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Chapter 18 Safety Lifting, Moving, and Positioning Patients
Terms in this set (89)
Bones 4 types
Short, long, flat, and irregular
A union of 2 or more bones; move freely
A small fluid filled sac that provides a cushion at friction points in the joints
Striated muscles surrounded by a connective tissue sheath
Fibrous tissue that connects muscle to bone
Connects bone to cartilage
Fibrous connective tissue; acts as a cushion
Groups of muscles work together (contract) to
Produce a single movement
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
movement and flexibility of the skeleton
Joint is the place of union of two or more
bones in the body
Functions of Muscles
-Can stretch; can be stimulated to contract electrically or to extend elastically
Good posture is important to prevent...
Fatigue, joint deformities, provide strength, support position of int. organs
Skeletal muscle contraction is accomplished though the
stimulation of muscle fibers (nerves stimulate muscle)
Changes occurring with age
-Bone mass loss may lead to osteoporosis
-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
How are male and female skeletons differ?
Male hip bones form narrow deep funnels; females hip bones are broad and shallow
Bone growth and strength depends on...
minerals, vitamin D, and blood supply to the bones
Bone disorders are common with
One of the most common injuries in health care workers?
Lower back strain
To prevent injuries
-Get help whenever possible; ask pt to help if able
-Encourage pt to assist when transferring and moving if possible
Instead of using back muscles...
-use thigh, arm, or leg muscles
-use a wide base of support
How can injuries be prevented?
Correct proper body movement is essential to prevent injuries
What are the benefits of core exercises as related to your back?
Core exercises keep you back healthy and strong. Core exercises train muscles in your abdomen, pelvis, lower back, and hips.
Improve stability for movement
-Keep feet approximately shoulder-width apart
-Use greatest number of muscles possible
-Smooth coordinated movements
-Keep loads close to the body and near center of gravity
-Pull and pivot, avoid jerking or sudden pulling
Use devices such as
Mechanical lifts and transfer or roller boards
Moving and Lifting Pts.
-Keep elbows close and work close to your body
-Work at same level or height as object moving
-Keep load near your center of gravity
Pulling action requires
Less effort than pushing or lifting
-Face direction of 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 pt.
Few injuries are sudden and painful such as
strain or sprain
Strain- occurs when muscle or tendon is twisted or stretched beyond limit
Sprain- Occurs when joint is forced beyond normal ROM
Principles of body movement for patients 2 basic principles
Maintain correct anatomic position
Change position frequently
Hazards of improper alignment and positioning
Interference with circulation
Muscle cramps and possible contracture
Fluid collection in the lungs
What are contractures?
Resistance to stretch in damaged muscle that pulls a joint into a fixed position
How can contractures be prevented?
Correct body positioning
What is a shearing force?
Applied force that causes a downward and forward pressure on the tissues beneath the skin
-Occur when pressure on the skin causes area of location tissue necrosis
-Occur most often on bony prominences and external surface
When assessing the pt's standing body alignment start by
noting the HEAD POSITION in relation to rest of the body
When assessing the sitting pt observe for
When assessing the lying pt, assess carefully for
ALIGNMENT AND CORRECT POSITION
Assess the pt's ability to ambulate and to
CHANGE POSITION INDEPENDENTLY
Body alignment refers to the
Relationship of one body part to another along a horizontal or vertical line
Body balance is achieved when
a low center of gravity is balanced over a wide, stable base of support
Body balance is enhanced by
position that most favors function, requires the least muscular work to maintain, and places the least strain on muscles, ligaments, and bones.
Assessment of mobility has 3 components
ROM, GAIT, EXERCISE
Factors influencing activity tolerance physiologically
Skeletal abnormalities, muscular impairments, Hypoxemia, Decreased cardiac function, decreased endurance, impaired physical stability, pain, sleep pattern disturbance, prior exercise patterns, infectious process and fever, fatigue
Factors influencing activity tolerance emotionally
Motivation, Psychological problems
Factors influencing activity tolerance developmental
Age and Sex
Factors influencing activity tolerance pregnancy
Physical growth and development of muscle and skeletal support
-Disorders of bones, joints, and muscles
Growth and developmental influences
-Newborn spine is flexed and lacks anteroposterior curves of the adult. As growth and stability increase, the thoracic spine straightens, and the lumbar curve appears, allowing sitting and standing.
-Greater coordination enables the child to perform tasks that require fine motor skills.
-With aging, changes in musculoskeletal function may limit client activity.
-Bone strength and mass are lost because of mineral resorption. (May lead to osteoporosis)
-Fractures do not heal as quickly because of the decreased mineral uptake.
-Knowledge; barriers to a program of exercise; current exercise behaviors or habits
-Stage of readiness
Cultural and Ethnic Influences
-Certain motivating factors may be different
-Certain activities may be deemed inappropriate
-Some activities are viewed as more or less enjoyable in certain cultures
Commonly used nursing diagnosis
-Risk for Injury
-Impaired physical mobility
-Risk for impaired skin integrity
-Prevent injury and mobility
-Restore function of muscles, nerves, bones, and joints
-Prevent deformity and stimulate circulation
-Build tolerance and endurance
Application of the nursing process: Planning
-Decide how to change the Pt's position and whether you can delegate this task to assistive personnel
-The home setting must also be considered when planning care for the pt.
Data collected during the assessment phase gives information about?
How to best promote independence or assist the patient
Expected outcomes of planning
-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
Positioning accomplish four objectives
-Positioning provides COMFORT
-Positioning RELIEVES pressure on bony prominences and the parts, decreasing the patients risk of developing bed sores
-Positioning PREVENTS contractures, deformities, and respiratory problems
-Positioning IMPROVES circulation
How can a nurse maintain a patients privacy during positioning?
-HOB 60-90 degrees
HOB 30-60 degrees
Low Fowlers position
HOB 15-30 degrees
High, Semi, and Low Fowlers all improve?
Cardiac output/respiration, promote urinary and bowel elimination
Why is elevation of the knees above 15 degrees contraindicated in elderly and post op patients?
Causes decreased circulation in lower extremities
Dorsal recumbent position
Supine with knees flexed and feet flat on the bed; used for many procedures and examination
Dorsal lithotomy position
Feet in stirrups and legs spread farther apart; used in pelvic exams
How is the distribution of weight in the Sims position different from the distribution in the side-lying position?
The distribution of weight is different from in the side-lying position because in the Sims position the weight is distributed over the anterior ileum, humerus, and clavicle.
-Patient lying face down
-Often used for patients with spinal cord injury
-Face down, with chest, knees, and elbows resting on the bed
-For rectal examinations
Patients on prolonged bed rest may develop...
External rotation deformity of the hip
Common positioning devices
Pillows, Boots or Splints, Footboards, High top sneakers, Trochanter rolls, Sandbags, Hand rolls, Trapeze bars, Side rails, Bed boards
Used to support the body extremities
Boots, Splints, Footboards, High-top sneakers
Prevent external rotation of the leg and prevent deformity of the hip
Hand Rolls prevent
Contractures and Dorsiflexion of the wrist
Used to immobilize an extremity, provide support, and maintain body alignment
Trapeze Bars, Side Rails, Bed boards
Enhance patient mobility, provide patient safety, and support patients back
Moving patients up in bed using the LIFT SHEET
-Requires at least 2 people standing on opposite side 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
___________ most important factor for the patient and the nurse
Nurse must use good _______ ____________ and __________
Body Mechanics and Balance
During logrolling communicate actions to patient and
ask for the patient's help and guidance if necessary
-Turning the patient as a single unit
-Body alignment maintained at all times
-Used to change bed linen, can be performed with or without lift sheet
-Requires two people if patient cannot turn herself
-Leave a pillow under the pt's head
When is logrolling usually used?
For patients with injuries or surgery to the spine, and for patients who must avoid twisting
Always __________ a patient at bedside before transferring to wheelchair, and observe for ____________ or ____________
DANGLE, DIZZINESS, NAUSEA
Remember to ______ the wheels on wheelchairs or gurneys before transferring a patient
Used for patients to transport if unable to sit in wheelchair
Why does transferring a patient from supine position to the chair require bedside dangling?
To accustom the body gradually to the position change
-Pull or lift sheets
-Transfer or Gait belts
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