The Nurse Uses Which Principles Of Body Mechanics When Caring For Immobilized Clients?

Learning Objectives

ane. Country the three principles underlying proper body mechanics and relate a nursing consideration for each.

2. Demonstrate safe, comfortable, and advisable positioning for clients in bed.

iii. State the purposes of range-of-motion exercises. Differentiate betwixt active and passive range of motion. Demonstrate the ability to perform passive range-of-motion exercises, to supervise active range-of-move exercises, and to perform combinations of passive and agile range-of-move exercises.

4. Place at least three principles related to safe movement of clients in and out of bed.

five. Demonstrate the ability to move a partially or totally immobile client safely from bed to chair and dorsum; safely up in bed or to the side of the bed; to a wheeled stretcher; and back to bed.

6. Demonstrate the ability to use the wheeled stretcher (litter, gurney) safely.

7. Demonstrate the power to teach each of the crutch-walking gaits to a client. Practise each gait. Demonstrate and practice going upwards and down stairs with crutches and a manus rail.

8. Describe the types of client reminder devices; land the precautions and nursing care for each; identify the regulations and documentation for each; and state when each is used. Differentiate betwixt client reminder devices for safety and for medical therapeutic reasons.

nine. Land at least half-dozen client positions commonly used for examinations and treatments. In the skills laboratory, demonstrate the power to position a client safely into each of these positions.

10. Depict the evaluation of autumn risk and how this applies to nursing care and client safety.

IMPORTANT TERMINOLOGY
abduction	gait	plantar flexion
adduction	gait belt	pronation
base of operations of back up	gravital airplane	protraction
trunk mechanics	gurney	decumbent
center of gravity	hemiplegia	protective device
circumduction	hyperextension	retraction
customer reminder device	inversion	rotation
contracture	isometric	Sims' position
contralateral	lateral	supination
dangling	line of gravity	supine
dorsiflexion	lithotomy	transfer chugalug
eversion	litter	transfer board
extension	logroll plough	Trendelenburg'due south position
flexion	orthopneic position	trochanter roll
footdrop	paralysis
Fowler's position	paraplegia

Acronyms

AROM

CPM

OOB

PROM

ROM

Nurses ofttimes demand to teach clients the apply of proper body mechanics for safe walking and motility. Beginning, however, the nurse needs to understand and do proper body mechanics himself or herself. People (clients and nurses alike) differ in weight, size, and ability to motility. The nurse'due south physical forcefulness is not every bit important as how efficiently he or she uses the torso. Ultimately, efficient use of i's body volition determine how finer and safely the nurse is able to motility clients. It is important to provide safety for both the nurse and the client.

PROPER Trunk MECHANICS

Use of the safest and most efficient methods of moving and lifting is chosen trunk mechanics. This means applying mechanical principles of movement to the human body.

Principles of Body Mechanics

The laws of physics govern all movement. From these laws we derive the full general principles of body mechanics (Box 48-1). In other words, some means of moving and conveying objects are more effective than others.

Principles underlying proper body mechanics involve iii major factors: eye of gravity, base of operations of back up, and line of gravity.

Center of Gravity

A person's center of gravity is located in the pelvic area. This means that approximately one-half the body weight is distributed above this area, half below it, when thinking of the body divided horizontally. In addition, half the body weight is to each side, when thinking of the body divided vertically. When lifting an object, bend at the knees and hips and proceed the back direct. By doing so, the center of gravity remains over the anxiety, giving extra stability. It is thus easier to maintain balance (Fig. 48-i).

Base of Support

A person's feet provide the base of operations of support. The wider the base of support, the more stable the object, within limits (run across Fig. 48-i). (The feet must not be as well wide apart, as this would crusade instability.) The anxiety are spread sidewise when lifting, to give side-to-side stability.

BOX 48-1. Basic Principles of Body Mechanics

i. It is easier to pull, push, or ringlet an object than it is to lift it. The motility should be polish and continuous, rather than hasty.

ii. Oft less free energy or force is required to keep an object moving than it is to start and cease it.

iii. It takes less endeavour to lift an object if the nurse works as close to information technology as possible. Utilise the potent leg and arm muscles every bit much equally possible. Utilize back muscles, which are not as potent, equally little as possible. Avoid reaching.

iv. The nurse rocks backward or forward on the feet and with his or her body as a force for pulling or pushing.

Effigy 48-ane · Maintaining balance. (A) The distance between this person'south feet (base of back up) is small, and the heaviest part of his body (middle of gravity) is far away from the base of support, making him more than probable to lose residue. (B) By increasing the altitude between his feet and lowering his body toward the basis, the person has increased power to maintain side-to-side balance. His right foot is slightly in front end of the left, for back-to-front stability.

One foot is placed slightly in front of the other for dorsum-to-front stability. The weight is distributed evenly betwixt both feet. The knees are flexed slightly, to absorb jolts. The anxiety are moved to turn the object existence moved. (It is important not to twist the body.)

Line of Gravity

Draw an imaginary vertical (upwards and downwardly) line through the top of the head, the center of gravity, and the base of support. This becomes the line of gravity, or the gravital aeroplane (Fig. 48-two). This is the management of gravitational pull (from the tiptop of the caput to the anxiety). For highest efficiency, this line should exist straight from the top of the head to the base of operations of support, with equal weight on each side. Therefore, if a person stands with the dorsum straight and the head erect, the line of gravity will exist approximately through the centre of the torso, and proper body mechanics will be in place.

When the body is held in proper alignment, the back is in a "neutral

Effigy 48-2 · When the torso is held in proper alignment, the back is in a "neutral" position, with the curve of the lower spine intact.

Body Alignment

When lifting, walking, or performing any body activity, proper body alignment is essential to maintain residue. When a person'southward trunk is in correct alignment, all the muscles work together for the safest and most efficient movement, without musculus strain. Stretching the torso as tall as possible produces proper alignment. This can exist accomplished through proper posture (come across Fig. 48-2). When standing, the weight is slightly forwards and is supported on the outside part of the feet. Again, the head is erect, the back is straight, and the abdomen is tucked in. (Remember that the client in bed should be in approximately the aforementioned position as if he or she were continuing [Fig. 48-iii].)

Figure 48-3 · When a person is in proper alignment, an imaginary directly line can exist fatigued connecting the person's nose, breastbone (sternum), and pubic bone. Alignment in bed should be approximately the same equally when standing. (A) Proper body alignment for a person lying on the dorsum (supine). (B) Proper body alignment for a person lying on the side (lateral). (C) Proper trunk alignment for a person lying on the stomach in bed (prone). A modest pillow or folded towel should exist placed under the shoulder toward which the head is turned.

POSITIONING THE CLIENT

Encouraging clients to move in bed, get out of bed, or walk serves several positive purposes. Clients may be reluctant to move or may stay in bed unnecessarily. This immobility tin contribute to a number of disorders, among which are force per unit area ulcers, blood clots, constipation, musculus weakness and atrophy, pneumonia, joint deformities, and mental disorders. Past assisting clients to maintain or regain mobility, yous promote self-intendance practices and assist to prevent these complications (Fig. 48-4).

It is important to exercise good torso mechanics when lifting and moving clients. In this way, the nurse prevents injury to self and client (Fig. 48-five).

Moving and Positioning Clients

At that place are many reasons to change the client'south position, including promoting comfort, restoring torso role, preventing deformities, relieving pressure level, preventing muscle strain, stimulating proper respiration and circulation, providing diversion, and giving nursing treatments. In Practice: Nursing Intendance Guidelines 48-1 gives tips on positioning clients for their maximum comfort.

Information technology is important to explain to the client why his or her position is being inverse and how it volition be done. The client's understanding is important because he or she will exist more likely to maintain the new position. If he or she can aid, explain how. The client's assistance will save strain on the nurse and will give the client some exercise, increase independence and self-esteem, and instill a feeling of control.

Sometimes turning the client is such an important office of treatment that the provider specifies how frequently to do it. This consideration is especially important for older or immobile clients. Some conditions practise non permit turning the client, such as fractures that require traction appliances. In other weather, such as unstabilized spinal injuries, turning may be harmful. In almost other atmospheric condition, turning is helpful and encouraged.

In some situations, the client is turned just to wash or rub the dorsum; to assess skin condition, wounds, or dressings; or to change the bed linens. Some clients may not be allowed or able to turn at all and must remain in a supine position. If this is the instance, and the client is physically able, the nurse may ask him or her to pull upward slightly on the overhead trapeze to provide back care and other interventions as needed. If the client is able to help motion himself or herself, explain what he or she tin do and why it is important. Encourage the customer to help as much as possible.

Key Concept It is important to give meticulous pare care to the person who must remain on his or her back. If the person can pull upward off the bed, the nurse can wash and gently massage the back with the hand held flat. This helps to prevent skin breakdown. In other situations, a special bed is often used (encounter Chap. 49).

There are many dangers to the immobile client.

Effigy 48-4 · There are many dangers to the immobile client.

Special beds operate in different ways to relieve pressure and provide dorsum support. Although non commonly used, in some cases, the client who cannot turn is placed in a circumvolve bed, which rotates the customer from head to toe, or on a Stryker (wedge) turning frame, which rotates the client from side to side. More commonly, the client is placed in a rotating or oscillating bed (eastward.g., the Roto-Rest), a flotation bed, or other special type of bed.

Nursing Alert Be sure to asking assistance from another person if the customer is heavy or if you are unsure that you can move the person by yourself. It is also important to exist sure y'all know how to apply special equipment for moving and lifting clients before use.

Positioning for Examinations and Treatments

The client is sometimes helped into a special position equally part of a handling or exam. Many dissimilar positions are used for concrete examinations, nursing treatments and tests, and to obtain specimens. Considering nurses assistance clients into some of these positions and volition encounter other positions used, it is of import to know how to assist the client and how to place the necessary drapes. Of import client positions are supine (dorsal recumbent—lying on the back), prone (lying on the abdomen), Sims' (semi-prone—lying on the side [normally the left]—with the upper knee flexed), Fowler's (lying on the dorsum, with the head elevated), knee-chest or genupectoral (lying on the knees, with the chest resting on the bed), dorsal lithotomy (lying on the dorsum, with the feet in stirrups), and lateral (lying on the side). The supine position may exist modified by bending the knees and placing the feet flat on the bed. Trendelenburg's (the caput-downward position—lying with the head lower than the anxiety)—is used to treat shock, by promoting blood menses to the brain. This position is also used for some portions of postural drainage, to assist drain secretions from item segments of the lungs. Opposite Trendelenburg'southward position may be used to raise tube feeding and as an emergency procedure to help stop bleeding in a head injury (see Chap. 43). Ii other, less commonly used positions are the modified standing position (continuing while bending over forward), and the position used for lumbar puncture. Special positioning is shown in Tabular array 48-1.

Lifting techniques using good body mechanics. Use long, strong muscles of arms and legs. Hold the object so the line of gravity falls within the base of support. Keep the back straight and the load close to the body. Ask for assistance, if necessary.

Figure 48-five · Lifting techniques using good body mechanics. Utilize long, strong muscles of arms and legs. Hold the object and so the line of gravity falls within the base of operations of support. Keep the back straight and the load close to the body. Ask for assistance, if necessary.

The following measures are carried out before draping the client for examination:

• The client is asked to empty the bladder, unless contraindicated. Rationale: This helps the person feel more relaxed and helps the examiner to better palpate the area being examined. (In some cases, a full bladder aids in the examination.)

IN Do :NURSING CARE GUIDELINES 48-ane

POSITIONING THE CLIENT FOR Comfort

• Maintain functional client torso alignment. (Alignment is similar whether the customer is continuing or in bed.)

• Maintain customer safety.

• Reassure the client, to promote comfort and cooperation.

• Properly handle the client's trunk, to prevent pain or injury

• Follow proper body mechanics, to protect yourself and the client.

• Obtain help, if needed, to move heavy or immobile clients.

• Follow specific provider's orders.

• Remember that a specific order is needed for a client to exist out of bed.

• Do non employ special devices (eg, splints, traction) unless ordered and trained to employ this equipment.

• Make certain the client is comfortable and has the nurse signal cord available afterward positioning.

• A urine specimen is collected, as ordered.

• The client is encouraged to defecate before most examinations, particularly a rectal examination.

• The client is provided with an test gown and/or bathroom towel to cover the chest and perineal area.

• A bath blanket or sheet is provided for warmth and privacy. In some cases, a minor pillow is provided.

• The test procedure is explained to the customer.

• The torso is draped appropriately for client privacy and examiner'due south access.

• Appropriate lighting is provided for the examiner.

• Needed equipment and supplies are prepared earlier the examination begins.

• The nurse stays with the customer during the test.

• Examiner and nurse wash or sanitize their easily before and after any test.

• Gloves are worn in many cases.

• Other personal protective equipment is worn when needed.

• A signed release is obtained from the client when needed.

• The nurse observes, in order to certificate the process and to maintain client prophylactic and confidentiality. In addition, the nurse provides comfort to the client and answers questions.

• After the examination, the nurse assists in disposing of equipment and supplies and readying the examination room for the adjacent exam.

• The nurse needs to know why the examination is beingness washed so the client's questions can be answered and to anticipate problems that might arise.

Tabular array 48-ane. Customer Positions

POSITION	COMMENTS	USES
	Back-lying, legs extended or slightly bent. Arms up or down. Minor pillow allowed. May be uncomfortable for client with back problem.	General examination; exam of breast, abdomen, pelvic area.
	On belly, head to side. Artillery above head or beside trunk. (Small pillow or folded towel may exist placed under shoulder toward which head is turned. Difficult for pregnant adult female, obese client, or client with abdominal incision or breathing problem.	Examination of spine, back. (Long time in this position may cause cervix strain and/or headache.)
	Side-lying, bottom arm behind or in front of client, not equally extreme equally Sims'. Pillow placed nether top leg for support. Comfy for longer time than decumbent.	Client positioned for extended rest periods.
	Side-lying (usually left side), upper knee flexed sharply, bottom arm backside body. Pocket-size pillow immune under head. Pillow may be placed under top leg. Difficult for client with arthritis or leg injuries.	Rectal test; procedures such as colonoscopy or enema.

Tabular array 48-i. Client Positions Continued

POSITION	COMMENTS	USES
	Supine, with head raised. Semi-Fowler'south (xxx°-45°); loftier Fowler'south (nearly vertical). Knees elevated slightly. Watch for dizziness or faintness.	Promotes drainage; assists with breathing; preparation for dangling or walking.
	Loftier Fowler's, leaning on overbed table, arms outstretched, head held up or turned to side on pillows.	Facilitates breathing in client with severe cardiac or respiratory disorders. Can be used for ar extended length of time.
	Client on knees with chest resting on bed. Arms above caput or to the side; head turned to side. Thighs directly upward and downward; lower legs flat on bed. Client may become lightheaded; do not leave alone.	Rectal or vaginal examination; treatment to bring retroflexed uterus into normal position.
	Supine, with legs separated, knees acutely flexed, hips at end of examination table, and feet in stirrups.	Pelvic or perineal exam.

Tabular array 48-ane. Client Positions Continued


POSITION	COMMENTS	USES
	Standing, with chest, head, and arms on table.	Prostate exam.
	Lying on right side, knees and head flexed every bit sharply equally possible; back exposed. Held in position past healthcare worker	Lumbar puncture for examination of spinal fluid, spinal anesthesia, specific drug assistants
	Caput lower than feet. (May be simulated using pillows under anxiety in emergency.) Place pillow betwixt customer's head and headboard of bed.	Treatment of stupor, fake using drainage, promoting venous return.
	Head college than feet. Place pillow between client's anxiety and footboard of bed.	To facilitate tube feedings, emergency treatment in astringent bleeding, head injury

The hand roll (a rolled washcloth or commercially prepared hand roll) helps prevent contractures of the fingers.

Figure 48-six · The manus roll (a rolled washcloth or commercially prepared hand roll) helps forbid contractures of the fingers.