activity and exercise 2010 review
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Activity and ExerciseActivity and Exercise
Fundamentals of Nursing ReviewFundamentals of Nursing Review
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MobilityMobility
The ability to move freely, easily,The ability to move freely, easily,
rhythmically and purposefullyrhythmically and purposefully
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Range ofMotionRange ofMotion
The ROM of the joint is the maximumThe ROM of the joint is the maximum
movement that is possible for that jointmovement that is possible for that joint
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ExerciseExercise
A type of physical activity defined as aA type of physical activity defined as a
planned, structure and repetitive bodilyplanned, structure and repetitive bodily
movement done to improve or maintainmovement done to improve or maintainone or more components of physicalone or more components of physical
fitnessfitness
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Types of ExerciseTypes of Exercise
ISOTONICISOTONIC
Dynamic exercise in which the muscleDynamic exercise in which the muscle
shortens to produce contraction andshortens to produce contraction and
movementmovement
Running, walking, swimming, cyclingRunning, walking, swimming, cycling
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Types of ExerciseTypes of Exercise
ISOMETRICISOMETRIC
Are those in which there is a change inAre those in which there is a change in
muscle tension but NO CHANGE in musclemuscle tension but NO CHANGE in muscle
lengthlength
Tensing, extending and pressing exercisesTensing, extending and pressing exercises
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Other Types of ExerciseOther Types of Exercise
ISOKINETICISOKINETIC
Involves muscle contraction or tensionInvolves muscle contraction or tension
against a resistanceagainst a resistance
Aerobic exerciseAerobic exercise
activity during which the amount ofactivity during which the amount of
oxygen taken into the body is greater thanoxygen taken into the body is greater than
that used to perform the activitythat used to perform the activity
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Benefits of ExerciseBenefits of Exercise
Increases joint flexibility, tone and ROMIncreases joint flexibility, tone and ROM
Bone density is maintainedBone density is maintained
Increases cardiac output and perfusionIncreases cardiac output and perfusion Prevents pooling of secretions in the lungsPrevents pooling of secretions in the lungs
Improves appetite and facilitate peristalsisImproves appetite and facilitate peristalsis
Elevates the metabolic rateElevates the metabolic rate Prevents stasis of urinePrevents stasis of urine
Produces a sense of wellProduces a sense of well--beingbeing
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Complications of IMMOBILITYComplications of IMMOBILITY
1. Contractures, atrophy and stiffness1. Contractures, atrophy and stiffness
2. Foot drop2. Foot drop
3. DVT3. DVT
4. Hypostatic pneumonia4. Hypostatic pneumonia
5. Pressure ulcers, skin breakdown,5. Pressure ulcers, skin breakdown,
reduced skin turgorreduced skin turgor
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Complications of IMMOBILITYComplications of IMMOBILITY
6. muscle atrophy6. muscle atrophy
7. osteoporosis7. osteoporosis 8. dependent edema8. dependent edema
9. urine stasis9. urine stasis
10. constipation10. constipation
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
ASSESSMENTASSESSMENT
Assess patients ability to moveAssess patients ability to move
Assess muscle tone, strengthAssess muscle tone, strength
Assess joint movement andAssess joint movement and
positioningpositioning
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions1. Position properly to prevent contractures1. Position properly to prevent contractures
Place trochanter roll from the iliac crest toPlace trochanter roll from the iliac crest to
the midthe mid--thigh to prevent EXTERNAL rotationthigh to prevent EXTERNAL rotation
Place patient on wheelchair 90 degrees withPlace patient on wheelchair 90 degrees with
the foot resting flat on the floor/foot restthe foot resting flat on the floor/foot rest
Place foot board or highPlace foot board or high--heeled shoes toheeled shoes toprevent foot dropprevent foot drop
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions2. Maintain muscle strength and joint2. Maintain muscle strength and joint
mobilitymobility
Perform passive ROMEPerform passive ROME Perform assistive ROMEPerform assistive ROME
Perform active ROMEPerform active ROME
Move the joints three times TIDMove the joints three times TID
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
3. Promote independent mobility3. Promote independent mobility
Warn patient of the orthostaticWarn patient of the orthostatichypotension when suddenlyhypotension when suddenly
standing uprightstanding upright
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
4. Assist patient with transfer4. Assist patient with transfer
Assess patients ability to participateAssess patients ability to participate
Position yourself in front of the patientPosition yourself in front of the patient
Lock the wheelchair or the bed wheelLock the wheelchair or the bed wheel
Use devices such as transfer boards,Use devices such as transfer boards,sliding boards, trapeze and sheetssliding boards, trapeze and sheets
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
4. Assist patient with transfer4. Assist patient with transfer
In general,In general, the equipments are placedthe equipments are placed
on the side of the STRONGER ,on the side of the STRONGER ,
UNAFFECTED body partUNAFFECTED body part
NursesNurses assist the patient to moveassist the patient to move
TOWARDS the stronger sideTOWARDS the stronger side
In moving the patient,In moving the patient, move to themove to the
direction FACING the nursedirection FACING the nurse
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions5. Assist patient to prepare for5. Assist patient to prepare for
ambulationambulation
Exercise such as quadriceps setting,Exercise such as quadriceps setting,gluteal setting and arm push upsgluteal setting and arm push ups
Use rubber ball for hand exerciseUse rubber ball for hand exercise
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
6.6. Assist patient in crutch ambulationAssist patient in crutch ambulation
Measure correct crutch lengthMeasure correct crutch length LYING DOWNLYING DOWN
Measure from theMeasure from theAnterior Axillary FoldAnterior Axillary Fold
to the HEEL
of the foot then:to the HEEL
of the foot then:Add 1 inch (Kozier)Add 1 inch (Kozier)
Add 2 inches (Brunner and Suddarth)Add 2 inches (Brunner and Suddarth)
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions6. Assist patient in crutch ambulation6. Assist patient in crutch ambulation
Measure correct crutch lengthMeasure correct crutch length
STANDING (Kozier)STANDING (Kozier)
Mark a distance of 2 inches to the sideMark a distance of 2 inches to the sidefrom the tip of the toe (first mark)from the tip of the toe (first mark)
6 inches is marked (second mark) ahead6 inches is marked (second mark) aheadfrom the firstfrom the first
Measure 2 inches below the axilla to theMeasure 2 inches below the axilla to thesecond marksecond mark
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
6. Assist patient in crutch ambulation6. Assist patient in crutch ambulation
Measure correct crutch lengthMeasure correct crutch length
STANDING (Kozier)STANDING (Kozier) Make sure that the shoulderMake sure that the shoulder--rest of therest of the
crutch is at least 1crutch is at least 1-- 2 inches below the2 inches below the
axillaaxilla
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
6. Assist patient in crutch ambulation6. Assist patient in crutch ambulation
Measure correct crutch lengthMeasure correct crutch length
Utilizing the patients HEIGHTUtilizing the patients HEIGHT Height MINUS 40 cm or 16 inchesHeight MINUS 40 cm or 16 inches
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
6. Assist patient in crutch6. Assist patient in crutch
ambulationambulationMeasure correct crutch lengthMeasure correct crutch length
Hand piece should allow 20Hand piece should allow 20--3030
degrees elbow flexiondegrees elbow flexion
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
6. Assist patient in crutch GAIT6. Assist patient in crutch GAIT
A. 4 point gaitA. 4 point gait
B. threeB. three--point gaitpoint gait
C. two point gaitC. two point gait
D. swing to gaitD. swing to gait
E. swing through gaitE. swing through gait
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GAITGAIT
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44--point gaitpoint gait
Safest gaitSafest gait
Requires weight bearing on both legsRequires weight bearing on both legs
Move RIGHT crutch ahead (6 inches)Move RIGHT crutch ahead (6 inches)
Move LEFT foot forward at the level ofMove LEFT foot forward at the level of
the RIGHT crutchthe RIGHT crutch
Move the LEFT crutch forwardMove the LEFT crutch forward
Move the RIGHT foot forwardMove the RIGHT foot forward
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33--point gaitpoint gait
Requires weight bearing on theRequires weight bearing on the
UNAFECTED legUNAFECTED leg
MoveMove BOTHBOTHcrutches and thecrutches and the
WEAKERLEGWEAKERLEGforwardforward
Move the STRONGER leg forwardMove the STRONGER leg forward
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22--point gaitpoint gait
FasterFasterthan 4than 4--pointpoint
Requires more balanceRequires more balance
Partial bearing on BOTH legsPartial bearing on BOTH legsMove theMove the LEFT crutch and RIGHT footLEFT crutch and RIGHT foot
FORWARD togetherFORWARD together
Move theMove the RIGHT crutch andLEFT footRIGHT crutch andLEFT footforward togetherforward together
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SwingSwing--to gaitto gait
Usually used by client with paralysis ofUsually used by client with paralysis of
both legsboth legs
Prolonged use results in atrophy ofProlonged use results in atrophy ofunused muscleunused muscle
MoveMove BOTH crutches togetherBOTH crutches together
L
ift body weight by the arms and swingL
ift body weight by the arms and swingto the crutches (at the level)to the crutches (at the level)
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SwingSwing--through gaitthrough gait
MoveMove BOTH crutches togetherBOTH crutches together
Lift body weight by the arms and swingLift body weight by the arms and swing
forward, ahead of the crutchesforward, ahead of the crutches (beyond(beyondthe level)the level)
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
6. Assist patient in ambulation with a walker6. Assist patient in ambulation with a walker
Correct height of the walker must allow aCorrect height of the walker must allow a
2020--30 degrees of elbow flexion30 degrees of elbow flexion
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IMPAIRED PHYSICAL MOBILITYIMPAIRED PHYSICAL MOBILITY
Nursing InterventionsNursing Interventions
6. Assist patient in ambulation with a cane6. Assist patient in ambulation with a cane
Correct cane measurement:Correct cane measurement:
With elbow flexion of 30 degrees,With elbow flexion of 30 degrees,
measure the length from the HAND to 6measure the length from the HAND to 6
inches lateral to the tip of the 5inches lateral to the tip of the 5thth toetoe
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Impaired Skin integrityImpaired Skin integrity
Pressure ulcersPressure ulcers
Are localized areas of dead softAre localized areas of dead soft
tissue that occurs when pressuretissue that occurs when pressureapplied to the skin overtime is moreapplied to the skin overtime is more
than 32 mmHg leading to tissuethan 32 mmHg leading to tissue
damagedamage
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Pressure soresPressure sores
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Impaired Skin integrityImpaired Skin integrity
INITIAL SIGN OF PRESSURE ULCER:INITIAL SIGN OF PRESSURE ULCER:
ERYTHEMA or redness of the skinERYTHEMA or redness of the skin
that DOES NOT blanchthat DOES NOT blanch
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Impaired Skin integrityImpaired Skin integrity
Weight bearing Bony prominencesWeight bearing Bony prominences
1. Sacrum and cocygeal area1. Sacrum and cocygeal area
2. Ischial tuberosity2. Ischial tuberosity 3. Greater trochanter3. Greater trochanter
4. Heel and malleolus4. Heel and malleolus
5. Tibia and fibula5. Tibia and fibula 6. Scapula and elbow6. Scapula and elbow
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Pressure areasPressure areas
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Risk Factors for pressure ulcersRisk Factors for pressure ulcers
1. Patients with sensory deficits1. Patients with sensory deficits
2. Decreased tissue perfusion2. Decreased tissue perfusion
3. Decreased nutritional status3. Decreased nutritional status 4. Friction and shearing forces4. Friction and shearing forces
5. Increased moisture and edema5. Increased moisture and edema
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Pressure ulcer stagesPressure ulcer stages
Stage 1Stage 1-- nonnon--blanchable Erythemablanchable Erythema
Stage 2Stage 2-- skin breakdown in dermisskin breakdown in dermis
Stage 3Stage 3-- ulceration extends to theulceration extends to the
subcutaneous tissuesubcutaneous tissue
Stage 4Stage 4-- ulcers involve the muscle and boneulcers involve the muscle and bone
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Nursing InterventionsNursing Interventions
RELIEVE THE PRESSURERELIEVE THE PRESSURE
Turn and reposition every 1Turn and reposition every 1--2 Hours2 Hours
Encourage weight shifting actively,Encourage weight shifting actively,
every 15 minutesevery 15 minutes
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Nursing InterventionsNursing Interventions
POSITION PATIENT PROPERLYPOSITION PATIENT PROPERLY
Follow the recommended sequenceFollow the recommended sequence
LateralLateral proneprone supinesupine laterallateral
Position patient with the bed elevatedPosition patient with the bed elevated
at NO MORE THAN 30 degreesat NO MORE THAN 30 degrees Utilize the bridging techniqueUtilize the bridging technique
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Nursing InterventionsNursing Interventions
UTILIZE PRESSURE RELIEVINGUTILIZE PRESSURE RELIEVING
DEVICESDEVICES
Use floatation padsUse floatation pads Use air, water or foam mattressesUse air, water or foam mattresses
Oscillating and kinetic bedOscillating and kinetic bed
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Nursing InterventionsNursing Interventions
IMPROVE MOBILITYIMPROVE MOBILITY
Active and passive exercisesActive and passive exercises
Assistive exerciseAssistive exercise
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Nursing InterventionsNursing Interventions
IMPROVE TISSUE PERFUSIONIMPROVE TISSUE PERFUSION
Exercise and repositioning are theExercise and repositioning are the
most important activitiesmost important activities
AVOID MASSAGE ON THE REDDENEDAVOID MASSAGE ON THE REDDENED
AREASAREAS
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Nursing InterventionsNursing Interventions
IMPROVE NUTRITIONAL STATUSIMPROVE NUTRITIONAL STATUS
HIGH proteinHIGH protein
HIGH vitamin C dietHIGH vitamin C diet Measure body weightMeasure body weight
Assess hemoglobin and albuminAssess hemoglobin and albumin
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Nursing InterventionsNursing Interventions
REDUCE FRICTION AND SHEARREDUCE FRICTION AND SHEAR
Lift and not drag patientLift and not drag patient
Prevent the presence of wrinkles andPrevent the presence of wrinkles andcreases on bed sheetscreases on bed sheets
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Nursing InterventionsNursing Interventions
PROMOTE WOUND HEALINGPROMOTE WOUND HEALING
Vitamin CVitamin C
Dictum: Remove the pressureDictum: Remove the pressure
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Nursing InterventionsNursing Interventions
PROMOTE WOUND HEALINGPROMOTE WOUND HEALING
Stage 1Stage 1
Remove pressureRemove pressure
Reposition Q 2Reposition Q 2
Never massage the areaNever massage the area
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Nursing InterventionsNursing Interventions
PROMOTE WOUND HEALINGPROMOTE WOUND HEALING
Stage 2Stage 2
Clean with sterile SALINE onlyClean with sterile SALINE only
Antiseptic solutions may damageAntiseptic solutions may damagehealthy regenerating tissue and delayhealthy regenerating tissue and delay
healinghealing Wet saline dressings are helpfulWet saline dressings are helpful
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Nursing InterventionsNursing Interventions
PROMOTE WOUND HEALINGPROMOTE WOUND HEALING
Stage 3 and 4Stage 3 and 4
Necrotic tissues are debridedNecrotic tissues are debrided
Administer analgesics before cleansingAdminister analgesics before cleansing
Do a mechanical flushing with salineDo a mechanical flushing with saline
solutionsolution Topical ointments may be applied UNTILTopical ointments may be applied UNTIL
granulation tissue appears then only salinegranulation tissue appears then only salineirrigation is recommendedirrigation is recommended
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PositioningPositioning
Any position,Any position, correct or incorrect,correct or incorrect, can becan be
harmful if maintained for a prolongedharmful if maintained for a prolonged
periodperiod
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PositioningPositioning
Frequent position changes helps toFrequent position changes helps to
prevent :prevent :
Muscle discomfortMuscle discomfortUnnecessary pressureUnnecessary pressure
Skin damageSkin damage
ContractureContractureBlood poolingBlood pooling
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PositioningPositioning
When the client is NOT able to moveWhen the client is NOT able to move
INDEPENDENTLY, the preferred methodINDEPENDENTLY, the preferred method
is to have two or more people move theis to have two or more people move the
patientpatient
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Requisites of proper positioningRequisites of proper positioning
Use of support devicesUse of support devices-- mattress, pillows,mattress, pillows,
bed boards, foot boardbed boards, foot board
Dry, clean and unwrinkled sheetsDry, clean and unwrinkled sheets
2424-- hour schedule should be postedhour schedule should be posted
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Fowlers PositionFowlers Position
The Sitting positionThe Sitting position
The position of choice for people whoThe position of choice for people who
have difficulty breathing and for somehave difficulty breathing and for some
people with hear problemspeople with hear problems
This allows greater chest expansion andThis allows greater chest expansion and
lung ventilationlung ventilation
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Fowlers PositionFowlers Position
The Sitting positionThe Sitting position
Low FowlersLow Fowlers
SemiSemi--fowlersfowlers Fowler'sFowler's
High FowlersHigh Fowlers
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Orthopneic positionOrthopneic position
The client sits in chair or bed, with anThe client sits in chair or bed, with an
overbed tableoverbed table
Allows maximum chest expansionAllows maximum chest expansion
Client can press the lower chest againstClient can press the lower chest against
the bed further facilitating ventilationthe bed further facilitating ventilation
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Dorsal RecumbentDorsal Recumbent
BackBack--lying position, with head andlying position, with head and
shoulders SLIGHTLY elevatedshoulders SLIGHTLY elevated
Provides comfortProvides comfort
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ProneProne
The client lies on the abdomen with theThe client lies on the abdomen with the
head usually turned to one sidehead usually turned to one side
Allows full extension of the hips to preventAllows full extension of the hips to prevent
flexion contracturesflexion contractures
Promotes drainage from the mouthPromotes drainage from the mouth
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LateralLateral
SideSide--lying positionlying position
Good for resting and sleeping because itGood for resting and sleeping because it
promotes back alignmentpromotes back alignment
Also prevents aspirationAlso prevents aspiration
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SimsSims
SemiSemi--prone positionprone position
Used for unconscious clients as it helpsUsed for unconscious clients as it helps
facilitated drainage of secretionsfacilitated drainage of secretions
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