POSTURE, BODY MECHANICS AND MOBILITY OF CLIENT AND CAREGIVER

NORMAL MOVEMENT 
Equilibrium is a normal movement and stability that are intact with: 1. Musculoskeletal system. 2. Nervous system. 3. Inner ear structures.

Normal movement (cont).. 

Body movement required coordinated muscle activity and neurologic integration.  It involves four basic elements: 
Body alignment (posture) Joint mobility Balance Coordinated movement

JOINT MOBILITY 
Refers to the person¶s ability to move freely.  Serves many purpose, such as expansion of an emotion with a nonverbal gesture, self defense, satisfaction of basic needs and performance of Activity of Daily Living (ADLs) and recreational activities.

Joint mobility (cont).. 

Many function of the body need mobility to function optimally. To maintain optimal physical mobility, the musculoskeletal and nervous systems of the body must be intact and functioning.

IMMOBILITY 
Refer to inability to move freely.

ALIGNMENT AND POSTURE 
Proper body alignment and posture bring body part into position in a manner that promotes optimal balance and maximal body function (sitting, standing or lying down)  A person maintains balance as long as the line of gravity passes through the center of gravity and the base of support.

Alignment and posture (cont).. 

In human, the usual line of gravity begins at the top of the head and falls between the shoulders, through the trunk, slightly anterior to the sacrum and between the weight-bearing joints and base of support.

Alignment and posture (cont).. 

When body is well aligned, strain on the joints, muscles, tendons or ligaments is minimized and internal structures and organ are supported.

Alignment and posture (cont).. 

A person¶s posture is one criterion for assessing general health, physical fitness and attractiveness.  Posture reflects the mood, self-esteem and personality of an individual.

JOINT MOBILITY 
Are the functional units of the musculoskeletal systems.  The bones of the skeletal articulate at the joints and attach to the two bones at the joint.

Joint mobility (cont).. 

The muscles are categorized according to the type of joint movement they produce on contraction. 
Muscles are called flexors, extensors, internal rotators. The flexor muscles are stronger than the extensor muscles.

Joint mobility (cont).. 
When a person inactive, the joints are pulled into a flexed (bent) position. If this tendency is not countered with exercise and position changes the muscle permanently shorten and the joint becomes fixed in a flexed position (contracture)

Types of joints

Joint mobility (cont).. 

Range of motion (ROM) is the maximum movement that is possible for that joint.

BALANCE 
Mechanisms involved in maintaining posture are complex and involve informational inputs from the inner ear, from vision and from stretch receptors of muscles and tendons.  Mechanisms equilibrium (sense of balance) respond, frequently without or awareness to various head movements.

Balance (cont).. 

Under normal conditions the equilibrium receptors in the semicircular canals and vestibule, collectively called the vestibular apparatus, send signals to the brain that initiate reflexes needed to make required changes in position.  The receptors, hair like cells, respond to displacement of the head in any direction.

Balance (cont).. 

When the head moves, the fluid flow within the vestibule and semicircular canals stimulates sensory hair cells.  Information from these balance receptors goes directly to reflect centers in the brain stem. This enables fast reflexive responses to body imbalance.

COORDINATED MOVEMENT 
The cerebellum coordinates the motor activities of movements and basal ganglia maintain the posture.  When a client¶s cerebellum is injured, movement become clumsy, unsure and uncoordinated.

BODY MECHANICS 
Is the term used to describe the efficient, coordinated and safe use of the body to more objects and carry out the activities of daily living.  Using principles of body mechanics during routine activity will prevent injury.  The nurse teaches a colleagues and clients families to lift, transfer or position clients properly.

PATHOLOGICAL INFLUENCES ON BODY MECHANICS 
For example: 
Congenital defects (disorders of bones, joints and muscles- Osteoporosis) Central nervous system damage Musculoskeletal trauma- bruises, confusions, sprain and fracture.

PRINCIPLE OF BODY MECHANICS 
The wider the base of support , the greater the stability of the nurse.  The lower the center of gravity, the greater the stability of the nurse.  The equilibrium of the subject is maintained as long as the line of gravity passes through its base of support.

Principle of body mechanic (cont).. 

Facing the direction of movement prevents abnormal twisting of the spine.  Dividing balance activity between arms and legs reduces the risk of back injury  Rolling, turning or pivoting requires less work than lifting.

Principle of body mechanic (cont).. 

When friction is reduced between the object to move and the surface on which it is moved, less force is required to move it.  Reducing the force of work reduce the risk of injury.  Maintaining good body mechanics reduce fatigue of muscle groups.  Alternating period of rest and activity helps to reduce fatigue.

LIFTING 
Nurse should not lift more than 51 lbs without assistance from proper equipment and/ or other persons.  When a person lift or carries an object, the weight of the object becomes part of the person¶s body weight ± affects the location of the person¶s center of gravity

Lifting (cont).. 

To counteracts this potential imbalance, body parts (e.g. arm & trunk) move in a direction away from the weight ± center of gravity is maintained over the base of support. 
Holding the lifted objects as close possible to the body ± avoids undue displacement of the center of gravity and achieves greater gravity.

Lifting (cont).. 

Lifting involves movement against gravity.  The nurse must use the major group of the thighs, knees, upper and lower arms, abdomen and pelvis to prevent back strain.

PULLING AND PUSHING 
When pulling and pushing an object, a person maintains balance with least effort when the base of support is enlarged in the direction in which the movement is to be produced or opposed.

PIVOTING 
Is a technique in which the body is turned in way that avoids twisting of spine (turn 90 degree in the desired direction )

PREVENTING BACK INJURY 
The major contributor is habitually poor standing and sitting posture ± lordosis.  Overweight individuals who carry their extra weight over their abdomen, pregnant women and women who consistently wear high-healed shoes are at risk ± exaggerated lumbar.

POSTURE, BODY MECHANICS AND MOBILITY OF CLIENT AND CAREGIVER (PROCEDURE)
MOVING / LIFTING

MOVING IMMOBILITY CLIENT UP IN BED (ONE NURSE) 
Place client on back with head of bed flat. Stand one side of bed.  Remove pillow from under head and shoulders and place pillow at head of bed

Moving immobility client up in bed (cont).. 

Begin at client feet. Face foot of bed at 45 degree angle. Place feet apart with foot nearest head of bed behind other foot (forward-backward stance). Flex knees and hips as needed to bring arms level with client¶s legs. Shift weight from front to back leg and slide client¶s legs diagonally toward head of bed.

Moving immobility client up in bed (cont).. 

Move parallel to client¶s hips. Flex knees and hips as needed to bring arms level with client¶s hips.  Slide client¶s hip diagonally toward head of bed.  Move parallel to client¶s head and shoulders. Flex knees and hips as needed to bring arms level with client¶s body.

Moving immobility client up in bed (cont).. 

Slide arms closest to head of bed under client¶s beck with hand reaching under and supporting client¶s opposite shoulder.  Place other arm under client¶s upper back.  Slide client¶s trunk, shoulders, head and neck diagonally toward head of bed.  Elevate side rail.

AUSTRALIAN LIFT

ASSIST CLIENT IN MOVING UP IN BED (ONE OR TWO NURSES)AUSTRALIAN LIFT. 

Remove pillow from under head and shoulders and place pillow at head of bed.

Assist client in moving up in bed (cont).. 
Face head of bed  Each nurse should have one arm under client¶s shoulder and one arm under client¶s thighs.  Alternative position; one nurse client¶s upper body. Nurse¶s arm nearest head of bed should under client¶s head and opposite shoulder; other arms should under client¶s closest arm and shoulder. Position other nurse at client¶s lower torso. The nurse¶s arm should be under client¶s lower back and torso.

Assist client in moving up in bed (cont).. 

Place feet apart, with foot nearest head of bed behind other foot.  When possible, ask client to flex knees with feet flat on bed.  Instruct client to flex neck, tilting chin toward chest.

Assist client in moving up in bed (cont).. 

Instruct client to assist moving by pushing with feet on bed surface.  Flex knees and hips, bringing forearms closer to level of bed.

Assist client in moving up in bed (cont).. 

Instruct client to push with heels and elevate trunk while breathing out, thus moving towards head of bed on count of three.  On count of three, rock and shift weight from front to back leg. At the same time client pushes with heels and elevates trunk.

MOVE WITH DRAWSHEET

MOVE IMMOBILE CLIENT UP IN BED WITH DRAWSHEET OR PULL SHEET (TWO NURSES) 
Place drawsheet or pull sheet under client by turning side to side. Have sheet extend from shoulders to thighs. Return client to supine position.  Position one nurse at each side of client.

Move immobile client up in bed with drawsheet or pull sheet (cont).. 

Grasp drawsheet or pull sheet firmly near the client.  Place feet apart with forward-backward stance. Flex knees and hips. Shift weight from front to back leg and move client and drawsheet or pull sheet to desired position in bed.  Realign client in correct body alignment.

LOGROLLING THE CLIENT

LOGROLLING THE CLIENT

LOGROLLING THE CLIENT (THREE NURSES) 
Place pillow between client¶s knees.  Cross client¶s arms on chest.  Position two nurse on side to which the client will be turned. Position third nurse on the other side of bed.

Logrolling the client (cont).. 

Fanfold or roll the drawsheet or pull sheet.  Move the client as one unit in a smooth, continuous motion on the count of three.

Logrolling the client (cont).. 
Nurse on the opposite side of bed places pillows along the length of the client.  Gently lean the client as a unit back towards the pillows for support.

ASSIST TO SITTING POSITION

ASSIST TO SITTING POSITION

Assist to sitting position (cont).. 

Place client in supine position.  Face head of bed at a 45 degree angle and move pillows.  Place feet apart with foot nearer bed behind other foot, continuing 45 degree angle to head of the bed.  Place hand further from client under shoulders, supporting client¶s head and cervical vertebrae.

Assist to sitting position (cont).. 

Place other hand on bed surface.  Raise client to sitting position by shifting weight from front to back leg.  Push against bed using arm that is placed on bed surface.

SIT ON SIDE OF BED

ASSIST TO SIT ON SIDE OF BED

Assist to sit on side of bed (cont).. 

Turn client to side, facing you on side of bed on which client will be sitting.  With client in supine position, raise head of bed 30 degrees.  Stand opposite client¶s hips. Turn diagonally so you face client and far corner of foot of bed.

Assist to sit on side of bed (cont).. 

Place feet apart with foot closer to head of bed in front of other foot.  Place arm nearer head of bed under client¶s shoulder supporting head and neck.  Place other arm over client¶s thighs.

Assist to sit on side of bed (cont).. 

Move clients lower legs and feet over side of bed. Pivot toward rear legs, allowing client¶s upper legs to swing downward.  At same time, shift weight to rear leg and elevate client.

TRANSFERRING FROM BED TO CHAIR

Transferring for bed to chair (cont).. 

Assist client to sitting position on side of bed. Have chair in position at 45 degree angle to bed.  Apply transfer belt or other transfer aids.  Ensure the client has stable nonskid shoes. Weight-bearing or strong leg is place forward, with weak foot back.

Transferring for bed to chair (cont).. 

Spread feet apart.  Flex hips and knees, aligning knees with client¶s knees.  Grasp transfer belt from underneath.  Rock client up to standing position on count of three while straightening hips and legs and keeping knees slightly flexed.

Transferring for bed to chair (cont).. 

Maintain stability of client¶s weak or paralyzed leg with knee.  Pivot on foot farther from chair.  Instruct client to use arm rest on chair for support and ease into chair.

Transferring for bed to chair (cont).. 

Flex hips and knees while lowering client into chair.  Assess client for proper alignment for sitting position. Provide support for paralyzed extremities.  Praise client¶s progress effort or performance.

THREE MAN LIFT

THREE- PERSON ( THREE MAN LIFT ) CARRY FROM BED TO STRETCHER

Three- person ( three man lift ) carry from bed to stretcher (cont).. 

Three nurses stand side by facing side of client¶s bed.  Each person assumes responsibility for one of three area; head and shoulder, hips and thighs and ankles.  Each person assumes wide base of support with foot closer to stretcher in front and knees slightly flexed.

Three- person ( three man lift ) carry from bed to stretcher (cont).. 
Arms of lifters are placed under client¶s head and shoulder, hips and thighs and ankles with fingers securely around other side of client¶s body.  Lifters roll client toward their chest. On count of three, client is lifted and held against nurses.  On second count of three, nurses step back and pivot towards stretcher, moving forward if needed.

Three- person ( three man lift ) carry from bed to stretcher (cont).. 

Gently lower client onto center of stretcher by flexing knees and hips until elbows are level with edge of stretcher.  Assess client¶s body alignment, place safety straps across body and raise side rails.

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