Chapter 8 Body Mechanics and Patient Mobility All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Introduction to Body Mechanics and Patient Mobility  Must be learned by nursing personnel to prevent injury  Back injuries rank second in occupational injuries All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

Introduction to Body Mechanics and Patient Mobility cont’d  Evidence-based practice  Safe-lift programs  Application to nursing practice All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3

Introduction to Body Mechanics and Patient Mobility cont’d  Life span considerations (older adults)  Mobility Skin fragile Support joints when moving in bed Lose flexibility and joint mobility Weakness Orthostatic hypotension Altered sensory perception All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4

Introduction to Body Mechanics and Patient Mobility cont’d  Using proper body mechanics  Protects large muscle groups from injury  Provides safety All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5

Body Mechanics  Area of physiology that studies muscle action and how muscles function in maintaining the posture of the body and prevention of injury during activity  Principles of body mechanics  Maintain appropriate body alignment  Maintain wide base of support  Bend knees and hips  Do not bend from waist All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6

Mobility Versus Immobility  Mobility  Ability to move around freely  Purposes Exercise Express emotions Attain basic needs Perform recreational activities Completing activities of daily living (ADLs) All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 7

Mobility Versus Immobility cont’d  Immobility  Inability to move around freely  Complications of immobility Muscle atrophy and asthenia (muscle weakness) Contractures Osteoporosis Pressure ulcer Constipation Pneumonia, pulmonary embolism All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8

Mobility Versus Immobility cont’d  Assistive devices  Pillows  Foot boots  Trochanter rolls  Sandbags  Trapeze bars All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9

Question 1 A patient was admitted to the hospital with a fractured hip. Which are complications of immobility? (Select all that apply.) 1. Pneumonia 2. Embolus 3. Pressure ulcer 4. Fever All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10

Positioning  Dorsal – lying flat on back  Dorsal recumbent – supine lying on back, head, and shoulder with extremities moderately flexed  Fowler’s – head of bed is raised degrees  Semi-Fowler’s – head of bed raised 30 degrees All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11

Positioning cont’d  Orthopneic – sitting up in bed at 90-degree angle or sometimes resting in forward tilt while supported by pillow on overbed table  Sims’ – lying on side with knee and thigh drawn toward chest  Prone – lying face down in horizontal position All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12

Positioning cont’d  Knee-chest (genupectoral) – kneels so weight of body is supported by knees and chest, abdomen raised, head turned to one side and arms flexed  Lithotomy – lying supine with hips and knees flexed, thighs abducted and rotated externally  Trendelenburg’s – head is low, body and legs are on inclined plane  Lateral All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13

Question 2 A patient has a nasogastric (NG) tube and is receiving tube feedings. While in bed, the patient is to be kept in what position? 1. Fowler’s 2. Semi-Fowler’s 3. Supine 4. Dorsal All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14

Neurovascular Assessment  CSM  Neurovascular function or circulation  Movement  Sensation  LPN/LVNs check skin color, temperature, movement, sensation, pulses, capillary refill, and pain All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15

Neurovascular Assessment cont’d  Compartment syndrome  Symptoms Muscle pain Paresthesia (tingling and burning or feeling of pins and needles in affected area) Numbness and paralysis  Causes Repetitive movements during exercise All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 16

Range-of-Motion Exercises [ROM]  Movement of the body that involves the muscles and joints in natural directional movements  Active – performed by patient  Passive – performed by caregivers All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17

Range-of-Motion Exercises cont’d  Neck and cervical spine  Flexion, extension, hyperextension, lateral flexion, rotation  Shoulder  Flexion, extension, hyperextension, abduction, adduction, internal and external rotation, circumduction  Elbow  Flexion, extension, hyperextension All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 18

Range-of-Motion Exercises cont’d  Forearm  Supination, pronation  Wrist  Flexion, extension, hyperextension, radial and ulnar flexion  Fingers  Flexion, abduction, adduction All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 19

Range-of-Motion Exercises cont’d  Thumb  Flexion, extension, abduction, adduction, opposition  Hip  Flexion, extension, hyperextension, abduction, adduction, internal and external rotation, circumduction  Knee  Flexion, extension All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20

Range-of-Motion Exercises cont’d  Ankle  Dorsiflexion, plantar flexion  Foot  Inversion, eversion  Toes  Flexion, extension, abduction, adduction All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21

Question 3 When performing range-of-motion wrist exercises, the nurse can put the wrist through all movements except: 1. flexion. 2. hyperextension. 3. extension. 4. adduction. All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 22

Life Span Considerations (Older Adult)  Inadequate calcium intake  Fear of falling  Depression  Arthritic  Chronic illness All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 23

Continuous Passive Motion Machines  Machine that flexes and extends joints to passively mobilize them  Prevents complications  Joint contracture, atrophy of muscles, thromboembolism All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 24

Moving the Patient  Assist patient with moving  Assist with ambulation  Using a lift All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 25

Nursing Process for Mobility  Assessment  Foci of ROM, muscle strength, activity tolerance, gait, posture  Observe for fatigue, muscle strength, ROM  Assistance needed for transfers All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 26

Nursing Process for Mobility cont’d  Nursing diagnosis  Expected goals and planning  Implementation  Evaluation All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 27

Question 4 An implementation a nurse may use to improve safety in transferring a patient is: 1. weighing the patient first. 2. using a gait belt. 3. putting shoes on the patient. 4. supporting a flaccid arm. All items and derived items © 2015, 2011, 2006 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 28