Body Mechanics, Moving, Transferring, Positioning, Ambulation, and ROM

Body Mechanics – What is it? Use of the body (nervous and musculoskeletal system) in movement (lifting, bending, moving) and at rest It includes: Proper body movement in daily activities Prevention and correction of problems associated with posture Enhancement of coordination and endurance

Body Mechanics – Why Use? It is very important that Health Care workers use proper body mechanics to______

Complications of Poor Body Mechanics leads to Lower back injury Don’t Let This Be You! Don’t Let This Be You!

Question The use of patient care ergonomics is associated with which of the following nurse’s outcomes? Reduce fatigue Prevent Injury Maintain balance Conserve Energy All of the Above

Patient Care Ergonomics How does the nurse prevent injury to back and other body parts? Use Patient Care Ergonomics

Patient Care Ergonomics Nurses should incorporate patient care ergonomics into nursing practice and patient care by using: Assistive patient handling equipment Lift teams Standard protocols for lifting and moving of patients

Application of Body Mechanics

Avoid This ! Twisting (rotation) of the thoracolumbar, stretching, or reaching. Acute flexion of the back with hips and knees straight (stooping).

Question True or False One essential principle for promoting safe patient care ergonomics is to face in the opposite directions you are moving. True False

Face in the Direction You are Moving Move/ Pivot your body as a Unit

Criteria for Safe Patient Handling First – Assess situation and patients level of assistance, cooperation, comprehension Plan ahead *If the patient is unable to assist with the transfer or If the patient is large GET HELP !

Use a Mechanical Lifting or Lateral-assist Devices How would the nurse intervene if the patient is still too heavy or sedated and unable to assist in the movement Use a Mechanical Lifting or Lateral-assist Devices or Gait Belt

Question What is the most important action to ensure the nurse is in proper body alignment when positioning a patient in bed? Use friction-reducing sheet. Raise the bed to a comfortable working height. Raise the side rails. Place a pillow between knees to avoid placing one part of the patient’s body on top of another

Positioning Frequent change of position helps to prevent: Muscle discomfort Undue pressure resulting in pressure ulcers Damage to superficial nerves and blood vessels Contractures

When Placing the Patient in Correct Alignment, the Nurse Should: Make sure the mattress is firm and level Ensure bed is clean, dry, wrinkle-free Place support devices in specified areas according to the patients condition – foot board, high-top shoes, trochanter rolls, etc. Avoid placing one part on top of another Ask the patient what position is most comfortable and appropriate.

Types of Positions Supine Prone Fowlers Lateral / Side-lying Sims See pages 1031-1033

Range of Motion

What is the Purpose of ROM Exercises Promote and maintain joint mobility Prevent contractures and shortening of muscles and tendons Increase circulation to extremities Decrease vascular complications of immobility Enhance rehabilitation Facilitate comfort for the patient

Principles of ROM 1. Normal range of motion of a joint prevents limitation of movement and loss of joint function. 2. Bones are moved with contraction of the skeletal muscles. 3. Muscles are always in a mild state of contraction (tonus). 4. Muscle contraction is under control of the central nervous system. 5. Muscle contraction is influenced by the transport of nutrients and oxygen and removal of waste by-products. 6. Muscle fatigue is caused by the build up of waste products. 7. Muscles need alternate periods of rest and work. 8. Almost every muscle has an antagonist that works in the opposite direction. 9. Muscles act in groups to perform work.

Principles of ROM 10. The strongest of any muscle group will dominate when there is sufficient stress placed on the group. 11. If muscles are not used, they degenerate in size, shape and strength. 12. If muscles are overused, they increase in size, shape and 13. Muscle weakness and atrophy / hypertrophy result in limited range of motion for the related joint. 14. Passive exercises provide only for joint mobility, not muscle tone. 15. Active exercises provide for joint mobility and muscle tone. 16. Moving a muscle beyond it elastic limits will result in tearing or damage. 17. Decreased activity affects all body systems.

Question True or False ___ Passive ROM is manual or mechanical moving of the joints. ___ Active ROM is joint movement activated by a person. Active and Passive ROM both: ___ Improved joint mobility. ___ Increase circulation to the affected part ___ Increases muscle mass, tone and strength. ___ Improves cardiac and respiratory functioning. Answers: A =T B = T A = T B = T C = F D= F

QUESTION When doing ROM exercises with a patient who is bedridden, the nurse is aware of which of the following considerations: Neck hyperextension should be encouraged, particularly in older people. Exercises should be continue unto the patient is fatigued. Exercises should be done frequently to lessen pain to the patient. Each joint is exercise to the point of resistance but not pain.

Assessment Prior to ROM Exercises Be aware of the patient’s medical condition Familiarize yourself with the patient’s current ROM Assess the patient’s ability to participate in the ROM exercises

Guidelines Teach the patient what exercise is being undertaken, why and how done. Avoid overexertion and exercise to the point that the patient develops fatigue. Avoid neck hyperextension Start gradually and movements should be smooth and rhythmic. Move each joint until there is resistance, but not pain. Use a variety of support measures when exercising.

Guidelines 7. Return joint to neutral position 8. Keep friction to a minimum 9. Perform ROM twice a day and do each exercise two to five times. 10. The patient’s heart rate and breathing will increase. Rate should return to normal within 3 minutes. 11. Move to active ROM as soon as condition is better.

Ask Yourself? The nurse is putting Mr. Jones joints through ROM. What conditions indicate that the nurse should stop? Fatigue / weakness Pain

Ambulation Some patient’s who are weak, unsteady, and shaky when first getting out of bed may need help with ambulation.

Question What would the nurse do if the patient complains of dizziness or nausea upon sitting up? Select all that apply: Allow to dangle which accustoms the patient to the change in position. While dangling – put on robe and slippers. Once dizziness subsides, ambulate with patient. If dizziness does not subside, put back to bed.

Question Mrs. E. tells the nurse she feels faint while walking in the hall. What should the nurse do? Instruct the patient to quicken there pace to return to her room. Leave her momentarily to find help. Advice her to look down at her feet to help maintain her balance. If a chair is not available, place your knee behind patients knee and guide the patient down your leg and into the floor, being sure to protect the head.

Safety when Ambulating Patient If a patient begins to fall, place your knee behind patients knee and guide the patient down your leg and into the floor, being sure to protect the head.