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Fundamental Nursing Skills and Concepts

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Change the inactive client's position every 2 hours. Enlist help from others ... Sims' position-(E)- (aka semiprone position) - left side lying with the knee ... – PowerPoint PPT presentation

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Title: Fundamental Nursing Skills and Concepts


1
Fundamental Nursing Skills and Concepts
  • Chapter 23
  • Page 479

2
Chapter 23
  • Body mechanics, Positioning, and Moving

3
IMMOBILITY
  • Leads to health deterioration
  • The consequences of inactivity are collectively
    referred to as disuse syndrome.
  • Disuse syndrome-signs and symptoms that result
    form inactivity
  • Nursing care activities such as positioning and
    moving clients reduce the potential for disuse
    syndrome

4
Muscle spasms
  • Sudden, forceful, involuntary muscle contraction,
    occurs
  • when muscles are strained or forced to work past
    their
  • capacity.

5
POSTURE
  • Position of the body or the way in which it is
    held
  • Affects
  • Appearance
  • Stamina
  • Ability to use the musculoskeletal system
  • Good posture distributes gravity through the
    center of the body over a wide base of support.

6
STANDING
  • Keep the feet parallel, at right angles to the
    lower legs, and about 4-8 inches apart
  • Distribute weight equally on both feet to provide
    a broad base of support
  • Bend the knees slightly to avoid straining the
    joints
  • Maintain the hips at an even level

7
STANDING
  • Pull in the buttocks and hold the abdomen up and
    in to keep the spine properly aligned, also this
    position supports the abdominal organs, reduces
    strain
  • Hold the chest up and slightly forward and extend
    or stretch the waist to give internal organs more
    space and maintain spinal alignment
  • Keep the shoulders even and centered above the
    hips
  • Hold the head erect with the face forward and
    chin tucked
  • Center of gravity for a standing person is the
    center of the pelvis and about ½ way between the
    umbilicus and the pubic bone

8
SITTING
  • Buttocks and upper thighs become the base of
    support
  • Both feet rest on the floor
  • The knees are bent with the posterior of the knee
    free from the edge of the chair to avoid
    interfering with distal circulation

9
LYING DOWN
  • Head and neck muscles are in a neutral position,
    centered between the shoulders
  • Hips, arms, and knees are slightly flexed
  • Trunk is straight and the hips are level
  • Legs are parallel to each other
  • Feet are at right angles to the leg
  • Looks the same as in standing position but
    horizontal

10
BODY MECHANICS
  • Efficient use of the musculoskeletal system or
    the use of proper body mechanics
  • Reduces fatigue
  • Increases muscle effectiveness
  • Avoids repetitive strain injuries

11
Nursing guidelines
  • Page 482

12
ERGONOMICS
  • Specialty field of engineering science devoted to
    promoting comfort, performance, and health in the
    workplace.
  • Use assistive devices to lift or transport heavy
    items or clients
  • Use alternative equipment for tasks that require
    repetitive motions
  • Position equipment no more than 20-30 inches away
  • Use a chair with good back support
  • Keep elbows flexed no more than 100-110 degrees
  • Work under nonglare lighting

13
POSITIONING CLIENTS
  • Change the inactive clients position every 2
    hours
  • Enlist help from others
  • Raise the bed to an appropriate height
  • Remove pillows and positioning devices

14
POSITIONING CLIENTS
  • Unfasten drainage tubes from bed linen so patient
    is able to move
  • Turn the client as a complete unit to avoid
    twisting the spine
  • Place the client good alignment, with joints
    slightly flexed
  • Replace pillows and positioning devices

15
POSITIONING CLIENTS
  • Support limbs in a functional position, which is
    a body part placed in a position to perform an
    activity. Page 485, fig. 23.10
  • Use elevation to relieve swelling or promote
    comfort
  • Provide skin care after repositioning

16
COMMON POSITIONS page 483
  • Supine position- (A)- back lying, careful for
    skin breakdown and foot drop. Gravity forces feet
    in a downward dysfunctional position. Example pg.
    484 fig. 23.7 Page 486 shows protective
    boots in fig. 23.11.
  • Lateral position- (B)-side lying position
  • Lateral oblique position-(C)- side lying with top
    leg placed in 30 of hip flexion and 35 of knee
    flexion. (less pressure on the hip and reduction
    in potential for skin breakdown.

17
COMMON POSITIONS page 483
  • Prone position- (D) -abdominal lying, provides
    good drainage from bronchioles. Improves arterial
    oxygenation.
  • Sims position-(E)- (aka semiprone position) -
    left side lying with the knee drawn up toward the
    chest. Left arm along patients back, chest and
    abdomen are allowed to lean forward.
  • Fowlers position- (F) semi-sitting position-

18
COMMON POSITIONS page 483
  • Low Fowlers position - 30
  • Mid-Fowlers or semi-Fowlers position, elevation
    up to 45
  • High Fowlers position 60 to 90 - also the
    position of choice for those with dyspnea.
    Abdominal organs fall away from diaphragm and
    allow for more fully filling the lungs with each
    inspiration.

19
POSITIONING DEVICES
  • Adjustable Bed- HOB up allows for drainage, let
    gravity help with drainage. Allows some
    independence for the pt.
  • Mattress-supportive, but flexible allows for good
    body alignment.
  • Bed Board-placed beneath mattress to provide
    skelatal support. It is rigid.
  • Pillows-provide support, comfort and used to
    elevate a body part.

20
POSITIONING DEVICES
  • Turning Sheet-lifter- placed upper back to mid
    thighs- used to prevent friction. The sheet is
    rolled close to the patients body and as a team,
    lift or roll the patient to new position.
    Wrinkle free and dry, please. Used for moving,
    lifting and turning patient.
  • Trochanter Rolls- these prevent the legs from
    rolling or turning outward. Page 485 fig. 23.9

21
POSITIONING DEVICES
  • Hand Rolls- preserve the ability to grasp and
    pick up objects. Keeps hands in functional
    position. Handrolls help prevent contractures
    which is permanent stiffness of a joint.

22
POSITIONING DEVICES
  • Foot Boards, Boots, and Foot Splints-keep feet in
    a normal walking position or a functional
    position that allows for walking. Prevents foot
    drop, keeps from an outward rotation of the foot
    and lower leg. Page 484, fig. 23-7. protective
    boots fig. 23.11, pg. 486, avoids foot drop.
    Ankle high tennis shoes accomplishes the same
    thing, less expensive. Several pillows could help
    the foot drop possibility also. By stacking the
    pillows against the footboard, the clients feet
    push against this stack of pillows disallowing
    foot drop to happen.

23
POSITIONING DEVICES
  • Trapeze- allows the patient to assist with
    turning, moving. But be aware, when pts. hand
    slips off, the trapeze bar can become a
    projectile into the face or head of the nurse or
    caregiver. Fig. 23.12 pg. 486. helps with patient
    moving self. What else will the trapeze help
    with?
  • Not in your book. Sand bags- pliable but provide
    firm support. Cover with absorbent material,
    because moisture collects next to the skin.

24
PROTECTIVE BED DEVICES
  • Side rails- pt. can use these to help position,
    hold, for bathing or procedures.
  • Mattress Overlays-are used to reduce pressure.
    Could be filled with foam, gel, air, water.
  • Foam and Gel Mattresses

25
PROTECTIVE BED DEVICES
  • Static Air Mattress-suspends the client on a
    buoyant surface, distributing the pressure on the
    underlying tissue.
  • Alternating Air Mattress- made up of channels for
    inflating and deflating at intervals to give a
    cycle change of perfusion to tissues. Do not kink
    tubing, will not be effective. Noise may be a
    concern. Page 487, fig. 23.14
  • Water Mattress-supports the body and equalizes
    the pressure per square inch over its surface.
  • Cradle- a shell to keep linens off an area of the
    patient. Either due to the weight of covers, a
    burn, pain or fractures. Pg. 490, fig. 23.19

26
SPECIALITY BEDS
  • Low-Air-Loss Bed-Inflated air sacs within the
    mattress to maintain capillary pressure well
    below that which can interfere with blood flow
  • Air-Fluidized Bed-Contains a tiny collection of
    beads which are blown upward. Excretions and
    secretions drain away from the body through the
    beads to prevent skin irritation and maceration
    from moisture.
  • Oscillating Support Bed-Slowly and continuously
    rocks the client from side to side in a
    124-degree arc. Foam-covered supports applied to
    the head, arms, and legs prevents sliding and
    skin shearing.

27
SPECIALITY BEDS
  • Circular Bed-Supports the client on a 6 or 7 foot
    anterior or posterior platform suspended across
    the diameter of the frame. This bed allows the
    client to remain passively immobilized during
    position change in a 180 arc. Totally dependent
    patient. Page 489, fig. 23.18.

28
Dangers
  • Shearing- force exerted against the surface and
    layers of the skin as tissues slide in opposite
    but parallel directions. Pg. 488b
  • Of inactivity- health deteriorates, multiple
    complications known as disuse syndrome. Table
    23.1 page 480

29
TRANSFERRING CLIENTS
  • Moving a client from place to place
  • Moving a client from bed to chair or back to bed
  • Active transfer when the client assists
  • Passive transfer when the client is transferred
    by others or by mechanical means. Nursing
    guidelines page 491.

30
TRANSFER DEVICES
  • Transfer handle-Pg. 490, fig.23.19. keeps pt.
    active.
  • Transfer belt- provide a means of gripping and
    supporting the client. It is padded and is a
    device secured around the clients waist.
  • Transfer board-serves as a supportive bridge
    between two surfaces. About 30 long and 8 wide.
  • Mechanical lift-helps to decrease injuries.
    Lifting capacity 350-600 lbs. Clients are placed
    in a canvas sling secured, lifted and moved as
    needed. When stationary wheels are locked and pt.
    is lowered into destination.

31
NURSING IMPLICATIONS NURSING DIAGNOSES
  • Impaired physical mobility
  • Risk for Injury
  • Risk for Disuse Syndrome
  • Risk for Perioperative-Positioning Injury
  • Impaired Transfer Ability
  • Impaired Bed Mobility
  • Risk for Impaired Skin Integrity

32
GERONTOLOGICAL CONSIDERATIONS
  • Decline in muscle strength, endurance, and
    coordination
  • Need to maintain mobility to prevent disability
  • Require extra time and assistance during
    positioning, transferring, and ambulating
  • May have a fear of falling
  • Bone demineralization increases the risk of
    fractures for older adults
  • Falls, fractures, and degenerative bone diseases
    have serious economic effects

33
GERONTOLOGICAL CONSIDERATIONS
  • Older adults with cognitive impairment generally
    have difficulty following directions regarding
    positioning and transferring
  • Disuse syndrome is a serious threat to older aduts

34
Promoting activity and mobility
  • Page 493
  • Balance periods of activity with rest periods
  • Teach dangers of inactivity
  • Allow adequate time for performing activities
  • Get involved with social activities, clubs,
    church, neighborhood gatherings, koffee klatches.

35
Promoting activity and mobility
  • Develop hobbies or recreational interests
  • Volunteer
  • Un-clutter home
  • Rent or purchase hospital equipment
  • Cancer patients- investigate loan of equipment
  • Investigate community services that encourage
    independent living

36
SKILLS
  • 23-1 turning and moving a client
  • 23-2 transferring clients
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