The document provides a comprehensive overview of body mechanics, emphasizing its importance in maintaining patient mobility and preventing injuries. It includes guidance on proper ergonomic practices, nursing interventions for various complications related to immobility, and strategies to promote patient safety and well-being. Additionally, it highlights the risks of immobility such as pressure ulcers and outlines nursing measures to mitigate these risks.

1. Prepared by: SANJAY SIR
Lecturer
Govt. College of Nursing
New Civil Hospital
SURAT-395006
Gujarat
INDIA
(M) 9824961594
SUBJECT: NURSING FOUNDATION
UNIT: X- MEETINGTHE NEED OFTHE PATIENT
MOBILITYAND IMMOBILITY

2. Body Mechanics
 The efficient, coordinated, and safe use of the body to
produce motion and maintain balance during activity.
Body mechanics involves the coordinated effort of muscles,
bones, and the nervous system to maintain balance, posture, and
alignment during moving, transferring, and positioning patients.
Purpose :
To facilitate safe and efficient use of appropriate groups of muscles.

3.  The Importance of Proper Body Mechanics - Keeping
Your Spine Healthy. Body mechanics is a term used to
describe the ways we move as we go about our daily
lives. It includes how we hold our bodies when we sit,
stand, lift, carry, bend, and sleep. Poor body
mechanics are often the cause of back problems

4. Some 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 hips
4. Exercise regularly, including exercises to strengthen
the pelvic, abdominal, and lumbar muscles
5. Sleep on a firm mattress

5. Poor Body Mechanics

10. Ergonomics:
 Ergonomics is the process of designing or arranging workplaces,
products and systems so that they fit the people who use them.

11. Ergonomics

12. Ergonomics

13.  Body alignment (posture): geometric
arrangement of body parts in relation to each
other.
 Balance (stability): state of equipoise
(equilibrium) in which opposing forces
counteract each other.
 Coordinated body movement: integrated
functioning of the musculoskeletal and
nervous system as well as joint mobility.

14.  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.
 The line of gravity is the vertical line passing through
the center of gravity.
 The base of support is the foundation that provides
the object/person’s stability.

15.  The wider the base of support and the lower the center of gravity, the
greater is the stability of the object.
 The equilibrium of an object is maintained as long as the line of gravity
passes through its base of support
 When the line of gravity shifts outside the base of support, the amount
of energy required to maintain equilibrium is increased
 Equilibrium is maintained with least effort when the base of support is
broadened in the direction in which movement occurs.
 Stooping with hips and knees flexed and the trunk in good alignment
distributes the work load among the largest and strongest muscle groups
and helps to prevent back strain.
 The stronger the muscle group, the greater is the work it can perform
safely.

16.  Using a larger number of muscle groups for an activity
distributes the work load.
 Keeping center of gravity as close as possible to the center of
gravity of the work load to be moved prevents unnecessary
reaching and strain on back muscles.
 Pulling an object directly toward (or pushing directly away
from) the center of gravity prevents strain on back and
abdominal muscles.
 Facing the direction of movement prevents undesirable
twisting of spine.
 Pushing, pulling, or sliding an object on a surface requires
less force than lifting an object, as lifting involves moving the
weight of the object against the pull of gravity.

17.  Moving an object on a level surface requires less effort than
moving the same object on an inclined surface because the pull of
gravity is less on a level surface.
 Working with materials that rest on a surface at a good working
level requires less effort than lifting them above the working
surface.
 Contraction of stabilizing muscle preparatory to activity helps to
protect ligaments and joints from strain and injury.
 Dividing balanced activity between arms and legs protects the
back from strain.
 Variety of position and activity helps maintain good muscle tone
and prevent fatigue.
 Alternating periods of rest and activity helps prevent fatigue.

18.  Moving an object by rolling, turning, or pivoting requires less
effort than lifting the object, as momentum and leverage are used
to advantage.
 Using a lever when lifting an object reduces the amount of
weight lifted.
 The less the friction between the object moved and surface on
which it is moved, the smaller is the force required to move it

19.  Growth and Development
 Physical Health
 Mental Health
 Nutrition
 Personal Values and Attitudes
 External Factors
 Prescribed Limitations

20.  Cardiovascular – decreased heart reserve, venous stasis, orthostatic
hypotension,thrombophlebitis, dependent edema (lower limbs will
swell)
 Respiratory – difficulty breathing, pulmonary embolism, pneumonia,
decreasedvital capacity, decreased chest expansion
 Musculoskeletal – atrophy, contracture, osteoporosis, decreased
muscle tone, size,strength
 Metabolic – gain weight, negative N balance, protein synthesis
(anabolism)exceeded by breakdown (catabolism), kidneys affected
 Gastrointestinal – slow down, decreased appetite & peristalsis
 Urinary – urine pool in kidneys get U.T. I.
 Skin – pressure ulcer risk
 Psychosocial – isolation, low self-esteem

21.  When sitting, particularly supported and/or with
poor posture, muscle and connective tissue
become altered due to the plastic properties of the
tissue that gives in to gravity. As a result we walk
without proper body mechanics(specifically
alignment) resulting in pain and injuries.

22. Nursing Interventions For
Impaired Body Alignment & Mobility

23. Prevention Of Musculoskeletal Complications
Goal:
• Prevent contractures, muscle
weakness/atrophy.
• Prevent disuse osteoporosis
Interventions:
Provide Active or passive range of motion
exercises(ROM ) three times/day.
Encourage activities of daily living(ADLs) as
possible and progressively.

24. Promote independence as much as possible.
Provide Therapeutic devices as needed.
(pillows, footboard, trochanter roll, hand rolls,
trapeze bar).
 Consult appropriate health care provider
(e.g. physician, physical therapist) if client's
mobility and range of motion are more limited
than expected.
Provide foods high in calcium
Prevention Of Musculoskeletal Complications

26. Prevention of cardio vascular complications
Goal:
• Reducing orthostatic hypotension
• Reducing cardiac workload
• Preventing thrombus formation
Interventions:
Reducing orthostatic hypotension-
Teaching patients to rise slowly from lying
to standing. Sit for a while before standing

27. :
Reducing cardiac workload:
• Discourage Valsalva maneuver.
• Encourage patient to take breath while
sitting or standing.
• Stool softeners to avoid straining during
defecation.
Preventing thrombus formation.
Exercise: perform active / passive exercises.
Prevention of cardio vascular complications

28. Prevention of cardio vascular complications
 Provide at least 2000 ml water daily.
 Encourage early mobilization.
•Medication:
Aspirin or antiplatelet agents should be given.
•Compression stockings, sequential compressive
devices must be used.
•Positioning:
Avoid crossing the legs, sitting for prolonged
period of time wearing clothing that constricts the
leg.
:

29. Prevention of respiratory complications
Goal
• Promotion of chest and lung expansion
• Removal of secretions
• Maintenance of patent airway
• Prevention of hypostatic pneumonia

30. Interventions:
 Place the client in fowlers position.
Cough and deep breathing.
Ambulate as soon as possible.
Adequate fluid intake.
Incentive spirometer.
Chest physiotherapy.
Prevention of respiratory complications

32. Prevention of metabolic complications
Goal:
• To prevent negative nitrogen and calcium
balance
• To meet the nutritional requirements
Interventions:
Nutritional needs:
Provide protein rich diet
Supply adequate calories in diet
Vitamin D, C rich diet.

33. Prevention of urinary complications
Goals:
• Prevent urinary stasis, calculi, and infection.
Interventions:
 Ensure adequate fluid intake (minimum 2L/day).
 provide Toileting aids.
 Foley’s or straight catheter if needed.
 Observe output, assess for bladder distention, signs
and symptoms of urinary tract infections (UTI).

34. Prevention of gastrointestinal effects
Goal:
• Prevention of constipation
Interventions:
• Encourage daily fluid intake of 2000 to 3000 ml per
day, if not contraindicated medically
• Encourage increased fiber in diet (e.g., raw fruits,
fresh vegetables); a minimum of 20 gm of dietary
fiber per day is recommended

35. Encourage physical activity and regular exercise
Encourage a regular time for elimination
Offer a warmed bedpan to bedridden patients
Provide privacy and maintain dignity
Stool softeners
Suppositories
Enema
Prevention of gastrointestinal effects

36. Prevention of Integumentary complications
Goal:
• To prevent skin breakdown
Interventions:
Change position every 2nd hourly.
Use proper transfer technique to avoid
shearing/friction.

37. Therapeutic devices as needed (air mattress, water
mattress, protective cushion, pressure rings, etc.)
Adequate hydration and nutrition
Protect skin from moisture.
Assess skin for signs of pressure areas/skin
breakdown.
Proper wound care.
Prevention of Integumentary complications

39. Prevention of psychosocial complications
Goal:
• To improve self esteem
• To avoid depression
Interventions:
Provide psychological support.
Encourage client’s verbalization of feelings.

40. Provide social interaction during care
encourage participation in ADLs as able
Provide stimuli to promote orientation and
contact with reality – clock, radio, TV,
newspaper.
Prevention of psychosocial complications

41. Common hazards of immobility and its management

1. Pressure Ulcers -
 A pressure ulcer is a specific tissue
injury caused by unrelieved
pressure that results in ischemia in
and damage to the underlying
tissue.
 Pressure ulcers occur most
commonly over bony prominences.
 Risk factors include:
1.immobility
2.malnutrition
3.incontinence
4.compromised peripheral
circulation.
 The elderly are especially at risk
because of a loss of lean body mass
and changes in body tissues and
peripheral circulation.
“Bed Sore”

42. Pressure Ulcer
Stage 1
redness of intact
skin

43. Pressure Ulcers
Stage2
abrasion, crater, or
blister; ulcer is shallow

44. Pressure Ulcers
Stage 3
damage to
subcutaneous
tissue
extending
down to fascia;
deep crater,
possibly with
drainage

45. Pressure Ulcers
Stage 4
damage to
muscle, bone,
tendon or
joint capsule;
small or large
surface
wound, but
with extensive
tunneling, and
foul smelling
discharge.

46. Nursing Measures to prevent
Pressure Sores:
 Frequent turning of immobile clients every 2 hours
 Instruct patients to do weight shifts (pressure relief ) at
least every 15-20 minuteswhen sitting in your
wheelchair.
 If your injury is at levels C4 and higher you can use a
power tilt wheelchair for regular pressure relief.
 With an injury at levels C5 or C6 you can usually lean
forward or side-to-side for regular pressure relief.
 If your levelof injury is C7 and below you can usually
perform a wheelchair push-up for regular pressure relief.

47. Nursing Measures to prevent
Pressure Sores:
 Provide for good nutrition with diet high in protein,
carbohydrates, fluids, vitamin C and zinc
 Use alternating-pressure air mattress, flotation pads,
elbow and heel pads, sheepskin pads
 Do not use “donuts” or rubber rings
 Protect from infection

48. Nursing Measures to prevent
Pressure Sores:
 Wash skin gently, pat dry to prevent skin abrasion
 Use clean, dry, wrinkle-free bed linens and pads
 Promote circulation by gently massaging skin with
lotion that does not contain alcohol
 Remove dead tissue and debris for stages 2-4
 Dead tissue in the pressure sore can delay healing and
lead to infection. Removing dead tissue is often painful.
The client may be given pain-relieving medicine 30 to 60
minutes before these procedures.

49. Nursing Measures to prevent
Pressure Sores:
 Procedure
 Rinsing (to wash away loose debris).
 Wet-to-dry dressings.
 Enzyme medications to dissolve dead tissue only.
 Special dressings
 Complications of pressure sores include localized (i.e.
osteomyelitis, cellulitis) and even systemic infection
(i.e. sepsis)

50. Bone Demineralization and
Hypercalcemia
 Prolonged bedrest
 absence of weight-bearing
 Osteoporosis
 hypercalcemia

51. Bone Demineralization and
Hypercalcemia
 Nursing Measures:
 Prevent injury related to dec. bone strength
 Encourage weight-bearing on long bones, if possible
 Correct Body alignment, firm mattress
 Encourage self – care, ROM, avoid fatigue
 Assume wt. bearing positions (Tilt Table)
 Decrease calcium intake, provide balanced diet
 Diet: high CHO, Vit.C, Dec. Ca
 May be given estrogen, as necessary, and medications like
biphosphonates (i.e. alendronate, residronate) to retard
demineralization
 Encourage fluids, acid-ash diet

52. Negative Nitrogen Balance
 Negative nitrogen balance is aggravated by anorexia. It
represents depletion of protein stores that are essential
for building muscle tissue and for wound healing.
 Nursing Measure: Give high protein diet in small,
frequent feedings

53. Orthostatic Hypotension
 Orthostatic hypotension is decrease in BP > 20/10 mmHg
and it happens when there is decreased ability of the
autonomic nervous system to equalize the blood supply
when position is changed from recumbent to upright.
Another contributing factor is the pooling of blood in the
lower extremities due to the decrease in muscle action that
causes pressure on the veins and assisting in venous return.
 May lead to faintness, weakness, or dizziness in an attempt
to stand. The patient is at high risk for injury due to falls.

54. Orthostatic Hypotension
 Nursing Measures:
 Increase activity gradually
 Encourage ROM and leg exercises
 Teach patient to rise from bed slowly and dangle legs
before getting up
 Elastic stockings
 Tilt table
 Sitting & lying BP

55. Increased Cardiac Workload
 When the body is recumbent, the
total blood volume that would be in
the legs due to gravity is redistributed
to other parts of the body, increasing
the circulating volume and workload
of the heart.
 With prolonged immobility the
sympathetic nervous system takes
over resulting to tachycardia

56. Increased Cardiac Workload
 Valsalva maneuver further increases cardiac workload
 Nursing Measures: Goal is to prevent injury and
further ischemic damage to cardiac tissue by
decreasing workload of heart:
 Semi-recumbent position when in bed, pillows between
legs when side-lying
 Passive & Active ROM exercises
 Turn every 2 hour, dangle legs
 Avoid Valsalva maneuver: use overhead trapeze when
moving in bed
 Encourage slow, deep breathing when moving in bed

57. Contractures
 Contractures are joint abnormalities
due to abnormal shortening of muscle
tissue, rendering the muscle highly
resistant to stretching.
 Due to lack of active or passive ROM
and improper positioning of joints
 On assessment: fixed, shortened
extremities with pain on manipulation
 Leads to difficulties in performing ADL


58. Contractures
 Nursing Measures:
 Promote frequent change in position
 Use pillows, trochanter rolls, and
foot board to promote proper body
alignment
 Avoid knee gatch
 Perform therapeutic ROM exercises
as appropriate
 Promote proper body alignment
 Position: Functional, correct
alignment

59. Thrombus Formation
This is development of clot in a
vein due to venous stasis,
increased coagulability of blood
and damage to the endothelial
wall of the vessel
DVT present as groin or calf
tenderness, pain, warm and
edematous extremities. It poses the
danger of throwing off an emboli
leading to pulmonary infarction

60. Thrombus Formation
 Nursing Measures:
 Prevent by leg exercises: flexion and extension of toes
for 5 minutes every hour
 Ambulate patients as appropriate
 Avoid using knee gatch on bed or pillows to support
knee f lexion
 Use anti-thromboembolic stockings
 Check for Homan sign

61. Stasis of Respiratory Secretions
 Due to inability of cilia to move normal secretion out
of bronchial tree due to ineffective coughing, lack of
thoracic expansion or effects of medications
 This leads to hypostatic pneumonia (frequent
nosocomial infection)

62. Stasis of Respiratory Secretions
 Nursing Measures:
 Teach patient the importance of turning,
deep breathing, coughing
 Teach patient how to use incentive
spirometry
 Hold the spirometer upright
 Teach patient to exhale first and seal the lips
tightly around the mouthpiece
 Take in a slow, deep breath to elevate the balls or
cylinder. Hold the breath initially for 2 seconds
and then increasing to 6 seconds.
 Repeat the procedure four or five times hourly.
Practice increases inspiratory volume, maintains
alveolar ventilation and prevents atelectasis.

63. Postural Drainage
 Administer postural drainage
 This is drainage by gravity of secretions from various lung segments
 Scheduled 2-3 times daily before meals and at bedtime
 Before the procedure, patient may be given a bronchodilator
medication or nebulization therapy to loosen the secretions
 Sequence: positioning, percussion, vibration, and removal of secretions
by coughing or suction. Positions are assumed for 10-15 minutes
depending on patient’s tolerance
 Position for draining middle to lower lung field: head is lower than a
chest; patient may be placed in Trendelenburg position
 Position for draining upper lung field: sitting position at about 45
degrees
 Postural drainage should not be performed on pregnant women; on
those with rib or chest injuries; on those with dizziness, fainting, head
or neck injuries; on those with pulmonary embolism or abdominal
surgery

64. Postural Drainage
Postural Drainage

65. Middle and Lower Portions

66. Postural Drainage
Sitting position at about 45 degrees
•Upper portions of lungs
•Sitting position at about a 45 angle

67. Postural Drainage

68. Postural Drainage

69. Constipation
 Constipation is due to stasis of fecal
material in the rectum and sympathetic
nervous system activity
 May present as ribbon-like diarrhea and
fecal smearing
 Nursing Measures:
 Promote ambulation early
 encourage high fiber, high f luid diet
 Ensure privacy with the use of bedpan or
commode
 Administer stool softeners as necessary

70. Urinary Stasis
 Immobility leads to inability to
completely empty the bladder
 Leads to urinary tract infection and
renal calculi formation
 Nursing Measures:
 Have patient void in normal position,
if possible
 Low calcium diet, increase f luid intake
and increase acid ash residue

71. Depression
Sensory Input
Changes
• This may lead to confusion and
disorientation
• Orient patient frequently and
place clock/ calendar within sight
• Encourage self care that starts
with simple gross activities then
advancing to complex, fine motor
movements
• Support patient with positive
feedback for his efforts and
accomplishments
• Schedule OT and allow visitors as
appropriate

72. ASSISTIVE DEVICES
 Crutches
 Height of crutch – measure two to three fingers or 2.5 -5
cm below the axilla
 Patient should support weight on the handpiece and not
at the axilla: to prevent brachial plexus palsy
 Tripod stance: proper standing position with crutches;
crutches are placed about 15 cm (6 inches) infront of the
feet and out laterally, about 15 cm, creating a wide base
 Elbows should be f lexed at 20 -30 degrees angle for
correct placement of hand grips

73. Crutch Walking Gaits

74. Using Crutches:
Sitting and Standing
 To sit on a chair
 Stand with the back of the unaffected
leg centered against the chair.
 Transfer the crutches to the hand on
the affected side and hold the
crutches by the hand bars.
 The client grasps the arm of the chair
with the hand on the unaffected side
to support himself.
 Lean forward. Flex the hips and
knees, and lower into the chair.

75.  stand up from a chair
 Hold the hand grips of both
crutches in one hand.
 Push off from the chair with
the other hand.
 Stand and check your balance.

76. Crutch walking Gaits

77. Cane

78. Cane
 Types: straight cane and quad cane
 Tips should have concentric rings as shock absorber and to
provide optimal stability
 Flex elbow 20-30 degrees angle and hold handle
 Tip of cane should be 15 cm lateral to the base of the fifth
toe
 Procedure:
 Hold cane on the good side
 Advance cane and affected leg
 Lean on cane when moving good leg
 When going up the stairs, follow “up with the good, down
with the bad”

79. Walker
 Lift and move walker forward 8-10 inches
 With partial or non-weight bearing, put weight on
wrists and arms and step forward with affected leg,
supporting self on arms, and follow with good leg
 Nurse should stand behind patient, hold onto gait belt
at waist as needed for balance