillows and positioning devices.

Support limbs in a functional position

Use elevation to relieve swelling or promote comfort.

Provide skin care after repositioning.


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Common Positions

Nurses commonly use six body positions when

caring for bedridden clients: supine, lateral,

lateral oblique, prone, Sims', and Fowler's.


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Supine Position

In the supine position, the person lies on the back

(Fig. 23-6A). There are two primary concerns

associated with the supine position: prolonged

pressure, especially at the end of the spine, leads toskin breakdown; and gravity, combined with pressure

on the toes from bed linen, creates a potential for foot

drop (permanent dysfunctional position caused by

shortening of the calf muscles and lengthening of theopposing muscles on the anterior leg; Fig. 23-7).


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Figure 23-6:A)Supine position


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Lateral Position

With the lateral position (side-lying position;

see Fig. 23-6B), foot drop is of less concern

because gravity does not pull down the feet as

happens when clients are supine. Nevertheless,unless the upper shoulder and arm are

supported, they may rotate forward and

interfere with breathing.


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B: )Lateral position


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Prone Position

The prone position (one in which the client lies onthe abdomen; see Fig. 23-6D) is an alternative

position for the person with skin breakdown frompressure ulcers. The prone position also provides

good drainage from bronchioles, stretches the trunkand extremities, and keeps the hips in an extended

position. The prone position improves arterialoxygenation in critically ill clients with adult

respiratory distress syndrome and others who aremechanically ventilated . The prone position poses anursing challenge for assessing and communicatingwith clients, however, and it is uncomfortable for

clients with recent abdominal surgery or back pain.


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:D)Prone position.


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Sims' Position

In Sims' position (semi-prone position), the

client lies on the left side with the right knee

drawn up toward the chest (see Fig. 23-6E).

The left arm is positioned along the client'sback, and the chest and abdomen are allowed

to lean forward. Sims' position also is used for

examination of and procedures involving therectum and vagina.


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E)Sims' position


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Fowler's Position

Fowler's position (semi-sitting position) makes it easier for the client to

eat, talk, and look around. Three variations are common (see Fig. 23-6F).In a , the P.522

In a low Fowler's position, head is elevated to 30 degrees. A mid-Fowler's

or semi-Fowler'sposition refers to an elevation of up to 45 degrees. A highFowler's positionis an elevation of 60 to 90 degrees. The knees may not beelevated, but doing so relieves strain on the lower spine.

Fowler's position is especially helpful for clients with dyspnea because itcauses the abdominal organs to drop away from the diaphragm. Relieving

pressure on the diaphragm allows the exchange of a greater volume of air.Sitting for a prolonged period, however, decreases blood flow to tissues inthe coccyx area and increases the risk for pressure ulcers in that area.


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(F)Fowler's position.


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Positioning Devices


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Adjustable Bed

The adjustable bed can be raised or lowered

and allows the position of the head and knees

to be changed.


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Mattress

A comfortable, supportive mattress is firm but

flexible enough to permit good body

alignment.


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Bed Board

A bed board (rigid structure placed under a

mattress) provides additional skeletal support


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Pillows

Pillows are used to support and elevate a body

part.


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Trochanter Rolls

Trochanter rolls (Fig. 23-10) prevent the legs

from turning outward.


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Hand Rolls

Hand rolls (Fig. 23-11) are devices that preserve the

client's functional ability to grasp and pick up objects.

Hand rolls prevent contractures (permanently

shortened muscles that resist stretching) of thefingers.


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Foot Boards, Boots, and Foot Splints

Foot boards, boots, and splints are devices that

prevent foot drop by keeping the feet in a

functional position (Fig. 23-12).


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Trapeze

A trapeze is a triangular piece of metal hung by a

chain over the head of the bed (Fig. 23-13).


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Protective Devices


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Side Rails

Side rails (Fig. 23-14) are a valuable device to aid

clients in changing their position and moving about

while in bed. With side rails in place, the client can

safely turn from side to side and sit up in bed.


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Mattress Overlays

Mattress overlays are accessory items made of

foam or containing gel, air, or water that

nurses place over a standard hospital mattress.


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Static Air Mattress

A static air pressure mattress is filled with a

fixed volume of air


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Alternating Air Mattress

An alternating air mattress (Fig. 23-15) is

similar to a static one with one exception:

every other channel inflates as the next one

deflates.


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Water Mattress

A water mattress supports the body and

equalizes the pressure per square inch over its

surface.


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Transferring Clients

Transfer(moving a client from place to place)

refers to moving a client from bed to a chair,

toilet, or stretcher and back to bed again. The

client assists in an active transfer.


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Nursing Implications

Impaired Physical Mobility

Risk for Injury

Risk for Disuse Syndrome

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Chapter 23dsc sm,ancm,nsacndm,sdncm,n,mcsacds

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