Chapter 8 Body Mechanics and Patient Mobility All

Introduction to Body Mechanics and Patient Mobility Must be learned by nursing personnel to prevent injury Back injuries rank second in occupational injuries All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 2

Introduction to Body Mechanics and Patient Mobility cont’d Evidence-based practice Safe-lift programs Ø Application to nursing practice Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 3

Introduction to Body Mechanics and Patient Mobility cont’d Life span considerations (older adults) Ø Mobility • Skin fragile • Support joints when moving in bed • Lose flexibility and joint mobility • Weakness • Orthostatic hypotension • Altered sensory perception All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 4

Introduction to Body Mechanics and Patient Mobility cont’d Using proper body mechanics Protects large muscle groups from injury Ø Provides safety Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 5

Body Mechanics Area of physiology that studies muscle action and how muscles function in maintaining the posture of the body and prevention of injury during activity Principles of body mechanics Maintain appropriate body alignment Ø Maintain wide base of support Ø Bend knees and hips Ø Do not bend from waist Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 6

Mobility Versus Immobility Mobility Ability to move around freely Ø Purposes • Exercise • Express emotions • Attain basic needs • Perform recreational activities • Completing activities of daily living (ADLs) Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 7

Mobility Versus Immobility cont’d Immobility Inability to move around freely Ø Complications of immobility • Muscle atrophy and asthenia (muscle weakness) • Contractures • Osteoporosis • Pressure ulcer • Constipation • Pneumonia, pulmonary embolism Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 8

Mobility Versus Immobility cont’d Assistive devices Pillows Ø Foot boots Ø Trochanter rolls Ø Sandbags Ø Trapeze bars Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 9

$Question 1 A patient was admitted to the hospital with a fractured hip. Which$

Question 1 A patient was admitted to the hospital with a fractured hip. Which are complications of immobility? (Select all that apply. ) 1. 2. 3. 4. Pneumonia Embolus Pressure ulcer Fever All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 10

Positioning Dorsal – lying flat on back Dorsal recumbent – supine lying on back, head, and shoulder with extremities moderately flexed Fowler’s – head of bed is raised 45 -60 degrees Semi-Fowler’s – head of bed raised 30 degrees All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 11

Positioning cont’d Orthopneic – sitting up in bed at 90 -degree angle or sometimes resting in forward tilt while supported by pillow on overbed table Sims’ – lying on side with knee and thigh drawn toward chest Prone – lying face down in horizontal position All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 12

Positioning cont’d Knee-chest (genupectoral) – kneels so weight of body is supported by knees and chest, abdomen raised, head turned to one side and arms flexed Lithotomy – lying supine with hips and knees flexed, thighs abducted and rotated externally Trendelenburg’s – head is low, body and legs are on inclined plane Lateral All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 13

Question 2 A patient has a nasogastric (NG) tube and is receiving tube feedings. While in bed, the patient is to be kept in what position? 1. 2. 3. 4. Fowler’s Semi-Fowler’s Supine Dorsal All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 14

Neurovascular Assessment CSM Neurovascular function or circulation Ø Movement Ø Sensation Ø LPN/LVNs check skin color, temperature, movement, sensation, pulses, capillary refill, and pain Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 15

Neurovascular Assessment cont’d Compartment syndrome Ø Symptoms • Muscle pain • Paresthesia (tingling and burning or feeling of pins and needles in affected area) • Numbness and paralysis Ø Causes • Repetitive movements during exercise All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 16

Range-of-Motion Exercises [ROM] Movement of the body that involves the muscles and joints in natural directional movements Active – performed by patient Passive – performed by caregivers All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 17

Range-of-Motion Exercises cont’d Neck and cervical spine Ø Shoulder Ø Flexion, extension, hyperextension, lateral flexion, rotation Flexion, extension, hyperextension, abduction, adduction, internal and external rotation, circumduction Elbow Ø Flexion, extension, hyperextension All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 18

Range-of-Motion Exercises cont’d Forearm Ø Wrist Ø Supination, pronation Flexion, extension, hyperextension, radial and ulnar flexion Fingers Ø Flexion, abduction, adduction All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 19

Range-of-Motion Exercises cont’d Thumb Ø Hip Ø Flexion, extension, abduction, adduction, opposition Flexion, extension, hyperextension, abduction, adduction, internal and external rotation, circumduction Knee Ø Flexion, extension All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 20

Range-of-Motion Exercises cont’d Ankle Ø Foot Ø Dorsiflexion, plantar flexion Inversion, eversion Toes Ø Flexion, extension, abduction, adduction All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 21

Question 3 When performing range-of-motion wrist exercises, the nurse can put the wrist through all movements except: 1. 2. 3. 4. flexion. hyperextension. adduction. All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 22

Life Span Considerations (Older Adult) Inadequate calcium intake Fear of falling Depression Arthritic Chronic illness All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 23

Continuous Passive Motion Machines Machine that flexes and extends joints to passively mobilize them Prevents complications Ø Joint contracture, atrophy of muscles, thromboembolism All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 24

Moving the Patient Assist patient with moving Assist with ambulation Using a lift All

Nursing Process for Mobility Assessment Foci of ROM, muscle strength, activity tolerance, gait, posture Ø Observe for fatigue, muscle strength, ROM Ø Assistance needed for transfers Ø All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 26

Nursing Process for Mobility cont’d Nursing diagnosis Expected goals and planning Implementation Evaluation All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 27

Question 4 An implementation a nurse may use to improve safety in transferring a patient is: 1. 2. 3. 4. weighing the patient first. using a gait belt. putting shoes on the patient. supporting a flaccid arm. All items and derived items © 2015, 2011, 2006 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 28