Fundamental Fundamental NursingNursing

Chapter 23Chapter 23

Body Mechanics, Body Mechanics, Positioning and Positioning and

MovingMovingInst.: Dr. Ashraf El - JediInst.: Dr. Ashraf El - Jedi

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Inactivity leads to deterioration of healthInactivity leads to deterioration of health. . Multiple Multiple complications can occur among people with limited complications can occur among people with limited activity and movement.activity and movement.

The consequences of inactivity are collectively The consequences of inactivity are collectively referred to as referred to as disuse syndromedisuse syndrome (signs and symptoms (signs and symptoms that result from inactivity). Nursing care activities that result from inactivity). Nursing care activities such as positioning and moving clients reduce the such as positioning and moving clients reduce the potential for disuse syndrome. Nurses can become potential for disuse syndrome. Nurses can become injured, however, if they fail to use good posture and injured, however, if they fail to use good posture and body mechanics while performing these activities body mechanics while performing these activities ((Table 23-1).Table 23-1).

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This chapter describes how to position and This chapter describes how to position and move clients to prevent complications move clients to prevent complications associated with inactivityassociated with inactivity. . It also discusses It also discusses methods for protecting nurses from workmethods for protecting nurses from work--related injuriesrelated injuries. . Basic terms are defined in Basic terms are defined in Table 23-2Table 23-2..

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Maintaining Good PostureMaintaining Good Posture

PosturePosture (position of the body, or the way in (position of the body, or the way in which it is held) affects a person's appearance, which it is held) affects a person's appearance, stamina, and ability to use the musculoskeletal stamina, and ability to use the musculoskeletal system efficiently. Good posture, whether in a system efficiently. Good posture, whether in a standing, sitting, or lying position, distributes standing, sitting, or lying position, distributes gravity through the center of the body over a gravity through the center of the body over a wide base of support and is important for both wide base of support and is important for both clients and nurses (Fig. 23-1).clients and nurses (Fig. 23-1).

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Figure 23-1 •

Good posture helps to align gravity through the center of the body. A wide stance provides a stable base for support

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When a person performs work while using When a person performs work while using poor posture, poor posture, muscle spasmsmuscle spasms (sudden, (sudden, forceful, involuntary muscle contractions) forceful, involuntary muscle contractions) often result. They occur more often when often result. They occur more often when muscles are strained and forced to work muscles are strained and forced to work beyond their capacity. beyond their capacity.

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StandingStanding To maintain good posture in a standing positionTo maintain good posture in a standing position

Keep the feet parallel Keep the feet parallel Distribute weight equally on both feet Distribute weight equally on both feet Bend the knees slightly Bend the knees slightly Maintain the hips at an even levelMaintain the hips at an even level.. Pull in the buttocks and hold the abdomen up Pull in the buttocks and hold the abdomen up Hold the chest up and slightly forward Hold the chest up and slightly forward Keep the shoulders even and centered above the hipsKeep the shoulders even and centered above the hips.. Hold the head erect with the face forward Hold the head erect with the face forward

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Figure 23-2

A ) Good standing posture. (B ) Poor standing posture.(

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SittingSitting

In a good sitting position In a good sitting position ((Fig. 23-3Fig. 23-3), the ), the buttocks and upper thighs become the base of buttocks and upper thighs become the base of support. Both feet rest on the floor. support. Both feet rest on the floor.

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Figure 23-3 A ) Correct sitting postureB ) Incorrect sitting posture.

(Courtesy of Lowren West, New York, NY.)

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Lying DownLying Down

Good posture in a lying position looks the Good posture in a lying position looks the same as in a standing position, except the same as in a standing position, except the person is horizontal (person is horizontal (Fig. 23-4Fig. 23-4). ).

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Figure 23-4 •

A) Correct lying posture. B) Incorrect lying posture.

(Courtesy of Lowren West, New York, NY)

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Body MechanicsBody Mechanics

The use of proper The use of proper body mechanicsbody mechanics (efficient (efficient use of the musculoskeletal system) increases use of the musculoskeletal system) increases muscle effectiveness, reduces fatigue, and muscle effectiveness, reduces fatigue, and helps to avoid helps to avoid repetitive strain injuries.repetitive strain injuries.

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Positioning ClientsPositioning Clients

Good posture and body mechanics and assistive Good posture and body mechanics and assistive devices are necessary when inactive clients require devices are necessary when inactive clients require positioning and moving. An inactive client's position positioning and moving. An inactive client's position is changed to relieve pressure on bony areas of the is changed to relieve pressure on bony areas of the body, promote body, promote functional mobilityfunctional mobility (alignment that (alignment that maintains the potential for movement and maintains the potential for movement and ambulation), and provide for therapeutic needs. ambulation), and provide for therapeutic needs. General principles for positioning are General principles for positioning are as follows:as follows:

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Change the inactive client's position at least every 2 hoursChange the inactive client's position at least every 2 hours.. Enlist the assistance of at least one other caregiver.Enlist the assistance of at least one other caregiver. Raise the bed to the height of the caregiver's elbow.Raise the bed to the height of the caregiver's elbow. Remove pillows and positioning devices.Remove pillows and positioning devices. Unfasten drainage tubes from the bed linen.Unfasten drainage tubes from the bed linen. Turn the client as a complete unit to avoid twisting the Turn the client as a complete unit to avoid twisting the

spine.spine. Place the client in good alignment with joints slightly Place the client in good alignment with joints slightly

flexed.flexed. Replace pillows and positioning devices.Replace pillows and positioning devices. Support limbs in a functional positionSupport limbs in a functional position Use elevation to relieve swelling or promote comfortUse elevation to relieve swelling or promote comfort.. Provide skin care after repositioning.Provide skin care after repositioning.

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Common PositionsCommon Positions

Nurses commonly use six body positions when Nurses commonly use six body positions when caring for bedridden clientscaring for bedridden clients: : supine, lateral, supine, lateral, lateral oblique, prone, Sims', and Fowler'slateral oblique, prone, Sims', and Fowler's..

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Supine PositionSupine Position

In the In the supine positionsupine position, the person lies on the back (, the person lies on the back (Fig. 23-6AFig. 23-6A). There are two primary concerns ). There are two primary concerns associated with the supine position: prolonged associated with the supine position: prolonged pressure, especially at the end of the spine, leads to pressure, especially at the end of the spine, leads to skin breakdown; and gravity, combined with pressure skin breakdown; and gravity, combined with pressure on the toes from bed linen, creates a potential for on the toes from bed linen, creates a potential for foot foot dropdrop (permanent dysfunctional position caused by (permanent dysfunctional position caused by shortening of the calf muscles and lengthening of the shortening of the calf muscles and lengthening of the opposing muscles on the anterior leg; opposing muscles on the anterior leg; Fig. 23-7Fig. 23-7).).

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Figure 23-6: A ) Supine position

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Lateral PositionLateral Position

With the With the lateral positionlateral position (side-lying position; (side-lying position; see see Fig. 23-6BFig. 23-6B), foot drop is of less concern ), foot drop is of less concern because gravity does not pull down the feet as because gravity does not pull down the feet as happens when clients are supine. Nevertheless, happens when clients are supine. Nevertheless, unless the upper shoulder and arm are unless the upper shoulder and arm are supported, they may rotate forward and supported, they may rotate forward and interfere with breathing.interfere with breathing.

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B: ) Lateral position

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Prone PositionProne Position

The The prone positionprone position (one in which the client lies on (one in which the client lies on the abdomen; see the abdomen; see Fig. 23-6DFig. 23-6D) is an alternative ) is an alternative position for the person with skin breakdown from position for the person with skin breakdown from pressure ulcers. The prone position also provides pressure ulcers. The prone position also provides good drainage from bronchioles, stretches the trunk good drainage from bronchioles, stretches the trunk and extremities, and keeps the hips in an extended and extremities, and keeps the hips in an extended position. The prone position improves arterial position. The prone position improves arterial oxygenation in critically ill clients with adult oxygenation in critically ill clients with adult respiratory distress syndrome and others who are respiratory distress syndrome and others who are mechanically ventilated . The prone position poses a mechanically ventilated . The prone position poses a nursing challenge for assessing and communicating nursing challenge for assessing and communicating with clients, however, and it is uncomfortable for with clients, however, and it is uncomfortable for clients with recent abdominal surgery or back pain.clients with recent abdominal surgery or back pain.

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: D ) Prone position.

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Sims' PositionSims' Position

In In Sims' positionSims' position (semi-prone position), the (semi-prone position), the client lies on the left side with the right knee client lies on the left side with the right knee drawn up toward the chest (see drawn up toward the chest (see Fig. 23-6EFig. 23-6E). ). The left arm is positioned along the client's The left arm is positioned along the client's back, and the chest and abdomen are allowed back, and the chest and abdomen are allowed to lean forward. Sims' position also is used for to lean forward. Sims' position also is used for examination of and procedures involving the examination of and procedures involving the rectum and vagina.rectum and vagina.

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E ) Sims' position

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Fowler's PositionFowler's Position

Fowler's positionFowler's position (semi-sitting position) makes it easier for the client to (semi-sitting position) makes it easier for the client to eat, talk, and look around. Three variations are common (see eat, talk, and look around. Three variations are common (see Fig. 23-6FFig. 23-6F). ). In a , the P.522In a , the P.522

In a In a low Fowler's positionlow Fowler's position, head is elevated to 30 degrees. A , head is elevated to 30 degrees. A mid-Fowler's mid-Fowler's or semi-Fowler'sor semi-Fowler's position refers to an elevation of up to 45 degrees. A position refers to an elevation of up to 45 degrees. A high high Fowler's positionFowler's position is an elevation of 60 to 90 degrees. The knees may not be is an elevation of 60 to 90 degrees. The knees may not be elevated, but doing so relieves strain on the lower spine.elevated, but doing so relieves strain on the lower spine.

Fowler's position is especially helpful for clients with dyspnea because it Fowler's position is especially helpful for clients with dyspnea because it causes the abdominal organs to drop away from the diaphragm. Relieving causes the abdominal organs to drop away from the diaphragm. Relieving pressure on the diaphragm allows the exchange of a greater volume of air. pressure on the diaphragm allows the exchange of a greater volume of air. Sitting for a prolonged period, however, decreases blood flow to tissues in Sitting for a prolonged period, however, decreases blood flow to tissues in the coccyx area and increases the risk for pressure ulcers in that area.the coccyx area and increases the risk for pressure ulcers in that area.

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(F ) Fowler's position.

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Positioning DevicesPositioning Devices

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Adjustable BedAdjustable Bed

The adjustable bed can be raised or lowered The adjustable bed can be raised or lowered and allows the position of the head and knees and allows the position of the head and knees to be changed. to be changed.

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MattressMattress

A comfortable, supportive mattress is firm but A comfortable, supportive mattress is firm but flexible enough to permit good body flexible enough to permit good body alignment.alignment.

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Bed BoardBed Board

A A bed boardbed board (rigid structure placed under a (rigid structure placed under a mattress) provides additional skeletal supportmattress) provides additional skeletal support

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PillowsPillows

Pillows are used to support and elevate a body Pillows are used to support and elevate a body part.part.

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Turning and Moving ClientsTurning and Moving Clients

Assistive devices and additional caregivers are Assistive devices and additional caregivers are needed when turning or moving a client who needed when turning or moving a client who cannot change from one position to another cannot change from one position to another independently or who needs help doing soindependently or who needs help doing so..

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Trochanter RollsTrochanter Rolls

Trochanter rolls (Trochanter rolls (Fig. 23-10Fig. 23-10) prevent the legs ) prevent the legs from turning outward.from turning outward.

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Hand RollsHand Rolls

Hand rolls (Fig. 23-11) are devices that preserve the Hand rolls (Fig. 23-11) are devices that preserve the client's functional ability to grasp and pick up objects. client's functional ability to grasp and pick up objects. Hand rolls prevent Hand rolls prevent contracturescontractures (permanently (permanently shortened muscles that resist stretching) of the shortened muscles that resist stretching) of the

fingersfingers. .

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Foot Boards, Boots, and Foot Foot Boards, Boots, and Foot SplintsSplints

Foot boards, boots, and splints are devices that Foot boards, boots, and splints are devices that prevent foot drop by keeping the feet in a prevent foot drop by keeping the feet in a functional position (Fig. 23-12).functional position (Fig. 23-12).

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TrapezeTrapeze

A trapeze is a triangular piece of metal hung by a A trapeze is a triangular piece of metal hung by a chain over the head of the bed (Fig. 23-13). chain over the head of the bed (Fig. 23-13).

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Protective DevicesProtective Devices

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Side RailsSide Rails

Side rails (Fig. 23-14) are a valuable device to aid Side rails (Fig. 23-14) are a valuable device to aid clients in changing their position and moving about clients in changing their position and moving about while in bed. With side rails in place, the client can while in bed. With side rails in place, the client can safely turn from side to side and sit up in bed. safely turn from side to side and sit up in bed.

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Mattress OverlaysMattress Overlays

Mattress overlays are accessory items made of Mattress overlays are accessory items made of foam or containing gel, air, or water that foam or containing gel, air, or water that nurses place over a standard hospital mattress. nurses place over a standard hospital mattress.

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Static Air MattressStatic Air Mattress

A static air pressure mattress is filled with a A static air pressure mattress is filled with a fixed volume of airfixed volume of air

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Alternating Air MattressAlternating Air Mattress

An alternating air mattress (Fig. 23-15) is An alternating air mattress (Fig. 23-15) is similar to a static one with one exception: similar to a static one with one exception: every other channel inflates as the next one every other channel inflates as the next one deflates.deflates.

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Water MattressWater Mattress

A water mattress supports the body and A water mattress supports the body and equalizes the pressure per square inch over its equalizes the pressure per square inch over its surface.surface.

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Transferring ClientsTransferring Clients

TransferTransfer (moving a client from place to place) (moving a client from place to place) refers to moving a client from bed to a chair, refers to moving a client from bed to a chair, toilet, or stretcher and back to bed again. The toilet, or stretcher and back to bed again. The client assists in an active transfer. client assists in an active transfer.

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Nursing ImplicationsNursing Implications

Impaired Physical MobilityImpaired Physical Mobility Risk for InjuryRisk for Injury Risk for Disuse SyndromeRisk for Disuse Syndrome