1. Lifting, Moving, and Positioning Patients
Chapter 18
Lifting, Moving, and Positioning Patients

2. Chapter 18
Lesson 18.1

3. Learning Objectives Theory
Describe the anatomy and function of the musculoskeletal system
Explain the importance of proper body mechanics, alignment, and position change for both patient and nurse
Discuss the principles of body movement and positioning, giving an appropriate example for each principle
Identify ways to maintain correct body alignment of the patient in bed or in a chair

4. Musculoskeletal System Overview
Bones
Four types
Short, long, flat, and irregular
Joint
A union of two or more bones; moves freely
Bursa
A small fluid-filled sac that provides a cushion at friction points in the joints

5. Musculoskeletal System Overview
Skeletal muscle
Striated muscles surrounded by a connective tissue sheath
Tendon
Fibrous tissue that connects muscle to bone
Ligament
Connects bone to cartilage
Cartilage
Fibrous connective tissue; acts as a cushion
What are the general functions of skeletal muscles?
Groups of muscles work together (contract) to produce a single movement.
Why are skeletal muscle functions so important to lifting, moving, and positioning patients?

6. Functions of Bones Provide a scaffolding to support the body
Give shape to the body and support the internal organs and skin
Provide places for ligaments and tendons to attach to facilitate movement
Joints allow movement and flexibility of the skeleton
Review the anatomy and functions of cartilage, ligaments, and tendons.

7. Functions of Muscles
Can stretch; can be stimulated to contract electrically or to extend elastically
Provide movement
Stabilize joints
Produce heat
Maintain posture
Good posture is important to prevent fatigue and joint deformities, provide strength, and support the position of internal organs.

8. Changes Occurring with Aging
Bone mass loss may lead to osteoporosis (more severe in women)
Loss of bone density predisposes the elderly to fractures
Muscle cells are lost and replaced by fat cells
Elasticity of muscle fibers is decreased, limiting flexibility
Joint motion may decrease, limiting motion and mobility
How do male and female skeletons differ? (male hip bones form narrow deep funnel; female hip bones form broad shallow basin)
Bone growth and strength depend on minerals, vitamin D, and blood supply to the bone.
Bone disorders are common in elderly people.
What is the role of exercise (active or passive) in maintaining bone and muscle health for the elderly?

9. Principles of Body Movement for Nurses
One of the most common injuries in health care workers is lower back strain!
Get help whenever possible; ask patient to help if able
Two nurses moving a patient divides the work
It is better to wait for help than to risk injury
Use your leg muscles; bend and flex your knees
Bend at the knees, not at the waist
How can injuries be prevented?
How can you use your leg muscles when turning a patient in bed? Back pain can be acute or chronic and may not respond favorably to therapy or medication.
Back problems are often the result of persistent bad posture; a sudden movement that strains the back muscles; or poor lifting techniques, which can damage muscles or vertebrae.
Stress causes muscle tension and contributes to back pain, which restricts flexibility and increases the risk of strains.

10. Principles of Body Movement for Nurses
Use the greatest number of muscles possible
Use thigh, arm, or leg muscles rather than back muscles, and use a wide base of support
Keep feet approximately shoulder-width apart
Pull and pivot, using smooth, coordinated movements; avoid jerking or sudden pulling movements
Encourage patient to assist when transferring and moving if possible
What should you do if you have difficulty finding a staff person to help you?
Use devices such as mechanical lifts and transfer or roller boards when available
Bones and muscles of the legs are strong and can be used to protect the back.
When lifting heavy objects, bend at the knees.
Never carry more than what is manageable.
Review OSHA guidelines for lifting and supporting weight in the workplace.

11. Figure 18-3: Use leg muscles to prevent back strain

12. Moving and Lifting Patients
Keep elbows close and work close to your body; work at same level or height as the object to be moved; keep the load near your center of gravity
Pulling actions require less effort than pushing or lifting; face the direction of the movement
Use arms as levers when pulling patient toward you; lock elbows and rock back on your heels, using weight of your body to move the patient
Why is pulling easier than pushing?
Few injuries are as sudden and painful as a strain or sprain—muscles, tendons, and ligaments stop functioning normally.
A strain occurs when a muscle (a pulled muscle) or tendon is twisted or stretched beyond its limits.
A sprain happens when a joint is forced beyond its normal range of motion. Ligaments may be overstretched or torn.

13. Body Movement and Alignment for Patients
Two basic principles
1. Maintain correct anatomic position
2. Change position frequently
Hazards of improper alignment
Interference with circulation, which may lead to pressure ulcers
Muscle cramps and possible contractures
Fluid collection in the lungs
What are contractures?
How can contractures be prevented? (correct body positioning)
What is a shearing force?

14. Figure 18-2: Correct standing body alignment

15. Figure 18-5: Correct sitting body alignment

16. Pressure Ulcers Also known as decubitus ulcers, or bedsores
Occur when pressure on the skin causes an area of local tissue necrosis
Occur most often between a bony prominence and an external surface
May be caused by shearing as force is applied downward and forward on tissue beneath the skin (as when a patient slides down in a chair)
Bedsores (decubitus ulcers) are localized areas of necrosis of skin and subcutaneous tissue produced by pressure.
What factors contribute to the development of pressure sores in elderly patients?
What body sites are most likely to be involved?

17. Nursing Diagnoses for Problems of Body Movement
Commonly used nursing diagnoses
Risk for injury
Impaired physical mobility
Risk for impaired skin integrity
Impaired walking
Therapeutic exercises:
prevent injury and immobility.
restore function of muscles, nerves, bones, and joints.
prevent deformity and stimulate circulation.
build tolerance and endurance.

18. Planning
Decide how to change the patient's position and whether you can delegate this task to assistive personnel
The home setting must also be considered when planning care for the patient

19. Goals and Expected Outcomes
Patient will experience no musculoskeletal injury
Former level of mobility will be reattained within 6 months
Skin integrity will remain intact while patient is on bed rest
Patient will not experience injury while ambulating
Patient should have full range-of-motion exercise actively or passively performed several times a day
How do these goals align with institutional standards?

20. Chapter 18
Lesson 18.2

21. Learning Objectives Theory
Describe the proper method for transferring a patient between wheelchair and bed

22. Learning Objectives Clinical Practice
Correctly position a patient in the following positions: supine, prone, Fowler’s, and Sims’
Assist patients to sit up in bed
Demonstrate complete passive range-of-motion (ROM) exercises for a patient
Correctly transfer a patient from a wheelchair to a bed
Transfer a patient from a bed to a stretcher
Demonstrate the correct techniques to ambulate a patient and to break a fall while ambulating

23. Positioning Accomplishes four objectives Positioning provides comfort
Positioning relieves pressure on bony prominences and other parts, decreasing the patient’s risk of developing bedsores
Positioning prevents contractures, deformities, and respiratory problems
Positioning improves circulation
How can a nurse maintain a patient’s privacy during positioning? (proper draping)

24. Common Positions and Variations: Supine
Patient lying on her back
Fowler’s position
Supine with the HOB elevated 60 to 90 degrees
Semi-Fowler’s position
Supine with the HOB elevated 30 to 60 degrees
Low Fowler’s position
Supine with the HOB elevated 15 to 30 degrees
For what conditions or purposes are these positions used? (supine = after spinal surgery and after administering spinal anesthetics; Fowler’s, Semi-Fowler’s, and Low Fowler’s = improve cardiac output/respiration, promote urinary and bowel elimination)
Why is elevation of the knees above 15 degrees contraindicated in elderly and postoperative patients? (often causes decreased circulation in lower extremities)

25. Figure: Fowler’s positions

26. Common Positions and Variations: Supine
Dorsal recumbent position
Supine with knees flexed and feet flat on the bed; used for many procedures and examinations
Dorsal lithotomy position
Feet in stirrups and legs spread farther apart; used in pelvic exams
What is the dorsal lithotomy position? (patient lies on back, legs are separated, thighs are acutely flexed on abdomen and legs on thighs; buttocks brought to the edge of the bed or table)

27. Figure 18-6: Dorsal recumbent position

28. Figure 18-7: Lithotomy position

29. Common Positions and Variations: Side-Lying Lateral
Patient lying on her side
Alleviates pressure on bony prominences of the back
Oblique side-lying position
Removes pressure from shoulder and hip
Easier for patients
Sims’ position
A variation of side-lying used for rectal examinations or insertions of tubes or suppositories

30. Figure: Side-lying positions

31. Figure: Sims’ position

32. Common Positions and Variations: Prone
Patient lying face down
Often used for patients with spinal cord injury
Not generally well tolerated
Knee-chest position
Face down, with chest, knees, and elbows resting on the bed
Used for rectal examinations
Patients on prolonged bed rest may develop external rotation deformity of the hip.

33. Figure: Prone position

34. Figure 18-8: Knee-chest position

35. Common Positioning Devices
Pillows
Used to support the body or extremities
Boots or splints
Maintain dorsiflexion
Footboards, high-top sneakers
Trochanter rolls
Prevent external rotation of the leg
To prevent a deformity of the hip (external rotation), use a trochanter roll.
Use a footboard when the patient is in the dorsal position to prevent footdrop.

36. Common Positioning Devices
Sandbags
Used to immobilize an extremity, provide support, and maintain body alignment
Hand rolls
Help prevent contractures and prevent dorsiflexion of the wrist
Trapeze bars, side rails, bed boards
Enhance patient mobility, provide patient safety, and support patient’s back

37. Moving the Patient in Bed
Using a lift sheet
Requires at least two people standing on opposite sides of the bed
Both face the bed and use the sheet to move the patient up in the bed
Moving the patient is performed as a coordinated effort
Patient is lifted and moved, not dragged
Safety is the most important factor for the patient and the nurse.
The nurse must use good body mechanics and balance.
Communicate actions to patient and ask for the patient’s help and guidance if necessary.

38. Figure 18-9A: Trapeze bar

39. Figure 18-9B: Trochanter roll

40. Logrolling Turning the patient as a single unit
Body alignment maintained at all times
Used to change bed linen, can be performed with or without a lift sheet
Requires two people if patient cannot turn herself
Leave a pillow under the patient’s head
What is the procedure for logrolling a patient with a lift sheet? Without a lift sheet?
When is logrolling usually used? (for patients with injuries or surgery to the spine, and for patients who must avoid twisting)
Describe proper body alignment for nurses to use during logrolling.
Describe the process step by step in detail.
How do nurses perform logrolling without a lift sheet?

41. Figure 18-10: Logrolling a patient using a lift sheet

42. Figure 18-11: Logrolling a patient without a lift sheet

43. Lifting and Transferring
Patients may transfer independently or require different levels of assistance
Always dangle a patient at bedside before transferring to a wheelchair, and observe for dizziness or nausea
Remember to lock the wheels on wheelchairs or gurneys before attempting to transfer a patient
Stretchers used for transporting a patient who is unable to sit in a wheelchair
Either lift equipment or two nurses should transfer a patient to a wheelchair if patient unsteady, weak, or heavy
Why does transferring a patient from a supine position to the chair require bedside dangling?
What physiologic dynamics occur when the patient is allowed to dangle for 5 minutes at the bedside?

44. Things to Remember
Determine how much help you will need to move or transfer the patient
Get help whenever possible
Make sure wheels on beds, wheelchairs, and gurneys are locked
Use a transfer device when possible
Dangle the patient before ambulating
Use a gait belt when ambulating patients
Nursing assessment before transfer and ambulation may include patient’s range of motion, breathing, positioning, balancing, and reaching and grasping ability.

45. Transfer Devices Pull or life sheets Mechanical lifts Roller boards
Slide boards
Transfer or gait belts
What is the purpose of a transfer or gait belt?
What mechanical aids are often used in transfer and ambulation?