Mobility, Body Mechanics, Skin and Pressure Sores

Gait

is the way a person walks

Mobile

can move

Immobile

can not move

Ambulatory

can get up and move around

Non Ambulatory

can NOT get up and move around

Lateral Position (Side Lying Position)

the patient lies on one side of the body with the top leg in front of the bottom leg and hip and knee flexed

Supine Position (Dorsal Recumbent)

is wherein the patient lies flat on the back with head and shoulders slightly elevated using a pillow unless contraindicated

Prone Position

the patient lies on the abdomen with their heads turned to one side and the

hips are not flexed

Sim’s Position (Semi - Prone Position)

the patient assumes a posture halfway between the lateral and the prone position s; the lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow

Fowlers’ Position (Semi - Sitting Position)

a bed position where the head of the bed is elevated 45 to 60 degrees

Low Fowler’s Position

15 to 30 degrees

Semi - Fowler’s Position

30 - 45 degrees

High Fowler’s Position

nearly vertical

Orthopneic Position (Tripod Position)

places the patient in a sitting position or on the side of the bed with an overbed table in front to lean on and several pillows on the table to rest on

Trendelenburg Position

lowers the head of the bed and raises the foot of the patient’s bed; the patient’s arm should be tucked at their sides

Incontinence

the inability to control when they void (pee) or have a bowel movement

Who is at risk for developing skin issues?

elderly, fair skinned, non - ambulatory and immobile

Peripheral Vascular Disease

is another risk factor for skin issues and other patient concerns

How do we prevent skin issues?

1. observe the skin every time you are with the patient

2. assure skin is clean and dry

3. assure skin has normal elasticity

4. encourage fluids and good nutrition

5. know signs of pressure sores

Signs of Pressure Sores

discoloration of the skin; reposition patient every 2 hours; left untreated can lead to serious infections

Names for Pressure Sores

1. bed sores

2. decubitus ulcers

3. pressure ulcers

Where might patients develop pressure sores?

Bony Prominences: elbows, shoulder, hips, heels, etc…

Stages of Pressure Sores

Stage 1: Discoloration

Stage 2: Skin Breakdown

Stage 3: Through the Epidermis into the Dermis

Stage 4: Muscle/Bone

Safely Ambulate Patient

1. assist and walk with the patient on their weak side

2. apply gait belt tight enough so you have two fingers between the patient and the gait belt

3. have two hands on the gait belt at all times

4. make sure patient is steady before you start to ambulate

5. know patients abilities from the Care Plan or from the nurse before you transfer or ambulate for the first time

Safety When Operating A Wheelchair

1. ALWAYS LOCK THE BREAKS when transferring a patient

2. Move the foot rest COMPLETELY out of the way

3. Use a Gait Belt

4. Have a Gait belt tight enough where two finger widths are between gait belt and patient

5. Do NOT put the gait belt over the patients head, reach it around the patient

6. Allow the patient to be as involved as possible

7. DO NOT ALLOW THE PATIENT TO GRAB ON TO YOU!!!!!

8. Do toe to toe, knee to knee technique

How do we prevent falls?

1. take frequent breaks

2. observe for changes in body movement

3. observe for signs of weakness

4. slowly assist patient out of bed to falls

5. use prescribes assistive devices: walker, cane, wheelchair, etc….

6. if the patient is suppose to use a walker, use a walker, if the patient is supposed to use a cane, use a cane

7. do not change the device the patient is prescribed with something else, this can lead to falls and injuries

How many people are required to use a mechanical lift?

two people

What side do you use a cane or walker on the patient?

assistive devices need to be used on the patient’s STONG side (strong arm)

What is a ted hose?

are used to help prevent blood clots

are similar to compression socks

What range of motion will help prevent?

atrophy

joint issues

adhesions

inflammation

circulatory impairment

constipation

neurological impairment

What are contractures?

these are shortening of the muscles; ROM will help prevent contractures

Case Care

1. Do not insert anything into the cast

2. Check the circulation on the toes and fingers and report any changes

3. Report weak pulse or discoloration

Hot Therapy

Arthritis

Muscle Aches

Menstrual Cramps

Joint Stiffness

Muscle Spasms

Increases blood flow and circulation

Cold Therapy

Swelling

Headaches

Tooth Pain

Sport Injuries

Fever

Decreases blood flow and circulation

What is a foot board?

are placed under the patient’s feet to help prevent a foot drop

help keep the foot at a 90 degree angle and are typicllay used when the patient is sleeping

help to prevent Plantar Flexion