BODY MECHANICS AND PATIENT MOBILITY

1. BODY MECHANICS AND PATIENT MOBILITY PRINCIPLES OF BODY MECHANICS

2. 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)

3. 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 464-472, LYNN’S CLINICAL NURSING SKILLS

4. BODY MECHANICSPAGE 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

5. 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.

6. CON’T BODY MECHANICS • ASSESS THE SITUATION BEFORE ACTING • USE MECHANICAL LIFTS ANDOR ASSISTANCE TO EASE THE MOVEMENT

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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)

13. 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

14. 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

15. CON’T POSITIONING PATIENTS • IMPLEMENTATION: • VIDEO • REVIEW PHYSICIAN ORDERS • CORRECT PATIENT • HAND HYGIENE • GATHER POSITIONING AIDS OR UPPORT • PROVIDE PRIVACY • EXPLAIN THE PROCEDURE TO THE PATIENT

16. 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.

17. 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.

18. 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

19. REVIEW • QUESTIONS AND COMMENTS

20. 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)

21. 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.

22. RANGE OF MOTION EXERCISES • VIDEO

23. 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.

24. 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.

25. 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.

26. CON’T ROM • DOCUMENTATION: DOCUMENT THE EXERCISES PERFORMED, ANY SIGNIFICANT OBSERVATIONS, AND THE PATIENT’S REACTION TO THE ACTIVITIES.

27. 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

28. 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

29. 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.

30. REVIEW/ SUMMARY • QUESTIONS AND COMMENTS