KEY POINTS
I. Body alignment
A. The way one’s body parts are in line with one-another
B. Refers to head, torso, arms, and legs and their relationship with one-another
C. Posture another word meaning the same
D. Refers to patients and staff, since both must be aware of alignment to prevent injury or deformity.
II. Knowledge of the anatomy of the spine and musculature necessary to understand body alignment
A. Vertebrae must be kept straight, without excessive twisting or turning
B. Muscles surrounding the spine, buttocks and thigh, and abdomen are essential for keeping the body in good alignment.
C. These muscles must be in good condition to maintain alignment
III. Body mechanics
A. How we use our body
B. Involves posture, balance, use of largest, strongest muscles
C. Results of poor body mechanics
1. fatigue
2. strain
3. injury
D. 8 out of every 10 Americans will suffer a back injury some time in their lives
E. An injury gaining more importance in the work place is the repetitive motion injury
1. caused by prolonged repetition of tasks.
2. Affects those who work with computers and keyboards, dentists, and others who work with there hands using repetitive movements.
3. Class of injuries includes Carpal Tunnel Syndrome - results from pressure on the median nerve as it passes from forearm through the carpal tunnel in the wrist and hand. Causes numbness, tingling and pain in some or all fingers.
IV. Rules of body mechanics
A. Have a wide base of support
B. Always use two hands to move something or someone
C. Hold the person or object being moved close to you
D. Use strongest muscles to lift
1. buttocks
2. thighs
3. not back
4. not arms
E. Bend at the knees
F. Keep back straight
G. Push and Pull rather than lift
H. Face the direction in which you intend to move
I. Avoid unnecessary bending or reaching
J. Plan ahead - move it twice
1. one in your head
2. once actually moving
K. Test the load and ask for help whenever needed
L. Tighten your abdominal muscles
M. Regarding carpal tunnel, it is important to use ergonomically designed equipment to keep hands in good alignment.
V. Keeping patients in good alignment when in bed, requires positioning, and support
A. Fowler’s positions
1. Fowler’s - head of bed is 45 degrees or higher
2. Semi-Fowler’s - head of bed is 30 - 45 degreed
3. Requires pillows to support the head and arms
B. Supine
1. Bed flat
2. Person facing with face looking up
3. Requires pillows at head and arms
4. Sometimes equated with dorsal recumbent - sometimes dorsal recumbent requires the knees to be bent
C. Prone
1. Bed flat
2. Person on abdomen
3. Flat pillow under the head
D. Lateral
1. Bed flat or in semi-Fowler’s position
2. Person on side
3. Pillows between legs, under the upper arm, at back, and under head
E. Sim’s/Semi-prone
1. Often used for rectal exams or enemas
2. Person almost prone, but slightly elevated on side
3. Lower leg is kept straight
4. Upper leg is bent to provide for best access to buttocks
F. Trendelenberg
1. Bed is straight, patient’s head is below the level of the feet
2. used for postural drainage or to prevent shock
a. shock is the gradual (although at times rapid) cessation of body functions as a result of severe physical or motional trauma
b. postural drainage is positioning a person with their head lower than their chest to rid the body of secretions by gravity from the respiratory tract
G. Reverse Trendelenberg
1. Bed is straight, feet are lower than head
2. Used for head injuries, rather than Trendelenberg, to reduce blood flow and pressure to the brain
3. Also used for profusely bleeding abdominal injuries to prevent a person from “bleeding out”
VI. When transferring, positioning, and ambulating
A. Use the rules of body mechanics at all times
B. Keep the bed at your working level when caring for a patient/resident in bed
C. Keep bed at lowest level/or level where they can place their feet flat on the floor if intending to help the patient leave the bed
D. Always use a gait belt when transferring and ambulating a patient
E. Always lock the wheels of the bed and the wheelchair when transferring, etc.
VII. Rules in using a gait belt
A. Buckle the gait belt to the side of the patient, not in front, for comfort
B. Tighten it fairly snugly. One should be able to slip two fingers between the abdomen and the belt
C. Always use an underhand grip on the belt
D. It is best to use two hands at all times
E. Watch out for pendulous breasts when applying a gait belt on an older woman
VIII. Range of Motion
A. Exercises that are done to promote alignment of the body, full range of all major joints
B. Prevent the formation of contractures
C. Involves all major joints of the body, and putting those joints through the full range of motions of which they are capable
D. Each motion is done three times according to the Texas Nurse Aide Curriculum
E. Extremities are supported with both hands at the joints
F. Exercises can be either passive or active
G. Work from top of the body to bottom
H. Do one side completely before doing the other side
IX. Use of aids for ambulation
A. Walker
1. Most used ambulatory aid for elderly
2. Can have wheels and be rolled, or just legs and lifted
3. Should be checked for safety. Rubber tips of legs on hard or cracked, All screws, etc., tight, hand grips tight and not cracked
4. Height of the walker should be about at the trochanter of the femur.
5. Arms grasping the walker handles should be bent 30 degrees
6. When using, it should not be placed farther that the tips of the person’s toes
7. Then the individual walks into the walker
B. Cane
1. Single-pointed canes, three, and four-point canes (called quad-canes) Three and four-point canes offer more support than single-tipped canes.
2. Canes are held on the strong side of the body
3. The tip of the cane should be placed 6-10 inches from the side of the foot when not in use.
4. The grip is level with the trochanter of the femur
5. The arm should be bent about 30 degrees.
6. When the resident moves the cane is moved forward first.
7. The cane is moved forward about 12 inches
8. Then the weak leg is moved even with the cane
9. Then the strong leg is brought forward and ahead of the cane and weak leg
10. The cane should always be checked first to make certain that the tip is not worn or cracked. If there is a hand grip, it should be intact (without cracks, etc.).
C. Crutches
1. Used when the person cannot use one let of when one or both legs need to gain strength
2. Not often used for elderly, because of lack of strength
3. Person on crutches is always at risk for falling
4. Fitting the crutches important
a. The person stands against a wall
b. The crutch is placed at the side about 6 inches from the side of the foot
c. The top of the crutch should fall about two finger-breadths below the axilla
d. Crutch tips should not be cracked or worn down or wet
e. There should be no cracks, bends, all bolts should be tight
f. If crutch is not fitted properly, the person might suffer from nerve damage, causing injury to the arms and palms
g. Crutch gaits
i. Four-point - person extends one crutch forward about 10 - 12 inches, followed by the opposite foot even with the crutch. Then the other crutch is put forward past the other crutch, followed by the other foot. This is continued.
ii. Two-point - person moves crutch and opposite foot together, other crutch and foot. Repeat. Modification of four-point, but can move faster.
iii. Three-point - One leg is not able to bear weight. Both crutches are put forward. Followed by the strong leg. Repeat.
iv. Swing-to - When there is equal, bilateral leg weakness - Crutches are moved forward together. Both legs are swept even with the crutches.
v. Swing-through - Crutches are moved forward together. Both legs Are swept through and past the crutches. Repeat.