Module 4 Mobility and Immobility PDF

MODULE 4: THE EFFECT OF IMMOBILITY Professor Splettstosser Updated 06/2024  Identify potential complications affiliated with impaired mobility. Outline multidimensional nursing care OBJECTIVES of the client with impaire...

MODULE 4: THE EFFECT OF IMMOBILITY Professor Splettstosser Updated 06/2024  Identify potential complications affiliated with impaired mobility. Outline multidimensional nursing care OBJECTIVES of the client with impaired mobility. Describe appropriate use of assistive equipment used for alterations in basic care and comfort. MODULE 4 Davis Advantage for Fundamentals of Nursing Volume 1, Chapter 4 Readings: Chapter 5: Section Planning Patient Goals/Outcomes Chapter 32 Suggested: Chapter 32 in Volume II Finish up ATI Practice Assessment A and begin Practice Assessment B Dynamic Quizzes Continue: Aim for a Benchmark of 78% or higher Review Content Areas based on scores Use ATI Active Learning Templates for Review Nursing Diagnosis Assignment: Due Sunday at 11:59 pm NURSING DIAGNOSIS: ANALYSIS The phase in which you will use critical thinking skills to analyze the assessment date (analyzing cues). Identify patterns and draw conclusions about the patient’s health status. – Strengths – Concerns – Problems – Other factors contributing to health problems   Health Problem: any condition that requires intervention to:  Promote wellness  Prevent disease  Treat disease or illness  Nursing Diagnosis  Statement on the client’s health status that nurses can identify, prevent, or treat independently  Stated in terms of human responses to disease injury or other stressors  Human response can be biological, emotional, interpersonal, social, or spiritual. It can either be a concern/problem or a strength.  Medical Diagnosis  Describes a disease, illness, or injury.  Identifies pathology so that the appropriate medical treatment can be given to cure the condition.  **Except for advanced practice nurses – nurses cannot legally diagnose or treat a medical problem.  More narrowly focused than a nursing diagnosis  Remains the same as long as the pathology/injury is still present  Multiple nursing diagnoses can be associated with it.  Collaborative Problems  Are certain physiologic complications of disease, treatments, or diagnostic studies that nurses monitor to detect onset or status changes.  All patients who have a certain disease or are undergoing medical treatment are at risk for developing the same complications.  Are always a POTENTIAL problem  If you can prevent the complication with independent nursing actions alone, it is not a collaborative problem. Types of Diagnoses  Diagnostic reasoning is the thinking process that enables you to make sense of data gathered during a comprehensive patient assessment. It is also known as an analysis or diagnostic process. Types of Nursing Diagnoses  Actual  Risk (Potential)  Possible  Syndrome  Wellness Review: Fundamentals Book  Table 4-2 ➤ Differentiating Problem Types: Medical, Collaborative, and Actual, Risk, Possible, Syndrome, and Wellness Nursing Diagnoses  Identify Significant Data (Cues) Analyze and Interpret Data Cluster Cues Identify Data Gaps and Inconsistencies Draw Conclusions About Make inferences Identify problem etiologies (what Health Status caused/contributed to the problem) Verify Problems With the Patient Problem Urgency Use Maslow’s hierarchy to Prioritize Problems Future Consequences prioritize nursing Patient Priority diagnoses Consider:  What Biases or Stereotypes may have influenced your interpretation of the data?  Did you rely too much on past experiences?  Did you rely too much on the medical diagnosis? The setting? Or what others may have said?  NURSING Problem- Focused Diagnosis related to [ } as Immobility related to right hip fracture DIAGNOSIS Diagnosis evidenced by [ ]. as evidenced by x- ray, external rotation of leg, and patient report of Use NANDA-I Nursing Diagnoses in pain. the correct Format Risk-Focused Diagnosis Risk for Adult falls See the Doenges Nursing Care Plans Diagnosis related to [ ]. related to vision book, Chapter 5, for a list of official loss. NANDA-I diagnoses. Or utilize the Health Diagnosis Readiness for NANDA book (if you have it). Promotion enhanced self-care. Nursing Diagnoses are often found Diagnosis within the readings as well. Syndrome Diagnosis Frail elderly Review Fundamentals book Chapter Diagnosis [Specify Level, if syndrome 4 on correct formatting needed] Correct Format (see grid) PLANNING PATIENT GOALS & OUTCOMES Determines what interventions will be implemented (interventions should help the patient achieve the goal). Goals and outcomes should state “patient behaviors,” NOT nursing activities/interventions. – The patient will walk 10 feet to the bathroom using their walker correctly before the end of the shift. – Patient will have soft, formed bowel movement within 24 hours. – Patient’s skin will remain intact during the shift. – Patient will demonstrate the correct steps for administering eye drops. Short-Term Goals: Achieved in a few hours or days Use Short-Term Goals Long-Term Goals: Achieved over a weeks, months in Class and Clinical  Bones: Outer shell & spongy inside. There are 206 bones in adults Long bones—femur and humerus SKELETAL Short bones—phalanges and metacarpals SYSTEM: Flat bones—sternum and cranial bones Irregularly shaped bones—vertebrae and tarsal BONES, CARTILAGE, bones LIGAMENTS & Osteoclast: Breaks old and damage tissue TENDONS Osteoblast: Repairs damage bone and builds new bone Bone marrow: Creates red blood cells (RBCs) located in flat, short and irregular bones MUSCULOSKELETAL SYSTEM JOINTS Articulate: – Joint is a form where 2 bones come together, and they are classified based on the amount of movement. Synarthroses: – Immovable joints (sutures between cranial bones) Amphiarthroses: – Limited movement (pubic, vertebrae) Diarthroses (Synovial Joints): filled with synovial fluid or covered with smooth articular articular cartilage – Free movement TYPES OF SYNOVIAL JOINTS Ball and socket = Shoulders & hips Condyloid = Wrist Gliding = Intervertebral joint Hinge = Knee & elbow Pivot = 1st vertebrae and base of skull Saddle = Carpal CARTILAGE, LIGAMENTS, AND TENDONS Ligaments: fibrous tissues that connect most movable joints flexible to allow freedom of movement (strong) Tendons: fibrous connective tissues attach muscles to the bone Muscles span a joint and attach by tendons to two different bones. Cartilage: smooth, elastic, connective tissue: cushion around the joints and other parts of the body (rib cage, ear pinnae, nose, bronchial tubes, vertebral disks). strong and flexible (relatively easy to damage) MUSCLES Skeletal muscle: Smooth muscle: Cardiac muscle: Moves joints and bones Part of organs such as the digestive Ability to contract tract and hollow structures (kidneys or GU tract, circulatory system or spontaneously, helps the veins & arteries, intestine or GI tract) ventricles contract NERVOUS SYSTEM Autonomic: Somatic: Sympathetic and parasympathetic. Innervates involuntary Innervates the voluntary skeletal muscle muscles (heart, lungs, blood vessels, etc.)  PHYSICAL ACTIVIT Y & IMMOBILIT Y  MOVEMENT KEY CONCEPTS Mobility: – Body movement. Physical Activity: – Movement caused by contraction of the skeletomuscular system Exercise: – Sub-concept of physical activity, & is planned, structured and repetitive Fitness: – Ability to carry out activities of daily living without fatigue and weakness Suggestion: ATI Active Learning Template – Basic Concept  Describes how we move our body – Body mechanics: Coordinated use of the body to safely transfer clients from place to place. Use lift equipment to protect the care provider from injury. BODY – Body alignment: Maintaining the body in alignment and balance while maintaining physiological MECHANICS functioning. – Balance: When the center of gravity is close to the base of support. – Coordination: Muscles work together to provide purposeful movement. BODY ALIGNMENT OR POSTURE Places the spine in a neutral (resting) position Allows the bones to be aligned, reduces stress and fatigue, & muscles, joints, and ligaments can work efficiently The “Line of Gravity” is an imaginary vertical line drawn from the top of the head through the center of gravity (the point about which mass is distributed. In the human body, the center of gravity is below the umbilicus at the top of the pelvis). (Wilkinson, 2019) CAUSES OF POOR POSTURE Accidents, traumas and falls Careless sitting, standing and sleeping Excessive weight Foot problems or improper shoes Negative self-image Occupational stress Poor sleep support Poorly designed workspace Visual difficulties Weak muscle or imbalance Skeletal misalignment or malformation (scoliosis, etc.)  Avoid standing in one position for a long period of time Do not lock your knees when standing Keep core tight Do not bent forward at the waist or neck Sit at a comfortable height when at the desk MAINTAINING Do not wear high-heeled or platform shoes for a long period of time PROPER POSTURE So not slump when sitting Sit close to your work Use back support Sit with your feet flat on the floor and knees below your hips Sleep on a firm mattress BALANCE Needs to have alignment Line of gravity should pass through the center of gravity ( imaginary vertical line drawn from the head through the center gravity.) Gravity of center should be close to the base of support (below the umbilicus at the top of the pelvis) Base of support is what holds your body up (feet) AVOID INJURY Place your center of gravity closest to the base of support. Stand with head raised, buttock pulled-in, abdomen tight, chest high, shoulder pulled- back and feet wide The lower the center of gravity the easier to maintain balance COORDINATION Symphony between the nervous and musculoskeletal system – Cerebral Cortex = Voluntary Movement – Cerebellum = Coordination (proprioception = awareness of posture, movement and position sense). – Basal Ganglia = Helps with Coordination JOINT Range of Motion (ROM) = Maximum Movement Active Range of Motion (AROM) = Independent Joint Movement MOBILITY Passive Range of Motion (PROM) = Dependent Joint Movement  JOINT MOVEMENT Flexion: Bending the hinge joint at 90 degrees. Extension: Straightening the hinge joint to 180 degrees. Abduction: Moving the joint away from the body. Adduction: Moving the joint toward the body. Circumduction: Ball and socket joint in a circular motion. Internal and external rotation: Turning the palm of the hand toward the ceiling then toward the floor. Opposition:Touching the thumb to each finger of the hand.  Flexion Extension Abduction Adduction Circumduction Neck Chin to chest Chin up towards N/A N/A Rotate neck ceiling Shoulder Elbow Wrist Spine Hips Knees Ankles FA CTOR S AF FECTI NG MOBIL IT Y: DEVELOPMENTAL AGE Known as neuromuscular Sadly, in the U. S. obesity has Older adults are also in high-risk developmental age. increased drastically in teenagers due to muscle wasting and mobility and children due to a more consequences. sedentary population. E. g. A newborn can move extremities but cannot get to places until the development continues. NUTRITIONAL STATUS Unhealthy eating habits caused Obesity caused by unhealthy by a busy schedule plays a diets increases the risk for crucial role in the food diseases selection Undernutrition of a balanced- Diseases related to the heart diet causes delay in body tissue and metabolism are increased repair, muscle wasting, fatigue when unhealthy nutrition is and decreases activity level present capacities LIFESTYLE CHOICES Selecting a sedentary life can have significant Cultural beliefs can have an impact on how, effects in the overall health. when and what type of activities are performed. E.g. A person raised in a modest culture would not want to use a swimsuit during water exercise. ENVIRONMENT Weather: depending on the weather that would be the Environment factors can affect activity level. E.g. Sunny & warm exercise or activity = activity; Cold & damp = inactivity Pollution: Exposure can cause Neighborhood conditions: allergens Sense of Safety can be affected Finances: Gyms or sport might Support System: pressure to be not be in budget inactive STRESS HIGH-LEVEL OF STRESS IS EXERCISE CAN HELP REDUCE USING EXERCISE OR RELATED TO FATIGUE. STRESS, WHICH HELPS ACTIVITY WILL HELP THE INCREASE ENERGY. PATIENT RECOVER FASTER.  Syndactylism: Fusion on one or more fingers Developmental dysplasia of the hip CONGENITAL (DHH): Hip dislocation due to femur ABNORMALITIES OF abnormality THE MUSCULOSKELETAL Foot deformities: Club foot (talipes SYSTEM equinovarus) can affect walking Scoliosis: lateral curvature of the spine Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning – System Disorder  Osteogenesis Imperfecta (OI): Brittle bones that fracture easily. CONGENITAL Achondroplasia: Dwarfism (bones harden prematurely) ABNORMALITIES OF THE MUSCULOSKELETAL Paget’s Disease: Increased bone loss results in SYSTEM pain, pathological fractures and deformities Vit. D & Calcium: Porous bones. Prolonged deficiency can cause bowed, retard growth and frequent fractures of the long bones. Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning – System Disorder  Rheumatoid arthritis (RA): Systemic autoimmune causing chronic inflammation of the joints and connective tissue. Causes pain, deformities, fever, fatigue, weakness, weight loss and loss of function. Most frequent begins at a mid-life age and in females. DISEASES Pain may not resolve with rest. AFFECTING Osteoarthritis (OA): Loss of articular cartilage in the joint. JOINT Causing pain, stiffness, crepitus, aggravated weight-bearing and joint use. Most frequent in females, older adults, and obesity Pain improves with rest. MOBILITY Ankylosing Spondylitis: Chronic inflammatory joint disease that causes stiffness and fusion of the spine and sacroiliac joints Gout: Inflammatory response to high-levels of uric acid. Forms tophi (white nodules) in the synovial fluid. Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning – System Disorder  Osteoporosis: Decrease in total bone density when osteoclast activity is higher than osteoblast. Internal structure of the bone is diminished. Most common in females at menopause age. The best treatment is prevention by proper diet high in calcium, fluoride and minerals. DISEASES AFFECTING Osteomyelitis: Infection of the bone. Can develop after injury, surgery or traumas. BONE DENSITY Bone tumors: Affects form and function. Causes pain and severely impedes mobility. Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning – System Disorder  Trauma: Fracture is the break of the bones. Sprain is a stretch injury of a ligament that causes the ligament to tear. Partial tear can heal with rest, complete tear requires surgery. OTHER FACTORS Strain is an injury to the muscle due to excessive stress. IMPACTING Disorders of the Central Nervous System: Disorders that affects the motor center of the brain. Ex. Stroke, spinal cord injury, multiple MOBILITY sclerosis, myasthenia gravis. Diseases of other body systems: Other systems disturbance can affect mobility. Respiratory disease: Limit mobility tolerance due to lack of oxygen Circulatory disorders: Impairs tissue oxygen delivery causing pain, edema, discomfort, etc. Fatigue: Limits activity to short period of time. Bedrest: Reduces overall activity Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning – System Disorder ASSESSMENT NURSING HISTORY Usual activity level Fitness goals Mobility problems Health problems Lifestyle External factors Assess ability to perform ADLs Term Definition Atrophy Clonus Flaccidity Hemiplegia Hypertrophy Paraplegia Paresis Paresthesia Quadriplegia Spasticity Tremor TERMS  ASSESSMENT Home: – Stairs – Home aspects that assist or hinder patient care – Falls, Fall Risks – Assistive equipment needed? – Can they navigate/move within the home Caregiver: – Who is providing care? – Availability – Additional support – Can the caregiver safely move the patient? – Frail, elderly, or ill caregiver? – Backup plan? Community: – Available resources (Meals on Wheels, PT, VNA) – Willingness to use? – Insurance coverage of resources – Private Services (affordability) Physical Assessment – Gait – Activity tolerance – Muscle strength – ROM HAZARDS OF IMMOBILITY & NURSING INTERVENTIONS Suggestion: Clinical Reasoning Worksheet on Immoblity EFFECT ON MUSCULOSKELETAL SYSTEM Atrophy: Bed confinement reduces 7 - 10% loss of muscle strength per week Wasting of muscles Joint stiffening, altered joint mobility Contractures: the stronger muscles pull the joints Osteoporosis changes due to calcium metabolism, leading to the possible formation of renal calculi Impaired balance Foot drop Pathological fractures Decreased stability of joints  Perform Perform Passive Range on Motion (PROM) NURSING INTERVENTIONS Reposition Reposition every 2 hours Encourage independent activity as possible even in best Encourage rest (AROM) Provide assistive devices if needed Provide Provide positioning devices to maintain body alignment  Effect on Cardiovascular E F F E C T O N TH E C I R C U L AT O R Y S Y S T EM Increases the workload of the heart Decreases cardiac reserves Promotes venous stasis Edema Orthostatic hypotension Risk of thrombus formation Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning Template – Basic Concept  Increase client’s activity as soon as possible Assess for peripheral, sacral and pedal edema NURSING Assess calves for signs and symptoms of thrombus formation INTERVENTIONS (redness, warmth and tenderness) OF THE Measure circumference of both calves and compare size CIRCULATORY Use TED hose or Sequential Compression device SYSTEM Administer low dose Heparin Dangle feet to prevent orthostatic hypotension EFFECT ON RESPIRATORY SYSTEM Respiratory depth decreases affecting ventilation, shallow Decreases all muscle strengths respirations leads to secretions including the chest wall pooling in the lungs Pooled secretions block air Increases secretion (Aspiration passages and alveoli. Air passage Pneumonia is a risk). blockage can lead to atelectasis (collapse of air sacs or alveoli) Decrease ventilation capacity in response to exercise. Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning Template – Basic Concept  Turn, Cough and Deep breath every 2 hours Incentive spirometer every 2 hours while awake NURSING Use chest physiotherapy INTERVENTION FOR Encourage fluid intake of at least 2000 mL per day unless contraindicated RESPIRATORY Assess lungs, cough and sputum production at least every shift Orthopneic positioning  Bonus: WONC Bonus: Wound Home Skills Kit for External Pressure Ulcers (For Patients) pressure leads to compressed capillaries in the skin EFFECT ON THE INTEGUMENTARY Leading to SYSTEM tissue ischemia and eventual necrosis  Change positions as indicated by skin assessment with Change position change NURSING INTERVENTIONS Assess Assess the client for pressure ulcer risk SKIN INTEGRITY Teach Teach client to shift weight every 15 minutes if possible PURPOSES FOR POSITIONING YOUR Use Use positioning devices as needed CLIENT: PREVENT SKIN BREAKDOWN PREVENT MUSCLE DISCOMFORT PREVENT DAMAGE TO SUPERFICIAL NERVES AND BLOOD VESSELS Assess Assess skin and provide skin and perineal care as needed PREVENT CONTRACTURES Bed Keep the bed clean and dry. Do not tuck in sheets too tightly.  Provide high calorie, high protein diet NURSING INTERVENTIONS Vitamin and mineral supplement MAINTAIN SKIN INTEGRITY I&O NUTRITION Calorie Count Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning Template – Basic Concept EFFECT ON METABOLISM Decreased energy, Drop in the metabolic rate Glucose intolerance Muscle mass reduction Can stimulate a stress response Bone loss from calcium reabsorption  osteoporosis Increases risk for renal calculi (kidney stones) Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning Template – Basic Concept Slows peristalsis EFFECT ON THE Constipation GASTROINTESTINAL SYSTEM Paralytic Illeus Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning Template – Basic Concept NURSING INTERVENTIONS FOR GASTROINTESTINAL MAINTAIN HYDRATION INCLUDE FRESH FRUIT AND PROMOTE AS NORMAL AS VEGETABLES IN DIET POSSIBLE POSITION FOR ELIMINATION AS POSSIBLE  Supine position inhibits drainage of urine from kidneys and bladder. EFFECTS ON THE GENITOURINARY Stagnant urine leading to increase in urinary SYSTEM tract infections Kidney stone formation NURSING INTERVENTIONS FOR GENITOURINARY ENCOURAGE FLUID BLADDER TRAINING ASSESS FOR URINARY PROMOTE URINATION BY INTAKE RETENTION USING A POURING WARM WATER BLADDER SCANNER OVER THE PERINEUM AREA  PSYCHOLOGICAL EFFECTS OF IMMOBILITY Isolation Mood change Depression Anxiety Suggestion: Clinical Reasoning Worksheet Suggestion: ATI Active Learning Template – Basic Concept INVOLVE CLIENTS IN DAILY CARE PROVIDE STIMULI SUCH AS NEWSPAPERS, TV, MAGAZINES ASSIST WITH GROOMING AND HYGIENE SUCH AS NURSING SHAVING AND MAKEUP INTERVENTIONS FOR IMMOBILITY INVOLVE THE CLIENT IN MAINTAIN PLANNING OF DAILY ORIENTATION TO TIME ROUTINE SUCH AS A CLOCK AND CALENDAR COMPLICATIONS OF IMMOBILITY Pressure Injury Constipation Joint contracture Muscle Weakness Balance Problems DVT Pooling of secretions in lungs Orthostatic Hypotension Increased risk of mortality NURSING DIAGNOSIS Activity Intolerance (insufficient physical or psychological energy to carry out ADLs) Impaired physical Mobility (limitation on independent purposeful movement of the body) – Impaired physical mobility: moving in bed – Impaired mobility: walking Disuse syndrome (patient’s prescribed or unavoidable inactivity) Sedentary lifestyle (lifestyle characterized by a low physical activity level) Mobility might be the etiology (related to) part of a nursing diagnosis POSTIONING POSITIONING TIPS Adequate help Avoid manual lifting Use assistive devices and equipment Avoid slippery and wet surfaces Remove physical obstructions Clutter-free environment Uneven floors, rugs, cords Lock the wheels of furniture or wheelchairs before moving a patient Avoid moving patients through narrow spaces POSITIONING DEVICES Adjustable, hospital beds Specialty beds: alternating, low air loss, immersion, oscillating, specialty mattresses (air, water, gel). Pillows Siderails (can cause injury) Trapeze bar Trochanter rolls Hip abduction pillows Sandbags LIST COMMON POSITIONING DEVICES AND THEIR PURPOSE Trochanter roll = tightly rolled towels placed adjacent to the hip and thighs Hand roll = rolled washcloths to keep wrist and hand in natural position and prevent claw-hand LIST COMMON POSITIONING DEVICES AND THEIR PURPOSE Abduction pillow = wedge to prevent internal hip rotation. Usually use after hip surgery Cradle boots = Spongy rubber used to prevent foot-drop, skin breakdown and external hip rotation Foot board = foot cradles used to secure the foot of the bed but allow free movement POSITIONING: TECHNIQUES ADVANTAGES DISADVANTAGES FOWLER’S POSITIONS Fowler (Sitting) head elevated 45-60 degrees – Semi-Fowler head is elevated only 30 degrees Promotes respiratory function Lowers Diagrams allowing better expansion. – High Fowler head is elevated 90 degrees Helps with cardiac disfunction – Orthopneic Position: head elevated 90 degrees; patient leans forward to help with respiration Used in shortness of breath (SOB)  LATERAL POSITIONS Lateral Position (lying sideway) – Lateral recumbent = side-lying with legs in line – Oblique position = lying semi to the side with leg slightly bent; decreases pressure on the trochanter  PRONE AND SIMS’ POSITION Prone (lying on the stomach) – Should be used for short periods only – Promotes secretions to drain from the mouth – Inhibits chest wall and abdominal expansion – Creates a significant lordosis – Never use in patients with back surgery or injury Sims’ position (lying semi lateral and semi on the stomach) – Semi-prone – Position for suppository, edema administration. Perineal procedures – Facilitates mouth drainage, limits trochanter and sacrum pressure POSITIONING TECHNIQUES Supine Position (lying on the back) – Also know as: Dorsal recumbent- shoulders and head are elevated in pillows – Alignment should be in a comfortable position – Usually use with spinal injury patients as the vertebrae needs to be stable ADVANTAGE & DISADVANTAGE (TABLE 32-2) Position Potential Problem Intervention Fowler’s Neck & Knees Hyperextension Small pillow under head and knees Shoulder Dislocation Position pillow under the forearms Wrist, and Fingers Flexion Contracture Support hands and arms Hands Edema Place trochanter rolls Finger Abduction Use firm mattress Foot Drop Lumbar Posterior Flexion Lateral Twisting of spine Aligned shoulder with hips Lateral flexion of the neck Support upper leg from groin to foot Cervical Spine Flexion Support upper arms Internal Rotation and abduction of the femur Place a pillow under the head and neck  ADVANTAGE & DISADVANTAGE Position Potential Problem Intervention Prone Lumbar Hyperextension Extend feet over the edge of mattress, Lateral Flexion of the neck Place pillow under the neck and head Foot-drop Place pillow under abdomen Sims’ Twisting of spine Aligned shoulder with hips Neck Hyperextension Support upper arms, upper legs from the groin to Foot-drop foot, and feet. Internal Rotation and abduction of the femur Place a pillow under the head and neck Internal Rotation and Abduction of the upper Position the lower arm behind and away from shoulder & limited respirations back Supine Internal Rotation and Abduction of the upper Place pillow underarms and aligned next to the shoulder & extension of elbows. body Finger Flexion and Abduction of the thumb Use hand splints or hand rolls as needed Spine Curvature and Hip Flexion Use a firm mattress or place a small pillow in the External rotation of the legs lumbar curvature Knees Hyperextension Use trochanter rolls Place pillows under the lower legs from the ankles to below the knee. Use footboard or high-top sneakers NURSING INTERVENTIONS: PURPOSES FOR POSITIONING YOUR PATIENT Prevent skin breakdown Prevent muscle discomfort Prevent damage to superficial nerves and blood vessels Prevent contractures  MOVING AND TRANSFERRING THE P AT I E N T S A F E LY Suggestion: ATI Active Learning Template – Basic Concept TURNING IN BED & LOGROLLING Turning: Every 2 hours Move patient up in bed during this time Use positioning devices Logrolling Used when patient is on spinal precautions Keeps spine in alignment to prevent damage Move the body as a “unit”. Scoot Sheet Thin, low-friction sheet used under the draw sheet TRANSFERRING PATIENTS OUT OF BED Assess the patient’s ability to stand/balance, if they will be standing Transfer board: Wood or plastic device to assist with moving the patient from bed to stretcher or bed to wheelchair (promotes independence). EQUIPMENT: Mechanical Lift: hydraulic devices to transfer patients Obese or immobile patients Lifts in a “seated” position. Some include scales for weighing Ceiling mounted or independent mobile unit Protects against caregiver back injuries Increases patient safety EQUIPMENT: Transfer belt: Heavy belt several inches wide to facilitate transfer or secure holding the patient while they ambulate SUGGESTION Review the following skills in the Fundamentals book and create an ATI Active Learning Template Nursing Skill for each Procedure 32-1A: Moving a Patient Up in Bed Procedure 32-1B: Turning a Patient in Bed Procedure 32-1C: Logrolling a Patient Procedure 32-2A: Transferring a Patient From Bed to Stretcher Procedure 32-2B: Dangling a Patient at the Side of the Bed Procedure 32-2C: Transferring a Patient From Bed to Chair Procedure 32-3: Assisting With Ambulation GAIT AND STRENGTH TRAINING Range of motion exercises AROM PROM CPM DANGLING This position helps with getting the patient up in a chair, standing, or ambulating Decreases incidence of orthostatic hypotension ASSISTING A PATIENT TO WALK Assess readiness/ability to ambulate Gather appropriate equipment Remove obstacles and hazards from the “path” Make sure the floor in not slippery Use correct footwear (non-slip) Use transfer or gait belt Have a chair or other device available for the first few attempts at ambulation If the patient becomes faint or begins to fall, do not attempt to hold him up by yourself. Instead, protect the patient as you guide him to a seated or lying position. Create a wide base of support, and project forward the hip closest to the patient. Help the patient slide down your leg as you call for help (Fig. 32-16). Protect the patient’s head as his body descends.  WALKING AIDES Type Who Insights Single-ended, half-circle handle Those who need minimal support and can climb stairs Single-ended, straight handle Multiprong cane (3 or 4) Walkers Braces CRUTCHES AND CRUTCH WALKING Who would you expect to use these different crutches and gaits? Types of Crutches: Forearm Axillary Gaits: Two-point gait—used for partial weight-bearing Three-point gait—used when weight-bearing must be avoided Four-point gait—used for partial weight-bearing Swing-to gait—used when weight-bearing is permitted Swing-through gait—used when weight-bearing is permitted. Tripod/Standing with crutches – when standing stationary Read Bottom to Top REFERENCE Animatorisland.com ARJO (2024). RotoProne. Retrieved from, link. CardinalHealth, (2024). T.E.D. Anti-Embolism Stockings. Retrieved from, link. Chamodinim.wordpress.com Examnotes.com Florida Foot & Ankle (2024). Clubfoot. Retrieved from, link. Genetic Literacy Project (2017). Syndactyly: Family’s ‘fused fingers’ deformity sheds light on the human genome. Retrieved from, link. Omicsonline.org Pexels.com (Photos) Pilatesfitcambridge.co.uk Rehabmart (2024). Hydroaire air fluidized therapy bed. Retrieved from, link. Roca, O., Pacheco, A. & García-de-Acilu, M. To prone or not to prone ARDS patients on ECMO. Crit Care 25, 315 (2021). https://doi.org/10.1186/s13054-021-03675-6 Studyblue.com Wilkinson, J. M. (2019). Fundamentals of Nursing (Two Volume Set) (4th ed.). F. A. Davis Company. https://ambassadored.vitalsource.com/books/9781719642132