Objectives

1. Understand the meaning of mobility

2. Understand the importance of mobility
3. Understand the complications of immobility
4. Learn different patient’s positioning
5. Learn how to transfer patient from one surface to another
Mobility
Is the ability of a patient to change and control their body position.
Physical mobility requires sufficient muscle strength and energy, along with
adequate skeletal stability, joint function, and neuromuscular synchronization.
Functional mobility - Is the ability of a person to move around in their
environment, including walking, standing up from a chair, sitting down from
standing, and moving around in bed.
The Three Main areas of Functional Mobility are the following:
1. Bed Mobility: The ability of a patient to move around in bed, including moving
from lying to sitting and sitting to lying.
2. Transferring: The action of a patient moving from one surface to another. This
includes moving from a bed into a chair or moving from one chair to another.
3. Ambulation: The ability to walk. This includes assistance from another person or
an assistive device, such as a cane, walker, or crutches
Importance of Mobility
◆ Minimize complications
◆ Improve total patient functioning
◆ Improve overall strength and endurance
◆ Decrease length of stay to hospital
◆ Decrease hospital costs
◆ Psychological outlook: positive outlook for recovery
Immobility/Physical Impaired Mobility
Is a term used to describe a person's inability to move.
Positioning
Involves properly maintaining a patient’s neutral body alignment by
preventing hyperextension and extreme lateral rotation to prevent
complications of immobility and injury.
In surgery, specimen collection, or other treatments, proper patient
positioning provides optimal exposure of the surgical/treatment site
and maintenance of the patient’s dignity by controlling unnecessary
exposure.
Goals of Patient Positioning
The goal of proper patient positioning is to safeguard the patient from
injury and physiological complications of immobility. Specifically,
patient positioning goals include:
• Provide comfort and safety to the patient
• Prevent nerve damage
• Prevent skin breakdown (Bedsore)
• In a surgery for example it allow accessibility to the surgical
site as well as for anesthetic administration
Guidelines for Patient Positioning
Proper execution is needed during patient positioning to prevent injury for both the
patient and the nurse. Remember these principles and guidelines when positioning
clients:
✓ Explain the Procedure. Provide explanation to the client on why his or her
position is being changed and how it will be done.
✓ Encourage Client to Assist as much as Possible. Determine if the client can fully
or partially assist. Clients that can assist will save strain on the nurse. It will also be
a form exercise, increase independence, and self-esteem for the client.
✓ Encourage Client to Assist as much as Possible. Determine if the client can fully
or partially assist. Clients that can assist will save strain on the nurse. It will also be
a form exercise, increase independence, and self-esteem for the client.
✓ Raise client’s bed. Adjust or reposition the client’s bed so that the weight is at
the level of the nurse’s center of gravity.
Guidelines for Patient Positioning
✓ Frequent position changes. Note that any position, correct or incorrect, can be
detrimental to the patient if maintained for a long period. Repositioning the patient every
2 hours helps prevent complications like pressure ulcers and skin breakdown.
✓ Avoid friction and shearing. When moving patients, lift rather than slide to prevent
friction that can abrade the skin making it more prone to skin breakdown.
✓ Proper Body Mechanics. Observe good body mechanics for you and your patient’s
safety.
• Position self-close to the client.
• Avoid twisting your back, neck, and pelvis by keeping them aligned.
• Flex your knees and keep feet wide apart.
• Use your arms and legs and not your back.
• Tighten abdominal muscles and gluteal muscles in preparation for the move.
• Person with the heaviest load coordinates efforts of the nurse and initiates the count to 3
COMMON PATIENT’S POSITION

SUPINE POSITION. Is wherein the

patient lies flat on the back with face
upward, head and shoulders slightly
elevated using a pillow unless
contraindicated.
Supine position in surgery, Supine is
frequently used on procedures
involving the anterior surface of the
body (e.g., abdominal area, cardiac,
thoracic area).
Used for general examination or
physical assessment.
COMMON PATIENT’S POSITION

Fowler's position. Is a standard position where the

patient is seated in a semi-upright position at an
angle between 30 and 90 degrees, with legs either
bent or straight.
Variations of Fowler’s position include:
A. Low Fowler’s (15 to 30 degrees),
B. Semi-Fowler’s (30 to 45 degrees)
C. High Fowler’s (nearly vertical)
Promotes lung expansion. Fowler’s position is used
for patients who have difficulty breathing because in
this position, gravity pulls the diaphragm downward
allowing greater chest and lung expansion.
Useful for NGT. Fowler’s position is useful for
patients who have respiratory problems and is often
optimal for patients who have nasogastric tube in
place
COMMON PATIENT’S POSITION

Prone Position. The patient lies on the abdomen

with head turned to one side and the hips are not
flexed.
Prone position. allows the back of your lungs to
expand fully. It can also help you cough up more of
the fluid in your lungs and can improve the way
oxygen travels through your body. This can lead to
better breathing overall.
The prone position is also used during surgeries that
require access to the back of your body. Some
common examples include:
• Brain or brainstem surgeries
• Spinal surgeries
• Rectal or buttock surgeries
• Surgical procedures on the back of your arms or
legs
COMMON PATIENT’S POSITION

Lateral Position. The patient lies on

one side of the body with the top leg
in front of the bottom leg and the hip
and knee flexed. Flexing the top hip
and knee and placing this leg in front
of the body creates a wider, triangular
base of support and achieves greater
stability.
Routine lateral positioning has been
proposed as one way to minimize or
prevent complications from bed rest in
critically ill patients while still
maintaining adequate oxygen delivery
and tissue oxygenation. The benefits
of lateral positioning include increased
patient comfort; prevention of
pressure injury, atelectasis, and
pneumonia.
COMMON PATIENT’S POSITION

Semi Prone Position. Is when the patient

assumes a posture halfway between the
lateral and the prone positions. The lower
arm is positioned behind the client, and the
upper arm is flexed at the shoulder and the
elbow. The upper leg is more acutely flexed
at both the hip and the knee, than is the
lower one.
Reduces lower body pressure. It is also
used for paralyzed clients because it
reduces pressure over the sacrum.
Perineal area visualization and treatment.
It is often used for clients receiving enemas
and occasionally for clients undergoing
examinations or treatments of the perineal
area.
COMMON PATIENT’S POSITION

ORTHOPNEIC POSITION. Places the

patient in a sitting position or on the
side of the bed with an overbed
table in front to lean on and several
pillows on the table to rest on.
Orthopnea. Difficulty of breathing
except in an upright position. This
position allows maximum expansion
of the chest.
COMMON PATIENT’S POSITION

LITHOTOMY POSITION. Is a patient

position in which the patient is on
their back with hips and knees flexed
and thighs apart.
Lithotomy position. Is commonly
used for vaginal examinations and
childbirth.
COMMON PATIENT’S POSITION

TRENDELENBURG’S POSITION.
Involves lowering the head of the bed
and raising the foot of the bed of the
patient. The patient’s arms should be
tucked at their sides.
Promotes venous return. Hypotensive
patients can benefit from this position
because it promotes venous return.
Postural drainage. Trendelenburg’s
position is used to provide postural
drainage of the basal lung lobes.
Watch out for dyspne, some patients
may require only a moderate tilt or a
shorter time in this position during
postural drainage. Adjust as tolerated.
COMMON PATIENT’S POSITION

REVERSE TRENDELENBURG’S
POSITION. Is a patient position
wherein the head of the bed is
elevated with the foot of the bed
down. It is the opposite of
Trendelenburg’s position.
Reverse Trendelenburg
position. Is used for surgeries
including nose, head and neck
surgeries because it reduces the
flow of blood to those areas.
COMMON PATIENT’S POSITION

KNEE-CHEST POSITION. Also known

as fetal position. The patient lies on
the side with both knees bent, with
the top leg brought closer to the
chest.
KNEE-CHEST POSITION. Is used in
the administration of spinal
anesthesia.
Moving patient in the bed
Using a drawsheet help move a helpless patient. An assistant is needed. Loosen the
sheet and roll it close to either side of the patient’s body. Grasp the rolled sheet
and slide the sheet and patient upward. Then smooth the loosened sheet free of all
wrinkles, tighten, and tuck it under the sides of the mattress.
Turning Patient. Changing a patient's position side to side in bed every 2 hours
helps keep blood flowing. This helps the skin stay healthy and prevents bedsores.
Log Rolling a Patient. Logrolling is a technique used to turn a patient whose body
must always be kept in a straight alignment. This technique is used for the patient
who has a spinal injury, hip fracture, hip replacement.
Transferring Patient. Are defined as moving a patient from one flat surface to
another, such as from a bed to a stretcher. Types of hospital transfers include bed
to stretcher, bed to wheelchair, wheelchair to chair, and wheelchair to toilet, and
vice versa.
Mobility
Is the ability of a patient to change and control their body position.
Physical mobility requires sufficient muscle strength and energy, along with
adequate skeletal stability, joint function, and neuromuscular synchronization.
Functional mobility - Is the ability of a person to move around in their
environment, including walking, standing up from a chair, sitting down from
standing, and moving around in bed.
The Three Main areas of Functional Mobility are the following:
1. Bed Mobility: The ability of a patient to move around in bed, including moving
from lying to sitting and sitting to lying.
2. Transferring: The action of a patient moving from one surface to another. This
includes moving from a bed into a chair or moving from one chair to another.
3. Ambulation: The ability to walk. This includes assistance from another person or
an assistive device, such as a cane, walker, or crutches
A.ASSISTIVE DEVICES
❑ Mobility aids,such as wheelchairs, scooters, walkers, canes, crutches1, prosthetic
devices, and orthotic devices

TYPES OF ASSISTIVE DEVICES

1. CANES
❑ similar to crutches in that they support the body’s weight and help transmit the load
from the legs to the upper body.
❑ they take less weight off the lower body than crutches and place greater pressure on
the hands and wrists.
❑ are useful for people who have problems balancing and who are at risk of falling.
Common types of canes include:
Quad canes. These have four feet at the end of the cane, providing a wider base and
greater stability.

Forearm canes. Offering extra forearm support, these canes allow greater weight to be
distributed from the wrist to the arm.
2. CRUTCHES
• type of Walking Aids that serve to increase the size of an individuals Base of support. It transfers weight from the legs to
the upper body and is often used by people who cannot use their legs to support their weight (ie short-term injuries to
lifelong disabilities).

CRUTCHES TYPE

• axilla or underarm crutches They should be positioned about 5 cm below the axilla with the elbow flexed 15 degrees,
approximately. The design includes an axilla bar, a handpiece and double uprights joined distally by a single leg. They are
adjustable in height; both the overall height and handgrip height can be adjusted (adjustable approximately 48 to 60 inches
(12 to 153 cm)
• Forearm crutches (or lofstrand, elbow or Canadian crutches). Their design includes a single upright, a forearm cuff and a
handgrip. The height of the forearm crutches are indicated from handgrip to the floor (adjustable from 29 to 35 inches or 74
to 89 cm).
• Gutter Crutches (or adjustable arthritic crutches, forearm support crutches) These are additional types of crutches, which
is composed of padded forearm support made up of metal, a strap and adjustable handpiece with a rubber ferrule. These
crutches are used for patients who are on partial weight bearing like Rheumatoid disease
 Proper Positioning

• When standing up straight, the top of your crutches should be about 1-2 inches below your armpits.
• The handgrips of the crutches should be even with the top of your hip line.
• Your elbows should be slightly bent when you hold the handgrips.
• To avoid damage to the nerves and blood vessels in your armpit, your weight should rest on your hands, not on
the underarm supports. Sitting To sit, back up to a sturdy chair.
• Put your injured foot in front of you and hold both crutches in one hand. Use the other hand to feel behind you
for the seat of your chair.
• Slowly lower yourself into the chair.
• When you are seated, lean your crutches in a nearby spot. Be sure to lean them upside down—crutches tend to
fall over when they are leaned on their tips. To stand up, • Inch yourself to the front of the chair.
• Hold both crutches in the hand on your injured side.
• Push yourself up and stand on your good leg.
•There should be a 2-3 finger width (1-2 inches) gap between the armpit (axillae) and
crutch rest pad when the patient holds the crutches. WHY? This prevents the patient from
resting on the crutch rest pad while using the crutches. The patient should place weight
on the hand grips NOT the crutch rest pad while ambulating. This prevents nerve damage
such as CRUTCH Palsy that can occur within the axillae region.
•The elbows should be flexed about 30 degrees when the hands are placed on the hand
grips.
AXILLARY ELBOW
CRUTCHES CRUTCHES
 WALKING PATTERN
2 point: the crutches and the fractured leg are one point and the uninvolved leg is the other point. The crutches and
fractured limb are advanced as one unit, and the uninvolved weight-bearing limb is brought forward to the crutches as
the second unit. This gait pattern is less stable as only two points are in contact with floor and good balance is needed to
walk with
2 points crutch gait .

3 point: this gait pattern is used when one side lower extremity (LE) is unable to bear weight (due to fracture,
amputation, joint replacement etc). It involves three points contact with the floor, the crutches serve as one point, the
involved leg as the second point, and the uninvolved leg as the third point. Each crutch and the weight-bearing limb are
advanced separately, with two of the three points maintaining contact with the floor at any given time.

4 point: this gait pattern is used when there›s lack of coordination, poor balance and muscle weakness in both LE, as it
provides slow and stable gait pattern with three points support on it, point one is the crutch on the involved side, point
two is the uninvolved leg, point three is the involved leg, and point four is the crutch on the uninvolved side . The
crutches and limbs are advanced separately, with three of the four points on the ground and bearing weight any given
time.
Gait to:
the fractured limb is advanced,
and then the intact limb brought
to the same position. When
weight-bearing status is
restricted to partial, toe-touch,
or as tolerated, crutches or a
walker is necessary and help the
patient step to the fractured limb
by pushing down with the upper
extremities, thus transferring
weight from the fractured limb
to the assistive device.
Gait through:
the intact leg is advanced,
and then the fractured leg is
advanced past it. With
restricted weight-bearing,
crutches are used instead of
the injured limb, and the
patient steps past the
crutches with the weight-
bearing lower extremity; the
gait assumes a two point or
three-point pattern.
3. WALKERS
• Type of mobility aid that offers stability and support while walking.
• Walkers are more stable than crutches or canes. They have a wide base of support that gives stability front to
back and side to side.
• Special pediatric walkers are also available for younger children. • Walkers may come with or without wheels.
• Rollators are a type of wheeled walker.

Benefits of a Walker
• Help with balance and lower the risk of falls
• Provide support when muscles are weak
• Limit weight bearing on the lower body
• Help patients move safely if they have reduced feeling or control in legs or feet
• Reduce pain or fatigue during walking or standing
• Assist in sitting down or standing up
Indications
✶ For person with poor balance,
✶ Generalized weakness,
✶ Restricted lower-limb weight bearing (e.g., post-hip surgery)
✶ Debilitating conditions.

Cautions
✶ Not be the most appropriate device for persons who have visual impairment,
✶ Severe balance disturbances or impaired cognition affecting safety judgment.
✶ They are not appropriate for rough terrain or stairs
✶ Pose a hazard in a crowded or cluttered setting.
Types of Walkers

1. Standard walker. This walker has four nonskid, rubber-tipped legs to provide stability. must
pick it up to move.
2. Two-wheel walker. This walker, which has wheels on the two front legs, is helpful if you
need some, but not constant, weight-bearing help. 3. Three-wheel walker. This walker
provides balance support like a four-wheel walker, but it is lighter weight and more
maneuverable.
4. Four-wheel walker. This walker is for people who don›t need to lean on the walker for
balance.
5. Knee walker. This walker is similar to a foot-propelled scooter, but it has a platform for
resting your knee.
 Fitting your walker

Adjust your walker so that it fits your arms comfortably. This will reduce stress on your
shoulders and back as you use the walker. To tell if your walker is the correct height, step
inside your walker and:

• Check your elbow bend. Keeping your shoulders relaxed, place your hands on the grips.
Your elbows should bend at a comfortable angle of about 15 degrees.
• Check your wrist height. Stand inside the walker and relax your arms at your sides. The top
of the walker grip should line up with the crease on the inside of your wrist
• Fitting your walker
• Adjust your walker so that it fits your
arms comfortably. This will reduce stress
on your shoulders and back as you use the
walker. To tell if your walker is the correct
height, step inside your walker and:

• • Check your elbow bend. Keeping your

shoulders relaxed, place your hands on the
grips. Your elbows should bend at a
comfortable angle of about 15 degrees.
• • Check your wrist height. Stand inside
the walker and relax your arms at your
sides. The top of the walker grip should
line up with the crease on the inside of
your wrist
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