Transcript BODY MECHANICS AND PATIENT MOBILITY

BODY MECHANICS AND PATIENT
MOBILITY
PRINCIPLES OF BODY MECHANICS
PRINCIPLES OF BODY MECHANICS
• OBJECTIVES:
• DEFINE THE FOLLOWING TERMS: BODY
MECHANICS, BODY ALIGNMENT, GRAVITY,
MUSCLE TONE, LEVERAGE, FRICTION, BASE
SUPPORT
• STATE THE PURPOSE FOR MAINTAINING GOOD
BODY AIGNMENT IN ALL ACTIVITIES OF DAILY
IVING (ADL)
PRINCIPLES OF BODY MECHANICS
• BODY MECHANICS: PAGES 438-439, LYNN
• POSITIONING: SKILL 9-1 ASSISTING A PATIENT
TURNING IN BED; 9-2 MOVING A PATIENT UP
IN BED WITH ASSISTANCE FROM ANOTHER
NURSE
• RANGE OF MOTION: SKILL 9-6, PAGES 464472, LYNN’S CLINICAL NURSING SKILLS
BODY MECHANICS
PAGE 438-439 LYNN
• CORRECT BODY ALIGNMENT
• FACE THE DIRECTION OF YOUR MOVEMENT (
this avoids twisting your body)
• BASE OF SUPPORT: MAINTAIN BALANCE; KEEP
SPINE IN VERTICAL ALIGNMENT, WEIGHT
CLOSE TO CENTER OF GRAVITY, AD FEET
SPREAD FOR A BROAD BASE OF SUPPORT
CON’T BODY MECHANICS
• USE OF KNEES AD THIGH MUSCLES: USE
BODY’S USCLE GROUPS AND NATURAL LEVERS
AND FULCRUMS
• USE LARGE MUSCLE GROUPS IN LEGS TO
PROVIDE FORCE OF MOVEMENT.
• KEEP BACK STRAIGHT, WITH HIPS AD KNEES
BENT.
• SLIDE, ROLL, PUSH OR PULL RATHER LIFT AN
OBJECT.
CON’T BODY MECHANICS
• ASSESS THE SITUATION BEFORE ACTING
• USE MECHANICAL LIFTS ANDOR ASSISTANCE
TO EASE THE MOVEMENT
TERMINOLOGY
• GRAVITY: THE FORCE OF ATTRACTION BY
WHICH TERRESTIAL BODIES TEND TO FALL
TWARD THE CENTER OF THE EARTH;
HAVINESS OR WEIGHT
• LEVER: A RIGID BAR THAT PIVOTS ABOUT ONE
POINT AND THAT IS USED TO MOVE AN
OBJECT AT A SECOND POINT BY A FORCE
APPLIED TO A THIRD
CON’T TERMINOLOGY
• PIVOT: A PIN, POINT, OR SHORT SHAFT ON
THE END OF WHICH SOMETHING ROTATES OR
OSCILLATES
• FULCRUM: THE SUPPORT, OR POINT OF REST,
ON WHICH A LEVER TURNS IN MOVING A
BODY
GUIDELINES FOR SAFE PATIENT
HANDLING AND MOVEMENT
• SAFETY IS PARAMOUNT
• ASSESS PATIENT AND SITUATION: PATIENT
CAPABILITIES, LIMITATIONS, ACTIVITY ORDERS,
DIAGNOSES, MEDICATIONS
• NEED FOR ASSISTIVE DEVICE OR EQUPMENT
OR ASSIST FROM ANOTHER NURSE
CON’T MOVING PATIENT SAFELY
• UNCLUTTER THE AREA
• EXPLAIN TO THE PATIENT WHAT YOU PLAN TO
DO. INVOLVE THE PATIENT AS APPROPRIATE
• GIVE AIN MEDICATION 30-60 MINUTES PRIOR
TO ACTIVITY AS NEEEDED
• LOCK THE WHEELS OF THE BED, ELEVATE THE
BED AS NEEDED FOR COMFORT AND FOR
PROPERBODY MECHANICS
CON’T MOVING PATIENT SAFELY
• MAKE SURE PATIENT IS IN GOOD BODY
ALIGNMENT
• SUPPORT THE PATIENT’S BODY WELL. AVOID
GRABBING AND HOLDING AN EXTREMITY BY
ITS MUSCLES
• USE FRICTION-REDUCING DEVICES
• MOVE YOUR BODY AND THE PATIENT IN A
SMOOTH, RHTHMIC, MOTION
CON’T MOVING PATIENT SAFELY
• USE MECHANICAL DEVICES, SUCH AS LIFTS,
SLIDES, TRANSFER CHAIRS, OR GAIT BELTS,
FOR MOVING PATIENTS
• MAKE YOU KNOW HOW TO OPERATE THE
DEVICES AND EXPLAIN TO THE PATIENT HOW
IT WORKS, AS APPROPRIATE
• ASSURE THE EQUPMENT MEETS WEIRHT
REQUIREMENT. (BMI GREATER THAN 50
REQUIRE BARIATRIC TRANSFER AID & EQUIP)
RISK OF POOR BODY MECHANICS
• STRAINS/SPRAINS
• STRAIN: TRAUMA TO MUSCLE OR
MUSCULOTENTINOUS UNIT FROM VIOLENT
CONTRACTION OR EXCESSIVE FORCIBLE
• STRAIN: TRAUMA TO LIGAMENTS
• STRETCH
• DISLOCATION
• FRACTURES
• CLIENT INJURIES
POSITIONING PATIENTS
• ASSISTING A PATIENT WITH TURNING IN BED
• UTILIZE THE NURSING PROCESS
• ASSESSMENT: PATIENT STATUS AND MOBILITY,
ACTIVITY ORDERS
• NURSING DIAGNOSIS: WHAT IS THE PATENT
NEED?
• OUTCOME IDENTIFICATON AND PLANNING: NO
INJURY TO PATIENT AND NURSE; PATIENT IS
COMFORTABLE AND IN PROPER BODY
ALIGNMENT
CON’T POSITIONING PATIENTS
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IMPLEMENTATION:
VIDEO
REVIEW PHYSICIAN ORDERS
CORRECT PATIENT
HAND HYGIENE
GATHER POSITIONING AIDS OR UPPORT
PROVIDE PRIVACY
EXPLAIN THE PROCEDURE TO THE PATIENT
CON’T POSITIONING PATIENTS
• IMPLEMRNTATION HIGHLIGHTS
• THE NURSE ON THE SIDE OF THE BED
TOWARD WHICH THE PATIENT IS TURNING
SHOULD STAND OPPOSITE THE PATIENT’S
CENTER WITH HER FEET SPREAD ABOUT
SHOULDER WIDTH AND WITH ONE FOOT
AHEAD OF THE OTHER.
• TIGHTEN YOUR GLUTEAL AND ABDOMINAL
MUSCLES & FLEX YOUR KNEES.
CON’T POSITIONING PATIENTS
• USE YOUR LEG MUSCLES TO DO THE PULLING
• THE OTHER NURSE SHOULD POSITION HIS OR
HER HANDS ON THE PATIENT’S SHOULDER
AND HIP, ASSISTING TO ROLL THE PATIENT TO
HIS SIDE.
• INSTRUCT THE PATIENT TO PULL ON THE BED
RAIL AT THE SAME TIME.
• USE THE FRICTION REDUCING SHEET TO
GENTLY PULL THE PATIENT ON HIS SIDE.
CON’T POSITIONING PATIENTS
• PLACE BED IN THE LOWEST POSITION, WITH THE
SIDE RAILS UP. MAKE SURE THE CALL BELL AND
NECESSARY ITEMS ARE WITHIN REACH.
• HAND HYGEINE
• EVALUATION: E.G. THE PATENT DEMONSTRATES
PROPER BODY ALIGNMENT AND VERBALIZES
COMFORT
• DOCUMENTATION: TIME, PT TOLERANCE,
PERTINENT OBSERVATIONS (SKIN), USE OF
SUPPORT OR AIDS
REVIEW
• QUESTIONS AND COMMENTS
RANGE OF MOTION EXERCISES
• RANGE OF MOTION (ROM) IS THE COMLETE
EXTENT OF MOVEMENT OF WHICH A JOINT IS
NORMALLY CAPABLE.
• WHEN THE PATIENT DOES THE EXERCISE FOR
HIMSELF, IT IS REFERRED TO AS ACTIVE RANGE OF
MOTION (AROM)
• EXERCISES PERFORMED BY THE NURSE WITHOUT
PARTICIPATION BY THE PATIENT IS REFERED TO AS
PASSIVE RANGE OF MOTION (PROM)
RANGE OF MOTION EXERCISES
• RANGE OF MOTION EXERCISES SHOULD BE
INITIATED AS SOON AS POSSIBLE BEDAUSE
BODY CHANGES CAN OCCUR AFTER ONLY
THREE (3) DAYS OF IMPAIRED MOBILITY.
RANGE OF MOTION EXERCISES
• VIDEO
RANGE OF MOTION EXERCISES
• HIGHLIGHTS
• UTILIZE THE NURSING PROCESS
• ASSESSMENT: PATIENT STATUS, CHECK
MEDICAL RECORDS, CHECK ORDERS,
LIMITATIONS IN MOBILITY, PAIN ASSESSMENT,
ABILITY TO PERFORM ROM. INSPECT AND
PALPATE JOINTS FOR REDNESS AND
TENDERNESS, PAIN, SWELLING, AND
DEFORMITIES.
CON’T ROM
• NURSING DIAGNOSIS: E.G. IMPAIRED BED
MOBILITY
• OUTCOME IDENTIFICATION AND PLANNING:
E.G. PATIENT MAINTAINS JOINT MOBILITY
• IMPLEMENTATION: HIGHLIGHTS
• STOP MOVEMENT IF PATIENT COMPLAINS OF
PAIN OR YOU MEET RESSISTANCE
• ENCOURAGE THE PATIENT TO DO AS MUCH BY
HIMSELF AS POSSIBLE.
CON’T ROM
• WHEN FINISHED, MAKE SURE THE PATIENT IS
COMFORTABLE, WITH SIDE RAILS UP AND THE
BED IN THE LOWEST POSITION.
• HAND HYGIENE
• EVALUATION: THE EXPECTED OUTCOME IS MET
WHEN THE PATIENT MANTAINS OR IMPROVES
JOINT MOBILITY AND MUSCLE STRENGTH, AND
MUSCLE ATROPHY AND CONTRACTURES ARE
PREVENTED.
CON’T ROM
• DOCUMENTATION: DOCUMENT THE
EXERCISES PERFORMED, ANY SIGNIFICANT
OBSERVATIONS, AND THE PATIENT’S
REACTION TO THE ACTIVITIES.
CON’T ROM
• NEXPECTED SITUATIONS:
• DURING ROM, IF THE PATIENT COMPLAINS OF
FEELING TIRED, STOP, PAUSE, RE-EVALUATE
THE PLANOF CARE. MAY NEED TO
DISCONTINUE. RE-VISIT NURSING CARE PLAN
• PAIN. STOP. NOTIFY PHYSICIAN. ROM
EXERCISES MAY NEED REVISION
CON’T ROM
• SPECIAL CONSIDERATIONS:
• MD ORDERS AND SPECIFIC INSTRUCTIOS
SHOULD BE OBTAINED FOR PATIENTS WITH
ACUTE ARTHRITIS, FRACTURES, TORN
LIGAMENTS, JOINT DISLOCATION, ACUTE
MYOCARDIAL INFARCTION, AND BONE
TUMORS AND METASTASES
CON’T ROM
• SPECIAL CONSIDERATIONS:
• AVOID NECK HYPEREXTENSION
• MUCH OLDER PATIENTS MAY NOT BE ABLE TO
ACHIEVE FULL RANGE OF MOTION IN ALL
JOINTS
• MANY OF THE ROM EXERCISES CAN BE
INCORPORATED INTO DAILY ACTIVITIES.
REVIEW/ SUMMARY
• QUESTIONS AND COMMENTS