You are on page 1of 45

Chapter 18

Lifting, Moving, and Positioning Patients

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

1

Chapter 18 Lesson 18.1

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

2

Learning Objectives
Theory
• Describe the anatomy and function of the musculoskeletal system • Explain the importance of proper body mechanics, alignment, and position change for both patient and nurse • Discuss the principles of body movement and positioning, giving an appropriate example for each principle • Identify ways to maintain correct body alignment of the patient in bed or in a chair
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

3

Musculoskeletal System Overview
• Bones
– Four types
• Short, long, flat, and irregular

• Joint
– A union of two or more bones; moves freely

• Bursa
– A small fluid-filled sac that provides a cushion at friction points in the joints
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

4

Musculoskeletal System Overview
• Skeletal muscle
– Striated muscles surrounded by a connective tissue sheath

• Tendon
– Fibrous tissue that connects muscle to bone

• Ligament
– Connects bone to cartilage

• Cartilage
– Fibrous connective tissue; acts as a cushion
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

5

Functions of Bones
• Provide a scaffolding to support the body • Give shape to the body and support the internal organs and skin • Provide places for ligaments and tendons to attach to facilitate movement
– Joints allow movement and flexibility of the skeleton
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

6

Functions of Muscles
• Can stretch; can be stimulated to contract electrically or to extend elastically • Provide movement • Stabilize joints • Produce heat • Maintain posture
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

7

Changes Occurring with Aging
• Bone mass loss may lead to osteoporosis (more severe in women) • Loss of bone density predisposes the elderly to fractures • Muscle cells are lost and replaced by fat cells • Elasticity of muscle fibers is decreased, limiting flexibility • Joint motion may decrease, limiting motion and mobility
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

8

Principles of Body Movement for Nurses
• One of the most common injuries in health care workers is lower back strain! • Get help whenever possible; ask patient to help if able
– Two nurses moving a patient divides the work – It is better to wait for help than to risk injury

• Use your leg muscles; bend and flex your knees
– Bend at the knees, not at the waist
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

9

Principles of Body Movement for Nurses
• Use the greatest number of muscles possible • Use thigh, arm, or leg muscles rather than back muscles, and use a wide base of support • Keep feet approximately shoulder-width apart • Pull and pivot, using smooth, coordinated movements; avoid jerking or sudden pulling movements • Encourage patient to assist when transferring and moving if possible
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

10

Figure 18-3: Use leg muscles to prevent back strain

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

11

Moving and Lifting Patients
• Keep elbows close and work close to your body; work at same level or height as the object to be moved; keep the load near your center of gravity • Pulling actions require less effort than pushing or lifting; face the direction of the movement • Use arms as levers when pulling patient toward you; lock elbows and rock back on your heels, using weight of your body to move the patient
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

12

Body Movement and Alignment for Patients
• Two basic principles
1. Maintain correct anatomic position 2. Change position frequently

• Hazards of improper alignment
– Interference with circulation, which may lead to pressure ulcers – Muscle cramps and possible contractures – Fluid collection in the lungs
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

13

Figure 18-2: Correct standing body alignment

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

14

Figure 18-5: Correct sitting body alignment

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

15

Pressure Ulcers
• Also known as decubitus ulcers, or bedsores • Occur when pressure on the skin causes an area of local tissue necrosis • Occur most often between a bony prominence and an external surface • May be caused by shearing as force is applied downward and forward on tissue beneath the skin (as when a patient slides down in a chair)
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

16

Nursing Diagnoses for Problems of Body Movement
• Commonly used nursing diagnoses
– Risk for injury – Impaired physical mobility – Risk for impaired skin integrity – Impaired walking

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

17

Planning
• Decide how to change the patient's position and whether you can delegate this task to assistive personnel • The home setting must also be considered when planning care for the patient

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

18

Goals and Expected Outcomes
• Patient will experience no musculoskeletal injury • Former level of mobility will be reattained within 6 months • Skin integrity will remain intact while patient is on bed rest • Patient will not experience injury while ambulating • Patient should have full range-of-motion exercise actively or passively performed several times a day
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

19

Chapter 18 Lesson 18.2

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

20

Learning Objectives
Theory
• Describe the proper method for transferring a patient between wheelchair and bed

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

21

Learning Objectives
Clinical Practice
• Correctly position a patient in the following positions: supine, prone, Fowler’s, and Sims’ • Assist patients to sit up in bed • Demonstrate complete passive range-of-motion (ROM) exercises for a patient • Correctly transfer a patient from a wheelchair to a bed • Transfer a patient from a bed to a stretcher • Demonstrate the correct techniques to ambulate a patient and to break a fall while ambulating
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

22

Positioning
Accomplishes four objectives
1. Positioning provides comfort 2. Positioning relieves pressure on bony prominences and other parts, decreasing the patient’s risk of developing bedsores 3. Positioning prevents contractures, deformities, and respiratory problems 4. Positioning improves circulation
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

23

Common Positions and Variations: Supine
• Patient lying on her back • Fowler’s position
– Supine with the HOB elevated 60 to 90 degrees

• Semi-Fowler’s position
– Supine with the HOB elevated 30 to 60 degrees

• Low Fowler’s position
– Supine with the HOB elevated 15 to 30 degrees
24

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

Figure: Fowler’s positions

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

25

Common Positions and Variations: Supine
• Dorsal recumbent position
– Supine with knees flexed and feet flat on the bed; used for many procedures and examinations

• Dorsal lithotomy position
– Feet in stirrups and legs spread farther apart; used in pelvic exams

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

26

Figure 18-6: Dorsal recumbent position

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

27

Figure 18-7: Lithotomy position

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

28

Common Positions and Variations: Side-Lying Lateral
• Patient lying on her side
– Alleviates pressure on bony prominences of the back

• Oblique side-lying position
– Removes pressure from shoulder and hip – Easier for patients

• Sims’ position
– A variation of side-lying used for rectal examinations or insertions of tubes or suppositories
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

29

Figure: Side-lying positions

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

30

Figure: Sims’ position

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

31

Common Positions and Variations: Prone
• Patient lying face down • Often used for patients with spinal cord injury • Not generally well tolerated • Knee-chest position
– Face down, with chest, knees, and elbows resting on the bed – Used for rectal examinations
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

32

Figure: Prone position

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

33

Figure 18-8: Knee-chest position

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

34

Common Positioning Devices
• Pillows
– Used to support the body or extremities

• Boots or splints
– Maintain dorsiflexion

• Footboards, high-top sneakers
– Maintain dorsiflexion

• Trochanter rolls
– Prevent external rotation of the leg
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

35

Common Positioning Devices
• Sandbags
– Used to immobilize an extremity, provide support, and maintain body alignment

• Hand rolls
– Help prevent contractures and prevent dorsiflexion of the wrist

• Trapeze bars, side rails, bed boards
– Enhance patient mobility, provide patient safety, and support patient’s back
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

36

Moving the Patient in Bed
• Using a lift sheet
– Requires at least two people standing on opposite sides of the bed – Both face the bed and use the sheet to move the patient up in the bed – Moving the patient is performed as a coordinated effort – Patient is lifted and moved, not dragged
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

37

Figure 18-9A: Trapeze bar

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

38

Figure 18-9B: Trochanter roll

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

39

Logrolling
• Turning the patient as a single unit • Body alignment maintained at all times • Used to change bed linen, can be performed with or without a lift sheet • Requires two people if patient cannot turn herself • Leave a pillow under the patient’s head
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

40

Figure 18-10: Logrolling a patient using a lift sheet

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

41

Figure 18-11: Logrolling a patient without a lift sheet

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

42

Lifting and Transferring
• Patients may transfer independently or require different levels of assistance • Always dangle a patient at bedside before transferring to a wheelchair, and observe for dizziness or nausea • Remember to lock the wheels on wheelchairs or gurneys before attempting to transfer a patient • Stretchers used for transporting a patient who is unable to sit in a wheelchair • Either lift equipment or two nurses should transfer a patient to a wheelchair if patient unsteady, weak, or heavy
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

43

Things to Remember
• Determine how much help you will need to move or transfer the patient • Get help whenever possible • Make sure wheels on beds, wheelchairs, and gurneys are locked • Use a transfer device when possible • Dangle the patient before ambulating • Use a gait belt when ambulating patients
Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

44

Transfer Devices
• • • • • Pull or life sheets Mechanical lifts Roller boards Slide boards Transfer or gait belts

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc.

45