Published on August 1, 2010
Slide 1: BODY MECHANICS POSITIONING & TURNING PATIENTS BODY MECHANICS : BODY MECHANICS Is the efficient, coordinated, and safe use of the body to move objects and carry out the activities of daily living. Rationale for the Use of This Skill : Rationale for the Use of This Skill A nurse engaged in clinical practice daily performs a variety of physical tasks, including reaching, stooping, lifting, carrying, pushing and pulling. With practice, using the principle of body mechanics, the nurse will move smoothly and surely, minimizing personal strain, conserving energy, and enhancing the safety, comfort, and confidence of the patients Practiced incorrectly, any of these has the potential to cause strain, fatigue, or injury to the nurse or patient. Slide 4: Major purposes: To facilitate the safe and efficient use of appropriate muscle groups To maintain balance To reduce the energy required, To reduce fatigue To decrease the risk of injury. Principles of Body Mechanics : 1. Balance is maintained and muscle strain is avoided as long as the line of gravity passes through the base of support. Principles of Body Mechanics Slide 6: Start body movement with proper alignment Stand as close as possible to the object to be moved Avoid stretching, reaching and twisting Slide 7: 2. The wider the base of support and the lower the center of gravity, the greater the stability. Slide 8: 3. Balance is maintained with minimal effort when the base of support is enlarged in the direction in which the movement will occur. Slide 9: When pushing an object, enlarge the base of support by moving the front foot forward When pulling an object, enlarge the base of support by either moving the rear leg back if facing the object or moving the front foot forward facing away from the object Slide 10: 4.Objects that are close to the center of gravity are moved with least effort. Slide 11: 5. The greater the preparatory isometric tensing, or contraction of muscles before moving an object, the less the energy required to move it and the less the likelihood of musculoskeletal strain injury Before moving objects, contract your gluteal, abdominal, leg and hip muscles to prepare them for action Slide 12: 6. The synchronized use of as many large muscle groups as possible during activity increases overall strength and prevents muscle fatigue and injury To move objects below your center of gravity, begin with the hip and knees flexed Use gluteal and leg muscles rather than the sacrospinal muscles of the back to exert an upward thrust when lifting weight Face the direction of the movement to prevent twisting of the spine Caution!!!!! : Caution!!!!! Slide 14: 7. The closer the line of gravity to the center of the base of support the greater its stability When moving or carrying objects, hold them as close as possible to the center of gravity Pull an object toward self whenever possible rather than pushing away Slide 15: 8. The greater the friction against a surface beneath an object, the greater force required to move an object. Provide a firm smooth, dry bed foundation before moving the client in bed. Slide 16: 9. Pulling creates less friction than pushing Slide 17: 10. The heavier an object, the greater the force needed to move an object. Encourage the client to assist as much as possible by pushing or pulling themselves by the use of arms as levers to increase lifting power. Slide 18: Use own body weight to counteract the weight of the object. Obtain the assistance of other persons or use mechanical devices to move objects that are too heavy. Caution !!!! “No Solo Lift” or “No Manual Lift” Slide 19: 11. Moving an object along a level surface requires less energy than moving object up an inclined surface or lifting it against the force of gravity. Pull, push, roll or turn objects instead of lifting them Lower the head of the client’s bed before moving the client up in bed. Slide 20: 12. Continuous muscle exertion can result in muscle strain and injury. Alternate rest periods with periods of muscle use to help prevent fatigue. Slide 21: . TECHNIQUES OF BODY MECHANICS Slide 22: Lifting. Use the stronger leg muscles for lifting. Bend at the knees and hips; keep your back straight. Lift straight upward, in one smooth motion. Slide 23: Pulling and Pushing When pushing, enlarge the base of support by moving the front foot forward. When pulling an object, enlarge the base of support by moving the rear back if the person is facing the object or moving the front foot forward if the person is facing away from the object. Slide 24: Pivoting Is a technique in which the body is turned in a way that avoids twisting of the spine To pivot, place one foot ahead of the other, raise the heels very slightly, and put the body weight on the balls of the feet. Keeping the body aligned, turn about 90 degrees in the desired direction. Slide 25: Positioning Client POSITIONING CLIENTS : POSITIONING CLIENTS Positioning a client in good body alignment and changing the position regularly and systematically are essential aspects of nursing practice. RATIONALE: Helps to prevent muscle discomfort, undue pressure resulting in pressure ulcers, damage to superficial nerves and blood vessels, and contractures. Maintains muscle tone and stimulate postural reflexes. When positioning clients in bed, the nurse can do a number of things to ensure proper alignment and promote client comfort and safety. : When positioning clients in bed, the nurse can do a number of things to ensure proper alignment and promote client comfort and safety. Make sure that the mattress is firm and level yet has enough give to fill in and support natural body curvatures. Rationale A sagging mattress, a mattress that is too soft, or an under filled water bed used over a prolonged period can contribute to the development of hip flexion contractures and low back strain and pain. Slide 28: Ensure that the bed is clean and dry. Wrinkled or damp sheets increase the risk or pressure ulcer formation. Make sure that extremities can move freely whenever possible. Slide 29: Place support devices in specified areas according to the client’s position. Support devices such as: pillows, mattresses, bed boards, chair beds, foot boot, foot board, etc.. Use only those support devices needed to maintain alignment and to prevent stress on the client’s muscle and joints. Slide 30: Avoid placing one body part, particularly with bony prominences, directly on top of another body part. Excessive pressure can damage veins and predispose the client to thrombus formation. Pressure against the popliteal space may damage nerves and blood vessels in this area. Slide 31: Plan a systematic 24-hour schedule for position changes Sometimes a person who appears well aligned may be experiencing real discomfort. Both appearance, in relation to alignment criteria, and comfort are important in achieving effective alignment. FOWLER’S POSITION : FOWLER’S POSITION Or a semisitting position, is a bed position in which the head and trunk are raised 45 to 90 degrees. In low-Fowler’s or semi-Fowler’s position, the head and trunk are raised 15-45 degrees. In high-Fowler’s position, the head and trunk are raised 90 degrees. ORTHOPNEIC POSITION : ORTHOPNEIC POSITION The client sits either in bed or on the side of the bed with an overbed table across the lap. Dorsal Recumbent Position : Dorsal Recumbent Position Is a back lying position, the client’s head and shoulders are slightly elevated on a small pillow, forearms maybe elevated on pillows or placed at the side. Supine or Dorsal Position : Supine or Dorsal Position Is a back lying position, the head and shoulders are not elevated. Prone Position : Prone Position The client lies on the abdomen with head turned to one side. Lateral Position (Side-lying) : Lateral Position (Side-lying) The client lies on one side of the body. Sam's Position (Semi-prone) : Sam's Position (Semi-prone) The client assumes a posture halfway between the lateral and the prone position. The lower arm is positioned behind the client, and the upper arm is flexed in the shoulder and elbow. Both legs are flexed in front of the patient, with upper leg more acutely flexed. Other positions : Other positions LITHOTOMY Position in which the patient is on their back with the hips and knees flexed and the thighs apart. The position is often used for vaginal examinations and childbirth. Slide 41: Knee-chest Position Patient is on knees with chest resting on bed and elbows resting on bed or arms above head. Head is turned to one side. Thighs are straight and lower legs are flat on bed. Used for rectal and vaginal examinations as treatment to bring uterus into normal position. Slide 42: Trendelenburg Position Client lie on the back, the head is lowered at 30 degree angle below horizontal level. Slide 43: Moving and Turning Clients in Bed Actions and rationales applicable to moving and lifting clients : Actions and rationales applicable to moving and lifting clients Before moving a client, assess the degree of exertion permitted, the client’s physical abilities and ability to assist with the move, ability to understand instructions, degree of comfort or discomfort when moving, client’s weight, presence of orthostatic hypotension, and your own strength and ability to move the client. Slide 45: If indicated, use pain relief modalities or medication prior to moving the client. Prepare any needed assistive devices and supportive equipment (pillows, trochanter roll) Plan around encumbrances to movement such as an IV or heavy cast Be alert ot the effect of any medications client must takes that may impair alertness, balance, strength or mobility Slide 46: Obtain required assistance from others. Explain the procedure to the client and listen to any suggestions the client or support people have Provide privacy Wash hands After moving the client, determined and documents the client’s comfort, body alignment, tolerance, ability to assist, use of supportive devices, and safety precautions required.