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Fundamentals of NursingFundamentals of Nursing
Body Mechanics PNU 145
Cheryl Proffitt RN, MSN
September, 2015
Chapter 23
ATI REVIEW-Chapters 14,40
Body MechanicsBody Mechanics
• Learning Objectives
Identify characteristics of good posture in a standing, sitting or lying position
Describe three principles of correct body mechanics.
Explain the purpose of ergonomics.
Give at least two examples of ergonomics recommendations in the workplace.
Describe at least 10 signs or symptoms associated with disuse syndrome
Describe six common client positions
Body MechanicsBody Mechanics
• Learning Objectives Cont’d
Explain the purpose of five different positioning device used for safety and comfort
Name one advantage for each of three different pressure relieving devices
Discuss four types of transfer devices
Give at least five general guidelines that apply to transferring clients
Body MechanicsBody Mechanics
• Introduction- Dangers of inactivity
Inactivity leads to deterioration of health. Multiple complications can occur among people with limited activity and movement. (table 23-1)
For example- As we get older our co-ordination, endurance and muscle strength declines. This caused limitation in mobility.
Inactivity leads to disuse syndrome (signs and symptoms that occurs from inactivity)
Body MechanicsBody Mechanics What are some activities that can be done
to reduce Disuse syndrome
Positioning
Moving the client.
Nurses should use good posture when performing these activities.
See table 23-1 for dangers of inactivity and fig 23-1 for good posture
Dangers of InactivityDangers of Inactivity
What is posture ? (fig 23-1)
Posture is the position of the body, or the way in which it is held, that affects the person’s appearance, how the person stands, and their ability to use the musculoskeletal system effectively.
Good posture distributes gravity through the center of the body over a wide base for clients and staff.
Poor Posture causes muscle spasms ( which are sudden, forceful, and involuntary muscle contraction). This occurs because muscles are strained and are forced to work harder
Maintaining Good PostureMaintaining Good Posture
Maintaining Good Posture (cont’d)Maintaining Good Posture (cont’d)
Standing PostureStanding Posture
Body MechanicsBody Mechanics
Correct Standing Position
Another way to maintain good posture is standing. (fig 23-3)
Most effective, when feet are parallel, with weight equally distributed on both feet to provide a broad base of support. (fig 23-2), bend knees slightly, chest up and slightly forward, shoulders ,even and centered above hip, hold head erect, face forward and chin slightly tucked
Sitting PostureSitting Posture
• Correct sitting posture
Buttocks and thighs base of support
Both feet rest on floor
Knees bent and clear of chair edge
(Figure 23-3 in the textbook.)
• Good lying-down posture - horizontal
Head, neck centered between shoulders
Shoulders level; arms, hips, knees slightly flexed
Trunk straight; hips level; legs parallel; feet at right angles to legs (Figure 23-4)
Lying-Down PostureLying-Down Posture
Body MechanicsBody Mechanics
• Proper body mechanics (the effective use of the musculoskeletal system) will
Increase muscle effectiveness
Reduce fatigue
Avoids repetitive strain injuries (disorders that results from cumulative trauma to musculoskeletal structures).
Nursing Guidelines (23-1) Nursing Guidelines (23-1) • Using Good body Mechanics (nursing guidelines)
Use the longest and strongest muscles of arms and legs
When lifting a heavy load, center is over feet.
Hold objects close to the body
Bend the knees
Contract the abdominal muscles and make a long midriff
Push, pull or roll objects whenever possible rather than lifting them.
Use body weight as a lever to assist with pushing or pulling an object
See 23-1for more.
ErgonomicsErgonomics
• Definition: special field of engineering science devoted to the promotion of comfort, performance of health in the workplace. Helps in the design of health in the work environment .
Example: using assistive devices to lift or transport heavy items or clients; using alternative equipment for task that require repetitive motions e.g. headsets or automatic staples.
Ergonomics Examples Cont’dErgonomics Examples Cont’d
• Positioning equipment – to avoid reaching and twisting at the hip
• Promoting stability by keeping feet apart
• Use strong muscles to improve balance by bending knees and keeping the back straight
• Avoid twisting and stretching muscles
• Rest between periods of exertion.
Some nurses are prone to injury in the work during lifting patients, twisting while lifting, reaching and lifting with loads far from the body
Positioning Clients Positioning Clients
• General principles for positioning
• Changing inactive clients position to relieve pressure & improve Functional mobility (alignment that maintains the potential for movement & ambulation)
Change the inactive client’s position at least every 2 hours
Enlist the assistance of at least one other caregiver
Remove pillows and positioning devices
Positioning Clients Cont’dPositioning Clients Cont’d
Unfasten Drainage from the bed linen.
Use Low friction fabric or gel filled plastic sheet, repositioning sling to slide/ do not drag the client
Turn client as a complete unit ( avoid injury to spine)
Place the client in good alignment with joints slightly flexed
Replace pillows and positioning devices
Support limbs in a functional position
Use elevation to relieve swelling
Provide skin care after repositioning
• Common positions for bed ridden clients, supine, lateral oblique, prone, sim’s, and Fowler’s ( Fig 23-6)
Supine position: client lies on back.
Concerns-prolonged pressure & skin breakdown. Foot drop: permanent dysfunctional position caused by shortening of the calf muscles and lengthening of the opposing muscles on the anterior leg.
Positioning Clients (cont’d)Positioning Clients (cont’d)
Foot DropFoot Drop
Positioning Clients (cont’d)Positioning Clients (cont’d)
• Lateral position- Side lying position
• Lateral Oblique- variation of side lying position
• Prone position-client lies on abdomen
provides drainage from bronchioles
Alternate position for client’s with ulcers
A challenge for nursing care.
• Sim’s position- a semi prone position. Used for rectal and vaginal procedures.
• Fowler’s position- semi-sitting position. Lowers abdominal organs from diaphragm , making breathing easier. Three types.
Common PositionsCommon Positions
• Positioning devices
– Adjustable bed
– Mattress
– Bed board (rigid structure placed under a mattress)
– Pillows
– Roller sheets
Positioning Clients (cont’d)Positioning Clients (cont’d)
Adjustable BedAdjustable Bed
– Turning and moving clients
– Assistive devices and additional caregivers are needed when turning or moving a client who cannot change from one position to another independently
Positioning Clients (cont’d)Positioning Clients (cont’d)
Trochanter Rolls -Prevents legs from turning outwards
Trochanter Rolls -Prevents legs from turning outwards
Hand Rolls- prevents contractures, helps clients functional mobility to
grasp objects
Hand Rolls- prevents contractures, helps clients functional mobility to
grasp objects
Foot Boards, Boots, and Foot SplintsFoot Boards, Boots, and Foot Splints
Trapeze- triangular, over the bed, helps client to lift the body and
move
Trapeze- triangular, over the bed, helps client to lift the body and
move
Protective/Pressure-Relieving DevicesProtective/Pressure-Relieving Devices
• Side rails- aids in changing position
• Mattress overlays- reduces pressure
– Foam and gel mattresses- redistributes pressure
– Static air mattress-distributes pressure
– Alternating air mattress-relieves pressure
– Water mattress –equalizes pressure
Protective devicesProtective devices
Protective/Pressure-Relieving Devices (cont’d)
Protective/Pressure-Relieving Devices (cont’d)
• Cradle: metal frame secured to or placed on top of the mattress to protect feet and lower legs from bed linens
• Specialty beds
– Low air loss
– Air fluidized
– Oscillating support
– Circular bed
Oscillating BedOscillating Bed
• It Slowly, continuously rocks from side to side in 124-degree arc
– Relieves skin pressure
– Helps mobilize respiratory secretions
– Prevents skin shearing (force exerted against skin surface and layers causes tissues slide in opposite direction)
– (Refer to Figure 23-18 in the textbook.)
Circular Bed-supports & maintains mobility during position change
Circular Bed-supports & maintains mobility during position change
Transferring Clients Transferring Clients
• Transfers –moving client from one place to the next, from bed to chair/toilet or stretcher/back to bed.
• Examples of transferring aids
– Transfer handle- active /independent
– Transfer belt – gripping/support for client
– Transfer boards – bed to stretcher
– Mechanical lift- raise/transfer, obese/helpless
Examples of transfer aidsExamples of transfer aids
• Nursing diagnoses for inactive clients
– Impaired physical mobility
– Risk for injury
– Risk for disuse syndrome
– Impaired bed mobility
Nursing Implications Nursing Implications
• Older adults
– Need to maintain as much mobility as possible to prevent disability
– Require extra time and assistance during positioning, transferring, and ambulating
– Instructions should be given using clear, simple words; make one request at a time
General Gerontologic ConsiderationsGeneral Gerontologic Considerations
ReferenceReference
Timby, B. (2009). Fundamental nursing skills and concepts (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Google pictures. (2015, August 10). Retrieved from http://www.google.com