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Chapter 15 Body Mechanics and Patient Mobility Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Using Appropriate Body Mechanics Body Mechanics Field of physiology that studies muscular action and the function of muscles in maintaining the posture of the body The musculoskeletal system must be protected to

prevent injury to the patient and the nurse. Maintain a wide base of support. Bend the knees and hips rather than the back. Stand in front of the object. Adjust the working level to one of comfort. Carry objects close to the midline of the body. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 2

Figure 15-1 (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.) Good position for body mechanics. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 3 Figure 15-2 (From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.) Picking up a box using good body mechanics. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 4 Positioning Patients There are many positions to use to prevent patients from developing complications. Dorsal (supine) Lying horizontally on the back Dorsal recumbent Supine position with patient lying on back, head, and shoulders, with extremities moderately flexed, legs may be extended

Fowlers Head of bed raised 45 to 60 degrees Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 5 Skill 15-1: Step 9a (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: Essentials for practice. [5th ed.]. St. Louis: Mosby.) Positioning patients.

Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 6 Skill 15-1: Step 9c Positioning patients. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 7 Skill 15-1: Steps 9e, 9f (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Positioning patients. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 8 Skill 15-1: Step 9g (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: Essentials for practice. [5th ed.]. St. Louis: Mosby.) Positioning patients. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 9 Skill 15-1: Step 9h

(From Potter, P.A., Perry, A.G. [2003]. Basic nursing: Essentials for practice. [5th ed.]. St. Louis: Mosby.) Positioning patients. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 10 Skill 15-1: Step 9i (From Seidel, H.M., Ball, J.W., Dains, J.E., Benedict, G.W. [2003]. Mosbys guide to physical examination. [5th ed.]. St. Louis: Mosby.) Positioning patients. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 11 Skill 15-1: Step 9j Positioning patients. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 12 Positioning Patients Semi-Fowlers Head of bed raised approximately 30 degrees

Orthopneic Sitting up in bed at 90-degree angle, sometimes resting forward supported by pillow on overbed table Sims Lying on side with knee and thigh drawn upward toward chest Prone Horizontal position when lying face down

Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 13 Positioning Patients Knee-chest Patient kneels; weight of body supported by knees and chest, with abdomen raised, head turned to one side, and arms flexed Lithotomy

Lying supine with hips and knees flexed and thighs abducted and rotated externally Trendelenburg Head low and body and legs elevated on an incline Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 14 Mobility versus Immobility Mobility

A persons ability to move around freely in his or her environment Serves Many Purposes Express emotion Self-defense Attain basic needs Perform recreational activities Perform activities of daily living (ADLs)

Maintain bodys normal physiological activities Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 15 Mobility versus Immobility Immobility Inability to move around freely Complications of Immobility

Muscle and bone atrophy; contractures; pressure ulcer Constipation; urinary tract infection Disuse osteoporosis; kidney stones Pneumonia; pulmonary embolism; postural hypotension Anorexia; insomnia Asthenia Disorientation Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 16 Figure 15-3 (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: Essentials for practice. [5th ed.]. St. Louis: Mosby.) Trochanter roll. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 17 Figure 15-4 (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: Essentials for practice. [5th ed.]. St. Louis: Mosby.)

Hand roll. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 18 Performing Range-of-Motion Exercises Range-of-Motion (ROM) Any body action involving the muscles and joints in natural directional movements Exercises may be performed by physical therapy

department personnel or by the nurse and allied staff. Exercises are indicated for patients confined to bed for long periods. Exercises may be performed passively by nurses or actively by patients. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 19 Performing Range-of-Motion Exercises The total amount of activity required to prevent physical disuse syndrome is only about 2 hours for every 24-hour period.

Designated body joints are moved to the point of resistance or pain, using care to avoid injury. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 20 Performing Range-of-Motion Exercises Joint Range-of-Motion Exercises Neck and cervical spine

Flexion Extension Hyperextension Lateral flexion Rotation Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 21 Performing Range-of-Motion Exercises

Joint Range-of-Motion Exercises Shoulder Flexion Extension Hyperextension

Abduction Adduction Internal rotation External rotation Circumduction Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 22 Performing Range-of-Motion Exercises Joint Range-of-Motion Exercises Elbow

Flexion Extension Hyperextension Forearm Supination Pronation Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23 Performing Range-of-Motion Exercises

Joint Range-of-Motion Exercises Wrist Flexion Extension Hyperextension Radial flexion Ulnar flexion

Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24 Performing Range-of-Motion Exercises Joint Range-of-Motion Exercises Fingers

Flexion Extension Hyperextension Abduction Adduction Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 25 Performing Range-of-Motion Exercises Joint Range-of-Motion Exercises Thumb

Flexion Extension Abduction Adduction Opposition Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 26

Performing Range-of-Motion Exercises Joint Range-of-Motion Exercises Hip Flexion

Extension Hyperextension Abduction Adduction Internal rotation External rotation Circumduction Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27 Skill 15-2: Step 8 (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Performing range-of-motion exercises. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 28 Performing Range-of-Motion Exercises Joint Range-of-Motion Exercises Knee Flexion Extension

Ankle Dorsiflexion Plantar flexion Foot Inversion Eversion Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 29 Performing Range-of-Motion

Exercises Joint Range-of-Motion Exercises Toes Flexion Extension Abduction Adduction Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 30 Moving the Patient Moving includes lifting the patient up into bed, to the side of the bed, to the tub, and into a car. Moving also includes turning, dangling, and assisting the patient in and out of the bed for ambulation. Mechanical Equipment for Lifting Patients Hydraulic lift Roller board

Gurney lift Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 31 Figure 15-5 (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: Essentials for practice. [5th ed.]. St. Louis: Mosby.) Patient using a trapeze bar. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 32

Figure 15-6, A-C (From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.) A, The lift is over the patient. B, The sling is attached to a swivel bar. C, The lift is raised until the sling and patient are off of the bed. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 33 Figure 15-6, D-E (From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.) D, The patients legs are supported as the patient and lift are moved away from the bed. E, The patient is guided into a chair.

Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 34 Moving the Patient Lift twice Once mentally and then once physically Be certain to have sufficient assistance. Assess patients ability to assist with moving. If moving may be painful for the patient, the nurse will want to administer medication to the patient before any such activity.

Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 35 Skill 15-3: Steps 9g(2), 9g(4) (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.) (From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.) Moving the patient. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 36 Skill 15-3: Step 12e

(From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.) Moving the patient. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 37 Skill 15-3: Steps 13c, 13f (From Potter, P.A., Perry, A.G. [2003]. Basic nursing: Essentials for practice. [5th ed.]. St. Louis: Mosby.) Moving the patient. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 38 Skill 15-3: Step 13j(7) (From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.) Moving the patient. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 39 Skill 15-3: Step 13j(8) (From Sorrentino, S.A. [2004]. Assisting with patient care. [2nd ed.]. St. Louis: Mosby.) Moving the patient.

Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 40 Skill 15-3: Step 14f (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.) Moving the patient. Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 41 Using the Lift for Moving Patients Mechanical devices, such as the hydraulic lift used

with a Hoyer sling, will Move patients safely Protect the nurses back Provide full-weight lifting of patients who cannot assist Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 42

Nursing Process Nursing Diagnosis Impaired physical mobility Mosby items and derived items 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 43

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