NSE111 Week #3 Lifting, Moving & Positioning DM - F23 - post too1.pptx

NSE111 Week 3 Minimizing Effects of Immobility – Lifting, Moving, Positioning & Preventing the Complications of Immobility Week 3 Learning Objectives 1. Review proper body mechanics to prevent musculoskeletal injuries to both nurse and client. 2. Identify what a pressure injury is and relate the...

NSE111 Week 3 Minimizing Effects of Immobility – Lifting, Moving, Positioning & Preventing the Complications of Immobility Week 3 Learning Objectives 1. Review proper body mechanics to prevent musculoskeletal injuries to both nurse and client. 2. Identify what a pressure injury is and relate the risk factors that contribute to the development of one. 3. Understand how to use the Braden Scale for predicting risk and reducing progression of pressure injury. 4. Recognize nursing interventions to decrease the complications associated with immobility. 5. Explain the purpose and types of range of motion exercises and explain different methods of joint mobilization when assisting with active and passive range of motion exercises Nurses and Body Mechanics In Ontario, more than 50% of nurses who lost work time experienced musculoskeletal disorders including injuries to the neck, shoulders and back. Nurses:  Work with patients who may be immobile and physically dependent for mobility.  Teach patients’ families how to transfer or position patients properly.  Lifting, transferring patients contributes to high incidence of work-related injuries.  Need to utilize good body mechanics to reduce the risk of injury (self, patients, co-workers) and to decrease work effort and lessen strain on musculoskeletal system (MSK).  Culture of safety and use principles for safe patient handling. Workers Health and Safety Centre (2011), as cited in P&P, 2014, p. 784; P&P, 2019, p. 839 TED Ed lesson: The Benefits of Good Posture http://ed.Ted.Com/lessons/the-benefits-of-good-posture-murat-dalkinic Principles of Body Mechanics • The wider the base of support the greater the stability • The lower the centre of gravity, the greater the stability • Face the direction of movement prevent abnormal twisting of the spine • Use transfer sheet to reduce friction between the patient and the surface Principles of Body Mechanics • Plan your lift. • Ask for help when needed. • Widen your base of support. • Bend at your knees. • Tighten your abdominal muscles. • Lift with your leg muscles. • Keep you’re the object close to your body. • Keep your back straight. Additional resource: http://images.Ccohs.Ca/products/liftinglrg.jpg You will see these slides again next week…. Always keep your own body mechanics in mind!! The Three Body Systems That Contributes To The Regulation Of Movements Are: Muscular System Skeletal System Nervous System The coordinated efforts of our body systems help to maintain balance, posture & body alignment to reduce the risk of injury when moving. Successful safe transfer of the client require nurses to apply the following: Body Mechanics Ergonomics Safe Patient Handling Immobility  Is the inability to move freely, easily and with purpose. What are some of the effects of immobility and what could the nurse do to decrease these effects of immobility among our clients? Effects of Immobility  Metabolic Changes  Altered endocrine metabolism  Calcium Resorption  Decreased GI motility  Cardiovascular Changes  Orthostatic Hypotension  Thrombus formation What could the nurse do to decrease these effects of immobility? Effects of Immobility  Urinary Elimination Changes  Altered urinary elimination  Urinary stasis  Increased risk of calculi formation  Respiratory Changes  Atelectasis  Hypostatic pneumonia What could the nurse do to decrease these effects of immobility? Effects of Immobility  Musculoskeletal Changes  Temporary or permanent impairment of permanent disability  Restricted mobility & impaired joint mobility What could the nurse do to decrease these effects of immobility? Effects of Immobility  Integumentary Changes:  Pressure injury  Localized injury to skin  Usually over bony prominence  Results from pressure or pressure with shear & friction What could the nurse do to decrease these effects of immobility? Effects of Immobility  Psychosocial Changes:  Quality of life and well being  Boredom  Feelings of isolation  Depression  Anger  Grief – coping with the loss  Distributive sleep patterns  Fear What could the nurse do to decrease these effects of immobility? What contributes to pressure sores/injury Extrinsic Factors Intrinsic Factors  Excessive Uniaxial Pressure  Friction and Shear Forces  Impact Injury  Heat  Moisture  Posture  Incontinence  Immobility  Sensory Loss  Age  Disease  Body Type  Poor Nutrition  Infection  Incontinence (Reilly et al., 2007) Risk Factors: Pressure Injury Development  Impaired sensory perception  Impaired mobility  Alteration in level of consciousness  Moisture  Nutrition  Tissue Perfusion  Infection  Shear  Pain  Friction  Age How does a pressure injury form?  Pressure slows the blood flow to an area which leads to tissue death  Friction, shear and maceration can add to the problem Maceration • Is prolonged moisture leads to skin breakdown • Occurs when the skin is consistently wet • Sitting in wet incontinent briefs • Excessive perspiration • Incontinence • Wound drainage • Skin softens, turns white and then can get infected with bacteria/fungi. The Braden Scale Predicting Pressure Sore (Injury) Directs the attention of the nurse to six specific risk Risk subscales: 1. Sensory Perception 2. Moisture 3. Activity 4. Mobility 5. Nutrition 6. Friction and Shear The lower the score, the higher the risk for pressure ulcer development. A total score of 18 is the cut-off for onset of pressure ulcer. 23 Scores: 15-16 = low risk 13-14 = moderate risk 12 or less = high risk 25 Stage 1 Pressure Ulcer Stage 2 Pressure Ulcer 26 Stage 3 Pressure Ulcer Stage 4 Pressure Ulcer Common pressure ulcer sites Lewis p. 1252 28 Pathogenesis of Pressure Injury Ischemia develops when the pressure on the skin is greater than the pressure inside the small peripheral blood vessels to the skin. 3 pressure related factors 1. pressure intensity 2. pressure duration 3. tissue tolerance More valuable resources:  https://rnao.ca/sites/rnao-ca/files/Pressure_Injuries_ BPG.pdf  https://cdn.ymaws.com/npiap.com/resource/resmg r/online_store/npiap_pressure_injury_stages.pdf Moving and Positioning Clients Review Assess Use Evaluat e Ask • Review Agency Policy • Assess Client: Mobility & Body Alignment • Use Proper Body Mechanics • Evaluate Your Knowledge And Skill Related To Client’s Requirements • Ask For Assistance When Required Proper Body Alignment 32 Contractures An irreversible contracture further decreases the person’s mobility because it makes moving the involved muscles difficult or impossible. Wrist Drop Contracture Multiple contractures in this patient 33 Plantar Flexion Contracture Positioning Devices Positioning Devices  Pillows  Hand-Wrist Splints  Foot Boards/Foot  Trapeze Bar Boots  Side Rails  Trochanter Rolls  Bed Board  Sandbags  Towels and Blankets  Hand Rolls Supine  Client rests on back (as in good standing alignment)  Trochanter rolls, hand rolls & pillows used to promote comfort  Foot support to prevent foot drop Dorsal Recumbent  Patient on back with knees flexed and soles of feet flat on the bed  Nursing care: peri-care (perineal care) Side Lying (Lateral) Position  Patient in side lying position Sim’s Position  Semi prone with weight on anterior ileum, humerus & clavicle  Nursing care: enema Prone position  Lying face or chest down with head to the side  Pillow under lower leg permits dorsiflexion of ankles & knee flexion promoting relaxation  If no pillow available, feet over end of mattress to promote dorsiflexion. Fowler’s Position  Head of bed (HOB) 45˚- 60 ˚  Knees slightly elevated Logrolling a Client Elastic Stockings Restorative care  Goal: For patient who is immobile is immobile is to:  Maximize functional mobility  Independence  Reduce residual functional deficits (i.e. impaired gait and decrease endurance)  Restorative care focuses on:  Activities of Daily Living (ADLs)  Instrumental Activities of Daily Living (IADLs) What could the nurse do to supporting client with restorative care? Range of Motion (ROM) • Measures the full movement of a joint • Helps to determine the degree of damage or injury to a joint (P&P, 2019, p.854) • Assesses joint stiffness, swelling, pain, limitation of movement, and crepitation bilaterally How do you perform ROM? Range of motion (ROM) Begin ASAP Begin as soon as possible after the client has lost ability to move the joint. Head to Toe Work from head To toe, moving from lager joints to smaller joints. Repeat 5x Support Joint Repeat each movement 5 X’s to promote movement. Provide support above and below the joint being assessed. Range of motion (ROM)  Start slowly with smooth movements.  Moveof joint until slight resistance is felt. Range motion Assess for fatigue, pain, movement, and (ROM) crepitation during ROM  Leave joint in the correct alignment after assessing Go To The Library And Watch The Mosby Video: Assisting With Range-of-motion Exercises Terminology for ROM Positions (P&P, 2019)  Flexion - decreasing angle of the joint  Extension – increasing the angle of the joint  Abduction – movement of the bone away from the midline of the body  Adduction – movement of the bone toward the midline of the body Terminology for ROM Positions 2019)  Rotation – moves around axis  Eversion – turn joint outward  Inversion – turn joint inward  Pronation – move joint down  Supination – move joint up (P&P, Joint Mobility  To maintain or improve mobility = ROM exercises  Active ROM  Client is able to move their joints unassisted.  Passive ROM  Nurse assist the client to move their joints as much as need to help client perform the ROM exercises Principles – Passive ROM 1. Explain technique to client and demonstrate the technique. 2. Start slowly with smooth, easy movements. 3. Move joint in ROM positions until slight resistance is felt. 4. Work from distal joints to proximal joints on one at a time. Principles – Passive ROM 5.Provide support for joints distal to joint being manipulated. 6.Assess client ROM for limitations in movement, pain/discomfort, and crepitation. 7.Leave joint in correct alignment position when finished. Reminders:  Week 6 Mid-Term Exam  Focus on the learning objectives from weeks 1-5.  Online during class time  Zoom link posted on eCentennial if you need to contact me during the exam.  Week 6 PPE performance Skill Test.  Focus rubric  During schedule lab time  Come to your scheduled time 15 minutes early.  Review Student Guidelines for the Exam on eCentennial.