BODY MECHANICS
The feet are the base of support when a person is in
 Is the efficient, coordinated and safe use of the body
to produce motion and maintain balance during
activities.
 Essential to both clients and nurses to prevent strain,
injury and fatigue.
PURPOSES
 It facilitates safe and efficient use of the appropriate
groups of muscles.
 It reduces the energy required to move and maintain
balance.
 It reduces fatigue.
 To prevent or decrease the risk of strain, injury and
fatigue for both nurses and clients.
NEW RESEARCH ON BODY MECHANICS
 Training nurses in body mechanics alone will not
prevent job-relation injuries.
 Back belts are like not effective in reducing back
injury.
 Nurses who are physically fit are at no less risk of
injury.
 The average nurse should not lift more than 51
pounds and only under very controlled
circumstances.
 Nurses are encourage to support “NO MANUAL LIFT”
and “NO SOLO LIFT” policies. In their work places.
 Long term benefits of proper equipment (mechanical
lifts) far outweigh cost related to injuries.
 Staff will use equipment when they participate in the
decision-making process for purchasing the
equipment.
CONCEPT
 GRAVITY – Force that pulls objects towards the
center of the earth.
 CENTER OF GRAVITY – Point at which the mass of an
object is centered.
o That is, the COG of a standing person is the
center of the pelvis and about halfway
between the umbilicus and the pubic bone.
 BALANCE – Steady weight of the person
 LINE OF GRAVITY – Imaginary vertical line that passes
through the center of gravity
o That is, the LOG in a standing person is a
straight line from the head to the feet
through the center of the body.
 BASE OF SUPPORT – An are on which an object rests.
standing position.
THINGS TO CONSIDER BY THE NURSE WHEN
MOVING CLIENTS AND OBJECTS
 LEVER – a rigid piece that transmit or modify motion
or force
 FORCE – The energy or power required to accomplish
movement
 FRICTION – Force that opposes the motion of an
object as it is slid.
 FULCRUM – a fixed point at which a lever moves.
 When a person moves, the center of gravity shifts
continuously in the direction of the moving body
parts. Balance depends on the interrelationship of the
center of gravity, the line of the gravity, and the
base of support.
 The closer the line of gravity is to the center of the
base of support, the greater the person’s stability.
 The closer the line of gravity is to the edge of the
base of support, the more precarious the balance.
 If the line of gravity falls outside the base of support,
the person falls.
 The broader the base of support and the lower the
center of gravity, the greater the stability and
balance.
o By widening the base of support
o Lowering the center of gravity, bringing it
closer to the base of support.
 The base of support is easily widened by spreading
the feet farther apart.
 Two movements to avoid because of their potential:
TWISTING and STOOPING
 Undesirable twisting of the back can be prevented by
squarely facing the direction of movement, whether
pushing, pulling or sliding, and moving the objects
directly toward or away from one’s center of gravity.
LIFTING
 Nurses should not lift more than 51 pounds without
assistance from proper equipment and/ or persons.
 It’s always necessary to us proper body mechanics,
even though they do not guarantee freedom from
injury.
 When a person lifts or carries an object, a suitcase,
the weight of an object becomes part of the person’s
body weight.
 The weight affects the location of the person’s center
of gravity, which is displaced in the direction of the
added weight.
 To counteract this potential imbalance, body parts
(arm and trunk) move in a direction away from the
weight. In this way, the center of gravity is
maintained over the base of support.
 By holding the lifted object as close as possible to the
body’s center of gravity, the lifter avoids undue
displacement of the center of gravity and achieves
greater stability.
PIVOTING
 A technique in which the body is turned in a way that
avoids twisting of the spine.
 To pivot, place one foot ahead of the other, raise the
heels very slightly and put the weight of the body on
the balls of the feet.
 Keeping the body aligned, turn about 90 degrees in
the desired position. The foot that was forward will
now be behind.

8. Before moving an object, contract your gluteal,
abdominal, leg, and arm muscles to prepare them for
action.
9. Avoid working against gravity. Pull, push, roll, or turn
objects instead of lifting them.
10. Use your gluteal and leg muscles rather than
sacrospinal muscles of your back to exert an upward
thrust when lifting.
11. Distribute the workload between both arms and legs
to prevent back strain.
12. When pushing an object, enlarge the base of support
by moving the front foot forward.
13. When pulling an object, enlarge the base of support
by either moving the rear leg back facing away from
the object.
14. When moving or carrying objects, hold them as close
as possible to your center of gravity.
15. Use the weight of the body as a force for pulling or
pushing, by rocking on the feet or leaning forward or
backward.
16. Alternate rest periods with periods of muscles to
help prevent fatigue.

GUIDELINES TO PROPER BODY MECHANICS

1. Plan the move or transfer carefully. Free the
surrounding area of obstacle and move required
equipment near the head or foot of the bed.
2. Obtain the assistance of other people or use
mechanical devices to move objects that are too
heavy. Encourage client to assist as much as possible
by pushing or pulling themselves to reduce muscular
effort.
3. Adjust the working area to waist level, and keep the
body close to the area. Elevate adjustable beds and
overbed tables or lower the side rails of beds to
prevent stretching and reaching.
4. Provide a firm, smooth dry bed foundation before
moving a client in bed or use a pull sheet.
5. Always face the direction of the movement.
6. Start any body movement with proper alignment.
Stand as close as possible to the object to be moved.
Avoid stretching, reaching, and twisting, which may
place the line of gravity outside the base of support.
7. Before moving an object, increase your stability by
widening your stance and flexing your knees, hips and
ankles
Common or Concerning Symptoms of the Neck Palpate in sequence the following nodes:

 Swollen Lymph nodes 1. Preauricular in front of the ear

 Enlarged Thyroid Glands 2. Posterior auricular – superficial to the mastoid
 Hoarseness process
3. Occipital – at the base of the skull posteriorly
Ask “Have you noticed any swollen glands or lump in the 4. Tonsillar – at the angle of the mandible
neck?” 5. Submandibular – midway between the angle and the
 Onset: When was you first notice it? tip of the mandible. These nodes are usually smaller
 Location: How long have you had the lump? and smoother than the lobulated submandibular
 Duration: How long have you had the lump? glands against which they lie
6. Submental – in the midline a few centimeters behind
 Characteristics symptoms: Size, tenderness, drainage,
the tip of the mandible
shape, consistency, change in size
7. Superficial cervical – superficial to the sternomastoid
 Associated Manifestations: Ask for difficulty of
8. Posterior cervical – along the anterior edge of the
swallowing, any recent infection, trauma, radiotion,
trapezius
surgery, history of smoking, drinking alcohol, chewing
9. Deep cervical chain – deep to the sternomastoid and
tobacco?
often inaccessible to examination. Hook thumb and
 Relieving factor: Ask if anything makes the lump
fingers around either side of the sternomastoid
smaller
muscle to find them.
 Treatment: Ask for any treatment or if have been to
10. Supraclavicular – deep in the angle formed by the
health care provider
clavicle and the sternomastoid
THYROID GLAND
 Assess thyroid function and any evidence on enlarged
thyroid gland
 To evaluate thyroid function: Ask about temperature
intolerance or sweating
o Ask for the preferred weather, hot or cold?
o Ask if they perspire more or less than others
o Ask for palpitations and change in weight
 With goiter thyroid function may be increased,
decreased or normal
 Intolerance to cold, preference for warm clothing and
decreased sweating suggest Hypothyroidism
 The opposite symptoms, palpitations and involuntary
weight loss suggest Hyperthyroidism

PHYSICAL EXAMINATION OF THE NECK TRACHEA

 Inspect for
 Observe the skin, note for its color, pigmentation, any
texture, thickness, hair distribution, and any lesions deviation
 Inspect and note for asymmetry, any mass or scars from the
 Look for enlargement of the parotid or usual
submandibular glands and any visible lymph nodes. midline
 Palpate the lymph nodes - using the pads of the index position
and middle fingers, move the skin over the underlying  Feel for any
tissues in each area in circular motion deviation
 Patient should be relax, with neck flexed slightly  Place finger
forward and if needed slightly toward the side of along one
being examined. side of the
 trachea and note the space between it and  Displace the trachea to the right with fingers of the
sternomastoid left hand; with the right hand finger, palpate laterally
 The space should be symmetric for the right lobe of the thyroid in the space between
the displaced trachea and the relaxed sternomastoid.
Then examine the left.
 Note the size, shape, and consistency of the gland
and identify any nodules or tenderness.
 They are harder to feel than the isthmus.

HYPERTHYROIDISM HYPOTHYROIDISM
Symptoms: Symptoms:
 Nervousness  Fatigue, lethargy
 Weight loss despite  Modest weight gain
increased appetite with anorexia
 Excessive sweating  Dry, coarse skin and
and heat intolerance cold intolerance
 Palpitations  Swelling of face,
THYROID GLAND
 Frequent BM hands and legs
 Inspect the neck for thyroid gland  Muscular weakness of  Constipation
 Tilt patients head back a bit and inspect the region the proximal type and  Weakness, muscle
below the cricoid cartilage tremor cramps, arthralgia,
 Ask the patient to swallow and watch for the most paresthesia, impaired
memory and hearing
important physical sign – a thyroid gland moves up
during deglutition.
Signs: Signs:
 This us due to the fact that thyroid gland is fixed to
 Warm, smooth, moist  Dry, coarse, cool skin,
the larynx
skin with nonpitting
 Such movement of the thyroid becomes greatly  With Grave’s disease, edema and loss of
limited when it is fixed by an inflammation or eye signs such as hair
malignant infiltration. stare, lid lag and  Periorbital puffiness
 The thyroid cartilage, cricoid cartilage, and thyroid exophthalmos  Decreased systolic
gland all rise with swallowing and then fall to their  Increased systolic and and increased
resting position. decreased diastolic diastolic pressure
pressure  Bradycardia, in late
 Tachycardia or atrial stage hypothermia
fibrillation  Impaired memory,
 Tremor and proximal mixed hearing loss,
muscle weakness peripheral neuropathy

STEPS FOR PALPATION OF THE THYROID GLAND

 Ask the patient to flex the neck slightly forward to

relax the sternomastoid muscles
 Place the fingers of both hands on the patient’s neck CULTURE AND ETHINICITY Assessment
so that the index fingers are just below the cricoid
cartilage Definition of Culture
 Ask the patient to sip and swallow water. Feel for the
thyroid isthmus rising up under the finger pads
 Purnell & Paulanka – “The totality of socially
transmitted behavioral patterns, arts, beliefs, values,
customs, lifeways and all other products of human
work and thought characteristics of a population of
people that guide their worldview and decision
 The system shared ideas, rules and meanings that
influence how we view the world, experience it
emotionally, and behave in relation to other people
 PATIENTS do not live in isolation… they are part of
families, communities, cultures, race and countries
 Nurses must assess them in context of this
background to fully understand them.
 CULTURE determines interpersonal communication
style, as well as health beliefs, values and practices
ASPECT OF CULTURE RELEVANT TO HEALTH
ASSESSMENT
1. Communication and language
2. Kinship and social networks
3. Educational background and learning style
4. Nutrition
5. Child-bearing and child-rearing practices
6. High risk behavior
7. Health Care beliefs and practices
8. Health Care practitioners
9. Spirituality
CULTURAL HUMILITY: another approach for caring for
patients from culturally diverse backgrounds.
 A process that requires humility as individuals
continually engage in self- reflection and self- critique
as lifelong learners and reflective practitioners
THREE DIMENSIONS OF CULTURAL HUMILITY
a. Self-awareness: learn about your own biases
b. Respectful communication: work to eliminate
assumptions about what is “normal” ; learn directly
from your patient – they are experts on their culture
and illness
c. Collaborative partnership: build your patients
respect and mutually acceptable plans
CULTURAL ASSESSMENT
Purpose and Scope
1. To learn about the client’s beliefs and usual behaviors
associated with health and illness
2. To compare and contrast the client’s beliefs and
practices to standard health care
3. To assess the client’s health relative to disease
prevalent in specific cultural group
CULTURAL BELIEFS AND VALUES TO ASSESS
 Value orientation – principles of what values and
behaviors are considered right or wrong by a group or
an individual
 Beliefs about human nature – natural way of thinking,
feeling and acting of a person
 Beliefs about purpose of life
 Beliefs about health, illness and healing – health care
beliefs, causes of illness, culture-based treatments
 Beliefs about what causes disease
 Beliefs about health care – pregnancy and
childbearing, blood products, transfusions and organ
donation, diet and nutrition, death rituals
 Beliefs about who serves in the role of healer or what
practices brings about the healing
 Beliefs about the meaning of suffering and pain
SPIRITUALITY AND RELIGIOUS PRACTICE
Assessment
 Spirituality and religion are important factors in
health and can influence health decision and
outcomes
TERMS RELATED TO SPIRITUALITY
RELIGION: rituals, practices, and experiences involving a
search for the sacred that are shared within a group
Characteristics:
 Formal
 Organized
 Group oriented
 Ritualistic
 Objective
SPIRITUALITY: a search for meaning and purpose in
life, which seek to understand life’s ultimate
questions in relation to the sacred
Characteristics:
 Informal
 No organized
 Self-reflective
 May involve spiritual experience
 Subjective
SPIRITUAL ASSESSMENT: active and ongoing  What lifestyle activities or practices does your religion
conversation that assesses the spiritual needs of the encourage, discouraged or forbid?
client  What meaning does these practices and restrictions
have for you?
Characteristics:
 To what extent have you followed these guidelines
 Formal or informal
I – Implication for Medical Care
 Respectful
 Nonbiased  Are there specific elements of medical care that your
religion discourages or forbids? To what extent have
SPIRITUAL CARE: addressing the spiritual needs of the
you followed these guidelines?
client as they unfold through spiritual assessment
 What aspect of your religion would you like me to
Characteristics: keep in mind as I care for you?
 What knowledge or understanding would strengthen
 Individualized
our relationship as nurse and patient?
 Client oriented
 Are there barriers to our relationship based on
 Collaborative
religious or spiritual issues?
TAKING SPIRITUAL HISTORY (S.P.I.R.I.T)  Would you like to discuss religious implications of
health care?
S – Spiritual Belief System
T – Terminal Events Planning
 Do you have a formal religious affiliation? Can you
describe it?  Are there particular aspects of medical care that you
 Do you have spiritual life that is important to you? wish to forgo or have withheld because of your
 What is your clearest sense of meaning of your life at spirituality?
this time?  Are there religious practices or rituals that you would
like to have available in the hospital or home?
P – Personal Spirituality  Are there religious practices that you wish to plan for
regarding time of death, or the period following
 Describe the beliefs and practices of your religion that
death?
you personally accept
 From what sources do you draw strength in order to
 Describes those beliefs and practices that you do not
cope with this illness?
accept or follow
 For what in your life do you still feel gratitude even
 In what ways is your spirituality/ religion meaningful
though your ill?
to you?
 When you are afraid or in pain, how do you find
 How is your spirituality important to you in daily life?
comfort?
I – Integration with Spiritual Community  As we plan for your medical care near the end of life,
in what ways will your religion and spirituality
 Do you belong to any religious or spiritual groups or influence your decision?
communities?
 How do you participate in this group? What is your
role?
 What importance does this group have for you?
 In what ways is this group a source of support for
you?
 What type of support and help does this group
provide for you in dealing with health issues?

R – Ritualized Practices and Restrictions

 What specific practices do you carry out as a part of
your religious and spiritual life?