BODY MECHANICS and TRANSFERRING PATIENT

Rhenier S. Ilado RN

BODY MECHANICS

} It is the coordinated use of the body parts to produce motion and maintain their equilibrium in relation to the skeletal, muscular and visceral systems and their neurological association } The term used to describe the efficient, coordinated and safe use of the body to move objects and carry out the activities of daily living } MAJOR PURPOSE facilitates the safe and efficient use of appropriate muscle groups to maintain balance, reduce the energy required, reduce fatigue and decrease the risk of injury

} BODY BALANCE depends on the following: 1. Center of Gravity lowered b flexing the hips and knees leading to squatting position 2. Line of Gravity lowered closer to the base of support 3. Base of Support widened by spreading the feet together apart } The closer the line of gravity to the center of the base of support, the greater the persons stability } The broader the base of support and the lower the center of gravity, the greater the stability and balance

PURPOSES

} To maintain good body posture } To promote good physiological functions of the body } To use the body correctly and to maintain its effectiveness } To prevent injury or limitation of movement of the musculoskeletal system

PROCEDURE
1. STANDING a. Stand erect with head upright, face forward, shoulders squared, back straight, abdominal muscles tucked in straight at sides with palms forward b.Keep feet 3-4 inches apart for wide basic support. Place equal weight on both legs to minimize strain on weight bearing joints c. Good posture requires that the body weight be balance on relation to the spine and the center of gravity

2. SITTING a. Position the buttocks against the back of the chair. Hips and knees are flexed at right angle to the trunk b.Keep trunk and head as in standing position c. Place feet flat on the floor at a 90 degree angle to the lower legs d.If the chair has arms, flex the elbows and place the forearms on the armrest to avoid shoulder strain

3. WALKING a. Stand erect with chest up b.Step with one foot forward c. Walk with normal strides and see to it that the feet are parallel in a heel to toe gait. Arms should be relaxed

4. LIFTING a. Stoop or squat to lift any object that is below the level of your hips b.Widen your feet to increase your base of support c. Move close in the object before you lift. Keep it close to your body as you lift or carry it d.Dont lift and twist your back at the same time. Instead, pivot on your feet when you need to turn

5. PUSHING AND PULLING a. Crouch and face the object b. Use your arms and legs to push/pull, push with arms partially bend c. Push/pull in a straight line, your force should be parallel to the floor d. Be certain, there are no objects in your path and doorways are wide enough for the object to pass through e. Move objects by pushing, pulling, sliding or rolling rather than lifting it when possible. Pushing is better than pulling. When pushing, enlarge base of support by moving your front foot forward. When pulling, enlarge base of support by moving one foot backward

6. CARRYING a. Carry all objects by holding close to your body. The best position is in front of the body and at the level of your waist/chest b. If you carry an object in one hand, alternate it with the other. Do not twist your back when moving the object from one to the other c. Balance the load, whenever possible d. Avoid carrying or balancing a small child in one hip

7. PIVOTING is a technique in which the body is turned in a way that avoids twisting of the plane a. Place on foot ahead of the other, raise the heels very slightly and put the body weight on the balls of the feet b.Keeping the body aligned, turn (pivot)about 90 degrees in the desired direction. the foot that was forward will now be behind

BODY MOVEMENT
ACTION 1. Start any body movement with proper alignment and balance RATIONALE Stretching creates unnecessary muscle fatigue and strain and places the lines of gravity outside the base of support, resulting in instability

2. Adjust the working area to waist level and keep your body close to the area 3. Face in the direction of the task Twisting the spinal column can produce back strain or injury

ACTION

RATIONALE

4. When moving a heavy object, This avoids torsion of the spine as keep your center of gravity as low well as increases your stability as possible and centered over and balance your base of support

5. Avoid working against gravity whenever possible

It takes less effort to slide, push or pull objects that it does to lift or carry them Helps to support the abdomen and stabilizes the pelvis thus preventing injury

6. Tighten the gluteal and abdominal muscles before lifting any object. Often referred as putting on the internal girdle

ACTION 7. Carry object close to the body and to the base of support

RATIONALE Holding objects close to the body prevents strain on the arm muscles. Body stability is enhanced if the object is close to the base of support

8. Use the palmar grip when grasping The hand muscles are larger and and lifting object stronger than the finger muscles

9. When lifting heavy objects, squat rather than stoop

Bending from the waist (stooping) to lift a heavy object load is a major cause of back strain. The squatting position uses the larger and stronger ventral and femoral muscles of the buttocks and thighs

ACTION 10. Use the bodys weight to pull or push objects

RATIONALE Body weight adds power to muscle action

11. Make your body movements smooth and rhythmic

Sudden, jerky movements expend more energy and put more strain in the muscles than controlled smooth motions

POSITIONING CLIENTS

} Positioning a client in good body alignment and changing the position regularly and systematically are essential aspects of nursing practice } Any position, correct or incorrect, can be detrimental if maintained for a prolonged period

Purposes:

} Prevents muscle discomfort } Prevents undue pressure resulting in pressure ulcers } Prevents damage to superficial nerves and blood vessels and contractures } Maintain muscle tone and stimulate postural reflexes

GUIDELINES when positioning client

1. Make sure the mattress is firm and level yet has enough support to natural body curvatures. RATIONALE: a sagging mattress, too soft or underfilled waterbed contribute to the development of hip flexion contractures and low back strain and pain 2. Ensure that the bed is clean and dry. RATIONALE: wrinkled or damp sheets increase the risk of pressure ulcer formation 3. Place support devices in specified areas according to the clients position. RATIONALE: maintain alignment and prevent stress on the clients muscles/joints

FOWLERS POSITION

} ALSO known as Semisitting position } A bed position in which the head and trunk are raised 45 to 90 degrees } A position of choice for people who have difficulty breathing and for people with heart problems because it allows greater chest expansion and lung ventilation } LOW-FOWLERS/SEMI-FOWLERS POSITION the head and trunk are raised 15 to 45 degrees } HIGH-FOWLERS POSITION the head and trunk are raised 90 degrees, knees may or may not be flexed

ORTHOPNEIC POSITION

} Client sits either in bed or on the side of the bed with an overbed table across the lap } This position facilitates respiration by allowing maximum chest expansion } Helpful to clients who have problems exhaling, because they can press the lower part of the chest against the edge of the overbed table

DORSAL RECUMBENT POSITION

} Also known as SUPINE POSITION } Client's head and shoulder are slightly elevated on a small pillow, forearms may be elevated on pillows or placed at sides.(not in supine pos.) } Also used to provide comfort and to facilitate healing following certain surgeries or anesthesia

PRONE POSITION

} The client lies on the abdomen with the head tuned to one side, hips are not flexed ADVANTAGES: 1. Allows full extension of the hip and knee joints 2. Helps to prevent flexion contractures of the hips and knees 3. Promotes drainage from the mouth and is useful for unconscious clients or those clients recovering from surgery of the mouth and throat

LATERAL POSITION

} Also known as Side-Lying position } The patient lies on one side of the body, flexing the top hip and knee and placing this leg in front of the body creating a wider, triangular base of support and stability ADVANTAGE 1. Reduces lordosis 2. Promotes good back alignment 3. Relieve pressure on the sacrum and heels in people who sits or rest in fowlers or dorsal recumbent position much of the time

SIMS POSITION

} Also known as semiprone position } Patient assumes a posture halfway between the lateral and the prone position } Lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow } Both legs are flexed in front of the client } Upper leg is acutely flexed at both the hip and the knee

INDICATION 1. Used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids 2. Used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter 3. Often used for clients receiving enemas 4. Clients undergoing examination and treatments of the perineal area 5. Used for pregnant women for sleeping 6. People with sensory or motor deficits on one side of the body

TRANFERRING CLIENTS

ASSISTING THE CLIENT TO MOVE IN BED (2 nurses)

} The nurses will frequently encounter a semi-helpless or immobilized client whose position must be changed or who must be moved up in bed } Proper use of body mechanics can enable her (and the helper) to move, lift, or transfer such a client safely and at the same time avoid musculoskeletal injury

ACTION 1. Explain the procedure to the client

RATIONALE An explanation reduces apprehension and facilitates cooperation. It also promotes the clients autonomy

2. Wash hands

Reduces transmission of microorganisms Lessens strain on nurses back muscles

3. Elevate bed to working height

4. Place draw sheets under the clients back and head

ACTION

RATIONALE

5. Place head of bed. If two Placing direction of movement nurses are assisting client, stands prevents twisting of your body at one side of bed when moving clients. This increases your balance. One foot be in the other allows you to transfer your body weight as client in moved up in bed

6. Place your feet apart 7. If possible, ask client to flex his Enables client to use his leg knees, bringing his feet close to muscle during process of actually buttocks as possible moving up in bed

ACTION 8. Instruct client to flex his neck, tilting chin toward chest

RATIONALE Prevents hyperextension of neck when moving head of bed

9. Ask client to assist in moving by using trapeze bar if available or pushing on bed surface

He uses his upper extremity muscles to elevate trunk and reduce friction when moving up in bed

10. If client, has limited upper extremity strength or mobility, place his arms across his chest

Prevents friction from arms dragging across bed surface during the movement. Friction can lead to bedsores

ACTION 11. Flex your knees and hips, bringing your forearms closer to level of the bed

RATIONALE This increases your balance and strength by bringing your center of gravity closer to client the object to be moved

12. Instruct the client to move up in bed on count of three as the nurses will lift the draw sheet

Prepares client for actual move, thus reinforcing assistance

13. Move in coordination to transfer Enables you to improve your balance as the client up toward the head of the you overcome inertia. Shifting your bed weight counteracts clients weight. When client pushes with his heels and lifts his trunk friction is reduced

ACTION 14. Reassess clients body alignment

RATIONALE Proper body alignment increases clients comfort, promotes rest, and reduces hazards of immobility

15. Elevate side rails

16. Record in nurses notes clients new position

Documents that the procedure was performed

NURSES ALERT

} The nurses must avoid dragging the patient up in bed. Dragging against the bed linen causes shearing force. With a shearing force the skin adheres to the surface of bed while the layers of subcutaneous tissue and even the bones slide in the direction of body movement. The underlying tissues capillaries are compressed and maybe severed by the pressure. This can cause bedsores

TRANSFERRING A CLIENT FROM BED TO CHAIR/WHEELCHAIR

} Transferring a client from bed to chair enables the nurse to change his surroundings as well as his position. } If the client is able to tolerate transfer to a wheelchair, the nurse can move him out of his room into other surrounding and increase his opportunities for socialization } For clients who have been on bed rest, this is one of the first activities to be assumed

ACTION 1. Inform client of the purpose and destination

RATIONALE Reduces client anxiety and increases cooperation

2. Assess client for ability to assist the transfer and for presence of cognitive or sensory deficits

Prevents orthostatic hypotension

3. Lower the height of the bed

Reduces distance clients have to step down, thus decreasing risk of injury

ACTION 4. Allow the client to dangle feet for few minutes

RATIONALE Allows time for assessing clients response to sitting, reduces possibility of orthostatic hypotension

5. Bring wheelchair/chair close to the side of the bed, facing the foot of the bed

Minimizes transfer distance

6. If wheelchair, lock its brakes and elevate foot pedals

Provide stability

ACTION

RATIONALE

7. assist client to side of bed until Guides and helps client maintain feet touch the floor balance

8. Assist the client to a standing position and provide support

Helps client stand safely and give time to assess status

9. Pivot client so clients back is toward the wheelchair

Moves client into proper position to be seated

ACTION 10. Place clients hands on the arm supports of the wheelchair

RATIONALE Allows client to gain balance and distance to sit

11. Bend at the knees, easing the Increases stability and minimizes client into a sitting position strain on back

12. Assist to maintain proper posture

Broadcast and therefore safest base of support is with client seated as far back in the seat as possible

ACTION 13. Secure safety belts (if present), place clients feet on foot pedals and release breaks

RATIONALE Ensures safety and prepares client movement

14. Record in nurses note clients safe transfer to chair

Documents the action taken

Nurses Alert: transfer of a client from bed to chair by one nurse requires assistance from the client and could not be attempted if the client is unable to help or to understand the nurses instruction

TRANSFERRING CLIENT FROM BED TO STRETCHER

ACTION 1. Inform client about desired purposes and destination RATIONALE Reduces anxiety and increases cooperation

2. Raise the height of the bed and Reduces distance. Nurses must lock brakes of bed bend, thus preventing back strain and prevents bed from moving

3. Instruct client to move to side of bed near the stretcher. Lower side rails of bed and stretcher

Decreases risk of client falling

ACTION

RATIONALE

4. Stand at outer side of stretcher Diminishes gap between bed and and push it toward bed stretcher, secures the stretcher position 5. Instruct client to move unto stretcher with assistance as needed 6. Cover client with sheet 7. Elevate side rails on stretcher and secure safety belt (if available). Release brakes of stretcher 8. Stand at head of stretcher to guide if when pushing Promotes client independence

Promotes comfort and protects privacy Prevents falls

Pushing not pulling, ensure proper body mechanics

LOGROLLING THE CLIENT

} Logrolling is used to turn a client who has a spinal cord injury; or who has had a spinal cord operation (with a prosthesis or pin). Another nurse should assist you with this procedure } EQUIPMENT: Pillows, draw sheets, wedge, extra linen as needed

ACTION

PROCEDURE

1. Determine the reason for logrolling The reason for the procedure should the client and the clients diagnosis be explained to the client

2. Raise the bed to a comfortable working level

A principle of body mechanics is to always position work at a comfortable height to prevent back strain

3. Look the wheels of the bed. Gently remove supportive devices around the client

Prevents the bed from rolling. Prepares client for position change

4. The two nurses should position themselves on opposite sides o the bed and roll the edges of the draw sheet toward the client

The nurses will grip the rolled drawsheets to roll the client

ACTION 5. With the draw sheet, slide the client to edge of the bed opposite the direction to which the client is to be turned 6. Place a pillow lengthwise between the clients legs 7. Position the clients arms. To turn the client to the right, place his or her left arm to the arm either flexed above the head or at the side. Raise the bedrails. Both nurses should move to the side of the bed that the client will turn toward

RATIONALE allows ample room for positioning the client once he or she is rolled to his opposite side Helps to maintain the correct alignment of the clients lower extremities as he or she is turned The clients arms are positioned as described to prevent injury and to make their final positioning easier

ACTION 8. One nurse should grasp the client at the clients shoulders and waist, supporting the neck. The other nurses should grasp the client at the clients buttocks and knees, supporting the legs. Roll the client all in one motion to a side-lying position

RATIONALE Allows the clients spine to remain straight and not rotate. The client is turned as a unit to prevent further spinal cord damage. Grasping the client rather than the drawsheet gives you better control of the clients body

9. Place the client's top leg at the knee and place a pillow under the knee and lower leg. A small pillow or folded lined may be placed under the head and shoulders

The client is aligned correctly to prevent any contracture and damage to the spinal cord

ACTION 10. Flex the clients top leg at the knee and place a pillow under the knee and lower leg. A small pillow or folded lined may be placed under the head and shoulders 11. Wash your hands 12. Assess the clients comfort and body alignment 13. Record the procedure time, clients response and other observations

RATIONALE Maximizes the clients comfort and provides good body alignment

Decrease the transmission of microorganism Proper body alignment aids in the clients comfort and assists in preventing complications Communicates to the other member of the health care team and contributes to the legal record by documenting the care given to the client