Body Mechanics, Turning, Positioning and ROM Teresa, V. Hurley, MSN, RN

Body Mechanics What is body mechanics?

Body Mechanic Principles  Center of gravity  Line of gravity  Base of support  Body alignment  Balance  Coordinated Movements  Assess before acting  Slide, roll, push, or pull rather than lift  Assistance

Effects of Immobility on the Body  Musculoskeletal  Respiratory  Circulatory  Gastrointestinal  Urinary  What other areas are effected?

Turning a Client  Place arms across chest  Cross one leg over the other leg  Tighten your gluteal and abdominal muscles, flex knees and use leg muscles to do pulling  Roll client toward you after you placed one hand on far shoulder and the other on the hip  Support back with pillow/blanket  Pull shoulder blade forward

Positions  Supine [dorsal recumbent]  Prone  Sims [semi-prone]  Fowlers [low, semi and high]  Lateral  Trendlenberg [shock

Which of the positions are contraindicated for:  cervical or lumbar problems?  cardiac or respiratory difficulty? Which position used for clients with SOB? Which position used for enema?

Positioning Clients  Turn and position q 2 hours (prevent nerve, small vessel, muscular, skin impairments

Positioning Devices  Maintain body alignment  Prevent contractures  Promote comfort Types of Devices -Can you name at least 5 devices?

Types of Devices  Pillows, blankets, towels, wash cloths, foam wedges  Side rails  Trapeze bar  Sandbags  Trochanter rolls  Foot board  Bed cradle or foot cradle  High top sneakers

Moving Up in Bed  Check for restrictions  Equipment attached to client moves with them  Assess size of client and their ability to assist  Medicate with analgesics  Lock wheels  Avoid friction  Use safety and lifting devices

Moving Client up in Bed  Place pillow against the head board  Client bend knees with feet flat on bed if able  Arms across chest  Lift head with chin on chest  Stand at mid-section  Spread feet shoulder length with one foot slightly in front of other  Flex knees and hips

Range of Motion  Active Range of Motion (AROM)  Passive Range of Motion (PROM)  Support areas proximal and distal to the joint  Repeat exercises 2 to 5 times  Stop if c/o pain or if resistance met

Special Considerations  Obtain MD order for ROM for clients with Arthritis Fractures Joint dislocations Torn ligaments Acute MI Bone tumors or metastases

Special Considerations  Elderly -avoid neck hyperextension -limit attempts at full ROM

ROM Exercises  Extension  Flexion  Circumduction  Abduction  Adduction  Internal Rotation  External Rotation  Pronation  Supination  Eversion  Inversion  Opposition

Documentation 10/3/2006 9:30 am Client performed AROM of head, neck, shoulders, arms, wrist and fingers. PROM to lower extremities performed by husband accurately. Denied c/o pain during exercises. Sitting in semi- fowlers position, one side rail up, call light in reach, watching DVD movie with husband. R. Powell, RN

Unexpected Situations  Client c/o of tiredness  Client c/o of sharp, sudden pain while exercising left leg  What will you do?