Activity Mobility Immobility ho - Faculty.mercer.edu

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2 Νοε 2013 (πριν από 3 χρόνια και 11 μήνες)

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Activity (Mobility/Immobility) Part I



Kelli Shugart RN, MS



Read Taylor pp.
692
-

698
;
1259
-

1274 and 1288
-
1301





Mobility



Physiology of Movement (Review)



Skeletal system



Muscular system



Nervous system




Joint Movements



Abduction



Adduction



Flexion



Extension



Rotation



Supination



Pronation



Inversion



Eversion




Body Mechanics



Coordinated effort of the musculoskeletal and nervous systems to maintain posture,
balance, and body alignment during lifting, bending, moving and ADLs.



Concepts of Body Mechanics



Alignment
or posture



Balance



Coordinated body movement



Postural reflexes



Body Mechanics



Body Alignment
-

Relationship between one body part to another.



Body Balance
-

is achieved when a relatively low center of gravity is balanced over a
wide, stable base of support a
nd a vertical line falls from the center of gravity through
the base of support.



Widen the base



Lower center of gravity



Body Mechanics



Friction
-
force that occurs in a direction opposite movement.



Greater surface area , greater the friction.



Must prevent f
riction



Lift… Avoid pulling…Use a lift sheet



Use clients strength when lifting , transferring, or moving the client in bed.



Application of Body Mechanics



Develop a habit of correct posture



Use the longest and strongest muscles of the arms and legs to help

provide the power
needed



Use the internal girdle to stabilize the pelvis and to protect the abdominal viscera when
stooping, reaching, lifting, or pulling.



Stand close to object being lifted or moved



Use the weight of the body as a force



Application of B
ody Mechanics



Slide, roll, push, or pull an object rather than lifting it



Push rather than pull



Broaden the base of support



Ensure surface is dry and smooth



Flex knees, put on internal girdle, and come down close to an object to be lifted



Break heavy load
s into smaller loads



Take breaks from lifting to recover




Proper and Improper Way to Pick up an Object



Factors Influencing Mobility



Developmental considerations



Physical health



Mental health



Lifestyle



Attitude and values



Fatigue and stress



External factors



Positioning Patients



Pillows



Mattresses



Adjustable beds



Bed side rails



Trapeze bar



Protective Positioning



Additional equipment



Foot board



Cradle



Sandbags



Trochanter rolls



Hand


wrist splint





Protective Positioning



Teach patient and family



Correct positi
on techniques



Change position frequently



Time schedule




Turning schedule





Protective Positioning



Fowler’s position



Supine or dorsal recumbent position



Side
-
lying or lateral position



Prone position



Variables Leading to Back Injury



Uncoordinated lifts



Heigh
t
-
weight differential among lifters



Lifting when fatigued



Lifting after recent recovery from back injury



Lack of training in body mechanics



Standing for long periods of time



Transferring patients



Prevent Injury to Self and Patient



Equipment and Assistive
Devices



Gait Belts



Lateral assist


see page 1298 for pictures



Friction reducing sheets



Mechanical lateral assist



Transfer chairs



Power stand assist and reposition lift



Powered full body lifts



Lifting Techniques



1
st

assess



Medicate if necessary



Verify orde
rs



Raise bed, lower side rails (if appropriate)



Remove all pillows



Obtain extra help if needed



Adjust tubes, poles, catheters



Lifting Techniques



Lower HOB to lowest position



Tighten stomach muscles and tuck pelvis



Bend at the knees
-

let the legs do the lif
ting



Keep the weight to be lifted as close to the body as possible



Maintain the truck erect and the knees bent



Avoid twisting




Transfer Techniques



Assess



Move immobile client up in bed



Assist client move up in bed (one or two nurses)



Move immobile client
up in bed with draw sheet or pull sheet (two nurses)



Position client in supported Fowler’s position (see illustration)




Turning a Patient Skill



Gather any positioning aids or supports, if necessary.



Identify the patient. Explain the procedure to the patien
t.



Perform hand hygiene and put on gloves, if necessary.



Close the room door or curtains. Place the bed at an appropriate and comfortable
working height.



Adjust the head of the bed to a flat position or as low as the patient can tolerate. Place
pillows, we
dges, or any other supports to be used for positioning within easy reach.



Lower the side rail nearest you if it has been raised. If not already in place, position a
friction
-
reducing sheet or drawsheet under the patient.



Using the friction
-
reducing sheet o
r drawsheet, move the patient to the edge of the bed,
opposite the side to which he or she will be turned. Raise side rail and move to the
opposite side of the bed.




Turning a Patient



Stand on the side of the bed toward which the patient is turning. Lower
the side rail
nearest you.



Place the patient’s arms across his or her chest and cross his or her far leg over the
leg nearest you.



Stand opposite the patient’s center with your feet spread about shoulder width and with
one foot ahead of the other.
Tighten
your gluteal and abdominal muscles and flex
your knees. Use your leg muscles to do the pulling.



If available, activate the bed mechanism to inflate the side of the bed opposite from
where you are standing.



Position your hands on the patient’s far shoulder

and hip, and roll the patient toward
you, or you may use the friction
-
reducing sheet or drawsheet to gently pull the patient
over on his or her side.



Use a pillow or other support behind the patient’s back. Pull the shoulder blade forward
and out from und
er the patient.



Make the patient comfortable and position in proper alignment, using pillows or other
supports under the leg and arm as needed. Readjust the pillow under the patient’s head.
Elevate the head of the bed as needed for comfort.



Place the bed i
n the lowest position, with the side rails up. Make sure the call bell and
other necessary items are within easy reach.




Moving a Patient Up in Bed with Assist



Identify the patient. Explain the procedure to the patient.



Perform hand hygiene and put on glov
es, if necessary.



Close the room door or curtains. Place the bed at an appropriate and comfortable
working height. Adjust the head of the bed to a flat position or as low as the patient can
tolerate. Placing the bed in slight Trendelenburg position aids mo
vement, if the patient
is able to tolerate it.



Remove all pillows from under the patient. Leave one at the head of the bed, leaning
upright against the headboard.



Position at least one nurse on either side of the bed, and lower both side rails.



If a fricti
on
-
reducing sheet or drawsheet is not in place under the patient, place one
under the patient’s midsection.



Ask the patient (if able) to bend his or her legs and put his or her feet flat on the bed to
assist with the movement.



Have the patient fold the arm
s across the chest. Have the patient (if able) lift the
head with chin on chest.




Moving a Patient Up in Bed with Assist



Position yourself at the patient’s midsection with your feet spread shoulder width apart
and one foot slightly in front of the other.



If available on bed, engage mechanism to make the bed surface firmer for
repositioning.



Fold or bunch the drawsheet close to the patient before grasping it securely and
preparing to move the patient.



Flex your knees and hips. Tighten your abdominal and glu
teal muscles and keep your
back straight.



Shift your weight back and forth from your back leg to your front leg and count to
three. On the count of three, move the patient up in bed. If possible, the patient
can assist with the move by pushing with the leg
s.

Repeat the process if necessary to
get the patient to the right position.




Assist the patient to a comfortable position and readjust the pillows and supports as
needed. Return bed surface to normal position, if necessary. Raise the side rails. Place
th
e bed in the lowest position.




Remove gloves if used and perform hand hygiene.




Move a Patient From Bed to Stretcher



Identify the patient. Explain the procedure to the patient.



Perform hand hygiene and put on gloves, if necessary.



Close the room door or cu
rtains. Adjust the head of the bed to a flat position or as low
as the patient can tolerate. Raise the bed to a height ½ inch higher than the transport
stretcher. Lower the side rails, if in place.



Place the bath blanket over the patient and remove the top

covers from underneath.



If a friction
-
reducing sheet or drawsheet is not in place under the patient, place one
under the patient’s midsection. Have patient fold arms against chest and move chin to
chest. Use the drawsheet to move the patient to the side o
f the bed where the stretcher
will be placed.



Position the stretcher next to and parallel to the bed.
Lock the wheels on the stretcher
and the bed.



Remove the pillow from the bed and place it on the stretcher. The two nurses should
stand on the stretcher s
ide of the bed. The third nurse should stand on the side of the
bed without the stretcher.




Move a Patient From Bed to Stretcher



Position the transfer board or other lateral
-
assist device under the patient. Use the
drawsheet to roll the patient away from t
he stretcher. Slide the transfer board across the
space between the stretcher and the bed, partially under the patient. Roll the patient
onto his back, so he is partially on the transfer board.



The nurse on the side of the bed without the stretcher should
kneel on the bed, with his
or her knee at the upper torso closer to the patient than the other knee. Fold or bunch
the drawsheet close to the patient before grasping it securely in preparation for the
transfer.



Have one of the nurses on the stretcher side

of the bed reach across the stretcher and
grasp the drawsheet at the head and chest areas of the patient. If the transfer device
used has long handles, each nurse should grasp two of the handles.



Have the other nurse reach across the stretcher and grasp t
he drawsheet at the patient’s
waist and thigh area.



At a signal given by one of the nurses, have the nurses standing on the stretcher
side of the bed pull the sheet. At the same time, the nurse (or nurses) kneeling on
the bed should lift the drawsheet, tra
nsferring the patient’s weight toward the
transfer board, and pushing the patient from the bed to the stretcher.




Once the patient is transferred to the stretcher, remove the transfer board, and secure
the patient until the side rails are raised. Raise the

side rails. Ensure the patient’s
comfort. Cover the patient with a blanket and remove the bath blanket from underneath.
Leave the friction
-
reducing sheet or drawsheet in place for the return transfer.



Move a Patient From Bed to Chair



Identify the patient
. Explain the procedure to the patient.



Perform hand hygiene and put on gloves, if necessary.



If needed, move equipment to make room for the chair. Close the door or draw the
curtains.



Place the bed in the lowest position. Raise the head of the bed to a si
tting position or as
high as the patient can tolerate.



Make sure the bed brakes are locked. Put the chair next to the bed, facing the foot
of the bed. If available, lock the brakes of the chair. If the chair does not have
brakes, brace the chair against a
secure object.



Encourage the patient to make use of a stand
-
assist aid, either free
-
standing or attached
to the side of the bed, if available, to move to the side of the bed and to a side
-
lying
position, facing the side of the bed the patient will sit on.



Lower the side rail if necessary and stand near the patient’s hips. Stand with your legs
shoulder width apart with one foot near the head of the bed, slightly in front of the
other foot.



Encourage the patient to make use of the stand
-
assist device. Assist

the patient to sit up
on the side of the bed; ask the patient to swing his or her legs over the side of the bed.
At the same time, pivot on your back leg to lift the patient’s trunk and shoulders.
Keep
your back straight; avoid twisting.



Move a Patient Fr
om Bed to Chair



Stand in front of the patient and assess for any balance problems or complaints of
dizziness. Allow legs to dangle a few minutes before continuing.



Assist the patient to put on a robe and nonskid footwear.



Wrap the gait belt around the pati
ent’s waist, based on assessed need and facility policy.



Stand facing the patient. Spread your feet about shoulder width apart and flex your hips
and knees.



Ask the patient to slide his or her buttocks to the edge of the bed until the feet touch the
floor
. Position yourself as close as possible to the patient, with your foot positioned on
the outside of the patient’s foot. If a second staff person is assisting, have him/her
assume a similar position.



Encourage the patient to make use of the stand
-
assist de
vice. If necessary, have second
staff person grasp the gait belt on the opposite side. Using the gait belt, assist the
patient to stand. Rock back and forth while counting to three.
On the count of three,
use your legs (not your back) to help raise the pat
ient to a standing position. If
indicated, brace your front knee against the patient’s weak extremity as he or she
stands.

Assess the patient’s balance and leg strength. If the patient is weak or unsteady,
return the patient to bed.



Pivot on your back foot

and assist the patient to turn until the patient feels the chair
against his or her legs.



Ask the patient to use an arm to steady himself or herself on the arm of the chair while
slowly lowering to a sitting position. Continue to brace the patient’s knees

with your
knees and hold the gait belt. Flex your hips and knees when helping the patient sit in
the chair.



Assess the patient’s alignment in the chair. Remove gait belt, if desired. Depending on
patient comfort, it could be left in place to use when retu
rning to bed. Cover with a
blanket if needed. Place the call bell close.



Remove gloves if used and perform hand hygiene.




Log Roll



Spinal injuries, recovering from neck, back, or spinal surgery



Keep body in straight alignment



Two or three nurses




Restra
ints



Physical device used to limit a patient’s movement.



Physical restraints



Side rails



Geriatric chairs with attached trays



Appliances tied at the wrist, ankle, or waist



Hand mitten



Chemical restraints



Drugs used to control behavior



Restraint Hazards



Dang
er of suffocation



Impaired circulation



Altered skin integrity



Pressure ulcers and contractures



Decrease muscle and bone mass



Fractures



Altered nutrition and hydration



Aspiration and breathing difficulties



Incontinence



Change in mental status



Alternatives

to Restraints



Box 26
-
4



Rule out causes for agitation



Ask family to stay



Use night light



Assist with toileting



Divisional activities



Relocate patient’s room



Use alternative restraints



Ambularm



Floor mats




Restraints



Last resort



Family must be notified



Alte
rnative methods first



Alert physician that restraint is needed



Order must include type, justification, and criteria removal, and duration of use.



Restraints



In an emergency a restraint can be placed but an order must be received within (1) hour



Patient mus
t be monitored and assessed regularly



Every 4 hours for adults



At least every 2 hours for children 9
-
17



At least every 1 hour for children under 9



Documentation must reflect date
and time

the restraint is applied, the type of restraint,
alternatives that w
ere attempted with their results, and notification of family and
physician. Include freq of assessment, your findings, regular intervals when the restraint
is removed and nursing interventions




Restraints



Skill 26
-
1 pp. 692
-

698



Two fingers between restrai
nt and skin



Quick release knot



Attach to bed frame, not side rails



Assess patient Q1 hour



Remove Q2 hours



Perform ROM



Assess skin



Early release



Offer bathroom



Offer hydration and food