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1. BODY MECHANICS AND MOVING 4/18/2023 1 Fuad Ahmed ( Msc ) BY Fuad A.

2. Objective By the end of this class the students will be able to Identify the five regions of the vertebral column List the purposes of body alignment Check proper standing,sitting and laying body alignment Properly Lift and position a patient 4/18/2023 2 BY Fuad A.

3. Vertebrae are the 33 individual bones that interlock with each other to form the spinal column . The vertebral column divided into five regions: Cervical spine : 7 vertebrae of the neck (C1-C7) Thoracic spine : 12 vertebrae of the mid-back (T1-T12) Lumbar spine : 5 vertebrae of the lower back (L1-L5) Sacrum (5 fused vertebrae )(S1-S5) Coccyx (4 fused vertebrae ) Only the top 24 bones are moveable; the vertebrae of the sacrum and coccyx are fused.   4/18/2023 3 Anatomy of Vertebral Column BY Fuad A.

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5. 1.Maintaining body alignment Definition Body alignment (posture) refers to the relative position of body parts in relation to each other when lying down, standing, sitting, or any other activity. is an individual’s ability to maintain equilibrium/balance . 4/18/2023 5 BY Fuad A.

6. Purpose of Body Alignment To promote client comfort To prevent contractures (abnormal/ permanent contraction/shortening of muscles/joints) To promote circulation To lessen stress on muscle, tendons, nerves, and joints To Prevent foot drop ( gait abnormality in which the dropping of the forefoot happens due to weakness, damage to nerves or paralysis of muscles in the anterior portion of the lower leg ) Gives an appearance of confidence and health 4/18/2023 6 BY Fuad A.

7. 1.1 Checking normal alignment of spine Definition Proper/normal alignment of the spine in standing patients refers to cervical concavity , a thoracic convexity , and a lumbar concavity . Purpose To check the normal posture of spine 4/18/2023 7 BY Fuad A.

8. Equipment Pen Documentation/Charting format Procedure 1. Greet the patient and explain the purpose 2. Instruct the patient to get stand 3.Observe the lateral view for cervical concavity, thoracic convexity and lumber concavity 4. Observe the posterior view (scapula, iliac crest and gluteal fold) 5. Document the findings 4/18/2023 8 BY Fuad A.

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10. 4/18/2023 10 Figure 4 . ----- proper Spinal posture BY Fuad A.

11. 1.2.Checking proper standing body alignment Defn: Proper standing alignment characterized by H ead upright, Face forward, Shoulders square, Back straight, Abdominal muscles tucked/fold/ in, Arms straight at side, Palm forward, Legs straight and Feet forward with the center of gravity in the middle of the pelvis. 4/18/2023 11 BY Fuad A.

12. 4/18/2023 12 Figure 2.----- Proper Alignment and Posture: Standing Male and Female BY Fuad A.

13. 1.3 Checking proper sitting posture Definition Proper/normal alignment on sitting posture has similar characteristics with standing posture except the hips and knees are flexed. Purpose To check the normal posture on sitting posture 4/18/2023 13 BY Fuad A.

14. 4/18/2023 14 Figure 3 - Proper sitting posture and center of gravity BY Fuad A.

15. 1.4.Checking proper alignment of client in lying posture Definition Proper/normal alignment on lying posture has similar characteristics with standing posture except that The patient is in supine/back lying position Arms at the side with palms facing downward , Neck straight , Leg extended and, Toes facing upward on the respective thighs. 4/18/2023 15 BY Fuad A.

16. 4/18/2023 16 Figure 4. -----. Proper lying posture with center of gravity BY Fuad A.

17. 2.Application of principles body mechanics Definition Body mechanics is the coordinated use of the body parts to produce motion and to maintain balance. Purpose Promotes the efficient use of muscles and conserves energy 4/18/2023 17 BY Fuad A.

18. In other way, it is the means of applying mechanical principles of movement to human body. Principles of body mechanics involve three major factors: 1 . Center of gravity 2 . Base of support 3 . Line of gravity 4/18/2023 18 BY Fuad A.

19. 4/18/2023 19 1 .Center of gravity A well aligned standing adult person’s center of gravity is located in the pelvic area i.e. half of the body weight is distributed above this area and half below it. BY Fuad A.

20. Principles of Body Mechanics cont’d When lifting an object, bend at the knees and hips, and keep the back straight, by doing so, the center of gravity remains over the feet, giving extra stability. 4/18/2023 20 BY Fuad A.

21. 2.Base of support Is the foundation on which an object rests. A person’s feet provide the base of support. i.e. T he wider the base of support, the more stable the object with in limits. The feet are spread sidewise when lifting, to give side to side stability. 21 4/18/2023 BY Fuad A.

22. Figure 5: Maintaining balance (A) The distance between this person’s feet ( base of support )is small, and the heaviest part of his body ( center of gravity) is far away from the base of support, making him more likely to lose balance (B) BY increasing the distance between his feet and lowering his body toward the ground , the person has increased ability to maintain side to side balance . His right foot is slightly in front of the left, for back-to-front stability . 4/18/2023 22 BY Fuad A.

23. 3.Line of gravity Is an imaginary vertical line drawn through an object’s center of gravity . Is the point at which all of the mass of an object is centered . If a person stands with the back straight and the head erect , the line of gravity will be approximately through the center of the body and proper body mechanics will in place. 23 4/18/2023 BY Fuad A.

24. Figure 6: when the body is held in proper alignment, the back is in neutral position, with the curve of lower spine intact 4/18/2023 24 BY Fuad A.

25. Rules for proper body mechanics Use stronger, larger muscles to perform tasks which require physical effort . When moving heavy objects, try to push or pull instead of lifting the items . Get help if object feels too heavy to lift in a smooth motion to prevent injury Maintain a good posture Avoid twisting the body When lifting Bend knees , keep back straight , spread feet about one foot apart , and use leg muscles . 25 4/18/2023 BY Fuad A.

26. Figure 7: L ifting techniques using good body mechanics. Use long, strong muscles of arms and legs, hold the object so the line of gravity falls within the base of support. Keep the back straight and the load close to the body. Ask for assistance if necessary 4/18/2023 26 BY Fuad A.

27. 2.1. Lifting the patient 2.1 . 1.Dangling Defn : Dangling is sitting on the side of the bed with the feet hanging down supported on a foots tool or on the floor. Purpose To prepare patient before walking ,moving to chair or wheelchair or performing others Indication Moving patient out of bed 4/18/2023 27 BY Fuad A.

28. Contraindication Unconscious patient Spinal injury Precaution Do not leave the patient alone when dangling If the patient becomes dizzy, lie him down. Have the patient cough, deep breath, and exercise their leg muscles when dangling. Check the person’s pulse and respirations. 4/18/2023 28 BY Fuad A.

29. 2.1.2 Log rolling Defn: Logrolling is a technique used to turn a patient whose body must be kept all times in a straight alignment . Purpose To turn a patient to the side of bed Indication Patient who has had spinal surgery, S uspected / Documented spinal injury. Note: logrolling is accomplished by two or three nurses working in a coordinated fashion. 4/18/2023 29 BY Fuad A.

30. Cont… 4/18/2023 30 Figure 8 … Log rolling BY Fuad A.

31. 2.1.3. Moving patient up in bed with two nurses using draw sheet Definition Moving patients up in bed refers to returning the patient to previous correct position in bed if he/she slides to the foot side of the bed. Purpose To make patients in comfortable position in bed. To maintain good body alignment. Indication Patient who slides to the foot of the bed 4/18/2023 31 BY Fuad A.

32. Conditions which affect moving , lifting, or transferring clients Obesity Fragility Amputation Paralysis Extra equipment needs Altered level of consciousness Language barriers Hearing or vision loss 4/18/2023 32 BY Fuad A.

33. 3. Positioning the patient Positioning Is turning or putting the patients in a proper body alignment for the purpose of preventive, promotive ,curative and rehabilitative aspects of health. 4/18/2023 33 BY Fuad A.

34. Purpose of positioning To relief pressure or lessen possible stress To prevent formation of deformity To improve circulation T o Preserve muscle function To provide comfort, support, and good body alignment Prevent decubiti (pressure sores) To make the patient ready for different procedures 4/18/2023 34 BY Fuad A.

35. Type of positioning Common positioning methods of patients includes: Front lying (prone) S emi-prone position (or Sims’ position) Dorsal Supine (back lying) Dorsal recumbent position Lateral recumbent (on either side) Knee chest position Fowler's position (semi-upright with back and knee rests elevated) Trendelenburg position Lithotomy position 4/18/2023 35 BY Fuad A.

36. 5.3.1. Front lying (prone) Definition Prone position is a position in which the patient lie flat on the abdomen, face down, legs extended, feet over the edge of the mattress, and toes pointing to the floor. Chest / ventral side i s down and the back / dorsal side becomes placed up ward. Purpose To Promote drainage from mouth. To prevent contractures (abnormal contraction or deformity of muscles) of hips and knee. To examine the spine and the back. 4/18/2023 36 BY Fuad A.

37. Cont.… prone Indication Patient with excessive secretion from mouth. Patient with potential risk of knee and hip contracture. Contraindication Respiratory impairment/breathing difficulties Foot drop Pregnant women Clients with abdominal incisions 4/18/2023 37 BY Fuad A.

38. Equipment 1. Small pillow (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Documentation format 5. Receiver for drainage( if any) 4/18/2023 38 BY Fuad A.

39. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing. 3. Collect all necessary equipment's. 4. Provide privacy. 5. Elevate bed to highest position. 6. Place, turn or draw sheet under client’s back and head 7. Assist the client to lie on a bed. 8.Place a small pillow under client’s head; turn head to side. 9. Extend the client’s arms near side or flexed toward head. 10. Place a small pillow under chest for female clients and for clients with barrel chest . 11.Place a small pillow under ankles or mattress. 12.Assess client for comfort. 13.Lower the bed and elevate the side rails. 4/18/2023 39 BY Fuad A.

40. 4/18/2023 40 Figure 9. ----- Proper prone position BY Fuad A.

41. 4/18/2023 41 BY Fuad A.

42. 5.3.2. Semi-prone position (or Sims’ position) Definition Semi-prone position is putting or assisting patients with upper arm flexed at shoulder and elbow; lower arm positioned behind client and both legs flexed in front of client with more flexion in upper leg either of body side. 4/18/2023 42 BY Fuad A.

43. Cont…semi prone Purpose To promotes drainage from mouth. To prevents aspiration. Comfortable for sleeping. Promotes comfort especially in pregnant clients. Indication For rectal examination. Pressure sore on the buttocks/sacrum and hips. Contraindication Lumbar lordosis Foot drop Client with leg injuries or arthritis 4/18/2023 43 BY Fuad A.

44. Equipment 1. Small pillow (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Sand bag 5. Documentation format 6. Receiver for drainage( if any) 4/18/2023 44 BY Fuad A.

45. Cont…semi prone position Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipments 4. Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client’s back and head 7. Flexed at shoulder and elbow 8. Position lower arm behind and away from the back 9. Put pillow between chest and upper arm; 10. Flex both legs in front with more flexion in upper leg. 11. Put pillow between legs 12. Support ankle with sand bag (if necessary ) 13. Lower the bed and elevate the side rails 14. Wash your hand 15. Note the patient reaction 16. Document the procedure 4/18/2023 45 BY Fuad A.

46. 4/18/2023 46 Figure 9.--- Proper Semi prone position BY Fuad A.

47. 4/18/2023 47 BY Fuad A.

48. 5.3.3 Supine (back lying) Is putting patient in back lying with a small pillow to support the head and shoulder . U sed for most abdominal operation . The most common position & the most natural position of the body at rest . Purpose Promote comfort To help healing after certain abdominal operations Indication After abdominal, chest and neck surgery For physical examination of anterior part of the body 4/18/2023 48 BY Fuad A.

49. Cont…supine Contraindication Spinal injury Cardiac patient (CHF) Breathing impairments Pressure sore (buttock, sacrum, heal and shoulder ) Equipments 1. Pillow of different size (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Wrist splint 5. Air rings 6. Cotton rings 7. Footboard or high-top tennis shoes 8. Documentation format 4/18/2023 49 BY Fuad A.

50. 4/18/2023 50 Figure 10 …. Proper supine position BY Fuad A.

51. 4/18/2023 51 BY Fuad A.

52. 5.3.4. Dorsal recumbent position Definition: Dorsal recumbent position is putting patient in back lying position with knees are flexed and the soles of the feet flat on the bed. Purpose Promote comfort For visualizing the perineum To insert urinary catheter To relief pressure from ileum, knee and ankle 4/18/2023 52 BY Fuad A.

53. Indication Rectal , vulval and vaginal examination Pelvic surgical procedures Vaginal douche /irrigate/ Perineal care Catheterization Supra-pubic puncture Contraindication Spinal injury Cardiac patient (CHF) Breathing impairments Pressure sore (buttock, sacrum, heal and shoulder ) 4/18/2023 53 BY Fuad A.

54. Equipments 1. Pillow of different size (3) 2. Bed with side rails 3. Draw sheet or turn sheet 4. Bath Blanket or sheet 5. Air rings 6. Cotton ring 7. Bed block ( if necessary) 8. Documentation format 4/18/2023 54 BY Fuad A.

55. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipments 4. Provide privacy 5. Elevate bed to highest position. 6. Place turn or draw sheet under client’s back and head 7. Place bed in a flat position. 8. Cover the client with a sheet or a bath blanket folded once across the chest. 9. Place the patient’s head in a straight line with his or her back, shoulders, hips and knees 4/18/2023 55 BY Fuad A.

56. Cont… 10. Place small pillows under head and shoulder or elevate the top of the bed with block. 11. Place air ring under the hips/buttock 12. Flex the leg and wide apart 13. Place cotton ring under the heels 14. Lower the bed and elevate the side rails 15.Wash your hand 16. Note the patient reaction 17. Document the procedure 4/18/2023 56 BY Fuad A.

57. 4/18/2023 57 Figure 11 ….. Proper dorsal recumbent position BY Fuad A.

58. 5.3.5. Lateral recumbent (on either side) I s putting patient on either side with legs flexed at knee ( the upper leg is more flexed than the lower leg) Purpose To perform back care To relieves pressure on sacrum and heels To perform enema To take rectal body temperature To insert suppositories 4/18/2023 58 BY Fuad A.

59. Indication Enema and colonic irrigation Pressure sore on heel and sacrum Rectal examination To measure rectal temperature Contraindication Arm and rib fracture Spinal injury Flank injury Equipments Pillow of different size (4) Bed with side rails Draw sheet or turn sheet Documentation format 4/18/2023 59 BY Fuad A.

60. Procedure 1. Great the patient ( if conscious ) and explain the procedure 2. Perform hand washing 3. Collect all necessary equipments 4. Provide privacy 5. Place turn or draw sheet under client’s back and head 6. Elevate bed to highest position 7. Logroll client to side 8. Place a small pillow under client’s head. 9. Place pillow behind client’s back. 10. Put a pillow tucked by the client’s abdomen. 11. Place a pillow between client’s legs. 12. Run your hand under the client’s dependent shoulder and move the shoulder slightly forward 13. Lower the bed and elevate the side rails 14. Wash your hand 15. Note the patient reaction 4/18/2023 60 BY Fuad A.

61. 4/18/2023 61 Figure 11 ….. Proper Lateral Recumbent position BY Fuad A.

62. 4/18/2023 62 BY Fuad A.

63. 3.6. Knee chest Is putting a patient on the Knee and the chest with the head turned one side, arms above the head and one cheek on a pillow. Purpose 1. Used for vaginal and rectal examination 2. Used in first aid Rx in cord prolapse or retroverted uterus 3. Assumed for postpartum and gynecologic exercises 4/18/2023 63 BY Fuad A.

64. Indication Sigmoidoscopic examination Vaginal and rectal examination Cord Prolapse Retoverted uterus Contraindication Cardio-pulmonary problem Upper arm, spine and ribs fracture Increased intra-cranial pressure (IICP) Equipments 1. Pillow (1) 2. Drape/ Bath Blanket or sheet 3. Screen 4. Documentation format 4/18/2023 64 BY Fuad A.

65. 4/18/2023 65 Figure 12 …..Proper knee chest position BY Fuad A.

66. 3.7. Fowler's position (semi-upright with back and knee rests elevated) Fowler's position is sitting position in which the head is elevated at different angle (15-90) angle and may have knees either bent or straight . 4/18/2023 66 BY Fuad A.

67. Type 1. High Fowler's position is when the patient's head is raised 80-90 degrees, 2. Fowler's which is 45-60 degrees 3. Semi-Fowler's position is when the patient's head is elevated 30-45 degrees. 4. Low Fowler's position is when the head of bed is elevated 15-30 degrees 4/18/2023 67 BY Fuad A.

68. Purpose To relive dyspnea To improve circulation To prevent thrombosis To prevent aspiration during the introduction of feeding tubes To facilitate drainage from abdomen and pelvic cavity post operatively To relax the muscle of the abdomen, back and thighs To relive tension on abdominal suture To promote comfort Increase comfort during eating To relieve edema of the chest and abdomen. 4/18/2023 68 BY Fuad A.

69. Cont’d…fowler position Indication Cardio-pulmonary problem (Respiratory distress, CHF, pulmonary edema..) Increased intra abdominal pressure Thrombosis Abdominal, back and thigh muscle strain Nasal or oral passageway procedures (e.g. NGT…) 4/18/2023 69 BY Fuad A.

70. Cont… Contraindication Comatose/unconscious patients Spinal injury Foot drop Head injury Shoulder dislocation Equipment 1. Small pillow (3) 2. Foot rest/foot board 3. Back support 4. Hand wrist support 5. Screen if necessary 4/18/2023 70 BY Fuad A.

71. Procedure Greet the patient ( if conscious ) and explain the procedure Perform hand washing Collect all necessary equipments Provide privacy Place the patient in sitting position with arms at sides knees raised with pillow Place bed in a 15° to 30° angle for low-Fowler’s position, 45° to 60° angle for Fowler’s position, or 80° to 90° angle for high-Fowler’s position. Turn patients head to one side and align the patient in good position Place a small pillow under client’s head. Support the backs and arms with pillows. Place a pillow between client’s legs. Lower the bed and elevate the side rails Wash your hand Note the patient reaction Document the procedure 4/18/2023 71 BY Fuad A.

72. 4/18/2023 72 Figure 13 ….. Proper High fowler’s position BY Fuad A.

73. Figure 14 …… Fowler position 4/18/2023 73 BY Fuad A.

74. Figure 15…… S emi fowler position 4/18/2023 74 BY Fuad A.

75. 3.8. Trendelenburg position Def n : is putting the patient in a flat on the back with the feet higher than the head by 15-30 degree . Purpose To increase cerebral perfusion pressure. To help in surgical reduction of hernia. To enhance access to central venous line for surgery on the lower abdomen and the pelvis . 3.9 Reverse Trendelenburg Position The entire table is tilted so the head is higher than the feet. Is used : To provide access to the head & neck & To facilitate gravitational pull on the viscera away from the diaphragm & toward the feet . F or gallbladder or biliary tract operation Thyroid position: the patient is placed supine with one or two sand bags under the shoulder so that the head is hyper extended by lowering the head piece of the bed. 4/18/2023 75 BY Fuad A.

76. cont’d…Trendelenburg Indication Hypotension/shock Abdominal and gynecologic surgery Placing central venous line Surgical reduction of hernia Contraindication Cervical –spine fracture Respiratory impairment/breathing difficulties Brain injury with increased intracranial pressure 4/18/2023 76 BY Fuad A.

77. Cont… Trendelenburg Spinal injury Cardiac patient (CHF) Pressure sore (buttock, sacrum, heal and shoulder ) Equipments Bed block(if necessary) Drape Screen Documentation format 4/18/2023 77 BY Fuad A.

78. Procedure Great the patient ( if conscious ) and explain the procedure Perform hand washing Collect all necessary equipments Provide privacy Place the patient’s head lower than the feet with arms at the side Place bed blocks at the foot end of the bed. Lower the bed and elevate the side rails Wash your hand Note the patient reaction Document the procedure 4/18/2023 78 BY Fuad A.

79. Figure …… Trendelenburg position 4/18/2023 79 BY Fuad A.

80. 5.3.9. Lithotomy position is positioning the client feet above or the same level as hips with perineum positioned at the edge of examination table Purpose To provide good visual and physical access to perineum To perform simple pelvic procedures to major surgeries To conduct delivery 4/18/2023 80 BY Fuad A.

81. Cont’d… lithotomy Indication Pelvic medical examination and surgeries Delivery Contraindication Spinal injury Breathing impairments 4/18/2023 81 BY Fuad A.

82. Cont… Lithotomy position Equipments Pillow (1) Bed with side rails/examination table/delivery couch Draw sheet /drape Screen Documentation format 4/18/2023 82 BY Fuad A.

83. Procedure Great the patient and explain the procedure Perform hand washing Collect all necessary equipments Provide privacy Elevate bed to highest position. Place bed in a flat position. Cover the client with a sheet or a bath blanket Lie the patient flat with pillow under the head Flex the feet above or the same level as hips and support with knee rest over a couch ( if available) Wash your hand Note the patient reaction Document the procedure 4/18/2023 83 BY Fuad A.

84. 4/18/2023 84 Figure Dorsal Lithotomy position BY Fuad A.

85. Thanks 4/18/2023 85 BY Fuad A.