body mechanics and mobility.pptx

Body mechanics
and mobility
1/20/2023 Birhanu Y MSN 1

Learning Objectives:
 At the end of this topic the learner will be able to:
• State the principle underlying proper body mechanics and relate a
nursing consideration.
• State the purposes of range of motion exercise.
• Identify principles related to safe movement of clients in and out of
bed.
• Demonstrate the ability to teach each of the crutch walking gaits to
a client.
• Mention different positions used for various examination and
treatment.

• Movement is an activity most people take for granted.
• The ability to move and be active benefits health status,
• immobility presents a threat to one’s physical, mental,
and social well-being.
• Mobility is
– the ability to engage in activity and free movement which
includes walking, running, sitting, standing, lifting, pushing,
pulling, and performing activities of daily living (ADLs).
– often considered an indicator of health status

Importance of mobility
• it influences the correct functioning of many body systems
– Respiratory
– gastrointestinal
– urinary systems.
• enhances
– muscle tone
– increases energy levels
– associated with psychological benefits such as independence and
freedom.

• Body Alignment
– Refers to the position of body parts in relation to each other.
– Proper body alignment (also called posture) results in balance, which
is an individual’s ability to maintain equilibrium.
– Good posture
• Promotes balance
• reduces strain and injury to support structures
• facilitates respiratory effort
• enhances gastrointestinal processes
• gives an appearance of confidence and health.
• A correct postural stance is maintained by a well-functioning
musculoskeletal system.

Proper alignment and posture of the client
lying in bed appear similar to the standing
position
The benefits of proper alignment and
posture include
• Client comfort;
• prevention of contractures;
• promotion of circulation;
• less stress on muscle, tendons, nerves, and joints; and
• prevention of foot drop

• Muscle tone
– normal state of balanced tension present in the muscle
– it allows a muscle to respond quickly to stimuli.
– allow a person to maintain an erect posture.
– affected by the individual’s exercise and activity patterns.
– hypotonicity (flaccidity),
• is a decrease in muscle tone
– spasticity,
• is an increase in muscle tension
• often noted with extreme flexion or extension.
• Muscle shape should be symmetrical.
– There may be hypertrophy or atrophy

• Body Mechanics
– The purposeful and coordinated use of body parts and
positions during activity.
– maximizes the effectiveness of the efforts of the
musculoskeletal and neurological systems
– reduces the body’s exposure to strain or injury during
movement.
– Proper body mechanics are as important to the nurse as to
the client.
– The purpose of proper body mechanics is prevention of
strain and injury to the muscles, joints, and tendons.

• Range of motion reflects the extent to which a
joint can move.
• The ranges vary with each joint and are
affected by several factors, including age,
physical condition, and heredity.

• EXERCISE
– any physical activity involving muscles that elevates the
heart rate above resting levels.
– reduces joint pain and stiffness, and increases flexibility,
muscle strength, and endurance.
– helps with weight reduction and contributes to an
improved sense of well-being.
• facts about exercise:
– People who are usually inactive can improve their health
and well-being by becoming even moderately active on a
regular basis.
– Physical activity need not be strenuous to achieve health
benefits.
– Greater health benefits can be achieved by increasing the
amount (duration, frequency, or intensity) of physical
activity.

Types of Exercise
• Aerobic;
– Improve cardiovascular fitness
– Assist with weight control
– Improve general functional ability
• E.g. Rowing Jumping rope, Walking, Running
• Strengthening
– Maintain or increase muscle strength
• E.g. Weight training, Physical labor

• Isometric
– Maintain muscle tone and strength
• E.g. Quadriceps setting, Gluteal setting, Triceps setting
• Isotonic
– Increase and maintain muscle tone and strength
– Shape muscles Working with pulleys
– Maintain joint mobility
– Improve cardiovascular fitness
• E.g. Weight lifting, Range-of-motion exercises Performance of activities
of daily living (ADL)
• Isokinetic
– Condition muscle groups
• E.g. Exercise equipment, Resistive water exercises
• Range-of-Motion (ROM)
– Maintain joint movement
– Maintain or increase flexibility
• E.g. Flexion and contraction Adduction and abduction

Range-of-Motion Exercise
• Active range-of-motion (ROM)
– independently by the client.
– the client moves various muscle groups.
• Passive ROM exercises are done by the nurse to
help maintain
• OUTCOMES OF PASSIVE RANGE-OF-MOTION
EXERCISES
– Prevention of contractures
– Improves muscle strength and tone
– Increases circulation
– Decreases vascular complications of immobility
– Facilitates client comfort

• Physical Fitness
– The ultimate outcome of regular physical activity
– four components of physical fitness:
• endurance and strength
• joint flexibility
• cardiorespiratory fitness
• body composition.
• Endurance and Strength
– the ability to withstand movement in terms of
duration and absence of fatigue.
– Adequate muscular strength and endurance to
accomplish one’s goals.

• Joint Flexibility
– The ability to use a muscle through its complete ROM
– limited flexibility leads to
• shortened muscles and tendons with resultant imbalance in
muscle strength and joint injury.
• Cardiorespiratory Fitness
– physical activity must be maintained for at least 20
minutes in order to raise the heart rate to the target
level.

BENEFITS
OF
EXERCISE
• Normalizes glucose
tolerance
• Improves gait and
balance
• Improves cardiovascular
function
• Increases energy
• Promotes bone density
• Improves mobility
• Promotes weight loss
• Reduces blood pressure
• Lowers cholesterol
• Promotes rest and
relaxation
• Improves sleep

• Negative Outcomes of Immobility
• Neurologic Gastrointestinal
• Sensory deprivation Decreased appetite
Stress ulcers
Constipation
Fecal impaction
• Cardiovascular Urinary
• Increased cardiac workload Urinary stasis
• Orthostatic hypotension Urinary tract infection
• Formation of thrombus Calculi
• Respiratory Integumentary
• Increased respiratory effort Pressure ulcers
• Hypostatic pneumonia Skin shearing
• Altered gas exchange
• Musculoskeletal Psychological
• Decreased bone density Anxiety
• (increased risk of fracture) Depression
• Contractures Helplessness, hopelessness
• Muscle atrophy Increased dependency
• Increased pain

• Application of Body Mechanics
• When lifting objects from the floor,
– bend at the hips and knees while keeping the back
straight and maintaining a wide base of support.
– Avoid bending from the waist as this will strain
muscles of the lower back.
– Adjust the height of the client’s bed to avoid back
strain.
– Carry objects close to the midline of the body.
– Avoid stretching to reach objects.

• Body Mechanics
– Think ahead to eliminate hazards and injuries.
– Consider the weight and bulk of a client or object
before lifting.
– Take your time and lift properly.
– Watch your footing.
– Teach proper body mechanics to others.
– Ask for help as needed.

Body Alignment
• When lifting, walking, or performing any activity,
proper body alignment is essential to maintain
balance.
• When a person’s body is in correct alignment, all
the muscles work together for the safest and most
efficient movement, without muscle strain.
• Stretching the body as tall as possible produces
proper alignment.
• This can be accomplished through proper posture.

• When standing, the weight is slightly forward and
is supported on the out side part of the feet.
• Again the head is erect, the back is straight, and
the abdomen is in (remember that the client in bed
should be in approximately the same position as if
he/she were standing).

• Positioning the client
• Prolonged immobility can cause a number of
disorders, among which are pressure ulcer,
constipation, and muscle weakness, pneumonia
and joint deformities.
• By assisting clients to maintain or regain mobility,
you promote self-care practices and help to
prevent deformities.
Moving and Positioning Clients
• Moving and positioning promote comfort, restore
body function, prevent deformities, relieving
pressure, prevent muscle strain, and stimulate
proper respiration and circulation.

Encouraging clients to move in bed, get out of bed, or
walk serves several positive purposes
Purpose:
• To increase muscle strength and social mobility
• To prevent some potential problems of immobility
• To stimulate circulation
• To increase the patient sense of independence and self
esteem
• To assist a patient who is unable to move by himself
• To prevent fatigue and injury
• To maintain good body alignment

Practice Guideline
• Maintain functional client body alignment.
(Alignment is similar whether client is standing or in
bed.)
Maintain client safety.
• Reassure the client to promote comfort and
cooperation.
• Properly handle the client’s body to prevent pain or
injury.
Follow proper body mechanics.
• Obtain assistance, if needed, to move heavy or
immobile clients.
• Do not use special devices (e.g. splints, traction
unless ordered)

Joint Mobility and Range of Motion
• Every body joint has a specific but limited opening
and closing motion that is called its range of motion
(ROM).
• The limit of the joint’s range is between the points
of resistance at which the joint will neither open nor
close any further.
• Generally all people have a similar ROM for their
major joints.
Passive Range of Motion
• If a client is unable to move, the nurse helps by
performing passive range of motion (PROM)
exercise.

Controlling Postural Hypotension
• Sleep with the head of the bed elevated (8-12
inches).
• This makes the person’s position change on rising
less severe.
• Avoid sudden changes of position.
• Arise from bed in steps:
• ⇒ Sit on the side of the bed with legs dangling for
1 minute
• ⇒ Stand with core holding on to the edge or the
bed or another non mobile object for 1 minute

• Gradual change in position stimulates renin,
kidney enzyme that has a role in regulating BP and
which prevents a dramatic drop in BP
• Balance is maintained with minimal effort when
the base of support is enlarged in the direction in
which the movement will occur
• Contracting muscles before moving an object
lessens the energy required to move it
• The synchronized use of as many large muscles
groups as possible during an activity increases
overall strength and prevents muscle fatigue and
injury

• The greater the friction against the surface beneath
an object the greater the force required moving the
object. (Pulling creates less friction than pushing)
• The heavier the object, the greater the force
needed to move the object
• Moving an object along a level surface required
less energy than moving an object up an inclined
surface or lifting it against gravity
• Continuous muscle exertion can result in muscle
stretch and injury

Body Positioning
• Positioning client in various positions is done for
diagnostic and therapeutic purposes.
• Some of the reasons include
• Promoting comfort,
• Restoring body function,
• Preventing deformities,
• Relieving pressure,
• Preventing muscle strain,
• Restoring proper respiration and
• Circulation and giving nursing treatment.

Guideline for Positioning the Client
• Positioning the Client for Comfort
• Maintain functional client body alignment.
(Alignment is similar whether the client is standing or
in bed.)
• Maintain client safety.
• Reassure the client to promote comfort and
cooperation.
• Properly handle the client’s body to prevent pain or
injury.
• Follow proper body mechanics.
• Do not use special devices (e.g. Splints, traction)
unless ordered client positioning for examination and
treatment.

1. Horizontal Recumbent Position / Supine
• This position is required for most of the physical
examinations.
• The client lies on the back with the legs extended.
• The arms are placed, folded on the chest, or along
side the body.
• One small pillow may be used.
• Cover the client with bath blanket for privacy.
• Caution: This position may be uncomfortable for
a person with a back problem

Client Positioning for Examination and Treatment
1. Horizontal Recumbent Position / supine

2. Dorsal recumbent position -used for variety of
examinations and procedures.
• The client lies on the back, with the knees flexed
and the soles of the feet flat on the bed.
• Cover the client with a sheet or a bath blanket
folded once across the chest.
• The second sheet should be cross wise over the
client thighs and legs.
• Wrap the lower ends of this sheet around the
client’s legs and feet.
• Fold the sheet so the genital area is easily exposed.
• Keep the client covered as much as possible

Dorsal recumbent position

3. Prone Position: - is used to examine the spine
and back.
• The client lies on the abdomen with head turned to
the side for comfort.
• The arms are held above the head or along side the
body.
• Cover the client with a bath blanket for privacy.
• Caution: Unconscious clients, pregnant women,
clients with abdominal incisions, and clients with
breathing difficulties cannot lie in this position.

Prone Position

4. Sims’ Position: - This position is used for rectal
examination.
• The client rests on the left side, usually with a
small pillow under the head.
• The right knee is flexed against the abdomen, the
left knee is flexed slightly, the left arm is behind
the body, and the right arm is in a comfortable
position.
• Cover the client with a bath blanket.
• Caution: The client with leg injuries or arthritis
often cannot assume this position

Sims’ Position

5. Fowler’s Position: - this position is used to promote
drainage or to make breathing easier.
Semi-sitting position.
Head of bed elevated to 45–60 degrees Knees slightly
elevated.
• Promote comfort
• Improve respiratory
• problems (i.e., dyspnea, pneumonia)
• Encourage postoperative drainage
• Adjust the head rest to the desired height, and raise
the bed section (Gatch bed) under the client’s knees.
• Place a rolled pillow between the client’s feet and use
the foot of the bed as a brace, if desired.
• Caution: Observe for signs of dizziness or faintness
when you raise the head of the bed.

Fowler’s Position

6. Knee-chest Position: - is used for rectal and
vaginal examinations and as treatment to bring the
uterus into normal position.
• The client is on the knees with the chest resting on
the bed and the elbow rested on the bed, or with
the arms above the head, the client’s head is turned
to the side.
• The thighs are straight up and down, and the lower
legs are flat on the bed.
• Caution: The client may become dizzy or faint and
fall. Do not leave the client alone.

Knee-chest Position

6. Dorsal Lithotomy Position: -
• is used for examination of pelvic organs.
• It is similar to dorsal recumbent position, except
that the client’s legs are well separated and the
knees are acutely flexed.
• The nurse will usually place the client’s feet in
stirrups.
• Keep the client covered as much as possible for
privacy.

Dorsal Lithotomy Position: -

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