1 Body Mechanics and SafetyMobility, positioning, transfers, safety devices
2 Body Mechanics The effective use of the body as a machine and as a means of locomotion
3 Concepts of Body MechanicsBody alignment or posture – to avoid strain on joints, muscles, tendons, ligaments Balance – center of gravity is closes to its base of support Coordinated body movement - necessary to avoid musculoskeletal strain and injury Postural reflexes - contractions of skeletal muscles to keep body in upright position against force of gravity Concepts of Body Mechanics
4 Application of body mechanicsDevelop habit of erect posture (back straight, head over shoulders, abd muscles contracted -upward pull, gluteal muscles contracted - downward pull) Use longest, strongest muscles of arms & legs to provide power for strenuous activities Use internal girdle and a long midriff to stabilize and to protect ABD viscera Work closely to objects when moving or lifting them Use body weight as a force when pushing or pulling objects by rocking Application of body mechanics
5 Application of body mechanics(cont)Slide, roll, push, pull objects rather than lift Push rather than pull equipment Use broad base of support Ensure dry, smooth surface when moving objects Flex knees Break up heavier loads into smaller, lighter loads (NIOSH recommendation limit lift load of 51 lbs) Application of body mechanics(cont)
6 Proper and Improper Way to Pick up an Object
7 Variables Leading to Back InjuryUncoordinated lifts Height-weight differential among lifters Lifting when fatigued Lifting after recent recovery from back injury Lack of training in body mechanics Standing for long periods of time Transferring patients Variables Leading to Back Injury
8 Mobility Ability to move to fulfill basic human needs.
9 Factors Influencing MobilityDevelopmental considerations Physical health Mental health Lifestyle Attitude and values Fatigue and stress External factors Factors Influencing Mobility
10 Physical Assessment for MobilityGeneral ease of movement and gait Alignment Joint structure and function Muscle mass, tone, and strength Endurance Physical Assessment for Mobility
11 Protective PositioningFowler’s position – HOB up degrees Supine or dorsal recumbent position – flat on back Side-lying or lateral position Prone position – flat on abdomen Protective Positioning
12 Bed Mobility and Positioning PatientsPillows Mattresses Adjustable beds Bed side rails Trapeze bar Additional equipment Bed Mobility and Positioning Patients
13 Mechanical Aids for WalkingWalker Cane Braces Crutches Mechanical Aids for Walking
14 Crutch Gaits Four-point – weight bearing bilateral legsThree-point – weight bearing one legs only Two-point – weight bearing bilateral – faster than 4 point Swing-to –no lower body weight bearing. crutches move ahead together and body weight is lifted by arms and swung to crutches Swing-through – as with the swing to except the body is swung beyond the crutches Crutch Gaits
15 The Tripod Position—Initial Crutch Stance
16 Safety Promoting safety and preventing injury are dual responsibility of the nurse
17 Factors Affecting SafetyDevelopmental considerations Lifestyle Mobility Sensory perception Knowledge Ability to communicate Physical health state Psychosocial health state Factors Affecting Safety
18 Focus of Safety AssessmentsThe individual The environment Specific risk factors Focus of Safety Assessments
19 Nursing History Assess for history of falls or accidentsNote assistive devices Be alert to history of drug or alcohol abuse Obtain knowledge of family support systems
20 Physical Examination Assess mobility statusAssess ability to communicate Assess level of awareness or orientation Assess sensory perception Identify potential safety hazards Recognize manifestations of domestic violence or neglect
21 Risk Factor AssessmentsFalls Fires Poisoning Suffocation and choking Firearm injuries Risk Factor Assessments
22 Factors That Contribute to FallsAge >65 History of falls Impaired vision or balance Altered gait or posture, impaired mobility Medication regimen Postural hypotension Slowed reaction time Confusion or disorientation Unfamiliar environment
23 RACE R – Rescue anyone in immediate dangerA – Activate the fire code and notify appropriate person C – Confine the fire by closing doors and windows E – Evacuate patients and other people to safe area
24 Decreasing Equipment-Related AccidentsUse only for intended use and be familiar with equipment Handle equipment with care so as not to damage it Use three-prong plugs Do not twist or bend electric cords Be alert to signs that equipment is faulty Be alert to wet surfaces
25 JCAHO Safety Goals Improve patient identificationImprove communication among caregivers Improve safety of high-alert medications Eliminate wrong site, wrong patient, wrong procedure, and wrong surgery Improve safety using infusion pumps Improve effectiveness of clinical alarm systems Reduce risk of healthcare acquired infections JCAHO Safety Goals
26 Abuse and Neglect Abuse:purposely causing physical, mental, or emotional pain or injury to someone. Active neglect: purposely harming a person physically, mentally, or emotionally by failing to provide needed care. Financial abuse: stealing, taking advantage of, or improperly using the money, property, or other assets of another. Abuse and Neglect
27 Types of abuse and neglectA nurse is legally required to report any observed or suspected abuse of residents and assist residents who wish to make a complaint of abuse in every way possible. Staff cannot retaliate in any way against a resident who makes a complaint. Types of abuse and neglect include: Physical abuse, Psychological abuse, Sexual abuse, Financial abuse Active and passive neglect, etc. Types of abuse and neglect
28 Recognize signs and symptoms of abuse and neglectAll care team members are considered mandated reporters and must assess for signs of abuse and report them. Residents are vulnerable and there are many ways for caregivers to help and protect them. Recognize signs and symptoms of abuse and neglect
29 Suspicious Injuries Transparency 1-4
30 The steps to take if abuse is suspected.The patient is immediately removed from the abusive situation (Patient safety is first). The alleged abuser is asked to leave immediately pending a investigation. Report allegations as per facility protocols. An investigation will be performed. If abuse is found to have occurred, the HCW is placed on the abuse registry in addition to other possible penalties. Employers check this registry before hiring HGW. The steps to take if abuse is suspected.
31 Types of Restraints Used for Adults and Children
32 Restraints Determine the need for restraintSecure physician order or validate order that has been ordered within the past 24 hours as per agency policy Perform hand hygiene Identify the patient Follow manufactures directions when applying restraint Use least restrictive type of restraint Pad bony prominences Wrap restraint with softest part next to the skin Maintain restrained extremity in normal anatomic position Restraints
33 Use quick release knot to secure, tie to bed frame not side railAssess patient according to agency policy at least every hour, include placement of restraint, neurovascular assessment and skin integrity on restrained limb, signs & symptoms of sensory deprivation (e.g. increased sleeping, daydreaming, anxiety, panic, and hallucinations) Restraints (cont)
34 Remove restraint according to agency policy, at least every two hoursRemove restraint according to agency policy, at least every two hours. Perform ROM. Evaluate need for continued use of restraint. Reapply only if continued need is evident and order is still valid. Reassure patient at regular intervals. Provide explanation of need for restraint and reorient as needed. Keep call light within reach. Restraints (cont)
35 Physiologic Hazards Associated With RestraintsSuffocation from entrapment Impaired circulation Altered skin integrity — pressure ulcers Diminished muscle and bone mass Fractures Altered nutrition and hydration Aspiration and breathing difficulties Incontinence Changes in mental status Physiologic Hazards Associated With Restraints
36 Skills Applying an Extremity RestraintAssisting a patient with turning in bed. Moving a patient up in bed with the assistance of another nurse Transfering a patient from bed to stretcher Transferring a patient from bed to chair Skills