Body Mechanics and Transferring Patient

8/3/2019 Body Mechanics and Transferring Patient

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BODY MECHANICS and

TRANSFERRING PATIENT

Rhenier S. Ilado RN


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BODY MECHANICS

} It is the coordinated use of the body parts to producemotion and maintain their equilibrium in relation to theskeletal, muscular and visceral systems and their

neurological association

} The term used to describe the efficient, coordinated and safeuse of the body to move objects and carry out the activitiesof daily living

} MAJOR PURPOSE facilitates the safe and efficient use ofappropriate muscle groups to maintain balance, reduce theenergy required, reduce fatigue and decrease the risk ofinjury


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} BODY BALANCE depends on the following:

1. Center of Gravity lowered b flexing the hips andknees leading to squatting position

2. Line of Gravity lowered closer to the base of support

3. Base of Support widened by spreading the feettogether apart

} The closer the line of gravity to the center of the base ofsupport, the greater the persons stability

} The broader the base of support and the lower the center ofgravity, the greater the stability and balance


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PURPOSES

} To maintain good body posture

} To promote good physiological functions of the body

} To use the body correctly and to maintain itseffectiveness

} To prevent injury or limitation of movement of themusculoskeletal system


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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 onweight bearing joints

c. Good posture requires that the body weight bebalance on relation to the spine and the center ofgravity


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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 tothe lower legs

d.If the chair has arms, flex the elbows and place theforearms on the armrest to avoid shoulder strain


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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 feetare parallel in a heel to toe gait. Arms should be

relaxed


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4. LIFTING

a.Stoop or squat to lift any object that is below thelevel of your hips

b.Widen your feet to increase your base of support

c. Move close in the object before you lift. Keep it closeto 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


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5. PUSHING AND PULLING

a. Crouch and face the objectb. 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

floord. 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 thanlifting it when possible. Pushing is better than pulling. When

pushing, enlarge base of support by moving your front footforward. When pulling, enlarge base of support by moving onefoot backward


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6. CARRYING

a.Carry all objects by holding close to your body. Thebest position is in front of the body and at the level ofyour waist/chest

b.If you carry an object in one hand, alternate it with theother. Do not twist your back when moving the objectfrom one to the other

c. Balance the load, whenever possibled.Avoid carrying or balancing a small child in one hip


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7. PIVOTING is a technique in which the body isturned in a way that avoids twisting of the plane

a.Place on foot ahead of the other, raise the heels veryslightly and put the body weight on the balls of thefeet

b.Keeping the body aligned, turn (pivot)about 90degrees in the desired direction. the foot that wasforward will now be behind


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BODY MOVEMENTACTION RATIONALE

1. Start any body movement withproper alignment and balance

Stretching creates unnecessarymuscle fatigue and strain andplaces the lines of gravity outsidethe base of support, resulting ininstability

2. Adjust the working area towaist level and keep your bodyclose to the area

3. Face in the direction of the task Twisting the spinal column canproduce back strain or injury


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4. When moving a heavy object,keep your center of gravity as lowas possible and centered over

your base of support

This avoids torsion of the spine aswell as increases your stabilityand balance

5. Avoid working against gravity

whenever possible

It takes less effort to slide, push

or pull objects that it does to liftor carry them

6. Tighten the gluteal andabdominal muscles before liftingany object. Often referred asputting on the internal girdle

Helps to support the abdomenand stabilizes the pelvis thuspreventing injury


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ACTION RATIONALE

7. Carry object close to the body andto the base of support

Holding objects close to the bodyprevents 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

and lifting object

The hand muscles are larger and

stronger than the finger muscles

9. When lifting heavy objects, squatrather than stoop

Bending from the waist (stooping) tolift a heavy object load is a majorcause of back strain. The squatting

position uses the larger and strongerventral and femoral muscles of thebuttocks and thighs


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ACTION RATIONALE

10. Use the bodys weight

to pull or push objects

Body weight adds power to

muscle action

11. Make your bodymovements smooth andrhythmic

Sudden, jerky movementsexpend more energy andput more strain in themuscles than controlledsmooth motions


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POSITIONING CLIENTS

} Positioning a client in good body alignment andchanging 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


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Purposes:

} Prevents muscle discomfort

} Prevents undue pressure resulting in pressure ulcers

} Prevents damage to superficial nerves and bloodvessels and contractures

}Maintain muscle tone and stimulate postural reflexes


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GUIDELINES when positioning client

1. Make sure the mattress is firm and level yet has enoughsupport to natural body curvatures.

RATIONALE: a sagging mattress, too soft or underfilled waterbedcontribute to the development of hip flexion contractures and low

back strain and pain2. Ensure that the bed is clean and dry.

RATIONALE: wrinkled or damp sheets increase the risk ofpressure ulcer formation

3. Place support devices in specified areas according to theclients position.

RATIONALE: maintain alignment and prevent stress on the clientsmuscles/joints


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FOWLERSPOSITION

} ALSO known as Semisitting position

} A bed position in which the head and trunk are raised 45 to 90degrees

} A position of choice for people who have difficulty breathing andfor people with heart problems because it allows greater chestexpansion and lung ventilation

} LOW-FOWLERS/SEMI-FOWLERS POSITION the head andtrunk are raised 15 to 45 degrees

} HIGH-FOWLERS POSITION the head and trunk are raised 90degrees, knees may or may not be flexed


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ORTHOPNEICPOSITION

}Client sits either in bed or on the side of the bed withan overbed table across the lap

} This position facilitates respiration by allowingmaximum chest expansion

}Helpful to clients who have problems exhaling,

because they can press the lower part of the chestagainst the edge of the overbed table


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DORSALRECUMBENT POSITION

}Also known as SUPINEPOSITION

}Client's head and shoulder are slightly elevated on asmall pillow, forearms may be elevated on pillows orplaced at sides.(not in supine pos.)

}Also used to provide comfort and to facilitate healingfollowing certain surgeries or anesthesia


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PRONEPOSITION

} The client lies on the abdomen with the head tuned toone 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 andknees

3.Promotes drainage from the mouth and is useful forunconscious clients or those clients recovering fromsurgery of the mouth and throat


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LATERALPOSITION

} Also known as Side-Lying position

} The patient lies on one side of the body, flexing the top hipand 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 alignment3. Relieve pressure on the sacrum and heels in people who sits

or rest in fowlers or dorsal recumbent position much of thetime


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SIMSPOSITION

} Also known as semiprone position

} Patient assumes a posture halfway between the lateraland the prone position

} Lower arm is positioned behind the client, and the upperarm 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


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INDICATION

1. Used for unconscious clients because it facilitates drainagefrom the mouth and prevents aspiration of fluids

2. Used for paralyzed clients because it reduces pressure overthe sacrum and greater trochanter

3.Often used for clients receiving enemas

4. Clients undergoing examination and treatments of theperineal area

5. Used for pregnant women for sleeping

6. People with sensory or motor deficits on one side of thebody


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TRANFERRING CLIENTS


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ASSISTING THE CLIENT TO MOVE IN BED (2nurses)

} The nurses will frequently encounter a semi-helpless orimmobilized 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 andat the same time avoid musculoskeletal injury


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ACTION RATIONALE

1. Explain the procedure to theclient

An explanation reducesapprehension and facilitates

cooperation. It also promotes theclients autonomy

2. Wash hands Reduces transmission ofmicroorganisms

3. Elevate bed to working height Lessens strain on nurses back

muscles

4. Place draw sheets under theclients back and head


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ACTION RATIONALE

5. Place head of bed. If twonurses are assisting client, standsat one side of bed

Placing direction of movementprevents twisting of your bodywhen moving clients. This

increases your balance. One footbe in the other allows you totransfer your body weight asclient in moved up in bed

6. Place your feet apart

7. If possible, ask client to flex hisknees, bringing his feet close tobuttocks as possible

Enables client to use his legmuscle during process of actuallymoving up in bed


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ACTION RATIONALE

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

Prevents hyperextension of neckwhen moving head of bed

9. Ask client to assist in movingby using trapeze bar if availableor pushing on bed surface

He uses his upper extremitymuscles to elevate trunk andreduce friction when moving up in

bed

10. If client, has limited upperextremity strength or mobility,

place his arms across his chest

Prevents friction from armsdragging across bed surface

during the movement. Frictioncan lead to bedsores


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ACTION RATIONALE

11. Flex your knees and hips,bringing your forearms closer tolevel of the bed

This increases your balance andstrength by bringing your center ofgravity closer to client the object to

be moved

12. Instruct the client to move upin bed on count of three as the

nurses will lift the draw sheet

Prepares client for actual move, thusreinforcing assistance

13. Move in coordination to transferthe client up toward the head of the

bed

Enables you to improve your balance asyou overcome inertia. Shifting your

weight counteracts clients weight.When client pushes with his heels andlifts his trunk friction is reduced


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ACTION RATIONALE

14. Reassess clients bodyalignment

Proper body alignment increasesclients comfort, promotes rest,

and reduces hazards ofimmobility

15. Elevate side rails

16. Record in nurses notesclients new position

Documents that the procedurewas performed


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NURSES ALERT

} The nurses must avoid dragging the patient up in

bed. Dragging against the bed linen causes shearingforce. With a shearing force the skin adheres to thesurface of bed while the layers of subcutaneoustissue and even the bones slide in the direction ofbody movement. The underlying tissues capillaries

are compressed and maybe severed by the pressure.This can cause bedsores


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TRANSFERRING A CLIENT FROM BED TOCHAIR/WHEELCHAIR

} Transferring a client from bed to chair enables the nurse tochange his surroundings as well as his position.

} If the client is able to tolerate transfer to a wheelchair, thenurse can move him out of his room into other surroundingand increase his opportunities for socialization

} For clients who have been on bed rest, this is one of the firstactivities to be assumed


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ACTION RATIONALE

1. Inform client of the purposeand destination

Reduces client anxiety andincreases cooperation

2. Assess client for ability toassist the transfer and for

presence of cognitive or sensorydeficits

Prevents orthostatic hypotension

3. Lower the height of the bed Reduces distance clients have tostep down, thus decreasing risk ofinjury

C O O


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ACTION RATIONALE

4. Allow the client to dangle feetfor few minutes

Allows time for assessing clientsresponse to sitting, reduces

possibility of orthostatichypotension

5. Bring wheelchair/chair close tothe side of the bed, facing thefoot of the bed

Minimizes transfer distance

6. If wheelchair, lock its brakesand elevate foot pedals

Provide stability


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ACTION RATIONALE

7. assist client to side of bed untilfeet touch the floor

Guides and helps client maintainbalance

8. Assist the client to a standingposition and provide support

Helps client stand safely and givetime to assess status

9. Pivot client so clients back istoward the wheelchair

Moves client into proper positionto be seated

ACTION RATIONALE


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ACTION RATIONALE

10. Place clients hands on thearm supports of the wheelchair

Allows client to gain balance anddistance to sit

11. Bend at the knees, easing theclient into a sitting position

Increases stability and minimizesstrain on back

12. Assist to maintain properposture

Broadcast and therefore safestbase of support is with clientseated as far back in the seat aspossible

ACTION RATIONALE


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ACTION RATIONALE

13. Secure safety belts (ifpresent), place clients feet onfoot pedals and release breaks

Ensures safety and preparesclient 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 theclient is unable to help or to understand the nurses instruction


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TRANSFERRING CLIENT FROM BED TO


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TRANSFERRING CLIENT FROM BED TOSTRETCHER

ACTION RATIONALE

1. Inform client about desiredpurposes and destination

Reduces anxiety and increasescooperation

2. Raise the height of the bed andlock brakes of bed

Reduces distance. Nurses mustbend, thus preventing back strainand prevents bed from moving

3. Instruct client to move to sideof bed near the stretcher. Lowerside rails of bed and stretcher

Decreases risk of client falling

ACTION RATIONALE


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ACTION RATIONALE

4. Stand at outer side of stretcherand push it toward bed

Diminishes gap between bed andstretcher, secures the stretcherposition

5. Instruct client to move untostretcher with assistance asneeded

Promotes client independence

6. Cover client with sheet Promotes comfort and protectsprivacy

7. Elevate side rails on stretcherand secure safety belt (ifavailable). Release brakes ofstretcher

Prevents falls

8. Stand at head of stretcher to

guide if when pushing

Pushing not pulling, ensure

proper body mechanics


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LOGROLLING THE CLIENT

} Logrolling is used to turn a client who has a spinalcord injury; or who has had a spinal cord operation

(with a prosthesis or pin). Another nurse shouldassist you with this procedure

}EQUIPMENT: Pillows, draw sheets, wedge, extra linenas needed

ACTION PROCEDURE


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ACTION PROCEDURE

1. Determine the reason for logrollingthe client and the clients diagnosis

The reason for the procedure shouldbe explained to the client

2. Raise the bed to a comfortableworking level

A principle of body mechanics is toalways position work at a comfortableheight to prevent back strain

3. Look the wheels of the bed. Gentlyremove supportive devices aroundthe client

Prevents the bed from rolling.Prepares client for position change

4. The two nurses should positionthemselves on opposite sides o thebed and roll the edges of the drawsheet toward the client

The nurses will grip the rolleddrawsheets to roll the client

ACTION RATIONALE


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ACTION RATIONALE

5. With the draw sheet, slide theclient to edge of the bed opposite thedirection to which the client is to be

turned

allows ample room for positioningthe client once he or she is rolled tohis opposite side

6. Place a pillow lengthwise betweenthe clients legs

Helps to maintain the correctalignment of the clients lowerextremities as he or she is turned

7. Position the clients arms. To turnthe client to the right, place his or

her left arm to the arm either flexedabove the head or at the side. Raisethe bedrails. Both nurses shouldmove to the side of the bed that theclient will turn toward

The clients arms are positioned asdescribed to prevent injury and to

make their final positioning easier

ACTION RATIONALE


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ACTION RATIONALE

8. One nurse should grasp the clientat the clients shoulders and waist,supporting the neck. The other

nurses should grasp the client at theclients buttocks and knees,supporting the legs. Roll the client allin one motion to a side-lying position

Allows the clients spine to remainstraight and not rotate. The client isturned as a unit to prevent further

spinal cord damage. Grasping theclient rather than the drawsheet givesyou better control of the clients body

9. Place the client's top leg at theknee and place a pillow under the

knee and lower leg. A small pillow orfolded lined may be placed under thehead and shoulders

The client is aligned correctly toprevent any contracture and damage

to the spinal cord

ACTION RATIONALE


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ACTION RATIONALE

10. Flex the clients top leg atthe knee and place a pillowunder the knee and lower leg. A

small pillow or folded lined maybe placed under the head andshoulders

Maximizes the clients comfort andprovides good body alignment

11. Wash your hands Decrease the transmission ofmicroorganism

12. Assess the clients comfort

and body alignment

Proper body alignment aids in the clients

comfort and assists in preventingcomplications

13. Record the procedure time,clients response and otherobservations

Communicates to the other member of thehealth care team and contributes to thelegal record by documenting the caregiven to the client


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