Lesson plan on Interventions for Impaired Body Alignment & Immobility Demonstration On Range Of Motion Exercises and Moving, Lifting and Transferring Of Casualty and In-Patient

1. 0
Rajkumari Amrit Kaur College of Nursing
Lajpat Nagar New Delhi
Lesson plan on
Interventions for Impaired Body Alignment
&
Immobility
Demonstration On
Range Of Motion Exercises and Moving, Lifting and
Transferring Of Casualty and In-Patient
Submitted To Submitted By
Mrs. Usha Phulara, MSc. (N), MBA (HCS) Mr.Mathew Varghese V
Nursing Tutor MSc. Nursing First Year

2. 1
IDENTIFICATION DATA
Class : Msc Nursing 1st
Year
Subject : Nursing Education
Topic : Interventions for impaired body alignment and
immobility
Demonstration : Range of motion exercises, moving, lifting and transferring of
casualty and in-patient.
Name of the Student Teacher : Mr. Mathew Varghese V
Class : BSc. Nursing (Hons.) First Year
Date of Session : 31.10.18
Duration of Session : 120 minutes (2hrs)
Venue : BSc. Nursing (Hons.) First Year Class Room &
Nursing Arts Class Room
Total No of Students : 63
Method of teaching : Lecture and Demonstration
Audio-visual aids : Power point presentation, Chart, Flashcard etc
Language : English
Previous Knowledge : Basic knowledge on body mechanics and posture
Basic anatomy and physiology of musculoskeletal
system and joints
General Objective : At the end of the session students will be able to exhibit
knowledge on Interventions for impaired body alignment and immobility and
Demonstrate Range of Motion Exercises and Technique of lifting, moving and
transferring of injured /immobile patient

3. 2
Time Specific
objective
Content Teaching & Learning
Activity
AV
Aids
Evaluati
on
2Minutes
5Minutes
Introduce
the topic
to the
group
Discuss
the
anatomy
and
physiolog
y of body
movement
Related anatomy and physiology
Skeleton:
It is the body’s supporting framework and comprises four types of
bones.
a. Long Bones E.g. Femur , Tibia
b. Short Bones E.g. Carpals , Tarsal ,Patella
c. Flat Bones E. g Ribs
d. Irregular bones : Vertebral column
Bones Characteristics: There are three main characteristics
a. Firmness
Introduction
Clinical nursing requires
coordinated efforts of
musculoskeletal and
nervous system and
therefore involves body
mechanism. It includes
how and why of using
various muscles of our
body in a more
coordinated manner so
that it involves integrated
functioning and efficient
use of above said systems
as machine.
ANNOUNCEMENT OF TOPIC
Student teacher
describes/revises the
related anatomy and
physiology of body
movements
Char
t on
Mus
culo
skele
tal
Syst
em
Give an
example
for long
Bone?

4. 3
b. Rigidity
c. Elasticity
Joint
Joints refers to the union points of two or more bones .There are
three types of joints
a. Fibrous joints : E.g. sacral joint
b. Cartilaginous joint: E.g. Costosternal joint
c. Synovial joint : E.g. Hip joint
Ligaments
They are white shiny flexible bands of fibrous tissue binding the
joints together
Tendons
It is a white fibrous cord of dense regularly arranged connective
tissue that attaches muscle to bone.
Cartilage :
It is a type of connective tissue consisting of chondrocytes .It gives
strength and flexibility to skeleton
Skeletal muscles :
It refers to muscle specialized in for contraction, composed of
muscle fibers. They have the ability to contract and relax. They are
concerned with movement and posture
Nervous system:
Movement and postures are regulated by the nervous system. During
voluntary movement impulses descends from the motor area of
cerebrum to the spinal cord. Then it goes to different motor nerves
and muscles, where the movement occurs. Transmission of these
impulses from the nervous system to the musculoskeletal system
requires some chemicals, known as neurotransmitter E.g. Acetyl
choline. These neurotransmitters stimulate the muscle and causes
movement.
Balance of the body is also maintained by nervous system
(Cerebellum )

5. 4
3Minutes Discuss
the basic
terminolo
gies
Related Terminologies
1. Anatomical position
It refers to a position where in the individual stands erect (upright
position) facing the observer, with feet flat on the floor and arms
placed at the sides, and the palms of the hands turned forward.
2. Center of gravity
The center of gravity of an object is the center of its mass. In
humans, it is at the center of the pelvis about midway between the
umbilicus and the symphysis pubis
3. Line of gravity
The line of gravity is the vertical line passing through the center of
gravity
4. Posture
It refers to the position of the body in relation to the surrounding
space.
5. Base of support
The base of support is the foundation that provides the
object/person’s stability.
6. Body balance :
It refers to a state of the body achieved when center of gravity is
balanced over a wide, stable base of support and vertical line falls
from the center of gravity through the base of support.
7. Body Mechanics
The efficient, coordinated, and safe use of the body to produce
motion and maintain balance during activity.
The major purpose of body mechanics is to facilitate safe and
efficient use of appropriate groups of muscles.
8. Mobility
Mobility refers to the ability to move or be moved freely and easily
9. Immobility
It is the state of not being able to move around.
Student teacher discusses
the basic terminologies
slides
Pow
er
point
Slide
s
What is
posture?

6. 5
3Minutes
3Minutes
4Minutes
Enlist
basic
componen
ts of
mobility
Discuss
the
purposes
of Body
mechanics
Review
the
principles
of Body
Mechanics
There are three basic elements in mobility
1. Body alignment (posture):it is the geometric arrangement
of body parts in relation to each other.
2. Balance (stability):it is the state of equilibrium in which
opposing forces counteract each other.
3. Coordinated body movement: integrated functioning of the
musculoskeletal system and nervous system as well as joint
mobility are needed for mobility
Purposes of Body Mechanics
Use of proper body mechanics in terms of posture and alignment
helps in
1. Reducing risk of injury to the musculoskeletal system
2. Facilitating body movement without muscle strain and
excessive use of muscle energy
3. Maintain adequate muscle tone ; thus contributing to balance
of the body
4. Preventing fatigue and deformities. Eg Kyphosis,Lordosis
5. Promoting physiological functions of the body as its aids
circulation
6. Facilitating aesthetic well being in terms of physical fitness
and shape.
Principles of Body Mechanics
1. The wider the base of support ,the greater the stability of nurse
2. The lower the center of gravity ,the greater the stability of nurse
3. The stronger the muscle group, the greater amount of work can be
done safely by it.
Student teacher enlists the
basic components of
mobility
Student teacher will
discuss the purposes of
body mechanics
Student teacher reviews
the principles of Body
Mechanics
Pow
er
point
Slide
s
Pow
er
point
Slide
s
Pow
er
point
Slide
s
What are
the
compone
nts of
mobility?
What are
the
purposes
of body
mechanic
s?
What are
the
principles
of body
mechanic
s?

7. 6
2Minutes
4Minutes
Explain
the
Strategies
to prevent
back
injuries
Discuss
the factors
affecting
body
alignment
and
mobility
4. Facing the direction of movement prevents abnormal twisting of
spine
5. Rolling, pulling, pushing, requires less work than lifting
6. Dividing balanced activity between arms and legs reduces the risk
of back injury
7. When there is less friction on the object, less force is required to
move it
8. Reducing the force of work reduces risk of injury
9. Maintaining good body mechanics reduces fatigue of muscle
groups
10. Alternative periods of rest and activity help reduce fatigue.
11. Keep objects to be moved close to the body.
12. When pushing or pulling an object, use the body’s weight to
counteract the weight of the object.
Strategies to Prevent Back Injuries
1. Wear low-heeled shoes that provide good foot support
2. When standing for long periods, occasionally flex one hip
and knee and rest your foot on an object if possible
3. Sit with knees slightly higher than hip
4. Exercise regularly, including exercises to strengthen the
pelvic, abdominal, and lumbar muscles
5. Sleep on a firm mattress.
Factors affecting body alignment and mobility
1. Congenital problems : It affects normal musculo skeletal
and neurological development.eg Cerebral palsy,spina bifida
etc
2. Neuromuscular deficits : It will alter the ability of nervous
system to coordinate muscular movement and mobility eg
Parkinson’s disease
3. Musculo skeletal deficits: It affects joint stability ,skeletal
Student teacher will
explain the Strategies to
prevent back injuries
Student teacher will
discuss factors affecting
body alignment and
mobility
Pow
er
point
Slide
s
Pow
er
point
Slide
s
What are
the
strategies
to
prevent
back
injuries?
What are
the
factors
affecting
body
alignmen
t and
mobility?

8. 7
3Minutes Discuss
the
common
devices to
promote
correct
alignment
strength and body movement E.g. Osteoporosis ,Rheumatoid
arthritis
4. Chronic health problems: It often decreases mobility
because it reduces oxygen and nutrients delivery to muscle;
they are the essentials for muscle contraction and movement
Eg. Lung disorders and cancer
5. Trauma : It often results injury to joints
,tendon,ligaments,muscle,nerve or bones.Eg.fractures,minor
to severe trauma
6. Mood disorders. Severe affective disorders can hinder
mobility Eg depression
7. Therapeutic modalities: sometimes movement is limited to
treat medical conditions. Restrictive devices such as casts,
braces and splints may be used to immobilize certain areas
of body to promote healing. Bed rest is a common treatment
Common devices to promote correct alignment:
✓ Pillows
✓ Mattresses
✓ Bed board
✓ Adjustable bed
✓ Rocking bed
✓ Chair bed
✓ Circular bed
✓ Stryker frame
✓ Footboards
✓ Cradle
✓ Sandbags
Student teacher discusses
the common devices to
promote correct alignment
Flas
h
card
What are
the
devices
to
promote
correct
body
alignmen
t?

9. 8
10
Minutes Discuss
the
procedure
of moving
and
lifting,
and
transferrin
g of
patients in
detail.
✓ Trochanter rolls
✓ Hand-wrist splints
✓ Bed side rails
✓ Trapeze bar
Procedures for Moving ,Lifting and Transferring of
Patients
General instructions in moving and lifting Patients
1. Maintain a good anatomical position of the body
2. Use longest and strongest muscles of extremities in strenuous
activities
3. Keep the object or patient close to the body to prevent
unnecessary strain on the muscle
4. Place the feet apart to provide a wide base of support
5. Flex the knees to come closer to patient /object
6. Slide ,roll, push or pull an object rather than lift it in order to
reduce the energy needed to lift the weight against pull of
gravity
7. Avoid disturbances /interruptions in path of the movement of
patient
8. Move obese patients by sliding them rather than lifting them.
9. Seek assistance when lifting or moving patients
10. The height of the bed should be adjusted to a height that
allows the nurse to keep her back as erect possible while
moving patient to avoid back injury
11. The patient is moved to the edge of the bed before he is lifted
from bed. This helps the nurse to keep her trunk more erect
12. When moving a patient by more than one nurse, each nurse
Student teacher discusses
the procedure of moving
and lifting, and
transferring of patients in
detail
Pow
er
point
Slide
s
What are
the
general
instructio
ns in
moving
and
lifting
patient?

10. 9
assumes the responsibility for supporting one of the patient’s
body sections.
13. In order to coordinate the movements of the nurses and to
maintain the patient’s body in correct alignment, the nurse
gives signal by counting 1...2...3. with each activity of
procedure
14. Unless contraindicated, encourage the patient to use his
abilities as much as possible.
15. Observe the patient for the symptoms of orthostatic
hypotension .e.g. Fainting, dizziness, sweating etc.
16. Always lock the wheels of the bed , stretcher or wheel chair
while transferring the patients so as to increase the maximum
static friction between the wheels and the floor.
Preparation of patient and unit
Preliminary assessment
• Check the diagnosis and specific precautions regarding the
movement of the patient
• Check the level of consciousness and ability to follow the
instructions
• Check the ability for self-care
• Check for the presence of muscle, skin and bone lesions and
attachment (E.g. Catheters and IV connections)
• Check for the number of personals required and available to
move the patient safely
• Check for the articles available in the patients unit (Stretcher,
Wheel chair etc.)
Preparation of patient and unit
• Provide privacy to patient
• Explain procedure to the patient and seek her /his

11. 10
10
minutes
Discuss
moving a
patient to
up in the
bed
participation
• Adjust the bed to working height, lower side rails and lock
the wheels of bed, wheel chair or stretcher etc.
• Fanfold the top linen to the foot end of the bed or remove
them.
• Change wet or soiled linen
• Remove all comfort devices used for the patient
• Remove pillow
• Clamp the catheter to prevent back flow of urine during
transfer
• Clamp ICD ,NG tube and any other tube present
• Attach the IV pole to the stretcher /wheel chair to hang the IV
bottle
• Position foot stool if needed
Procedures
a. Moving the patient up in bed:
▪ Explain the procedure to the client.
▪ Wash hands
▪ Raise the bed to a comfortable position.
▪ Adjust the bed to a flat position if the client can tolerate it.
▪ Lower the side rail nearest to you.
▪ Remove the pillow and place it at the head of the bed.
▪ If possible, ask the client to flex the knees with the feet flat
on the bed.
▪ Fold the client’s arms across the chest.
▪ Instruct the client to flex the neck with the chin on the chest.
▪ Stand opposite the client’s centre with your feet spread and
turned toward the head of the bed. Position one foot slightly
forward
▪ .Flex your knees and hips. Place one arm under the client’s
Student teacher discusses
the procedures of moving
the client
Pow
er
point
Slide
s
How to
prepare
patient
and unit?

12. 11
10
minutes
Discuss
moving a
patient to
one side
of the bed
neck and shoulders, grasping the far shoulder with your
hand. Place your other arm under the client’s upper thighs.
Pull the client close to your side of the bed. Move the
client’s head and legs into alignment.
▪ Review the plan of movement with the client.
▪ Tighten your abdominal and gluteal muscles. Assume the
position to move the client.
▪ Shift your weight back and forth from back leg to front leg,
and on count of three, move the client upward in bed. If
possible, the client should push with legs and assist
movement upward.
▪ Assist the client to a comfortable position in the centre of the
bed. Reposition the pillow. Raise the side rail and adjust the
bed position, if necessary.
▪ Wash your hands.
b. Moving patient to one side of the bed
Steps Rationale
Stand facing the patient at the
side of the bed in which he is to
be moved.
Stand with a wide base of
support with knees and hips
flexed to bring your arms to
the level of bed
Wide base provides a stable
base.
Flexed knees bring the nurses
arms to the bed level and place
them in a position to lift with
strong leg muscles.
Place the arm of the patient on
his/her chest
Place one arm under the
shoulders and neck of the
patient and the other hand
under the patient’s back
This will help to prevent an
injury and will not hinder the
movement
Helps to move the patient ‘s
body in unison
Student teacher discusses
and demonstrates moving
a patient to one side of the
bed
Pow
er
point
Slide
s
How to
move
patient to
one side
of the
bed?

13. 12
10
minutes
Discuss
transferrin
g of a
patient to
stretcher
Shift own body weight from
your front foot to back foot as
you rock back ward , bringing
the patient towards you to the
side of the bed
Avoid strain on the patient’s as
well as the nurse’s muscles
Move the middle part of the
patient in the same manner by
placing one arm under his back
and one arm under his thigh
Helps to move the patient ‘s
body in unison
Then move the feet and lower
legs with the same motion
Avoids any musculo -skeletal
injury to the patient and the
nurse.
c. Transferring a helpless patient from the bed to stretcher
and Vice versa
Steps Rationale
Position the stretcher at
right angel to head end or
foot end of the bed
Give space for nurses to move
Shortens the distance to carry t
he patient
Call helpers to position
them at the bed side along
the same side of the bed
If the patient is heavy ,call
for more helpers
Move the patient to the
edge of the bed ( As
discussed above)
Placing the patient to the edge of
the bed prevents over reaching
and sustains injury to the back
Position yourself (3 Nurses)
at the following level
1. Head, shoulder and
chest
2. Hips
Facilitates moving of the body as
whole
Student teacher discusses
and demonstrates
transferring a helpless
patient from the bed to
stretcher
Pow
er
point
Slide
s
What are
body
parts to
hold
while
transferri
ng a
patient
from bed
to trolley
by 3
nurses?

14. 13
3. Thighs and ankles
Count 1,2,3,4, &5
• At count 1, the
nurses slide their
arms under the
patient to support
his body sections.
• At count 2 , the
nurses stand with
back erect, holding
the patient as near
their body as
possible
• At count 3 ,the
nurses take one step
backwards and pivot
on their heels
towards the stretcher
• At count 4 , the
nurses move to the
side of the stretcher
and stand with a
wide base and
flexed knees ready
to lower the patient
in to stretcher
• At count 5, the
nurses lower the
patient to the
stretcher in a supine
position
Helps to bring the patient’s body
weight with in nurses base of support
A feeling of security to patient.

15. 14
10
minutes
Discuss
transferrin
g a
helpless
patient
from the
bed to
wheel
chair/chair
d. Transferring a patient from bed to wheel chair/ chair and
vice versa
Steps Rationale
Place the chair/ wheel chair at
the right side of the bed ,with
the back towards the foot of
the bed
Helps to reduce energy
expenditure
The wheels should be locked or
placed against the wall or
another person
Help the patient to sit on the
right side of the bed
To prevent rolling of the wheel
chair during the transfer of the
patient
Stand in front of the patient ,
facing him
To extend the help to the
patient, when needed.
Slide the patient’s buttocks
close to the edge of the bed by
shifting his weight
alternatively from right to left
buttock till his feet are placed
on the floor
Instruct the patient to stand on
command by simultaneously
leaning forward, pushing with
the foot placed at the back as
Rocking motion lifts weight on
alternate buttocks and enhances
forward movement.
Do not risk the danger of the
patient falling to the floor
Student teacher l discusses
and demonstrates
transferring a helpless
patient from the bed to
wheel chair/chair
Pow
er
point
Slide
s
How to
transfer
the
patient
from
trolley to
bed?

16. 15
5Minutes Discuss
about
assisting
the client
to walk
he straightens his legs.
Balance the patient on the arm
chair/side rails or mattress
Observe the symptoms of
orthostatic hypotension
Instruct the patient to place his
left arm on the far arm of the
wheel chair/chair and pivot on
the heel of his/her feet,
bringing the buttocks towards
the wheel chair
Helps to reduce energy
expenditure
Instruct the patient to step back
to the chair/ wheel chair until
he/she touches the seat and
grasp the other arm of the chair
with his / her right-hand
Facilitates sitting in the chair
with ease
Instruct the patient to lean
forward and lower his /her
buttocks slowly to the seat by
bending knees and elbows
Facilitates sitting in the chair
with ease
Check for any discomfort ,
correct posture of the patient
Helps to check for orthostatic
hypotension
Assisting the client to walk:
➢ Explain to the client about what is to be done
➢ Ensure a clear path for ambulation
➢ Initially plan a short distance movement
➢ Have a chair readily available in case the client feels faint
or needs to rest.
Student teacher discusses
about assisting the client
to walk
PPT
How to
assist
client to
walk?

17. 16
2Minutes
Discuss
about
transport
of injured
person
One nurse assist: The client who requires minimal assistance may
ambulate well with a nurse alongside and keeping the arm that is
near the client under the client’s arm in an arm-to-arm position.
Two nurse assist: In this the nurses stand at the client’s sides with
their near hands grasping the inferior aspect of the client’s near upper
arm and their far hands holding the client’s lower arm or hand
Mechanical aids for walking:
Walker
Canes
Braces
Crutches
Transport of injured person:
• Never move a severely injured person unless there is
immediate danger to life.
• It is better to leave the casualty undisturbed, send for help,
and provide first aid on the spot.
• Never attempt to move a seriously injured casualty on your
own if help is available
• The position of the casualty should not be changed
unnecessarily.
• If the casualty is to be removed to the hospital arrange for an
ambulance
• Watch the general conditions of the person during
transportation any hemorrhage/any deterioration in the
general condition.
Student teacher will
discuss about transport of
the injured person
PPT How to
transport
an
injured
person?

18. 17
• The casualty’s airway should stay open.
• If there is bleeding, it should be controlled.
• The casualty must maintain an accurate position.
• There should be regular monitoring of the condition of the
casualty.
• The supporting bandages and dressing should stay in place
and remain effectively applied.
• The chosen transfer method is secure, comfortable
and prompt as the situation allows.
• The body of the patient is transferred as one unit.
• The head side of the casualty must be carried by taller first
aiders
• When transferring an individual, there are several factors that
must be considered in the choosing of transfer method
▪ Nature and severity of the injury.
▪ Size of the individual.
▪ First aider’s physical capabilities.
▪ Number of staff and equipment on hand.
▪ Nature of evacuation route.
▪ Distance to be covered
▪ Sex of the individual

19. 18
8
minutes
Discuss
various
methods
of patient
transfer
Methods of transfer
There are several methods of transfer that can be performed when
moving a casualty:
For a single person (One first aider):
1. Drag method
a. Ankle pull method
The ankle pull is the fastest method for moving a victim a short
distance over a smooth surface. This is not a preferred method of
patient movement.
Steps
1. Grasp the victim by both ankles and pant cuffs.
2. Pull with your legs, not your back.
3. Keep your back as straight as possible.
4. Try to keep the pull as straight and in-line as possible.
5. Keep aware that the head is unsupported and may bounce over
bumps and surface imperfections
b. Shoulder pull method
The shoulder pull is preferred to the ankle pull. It supports the head
of the victim. The negative is that it requires the rescuer to bend over
at the waist while pulling.
1. Grasp the victim by the clothing under the shoulders.
2. Keep your arms on both sides of the head.
Student teacher
demonstrates and
discusses various transfer
methods of patient
PPT
What is
drag
method?

20. 19
3. Support the head.
4. Try to keep the pull as straight and in-line as possible
c. Blanket pull method
This is the preferred method for dragging a victim.
1. Place the victim on the blanket by using the "logroll" or the three-
person lift.
2. The victim is placed with the head approx. 2 ft. from one corner of
the blanket.
3. Wrap the blanket corners around the victim.
4. Keep your back as straight as possible.
5. Use your legs, not your back.
6. Try to keep the pull as straight and in-line as possible.
2. Cradle method
This only works with a child or a very light person.
1. Place your arms under the victim's knees and around their back.
3. Fireman’s carry.
This technique is for carrying a victim longer distances. It is very
difficult to get the person up to this position from the ground. Getting
the victim into position requires a very strong rescuer or an assistant.
1. The victim is carried over one shoulder.
2. The rescuer's arm, on the side that the victim is being carried, is
wrapped across the victim's legs and grasps the victim's opposite
arm.
PPT
What is
cradle
method?

21. 20
4. Pick-A-Back carry
When injuries make the firefighter carry unsafe, this method is better
for longer distances than the one-person lift.
1. Place both the victim's arms over your shoulders.
2. Cross the victim's arms, grasping the victim's opposite wrist.
3. Pull the arms close to your chest.
4. Squat slightly and drive your hips into the victim while bending
slightly at the waist.
5. Balance the load on your hips and support the victim with your
legs.
5. Human crutch method.
If the person is conscious and can move on their own, this method
might be the most effective. It can be used if the person has an injury
to only one leg.
• Crouch with your knees bent and back straight next to the injured
person on the side of the injury. Have the person sit up and wrap
their arm over your shoulder. Slowly stand, allowing the injured
person to support themselves with their good leg. You will support
their weight on the side with the injury. Hold their hand around your
shoulders with the hand furthest from them. Put your other hand
around their waist.
For two persons (Two first aiders):
1. Double human crutch- Two persons are involved
2. Two-handed seat
This technique is for carrying a victim longer distances. This

22. 21
technique can support an unconscious victim.
1. Pick up the victim by having both rescuers squat down on either
side if the victim.
2. Reach under the victim's shoulders and under their knees.
3. Grasp the other rescuer's wrists.
4. From the squat, with good lifting technique, stand.
5. Walk in the direction that the victim is facing
3. Four-handed seat
This technique is for carrying conscious and alert victims moderate
distances. The victim must be able to stand unsupported and hold
themselves upright during transport.
1. Position the hands as indicted in the graphic.
2. Lower the seat and allow the victim to sit.
3. Lower the seat using your legs, not your back.
4. When the victim is in place, stand using your legs, keeping your
back straight.
4. Chair method
This is a good method for carrying victims up and down stairs or
through narrow or uneven areas. The chair used should be a sturdy
one.
1. Pick the victim up and place them or have them sit in a chair.
2. The rescuer at the head grasps the chair from the sides of the
back, palms in.
3. The rescuer at the head then tilts the chair back onto its rear legs.
4. For short distances or stairwells, The second rescuer should face in
and grasp the chair legs.
5. For longer distances, the second rescuer should separate the
PPT

23. 22
3 minutes
5 minutes
Discuss
about
triage
Discuss
after care
of patient
victim's legs, back into the chair and, on the command of the rescuer
at the head, both rescuers stand using their legs.
5. Wheel chair method
6. Stretchers
TRIAGE or TAGGING
Another component in patient/ casualty handling is the initial triage
or tagging. Triage pertains to the sorting of patients in priority
categories for care and transport. The category is based on how
severe the injuries are and if they are considered medical
emergencies. Patient tags are as follows:
Red tag: life-threatening conditions; considered the worst,
requires immediate transfer.
Yellow tag: can wait for up to an hour
Green tag: wounded but can walk
Black tag: dead
After care of the patient
• Ensure correct body alignment and comfort of the patient
• Replace pillow and other comfort devices as needed
• Raise the side rails if necessary for the safety of the patient
• Check for any discomfort, pain, skin condition etc.
• Check the vital signs of the patient after assuming the desired
posture for assessing orthostatic hypotension
• Remain with the patient during change of position to prevent
falling
• Record following aspects
Student teacher will
discuss about triaging
Student teacher will
discuss after care of
patient
PPT
PPT
What is
triage?
What are
important
data
including
in
document
ation of
procedur
e?

24. 23
2
Minutes
Enumerate
complicati
ons of
improper
body
alignment
▪ General condition of the patient before , during and
after procedure
▪ Vital signs of the patient
▪ Amount of assistance needed
▪ Reaction of the patient to the activity
▪ Any other observation
• Ensure that patient is comfort and safe
Complications of improper body alignment
If body mechanics principles are not properly maintained ,it may
lead to various complications
• Musculo-skeletal injuries
• Muscle fatigue
• Orthostatic hypotension
• Hypostatic bronchopneumonia
• Decreased BMR
• Complications of immobility
▪ Pressure sore
▪ Contracture
▪ Constipation etc.
Student teacher
enumerates complications
of improper body
alignment
PPT
What are
the
complicat
ions of
immobilit
y?

25. 24
1 Minute
3
Minutes
Define
exercise
Identify
various
purposes
of
exercise
Range of Motion Exercise
Definition of Exercise
Exercise is the exertion of the body for maintenance of its health
Exercise is a physical activity for conditioning the body, improving
health and maintaining fitness
Purposes of the exercises
a. In health
• To promote health by improving functioning of circulatory
system and lungs
• To retain movements in joints and normal tone in the muscles
• To prevent stiffness in joint
• To decrease cholesterol level
• To decrease the body weight of obese persons by increasing
caloric expenditure
• To delay the degenerative changes
In sickness
• To prepare the patient in ambulation in various disease
condition (After surgery, after fracture, stroke etc.)
• To restore muscle function in case of diseases, injuries and
deformities
• To rejuvenate muscles and to restore muscle balance after
injury and disease
• To improve gait
Student teacher defines
exercise
Student teacher explains
various purposes of
exercise?
PPT
PPT
What is
exercise?
What are
the
purposes
of
exercise?

26. 25
5
minutes
Classify
exercises
• To promote physical mobility
• To prevent deformity
• To strengthen weak muscles
• To improve blood supply
• To prevent constipation
• To control blood sugar level
• To reduce stress
• To improve functioning of lungs
• To prevent thrombus formation
Types of exercises
1. Active exercises : These are the free movements performed
by a patient himself without help
2. Passive exercises: These are the movements performed by
another person for the patient. It is also called assisted
movement
3. Aerobic exercises :These are the activities that stimulate
heart and lung sufficiently , increase oxygen uptake and its
delivery to body tissue
4. Isotonic exercise: These are the normal type of exercise
which involves movement of joint take place by shortening of
muscles
5. Isometric exercise (also called static exercise): There is no
movement of joint .It involves concentration and relaxation
of muscles. ( E.g. Deep breathing exercise)
6. Range of motion exercise: ROM exercises are those in
which a joint is moved through its full range of motion.
Student teacher classifies
exercises
PPT
What is
passive
exercise?

27. 26
5 minutes
Discuss
movement
of various
joint
Movements of various joints
1. Abduction :Movement Away from the mid line of the
body
2. Adduction : Movement towards the midline of the body
3. Flexion : Bending of a joint
4. Extension: The return movement from flexed state
5. Rotation : turning or moving around its axis
• Internal rotation : Turning inward , towards center
• External rotation :Turning out ward , way from the center
6. Dorsiflexion :Movement that flexes or bends the hand
back towards the body or foot towards the leg
7. Palmar flexion: Movement that flexes or bends the hand
in the direction of the palm
8. Plantar flexion: Movement that flexes or bends the foot
in the direction of the sole.
9. Pronation : Rotation of the fore arm so that the palm of
the hand is down
10. Supination : Rotation of the fore arm so that the palm of
the hand is up
Student teacher discusses
movement of various joint
PPT
What is
plantar
flexion?

28. 27
Figure on movements of various joints

29. 28

30. 29
References
1. TNAI. Fundamentals of Nursing – A procedure manual .1st
Ed.New Delhi:TNAI;2005
2. Potter ,Patricia A and Perry,Anne G . Fundamentals of Nursing.3rd
Ed.St Louis :Mosby year Book Inc;1993
3. Kozier ,Barbara black wood. Fundamentals of patient care.Philadelphia:W.Bsaunders company;1967
4. Sr. Nancy .Principles and practice of nursing Vol 1.Ed 3rd
.Kerala:N.R Brothers;1997
5. Gupta LC, Gupta K. First Aid: management of injuries and common ailments. New Delhi: Jaypee Brothers; 1985. p.79-91
6. Gupta LC, Gupta A. Manuals of first aids:management of general injuries, sports injuries and common ailments. First edition.
New Delhi: Jaypee Brothers; 1995. p.312-343
7. Taylor C, LillisC, LeMoneP. Fundamentals of Nursing: the art and science of nursing care. Philadelphia, USA: J.B Lippincott
Company; 1989.p.618-688.
8. https://www.wikihow.com/Carry-an-Injured-Person-by-Yourself-During-First-Aid
Conclusion
Exercises are very
important in our life in
order to improve
circulation of blood,
mobility and normal
functioning of all tissues
in our body. Much care
should be taken in case of
sick person. The nurse or
physiotherapist must be
with the client while doing
exercises.