Body Mechanics & Range of Motion (ROM) Exercise Flashcards
labels that pertain to
exercise and activity include the following:
activity therapy; cardiac
care; rehabilitation; constipation management; exercise promotion
(strength and stretching); exercise therapy (ambulation, balance, joint
mobility, muscle control); fall prevention; health education; mood
management; pelvic muscle exercise; pressure ulcer prevention; progressive muscle relaxation; recreation therapy; self-care assistance;
self-esteem enhancement; simple relaxation therapy; sleep enhancement; sports-injury prevention; teaching: prescribed activity/
exercise; therapeutic play; and weight management and weight reduction
ROM
Nursing strategies to maintain or promote body alignment and
mobility involve positioning clients appropriately, moving and turning clients in bed, transferring clients, providing ROM exercises ambulating clients with or without mechanical aids, and strategies
to prevent the complications of immobility. Whenever positioning,
moving, and ambulating clients, nurses must use proper body mechanics and assistive lifting/moving equipment to avoid musculoskeletal strain and injury
Body Mechanics
s is the term used to describe the efficient, coordinated,
and safe use of the body to move objects and carry out the ADLs. When
a person moves, the center of gravity shifts continuously in the direction of the moving body parts. Balance depends on the interrelationship of the center of gravity, the line of gravity, and the base of support.
The closer the line of gravity is to the center of the base of support, the
greater the person’s stability (Figure 44–42 A •). Conversely, the closer
the line of gravity is to the edge of the base of support, the more precarious the balance (Figure 44–42 B). If the line of gravity falls outside the
base of support, the person falls (Figure 44–42 C).
Body balance, therefore, can be greatly enhanced by
(a) widening the base of support and
(b) lowering the center of gravity, bringing it closer to the base of support.
“correct” body mechanics
would facilitate the safe and efficient use of appropriate muscle
groups to maintain balance, reduce the energy required, reduce fatigue, and decrease the risk of injury for both nurses and clients, especially during transferring, lifting, and repositioning
Lifting
It is important to remember that nurses should not lift more than
35 pounds without assistance from proper equipment and/or other
individuals. Types of assistive equipment include mobile-powered
or mechanical lifts, ceiling-mounted lifts, sit-to-stand powered lifts,
friction-reducing devices, and transfer chairs
Pulling and Pushing
When pulling or pushing an object, a person maintains balance with
least effort when the base of support is increased in the direction in
which the movement is to be produced or opposed. For example, when pushing an object, a person can enlarge the base of support by moving
the front foot forward. When pulling an object, a person can enlarge
the base of support by (a) moving the rear leg back if the person is facing the object or (b) moving the front foot forward if the person is facing away from the object. It is easier and safer to pull an object toward
one’s own center of gravity than to push it away, because a person can
exert more control of the object’s movement when pulling it
Pivoting
Pivoting is a technique in which the body is turned in a way that
avoids twisting of the spine. To pivot, place one foot ahead of the
other, raise the heels very slightly, and put the body weight on the
balls of the feet. When the weight is off the heels, the frictional surface
is decreased and the knees are not twisted when turning. Keeping the
body aligned, turn (pivot) about 90 degrees in the desired direction.
The foot that was forward will now be behind.
Preventing Back Injury
Nurses provide clients with the opportunity to change positions, expand their lungs, or change their environments as appropriate. It is
important, however, that nurses not jeopardize their own health while caring for clients. Client positioning, lifting, and transferring are significant risk factors for back injuries. As mentioned earlier, 35 pounds of client weight should be the maximum a nurse should attempt. Two movements to avoid because of their potential for causing
back injury are twisting (rotation) of the thoracolumbar spine and acute
flexion of the back with hips and knees straight (stooping). Undesirable
twisting of the back can be prevented by squarely facing the direction
of movement, whether pushing, pulling, or sliding, and moving the object directly toward or away from one’s center of gravity. Guidelines for
preventing back injuries are presented in Client Teaching.
Positioning Clients
Positioning a client in good body alignment and changing the position regularly (every 2 hours) and systematically are essential aspects
of nursing practice. Clients who can move easily automatically reposition themselves for comfort. Such people generally require minimal
positioning assistance from nurses, other than guidance about ways
to maintain body alignment and to exercise their joints. However,
people who are weak, frail, in pain, paralyzed, or unconscious rely on
nurses to provide or assist with position changes. For all clients, it is
important to assess the skin and provide skin care before and after a
position change
Fowler’s position
or a semisitting position, is a bed position in
which the head and trunk are raised 45° to 60° relative to the bed (visualize a 90° right angle to orient your thinking) and the knees may
or may not be flexed. Nurses may need to clarify the meaning of the
term Fowler’s position in their particular setting. Typically, Fowler’s
position refers to a 45° angle of elevation of the upper body.
Semi-Fowler’s position (Figure 44–49 •) is when the head
and trunk are raised 15 to 45 degrees. This position is sometimes
called low Fowler’s and typically means 30 degrees of elevation. Inhigh-Fowler’s position, the head and trunk are raised 60° to 90°,
and most often means the client is sitting upright at a right angle to
the bed (Table 44–4).
Fowler’s position is the position of choice for people who have
difficulty breathing and for some people with heart problems. When
the client is in this position, gravity pulls the diaphragm downward,
allowing greater chest expansion and lung ventilation.
A common error nurses make when aligning clients in Fowler’s
position is placing an overly large pillow or more than one pillow behind the client’s head. This promotes the development of neck
flexion contractures. If a client desires several head pillows, the nurse
should encourage the client to rest without a pillow for several hours
each day to extend the neck fully and counteract the effects of poor
neck alignment
Orthopneic Position
, the client sits either in bed or on the
side of the bed with an overbed table across the lap (Figure 44–51 •).
This position facilitates respiration by allowing maximum chest expansion. It is particularly helpful to clients who have problems exhaling, because they can press the lower part of the chest against the edge
of the overbed table.
Dorsal Recumbent Position
In the dorsal recumbent (back-lying) position (Figure 44–52 •),
the client’s head and shoulders are slightly elevated on a small pillow.
In some agencies, the terms dorsal recumbent and supine are used
interchangeably; strictly speaking, however, in the supine or dorsal position the head and shoulders are not elevated. In both positions, the client’s forearms may be elevated on pillows or placed at the client’s sides. Supports are similar in both positions, except for the head pillow (Table 44–5). The dorsal recumbent position is used to provide comfort and to facilitate healing following certain surgeries
or anesthetics (e.g., spinal).
Prone Position
the client lies on the abdomen with the head
turned to one side (Figure 44–53 •). The hips are not flexed. Both
children and adults often sleep in this position, sometimes with one
or both arms flexed over their heads. It is the only bed position that
allows full extension of the hip and knee joints. When used periodically, the prone position helps to prevent flexion contractures of the
hips and knees, thereby counteracting a problem caused by all other
bed positions. The prone position also promotes drainage from the
mouth and is especially useful for unconscious clients or those clients
recovering from surgery of the mouth or throat
Lateral Position
In the lateral (side-lying) position (Figure 44–54 •), the client lies
on one side of the body. 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. The greater the flexion of the top hip
and knee, the greater the stability and balance in this position. This flexion reduces lordosis and promotes good back alignment. For this
reason, the lateral position is good for resting and sleeping clients.
The lateral position helps to relieve pressure on the sacrum and heels
in people who sit for much of the day or who are confined to bed and
rest in Fowler’s or dorsal recumbent positions much of the time. In
the lateral position, most of the body’s weight is borne by the lateral
aspect of the lower scapula, the lateral aspect of the ilium, and the
greater trochanter of the femur. People who have sensory or motor
deficits on one side of the body usually find that lying on the uninvolved side is more comfortable
