iii exercise and mobility

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III. MOBILITY AND EXERCISERLE 007 Lecture Notes in LABORATORY

MS. SUSAN LOIDA SANTIAGO-SORIANO, RN, MSN

IMPORTANT NOTES:

Changing position regularly (every 2 hours) and systematically, and positioning the client in a

good body alignment are essential aspects of nursing practice

- Maintain muscle tone and stimulate postural reflexes

- It prevents:

- Muscle discomfort- Pressure ulcers- Contractures-

1. EFFECTS OF IMMOBILITYAtrophy: the shrinking in size of some part or organ of the body, usually caused by

injury, disease, or lack of use

Contractures: a permanent tightening or shortening of a body part such as a muscle,

tendon, or the skin, often affecting its shape

Orthostatic/Postural hypotension: associated with or caused by standing in an upright

position

Dependent edema: shifting of fluids onto extremities

Thrombus formation: blood clot; a blood clot that forms in a blood vessel and remains

at the site of formation

Decreased respiratory movement

Pooling of respiratory secretions

Constipation

Decubitus/Pressure ulcers: also called bed sores

2. GUIDELINES in CLIENT POSITIONING1. Make sure the mattress is firm and level yet has enough give to fill in and

support natural body curvature

2. Ensure that bed is clean and dry, linens are wrinkle-free, and extremities canmove freely

3. Place support devices in specified areas according to the clients positionPillows, mattresses, bed boards, chair beds, foot board

4. Avoid placing one body part, particularly one with bony prominences, directlyon top of another body part

5. Plan a systematic 24-hour schedule for position changes


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3. CLIENT POSITIONS FOWLERS POSITIONa semi-sitting position; A bed position in which the head

and trunk are raised 4590

LOW FOWLERS or SEMI-FOWLERS- The head and trunk are raised 1545 HIGH FOWLERS- The head and trunk are raised 90

ORTHOPNEIC- the client sits either in bed or on the side of the bed with an overbed table across the lap

SUPINE - back-lying position; the clients head and shoulders are slightlyelevated on a small pillow

DORSAL RECUMBENT - back-lying position with the knees flexed PRONEthe client lies on the abdomen with the head turned to one side LATERALside-lying position SIMS semi-prone position; the client assumes a posture halfway between the

lateral and prone position

4. POSITIONING, MOVING and TRANSFERRING1. Perform appropriate client assessment

a. clients physical abilitiesb. Ability to understand instructionsc. Degree of comfort or discomfortd. Clients weighte. Availability of equipment, assistive devices and other personnel

2. Assemble equipment and suppliesa. Pillowsb. Trochanter rollc. Pull or turn sheetsd. Transfer or sliding bare. Footboardf. Assistive devices (if necessary)

3. Identify yourself and verify clients identity. Explain the procedure, why is itnecessary and how the patient can cooperate

4. Perform hand hygiene and other appropriate infection control measures5. Provide for client privacy6. Adjust the bed to a comfortable working height. Lower the side rails nearest you

a. Adjust the bed to a flat position or as low as the patient can tolerateb. Raise the bed to a comfortable working heightc. Lock the wheelsd. Raise the side rail on the opposite side and lower the side rail near you

Moving the client up in bed

Ask patient to bend legs (flex knees), feetflat on bed

Nurse maintains a broad stance (feetshoulder-width-apart, one foot in front of


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the other, keep head up and back straight),

flex knees and hips, one arm under the

patientsshoulder, other arm on the thigh

Ask patient to put arms across the chest,head up

Nurse rock back and forth and on signal,pull the patient up in bed while the patient

push up with feet

Moving patient up in bed (2 nurses)

Nurses position themselves on both sides of the bed Place a draw sheet under the patient Ask the client to flex knees and keep the head up Nurses position themselves on the patients midsection, feet shoulder-width

apart facing the head of the bed

Roll the draw sheet toward the patient, grasp securely and on signal pull thepatient up

7. SUPINE POSITIONa. Position the client on his back with his spine and legs straight, arms are at

the side with the hands prone

b. Place the pillow under the head and the shoulders of the clientc. Place the footboard at the right angle to the legs.

8. FOWLERS/SEMI-SITTING POSITIONa. Place the client in a supine position with the head near the top of the bedb. Elevate the head of the bed 45-90 (low fowlers 15-45; high fowlers 90)c. Place a small pillow on the lumbar region of the back if the space is felt on

the lumbar curvature

d. Place a small pillow under the clients head or just rest the head against themattress

e. Place 2 pillows under the legs below the knees to the ankles and position atrochanter roll lateral each femur then support the clients feet with a

footboard

9. LATERAL OR PRONE POSITIONa. Move patient to the side of the bed opposite to where the patient will be

turned

b. Move to the other sidec. Ask patient to put arms across the chest and the farther leg on top of the

other legd. Grasp the draw sheet, position yourself for turning the patient* Feet shoulder-width apart, one foot in front of the other, tighten gluteal and abdominal muscles, flex

knees and hips, use leg muscle for pulling

e. Place one hand on the clients far hip and the other hand on the clients farshoulder then roll the client onto the side facing you.

f. Position the client on side with arms and legs positioned and supported

properly (LATERAL POSITION)


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g. Secure a pillow under the clients upper arm and flex the lower shoulder

forward. Place another pillow between the clients upper legs and thigh

h. Turn the client halfway between lateral and prone position with the lower armbehind the client. Flex the upper leg more accurately than the lower leg.POSITION)

i. Place a pillow under the clients head , under the spaces between the clients chestand abdomen, and between the pelvis and upper thigh

j. Instead of abducting the far arm, keep the clients arm alongside the body to rollover then roll the client completely onto the abdomen and turn the clients head to

one side

(PRONE POSITION)

* Place a small pillow under the head, another in the abdomen in between the iliac crest and

diaphragm

Raise the side rails. Lower the bed and ensure other safety and comfort measures Perform hand hygiene. Clean/dispose equipments/supplies appropriately Document relevant information

- Time and change of position moved from and position moved to- Any sign of pressure areas- Use of supportive devices- Other assessment findings- Response to the client to the procedure

ROM Exercise

Verify physicians order Perform hand hygiene Identify self and verify clients identity Explain the procedure

Perform appropriate client assessment- Any limitation in activity/ROM- Presence of pain

Adjust the bed to a comfortable working position Head

- Chin to chest- Ear to shoulder- Chin to shoulder

Shoulder & Elbow- Raise hand up above the head- Hand to the side- Hand across the body- Right angle-elbow, forearm up

Forearm- Supine to prone

Wrist- Flexhyperextend- Make a fist- Spread fingers out


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iii exercise and mobility

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