Fundamentals of NursingFundamentals of Nursing

Body Mechanics PNU 145

Cheryl Proffitt RN, MSN

September, 2015

Chapter 23

ATI REVIEW-Chapters 14,40

Body MechanicsBody 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

Body MechanicsBody 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 MechanicsBody 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 MechanicsBody 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 InactivityDangers of Inactivity

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 PostureMaintaining Good Posture

Maintaining Good Posture (cont’d)Maintaining Good Posture (cont’d)

Standing PostureStanding Posture

Body MechanicsBody 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 PostureSitting 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.)

• 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)

Lying-Down PostureLying-Down Posture

Body MechanicsBody 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) 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.

ErgonomicsErgonomics

• 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’dErgonomics 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 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’dPositioning 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

• 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.

Positioning Clients (cont’d)Positioning Clients (cont’d)

Foot DropFoot Drop

Positioning Clients (cont’d)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 PositionsCommon Positions

• Positioning devices

– Adjustable bed

– Mattress

– Bed board (rigid structure placed under a mattress)

– Pillows

– Roller sheets

Positioning Clients (cont’d)Positioning Clients (cont’d)

Adjustable BedAdjustable Bed

– 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

Positioning Clients (cont’d)Positioning Clients (cont’d)

Trochanter Rolls -Prevents legs from turning outwards

Trochanter Rolls -Prevents legs from turning outwards

Hand Rolls- prevents contractures, helps clients functional mobility to

grasp objects

Hand Rolls- prevents contractures, helps clients functional mobility to

grasp objects

Foot Boards, Boots, and Foot SplintsFoot Boards, Boots, and Foot Splints

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

move

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

move

Protective/Pressure-Relieving DevicesProtective/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 devicesProtective devices

Protective/Pressure-Relieving Devices (cont’d)

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 BedOscillating 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

Circular Bed-supports & maintains mobility during position change

Transferring Clients 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 aidsExamples of transfer aids

• Nursing diagnoses for inactive clients

– Impaired physical mobility

– Risk for injury

– Risk for disuse syndrome

– Impaired bed mobility

Nursing Implications Nursing Implications

• 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

General Gerontologic ConsiderationsGeneral Gerontologic Considerations

ReferenceReference

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