Fundamentals of Nursing Body Mechanics PNU 145 Cheryl Proffitt RN, MSN September, 2015 Chapter 23 ATI REVIEW-Chapters 14,40

Body 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

Discuss four types of transfer devices Body 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 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 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 Inactivity

Maintaining Good Posture 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 Posture (cont’d)

Standing Posture

Another way to maintain good posture is standing. (fig 23-3) Body 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 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.)

Lying-Down Posture 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)

Body 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) 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.

Ergonomics 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’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 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’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

Positioning Clients (cont’d) 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.

Foot Drop

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 Positions

Positioning Clients (cont’d) Positioning devices Adjustable bed Mattress Bed board (rigid structure placed under a mattress) Pillows Roller sheets

Adjustable Bed

Positioning Clients (cont’d) 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

Trochanter Rolls -Prevents legs from turning outwards

Hand Rolls- prevents contractures, helps clients functional mobility to grasp objects

Foot Boards, Boots, and Foot Splints

Trapeze- triangular, over the bed, helps client to lift the body and move

Protective/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 devices

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 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

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 aids

Nursing Implications Nursing diagnoses for inactive clients Impaired physical mobility Risk for injury Risk for disuse syndrome Impaired bed mobility

General Gerontologic Considerations 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

Reference 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