chapter 15

Movement of an extremity away from the midline of the body

Movement of an extremity toward the axis of the body

Relationship of various body parts to one another

Area on which an object rests; a stance with feet slightly apart

Physiologic study of the muscular actions and the functions of muscles in maintainingthe posture of the body

Pathologic condition caused by progressive development of arterialcompression and reduced blood supply to an extremity. Increased pressure from external devices (cast,bulky dressings) causes decreased blood flow, resulting in ischemic tissue necrosis; most often occurs inthe extremities

Abnormal usually permanent condition of a joint characterized by flexion and fixation andcaused by atrophy and shortening of muscle fibers

Lying horizontally on the back

Supine position with patient lying on the back, with head, shoulders, and extremitiesmoderately flexed and legs extended

Movement allowed by certain joints of the skeleton that increases the angle between the twoadjoining bones

Movement of certain joints that decreases the angle between two adjoining bones

posture assumed by patient when head of bed raised 45-60 degrees

Patient kneels so weight of body is supported by knees and chest

Position of maximum extension; extreme or abnormal stretching

Immobility-Inability to move around freely, caused by any condition in which movement is impaired ortherapeutically restricted

Any one of the connections between bones

Incision of a duct or organ

A personʼs ability to move around freely in his or her environment

Pertaining to the posture assumed by the patient sitting up in bed at a 90 degree angle;patient may also lean forward supported by a pillow or over a bed table

A state in which an individual is at risk for deterioration of body systems asthe result of prescribed or unavoidable inactivity

Palm of the hand turned down

Lying face down on the abdomen

Normal movement that any given joint is capable of making. Any body actioninvolving the muscles, joints, and natural directional movements

The position a patient assumes while lying in bed; the head of the bed is raised to about30 degrees, and the foot of the bed is raised slightly

Lying on the left side with the right knee and thigh drawn upward toward the chest; the chest andabdomen are allowed to fall forward

Kind of rotation that allows the palm of the hand to turn up

A position in which the patient is lying supine with the head lower than the body with bodyand legs elevated and on an incline

Workerʼs Compensation claims show that nursing personnel have the highest claim rates ofworkers in any occupation or industry. Patient handling tasks, such as lifting, transferring, andrepositioning, are the primary causes of musculoskeletal disorder (MSD) among nurses

Using Appropriate Body Mechanics:
• Body Mechanics-The field of physiology that studies muscular actions and the functions ofmuscles in maintaining the posture of the body

• Body mechanics are used daily: making beds, assisting the patient to walk, carrying supplies andequipment, lifting, providing patient care, and carrying out other procedures

• Maintaining appropriate body alignment is the key factor in proper body mechanics

• Alignment- Refers to the relationship of various body parts to each other
• Helps balance
• Helps coordinate movements smoothly
and effectively

• Maintain a wide base of support when standing

• Base of Support-A stance with feet slightly apart

• Keep the base about 1.5 times the length of your shoes

• Skeletal muscles and the nervous system maintain equilibrium, or balance, which facilitatesappropriate body alignment when lifting, bending, moving, and doing other activities

• Avoid bending from the waist because this will, in time, strain the lower back

• Work at a height or level that is comfortable and easy for you

• Most common back injury is lumbar muscle

• Adjust the height of the bed to a level appropriate for your height

• Using large muscle groups helps in performing a bigger workload more safely

• Cary objects close to the midline of your body

• Avoid reaching too far

• Avoid lifting when other means of movement are available

• Use devices instead of or in combination with lifting and use alternating periods of rest andactivity

• Never attempt more than 35% of your own body weight or >50lbs

• Assess your own abilities and limitations and that of your partner, if working in pairs

Correct Use of Body Mechanics box 15-1:

• Position feet 6 to 8 inches apart

• Align and balance weight on both feet

• Flex knees slightly

• Tilt pelvis forward by pulling buttocks inward so gluteal muscles are contracted in and down

• Contract abdominal muscles in and up

• Hold chest up

• Keep head erect

• Use appropriate body mechanics in all activities: standing, sitting, bending, and lifting

• Face your work area

• Push, slide, or pull heavy objects

• Lift twice, first mentally, and they physically

• Do not lift objects higher than chest level. Do not reach above your shoulders

Positioning Patients:

• Dorsal (supine) position: lying flat on the back; face up
• Fowlerʼs position: patient is placed in semi upright sitting position (45-60 degrees) and may haveknees either bent or straight
• Semi Fowlerʼs position: HOB is raised approximately 30 degrees: sitting position
• Simʼs position: patient lies on side with knee and thigh drawn upward toward chest
• Prone position: lying face down in horizontal position
• Lithotomy position: Patient lies supine with hips and knees flexed and thighs abducted androtated externally (sometimes feet are positioned in stirrups)Body Mechanics and Patient Mobility
• Trendelenburg position: patientʼs head is low and the body and legs are on inclined plane

Mobility Versus Immobility:
• Mobility-A personʼs ability to move around freely in his or her environment
• Mobility is fundamental to maintaining the bodyʼs normal
• Completing activities of daily living (ADLʼs)
• Immobility-The inability to move around freely
• There are various assistive devices to use to maintain correct body positioning and to helpprevent complications that commonly arise when a patient needs prolonged bed rest

Complications:
• Muscle and bone atrophy
• Contractures
• Pressure ulcer
• Constipation
• Urinary tract infection
• Disuse osteoporosis -fractures occur easily
• Renal calculi (kidney stones)
• Hypostatic pneumonia
• Pulmonary embolism
• Postural hypotension
• Anorexia
• Insomnia
• Asthenia (muscular weakness)
• Disorientation
• Thrombophlebitis

Interventions:
• Reposition at least every 2 hours
• Ensure adequate intake-encourage fluids
• Encourage a well balanced diet
• Prevent deformities
• Handle and transfer patients carefully
• Position lower extremities properly
• Early ambulation
• Anti embolism measures
• Progressive ambulation
• Roll up head of bed
• Dangle over side of bed
• Stand
• Take a few steps
• Sit in the chair
• Up to bathroom
• Up and about the room
• Up and out in the hallway
• Up as desired

During Ambulation:
• Observe the patient closely
• Encourage the patient to:
• Take slow,deep breaths
• Keep eyes open and look straight ahead
• Keep head up
• If the patient starts to fall, do not attempt to prevent the fall. Ease patient to floor.
• On a daily basis encourage the following:
• Deep breathing and coughing exercises
• Careful use of medications
• Be certain to provide the following:
• Suitable diversion
• Meticulous skin care
• Range of motion exercise
• Reality Therapy

Assistive Devices for Proper Positioning (table 15-2):
• Pillow: Provides support of body or extremity; elevates body part; splints incisional area to reducepostoperative pain during activity or coughing and deep breathing

• Foot Boots: Maintains feet in dorsiflexion

• Sandbag: Provides support and shape to body contours; immobilizes extremity; maintains specificbody alignment

• Hand Roll: Maintains thumb slightly adducted and in in opposition to fingers; maintains fingers inslightly flexed position

• Hand-wrist Splint: Individually molded for patient to maintain proper alignment of thumb; slightlyadducted in opposition to fingers; maintains wrist i slight dorsiflexion

• Trapeze Bar: Enables patient to raise trunk from bed; enables patient to transfer from bed towheelchair; allows patient to perform exercises that strengthen upper arms

• Side Rail: Helps weak patient to roll from side to side or to sit up in bed

• Bed Board: Provides additional support to mattress and improves vertebral alignment

• Wedge Pillow: Also called abductor pillow (triangular pillow made of heave foam); used tomaintain the legs in abduction following total hip replacement surgery

Performing Range of Motion Exercises:
• ROM is performed to prevent excessive muscle atrophy and joint contractures in immobilizedpatients

• ROM: Any body action involving the muscles and joints in natural directional movements

• Passive ROM: exercise is performed by caregivers

• Active ROM: exercise is performed by patient

• Passive Assisted ROM: help the patient finish the full ROM

• Active Assisted ROM: patient uses the strong arm to exercise the weaker or paralyzed arm

• Always encourage the patient to be as independent as possible

• Repeat each full sequence 5 times during the exercise period

Joint ROM Exercises (table 15-4):
• Flexion- bring chin to rest on chest
• Extension- return head to erect position
• Hyperextension- bend head back as far as possible. Use caution with older adults
• Abduction- raise arm to side to position above head with palm away from head
• Adduction- lower arm sideways and across body as far as possible
• Supination- turn lower arm and hand so that palm is up
• Pronation- turn lower arm so that palm is down
• Dorsiflexion- move foot so that toes are pointed upward.

Moving the Patient:
• Remember to lift twice
• First mentally
• Second physically
• Assess the patientʼs ability to assist with moving
• Patients are often reluctant to move if it will cause more pain for them
• Administer medication to the patient before activities tat you anticipate will fall in this category

Using The Lift For Moving Patients:

• Mechanical devices, such as the hydraulic lift used with a Hoyer sling

Nursing Process:
Assessment:
• Assessment focuses on ROM, muscle strength, activity tolerance, gait, and posture.
• Observation during ADLs enables you to estimate the patientʼs fatigability, muscle strength, andROM
• Determines the type of assistance the patient requires to change position or transfer from bed tochair, or to toilet, tub , or car
Nursing Diagnosis:• Example: Impaired physical mobility r/t activity intolerance secondary to (2 degrees) left shoulderpain
Expected Outcomes and Planning:
• Individualize care planning
• Take into consideration the patientʼs most immediate needs
• Goals are based on the nursing diagnosis formulatedImplementation:
• Individualize nursing interventions according to the level of risk to the patient
• Never attempt to life more than 35% of your own body weight
Evaluation:
• Evaluates the success of interventions by comparing the patentʼs response to the outcomeestablished for each nursing goal