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Role of the Skeletal System in reference to activity/mobility: 
= framework of bones, joints and cartilage
- *Supports the soft tissue (maintains form and posture)
- *Protection (brain, spinal cord, heart)
- *Furnishing surfaces for attachment of muscles/tendons/ligaments
- *Producing Blood Cells
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Role of the Muscular System in reference to activity/mobility:
- *Provides movement by contraction of its cells
- *Motion
- *Mantaining Posture
- *Heat Production
- (1) Smooth Muscle
- (2) Skeletal Muscle
- (3) Cardiac Muscle
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Role of the Nervous System in response to activity/mobility:
- = Stimulates muscle contractions
- *Neurons conduct impulses
- *Afferent Nervous System (ANS) conveys info from the body --> CNS
- *CNS--> Response movement
- *Efferent System conveys from CNS--> Skeletal Muscle
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The application of mechanical laws to the human body, specifically in regard to structure, function, and position of the body
Body Mechanics
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The practice of designing equipment and work tasks to conform to the capability of the worker in relation to the patient care
Patient Care Ergonomics
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Correction or prevention of disorders of the body structures used in locomotion:
Orthopedics
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Factors Affecting Movement/Alignment:
- *Growth and development
- *Stress
- *Physical Health
- *Mental Health
- *Lifestyle variables
- *Attitude
- *Fatigue
- *Weather
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Coordinated effort of the musculoskeletal and nervous systems to maintain posture, balance, and body alignment during lifting, bending, and moving
Body Mechanics
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Force that occurs opposite of a movement
Friction
...The GREATER the surface area, the GREATER the friction
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Examples of Protective Positioning for a patient:
- *Trochanter Roles= prevent external rotation
- *Foot boards= prevent "foot drop"
- *Cradle
- *Sandbags
- *Hand-wrist splints
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Types of Joint Movements:
- Abduction = away from body
- Adduction = toward body
- Flexion = bent
- Extension
- Rotation
- Supination
- Pronation
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What kind of muscles are used when moving a patient?
Longest and Strongest of the Arms and Legs
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What do you use to stabilize the pelvis and to protect the abdominal viscera when stooping, reaching, lifting, or pulling??
Internal Girdle
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Postioning Patients with:
- Adjustable Bed
- Side rails
- Trapeze bars
- Pillows
- Matresses
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What should you (as the nurse) teach the family and patient about their positioning?
›Correct position techniques
›Change position frequently
›Time schedule
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Fowler's Position:
40-90 degrees
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Variables leading back to INJURY:
Uncoordinated lifts
Height-weight differential among lifters
Lifting when fatigued
Lifting after recent recovery from back injury
Lack of training in body mechanics
Standing for long periods of time
Transferring patients
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Liting Techniques:
1.1st assess
2.Medicate if necessary
3.Verify orders
4.Raise bed, lower side rails (if appropriate)
5.Remove all pillows
6.Obtain extra help if needed
- 7. Adjust tubes, poles, catheters
- 8.Lower HOB to lowest position
- 9.Tighten
- stomach muscles and tuck pelvis
- 10.Bend at
- the knees- let the legs do the lifting
- 11.Keep the
- weight to be lifted as close to the body as possible
- 12.Maintain
- the truck erect and the knees bent
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Transfer Techniques:
Assess
Move immobile client up in bed
Assist client move up in bed (one or two nurses)
- Move immobile client up in bed with draw sheet or pull
- sheet (two nurses)
Position client in supported Fowler’s position
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Turning a Patient:
1.Gather any positioning aids or supports, if necessary.
2.Identify the patient. Explain the procedure to the patient.
3.Perform hand hygiene and put on gloves, if necessary.
4.Close the room door or curtains. Place the bed at an appropriate and comfortable working height.
- 5.Adjust the head of the bed to a flat position or as low as the patient can tolerate. Place pillows, wedges, or any other supports to be used for positioning within
- easy reach.
6.Lower the side rail nearest you if it has been raised. If not already in place, position a friction-reducing sheet or drawsheet under the patient.
- 7.Using the friction-reducing sheet or drawsheet, move the patient to the edge of the bed, opposite the side to which he or she will be turned. Raise side rail and move to the opposite side of the bed.
- 8.Stand on the side of the bed toward which the patient is turning. Lower the side rail nearest you.
- 9.Place the patient’s arms across his or her chest and cross
- his or her far leg over the leg nearest you.
10.Stand opposite the patient’s center with your feet spread about shoulder width and with one foot ahead of the other. Tighten your gluteal and abdominal muscles and flex your knees. Use your leg muscles to do the pulling.
11.If available, activate the bed mechanism to inflate the side of the bed opposite from where you are standing.
12.Position your hands on the patient’s far shoulder and hip, and roll the patient toward you, or you may use the friction-reducing sheet or drawsheet to gently pull the patient over on his or her side.
13.Use a pillow or other support behind the patient’s back. Pull the shoulder blade forward and out from under the patient.
14.Make the patient comfortable and position in proper alignment, using pillows or other supports under the leg and arm as needed. Readjust the pillow under the patient’s head. Elevate the head of the bed as needed for comfort.
15.Place the bed in the lowest position, with the side rails up. Make sure the call bell and other necessary items are within easy reach.
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Moving a patient UP in bed (assisted):
1.Identify the patient. Explain the procedure to the patient.
2.Perform hand hygiene and put on gloves, if necessary.
3.Close the room door or curtains. Place the bed at an appropriate and comfortable working height. Adjust the head of the bed to a flat position or as low as the patient can tolerate. Placing the bed in slight Trendelenburg position aids movement, if the patient is able to tolerate it.
4.Remove all pillows from under the patient. Leave one at the head of the bed, leaning upright against the headboard.
5.Position at least one nurse on either side of the bed, and lower both side rails.
6.If a friction-reducing sheet or drawsheet is not in place under the patient, place one under the patient’s midsection.
7.Ask the patient (if able) to bend his or her legs and put his or her feet flat on the bed to assist with the movement.
- 8.Have the patient fold the arms across the chest. Have the
- patient (if able) lift the head with chin on chest.
- 9.Position yourself at the patient’s midsection with your feet spread shoulder width apart and one foot slightly in front of the other.
10.If available on bed, engage mechanism to make the bed surface firmer for repositioning.
11.Fold or bunch the drawsheet close to the patient before grasping it securely and preparing to move the patient.
12.Flex your knees and hips. Tighten your abdominal and gluteal muscles and keep your back straight.
- 13.Shift your weight back and forth from your back leg to your front leg and count to three. On the count of three, move the patient up in bed. If possible, the patient can assist with the move by pushing with the legs. Repeat the process if necessary to get the patient to
- the right position.
14. Assist the patient to a comfortable position and readjust the pillows and supports as needed. Return bed surface to normal position, if necessary. Raise the side rails. Place the bed in the lowest position.
15. Remove gloves if used and perform hand hygiene.
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Log Roll
Spinal injuries, recovering from neck, back, or spinal surgery
Keep body in straight alignment
Two or three nurses
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RESTRAINTS
=Physical device used to limit a patient’s movement.
Physical restraints
›Side rails
›Geriatric chairs with attached trays
›Appliances tied at the wrist, ankle, or waist
›Hand mitten
Chemical restraints
›Drugs used to control behavior
- (Last resort
- Family must be notified
- Alternative methods first
- Alert physician that restraint is needed
- Order must include type, justification, and criteria removal, and duration of use.
- Assess Q1-2 hours depends on hospital policy and patient need
- Remove Q2 hours and perform ROM -also depends on hospital policy and patient need)
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Restraint Hazaards
Danger of suffocation
Impaired circulation
Altered skin integrity
Pressure ulcers and contractures
Decrease muscle and bone mass
Fractures
Altered nutrition and hydration
Aspiration and breathing difficulties
Incontinence
Change in mental status
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Alternatives to Restraints:
›Rule out causes for agitation
›Ask family to stay
›Use night light
›Assist with toileting
›Divisional activities
›Relocate patient’s room
›Use alternative restraints:
(Ambularm & Floor mats)
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When Applying Restraints....Remember to:
Two fingers between restraint and skin
Quick release knot
Secure to bed frame, not side rails
Assess patient Q1 hour
Remove Q2 hours
›Perform ROM
›Assess skin
›Early release
›Offer bathroom
›Offer hydration and food
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