Body Mechanics PDF

Body Mechanics Knowledge of a client’s body and how it moves is important. Knowledge of your own body and what happens to it when you care for clients with altered mobility is also important. Before you lift or move a client, determine the causes and consequences of the client’s illness and impleme...

Body Mechanics Knowledge of a client’s body and how it moves is important. Knowledge of your own body and what happens to it when you care for clients with altered mobility is also important. Before you lift or move a client, determine the causes and consequences of the client’s illness and implement the use of safe patient handling and management algorithms to determine the appropriate client moving/ transfer protocols. These guidelines also indicate the equipment needed for safe client transfer/ moving, or the need for the lift team. This knowledge enables you to move the client without causing additional discomfort. Definition of body mechanics Body mechanics is the term used to describe the efficient, coordinated, and safe use of the body to move objects and carry out the activity of daily livings (ADLs). It is the utilization of the correct muscle to complete a task safely and efficiently without undue strain to muscles or joints. Purposes To promote comfort To conserve energy To maintain good body alignment To avoid skeletal injury To prevent excessive fatigue To avoid muscle strain or tears. To avoid injury to the patient or to the care giver Terminology Posture (alignment) It is the relationship of body parts to one another Base of Support Area on which an object rests and that provides support for the object Center of gravity The point at which the mass of a body or object is centered; when weight on all sides is equal. Line of Gravity An imaginary vertical line drawn through the body’s center of gravity 21 Principles of good body mechanics Always face the direction of the work, avoid twisting your body. Evaluate the weight of the object you are trying to lift or move, get help if necessary If you get help, make team leader and signal (count 1,2,3 and lift or move). Keep your back as straight as possible to maintain correct body alignment Avoid stopping back because the back muscles are shorter and easily fatigue Bend knees instead of back, this shift work to large muscles and strongest muscles (hip) Maintain stability of an object through use of wide base of support, low center of gravity and the line of gravity must fall within my base of support to maintain balance The closer the line of gravity is to the center of the base of support, the greater the individual’s stability (Figure A). Conversely, the closer the line of gravity is to the edge of the base of support, the more precarious the balance (Figure B). If the line of gravity falls outside the base of support, the individual falls (Figure C). Push, pull or slide an object instead of lifting it because lifting necessitate forcing against line of gravity It is easier and safer to pull an object toward your own center of gravity than to push it away, because you can exert more control of the object’s movement when pulling it. Use smooth, coordinated motions instead of jerky movements. Pivoting is a technique in which the body is turned in a way that avoids twisting of the spine. o To pivot, place one foot ahead of the other o Raise the heels very slightly o Put the body weight on the balls of the feet. 22  o When the weight is off the heels o The frictional surface is decreased and the knees are not twisted when turning. o Keeping the body aligned, turn (pivot) about 90 degrees in the desired direction. The foot that was forward will now be behind. When lifting an object from the ground, flex your knees and stoop dawn. Keep your back straight. Lift the object using your hip and legs muscles. Lifting; It is important to remember that nurses should not lift more than 35 pounds (15.9 kg) without assistance from proper equipment or other individuals. Types of assistive equipment include mobile-powered mechanical lifts (1), ceiling mounted lifts (2), sit-to-stand powered lifts (3), friction-reducing devices (4), and air transfer systems (5). (1) (2) (3) 23  (4) (5) Types of assistive equipment Techniques used in turning and moving a client Moving a Client Up in Bed (1st technique) Purpose To assist clients who have slid down in bed from the Fowler’s position to move up in bed Equipment Assistive devices such as an overhead trapeze, friction-reducing device, or a mechanical lift Action Rationale 1. Prior to performing the procedure, introduce self and verify the client’s identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how to participate. Listen to any suggestions made by the client or support people. 2. Perform hand hygiene and observe other appropriate infection prevention procedures. 3. Provide for client privacy. 4. Adjust the bed and the client’s position. Raise the bed to a height appropriate for Moving the client upward personnel safety (i.e., at the caregiver’s against gravity requires more elbows). force and can cause back strain. 24  Lock the wheels on the bed and raise the rail on the side of the bed opposite you. This pillow protects the Remove all pillows, then place one against client’s head from the head of the bed. inadvertent injury against the top of the bed during the upward move. 5. For the client who is able to reposition without assistance: Place the bed in flat or reverse Trendelenburg’s position (as tolerated by the client). Stand by and instruct the client to move self. Assess if the client is able to move without causing friction to the skin. Encourage the client to reach up and grasp the upper side rails with both hands, bend knees, and push off with the feet and pull up with the arms simultaneously. Ask if a positioning device is needed (e.g., pillow). 6. For the client who is partially able to assist: For a client who weighs less than 200 pounds (90.7 kg): Use a friction-reducing device and two assistants. Ask the client to flex the hips and knees and position the feet so that they can be used effectively for pushing. Place the client’s arms across the chest. Ask the client to flex the neck during the move and keep the head off the bed surface. Use the friction-reducing device and assistants to move the client up in bed. Ask the client to push on the count of three. For a client who weighs between 201–300 pounds (91.2- 136.1 kg): Use a friction- reducing slide sheet and four assistants OR an air transfer system and two assistants. For a client who weighs more than 300 pounds (136.1 kg): Use an air transfer system and two assistants OR a total transfer lift. 7. For the client who is unable to assist: Use the ceiling lift with supine sling or mobile floor-based lift and two or more caregivers. Follow 25 manufacturer’s guidelines for using the lift. 8. Ensure client comfort. 9. Document all relevant information. Record: Time and change of position moved from and position moved to Any signs of pressure areas Use of support devices Ability of client to assist in moving and turning Response of client to moving and turning (e.g., anxiety, discomfort, dizziness). Logrolling a Client (2nd technique) Purpose Logrolling is a technique used to turn a client whose body must at all times be kept in straight alignment (like a log). An example is the client with back surgery or a spinal injury. Action Rationale 1. Prior to performing the procedure, introduce self and verify the client’s identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how to participate. 2. Perform hand hygiene and observe other appropriate infection prevention procedures. 3. Provide for client privacy. 4. Position yourselves and the client appropriately Doing so ensures that they before the move. will not be injured or become Place the client’s arms across the chest. trapped under the body when the body is turned. 5. Pull the client to the side of the bed. Use a friction-reducing device to facilitate logrolling. First, stand with another nurse on the same side of the bed. Assume a broad stance with one foot forward, and grasp the rolled edge of the friction-reducing device. On a signal, pull the client toward both of you. One nurse counts: “One, two, three, go.” Moving the client in unison Then, at the same time, all staff members maintains the client’s body 26  pull the client to the side of the bed by alignment. shifting their weight to the back foot. 6. One nurse moves to the other side of the bed, and places supportive devices for the client when The pillow prevents turned. lateral flexion of the Place a pillow where it will support the neck and ensures client’s head after the turn. alignment of the Place one or two pillows between the client’s cervical spine. legs to support the upper leg when the client This pillow prevents is turned. adduction of the upper leg and keeps the legs parallel and aligned. 7. Roll and position the client in proper alignment. Reaching over the client, grasp the friction- reducing device, and roll the client toward you. One nurse counts: “One, two, three, go.” Then, at the same time, all nurses roll the client to a lateral position. The second nurse (behind the client) helps turn the client and provides pillow supports to ensure good alignment in the lateral position. Support the client’s head, back, and upper and lower extremities with pillows. Raise the side rails and place the call bell within the client’s reach. 8. Document all relevant information. Record: Time and change of position moved from and position moved to Any signs of pressure areas Use of support devices Ability of client to assist in moving and turning Response of client to moving and turning (e.g., anxiety, discomfort, dizziness). 27  Assisting a Client to Sit on the Side of the Bed (Dangling) (3th technique) Purpose The client assumes a sitting position on the edge of the bed before walking, moving to a chair or wheelchair, eating, or performing other activities. Action Rationale 1. Prior to performing the procedure, introduce self and verify the client’s identity using agency protocol. Explain to the client what you are going to do, why it is necessary, and how to participate. 2. Perform hand hygiene and observe other appropriate infection prevention procedures. 3. Provide for client privacy. 4. Position yourself and the client appropriately before performing the move. Assist the client to a lateral position facing you, using an assistive device depending on client assistance needs. Raise the head of the bed slowly to its This decreases the highest position. distance that the client Position the client’s feet and lower legs at needs to move to sit up the edge of the bed. on the side of the bed. Stand beside the client’s hips and face the This enables the client’s far corner of the bottom of the bed (the feet to move easily off angle in which movement will occur). the bed during the Assume a broad stance, placing the foot movement, and the client nearest the client and head of the bed is aided by gravity into a forward. Lean your trunk forward from the sitting position. hips. Flex your hips, knees, and ankles. 28 5. Move the client to a sitting position, using an assistive device depending on client assistance needs. Supporting the client’s Place the arm nearest to the head of the shoulders prevents the client bed under the client’s shoulders and the from falling backward during other arm over both of the client’s thighs the movement. near the knees. Supporting the client’s thighs reduces friction of the thighs against the bed surface during the move and increases the force of the movement. Tighten your gluteal, abdominal, leg, and arm muscles. Pivot on the balls of your feet in the Pivoting prevents desired direction facing the foot of the bed twisting of the nurse’s while pulling the client’s feet and legs off spine. The weight of the the bed. client’s legs swinging downward increases downward movement of the lower body and helps make the client’s upper body vertical. This movement may Keep supporting the client until the client cause some clients to is well balanced and comfortable. become light-headed or Assess vital signs (e.g., pulse, respirations, dizzy. and blood pressure) as indicated by the client’s health status. 6. Document all relevant information. Record: Ability of the client to assist in moving and turning Type of assistive device, if one was used Response of the client to moving and turning (e.g., anxiety, discomfort, dizziness). 29