Body Mechanics, Patient Mobility, Pain, Comfort, Rest, and Sleep Lecture Notes

Body Mechanics

• Body mechanics are the efficient, coordinated, and safe use of the body to produce motion.
• Good body mechanics are essential for both the patient and the nurse to prevent strain, injury, and fatigue.
• Three important elements:
  • Body alignment or posture: Ears, shoulders, hips, and ankles should be aligned.
  • Balance: Widen stance for more balance and coordinated movement.
  • Broad base of support.
• Use large muscle groups (legs and arms), not the back.
• Avoid lifting and twisting; bend at the knees when lifting.
• Adjust work level to comfort (e.g., raising the bed).

Specific Body Mechanics for Healthcare Workers

• Arrange for adequate help; two workers can divide the workload by 50%.
  • Workload_{each} = \frac{TotalWorkload}{NumberOfWorkers}
• Encourage patient assistance to promote ability and strength.
• Keep back, neck, pelvis, and feet aligned.
• Avoid twisting to reduce the risk of injury.
• Align and balance weight on both feet for even distribution.
• Flex knees and keep feet shoulder-width apart for stability.
• Don't lift objects higher than chest level and avoid reaching above shoulders.
• Position yourself close to the patient to minimize strain.
• Use arms and legs, not the back, leveraging stronger leg muscles.
• Slide the patient towards yourself using a pull sheet to minimize shearing forces on the skin.
• Set or tighten abdominal and gluteal muscles in preparation for moving to limit strain.
• Coordinate lifts by counting to three for simultaneous lifting and minimizing individual load.

Patient Mobility

• Movement is necessary for work and play and relates directly to quality of life.
• Inactivity leads to deterioration of health.
• Nurses aid patients with positioning, turning, walking, etc., to prevent complications.
• Mobility: Ability to move freely.
• Immobility: Inability to move freely due to impaired or restricted movement.

Benefits of Activity

• Increased physical and emotional well-being.
• Increased cardiopulmonary function.
• Increased muscle strength and stamina.
• Maintenance of joint mobility.
• Increased bone strength and density.
• Promotion of bowel elimination.
• Aid in sleep.
• Decreased tension.
• Decreased risk for skin breakdown.

Assessing Patient Mobility

• Body alignment and posture
  • Slumped posture is common.
  • Scoliosis: Lateral curvature of the spine.
  • Kyphosis: Fixed flexion deformity of the thoracic spine (humpback).
  • Lordosis: Inward curvature of the lumbar spine.
• Joint range of motion
  • Can be hampered by pain or mental status. An active range of motion means the patient can do it themselves; passive range of motion means that we are doing it for them.
• Assistance needed for turning, transferring, or ambulation.
• Gait (pattern of walking)
  • Head up, spinal column straight.
  • Toes and kneecaps forward.
  • Easy or unsteady gait.
  • Appropriate step length (not too small or shuffling).
  • Ease of starting and stopping.
• Ability to perform ADLs (activities of daily living): eating, dressing, bathing, toileting.
• Daily activity level: sedentary or active.
• Activity tolerance: Assess before, during, and after activity for chest pain, increased heart rate, or air hunger.
• Exercise and fitness goals:
  • Adults: 30 minutes a day, 3-5 days a week.
  • Youth: 60 minutes per day, 3-5 days a week.
• Pain level.

Complications of Immobility

• Major reasons for immobility:
  • Pain.
  • Impaired muscular, skeletal, or nervous system function.
  • Generalized weakness.
  • Psychosocial problems (depression).
  • Infectious processes.
  • Bed rest.

Physical Responses to Immobility

• Muscle atrophy: Decrease in muscle size and strength due to non-use.
• Contractures: Permanent shortening of muscles, tendons, and ligaments due to lack of movement.
• Disuse osteoporosis: Lack of weight-bearing leading to bone demineralization and fractures.
• Constipation: Slowed peristalsis due to immobility, causing stool to linger in the colon.
• Urinary tract infections: Urinary stasis causing a change in pH allows bacterial growth.
• Renal calculi (kidney stones): Urinary stasis slows calcium metabolism, leading to stone formation.
• Hypostatic pneumonia: Decreased ventilation with accumulation of secretions, leading to lung inflammation and infection.
• Orthostatic hypotension: Decreased venous return and cardiac output, causing blood pressure drop and dizziness.
• Thrombophlebitis: Clot with inflammation of the vein, potentially leading to deep vein thrombosis (DVT).
  • Can lead to decreased circulation, blood pooling, inflammation, and further clot formation.
• Pulmonary embolism: Clot travels to the lung.

Psychological Changes from Immobility

• Depression and change in self-concept.
• Anorexia: Slow digestion, slowed metabolic rate, decreased hunger.
• Insomnia: Decreased stimulation, frequent napping.
• Disorientation: Decreased stimulation, decreased endorphin production, decreased need for thought processing, and decreased socialization.

Pressure Ulcers

• Also known as decubitus ulcers, bed sores, or pressure wounds.
• Four stages (1-4) plus two unstageable types (deep tissue injury and eschar).
• Causes:
  • Pressure: Bony prominences press soft tissue against a hard surface, decreasing circulation.
  • Shearing forces: Skin sticks in place while deeper tissues move, rupturing microcirculation (e.g., sliding up in bed or Fowler's position).
    *Sacral area is at highest risk.
  • Friction: Rubbing of one surface against another.
• Risk factors:
  • Immobility.
  • Altered nutrition (decreased intake).
  • Secretions and excretions on the skin.
  • Altered circulation.
  • External devices (braces or traction).

Promoting Mobility

• Use supportive devices: footboards, pillows, transfer rolls, heel elevators, bed cradle.
• Avoid body parts laying on top of each other.
• Reposition the patient at least every two hours.