Body mechanics:(moving a patient)04:03:2010

0bjectives:Carry out a full assessment of the environment, the patient, and other helpers before moving or changing a patients position. Apply the basic principle of, and guide-lines for body mechanics, that will enable him\her to move and change the position of patients with different degrees of helplessness.Evaluate the patient on an ongoing basic regarding safety, comfort and mobility needs, and report on these aspects

Basic principles of body: Good body alignment not only contribute to the ones outer appearance-it also promotes health and prevent back injuries. A broad base of support ensure stability.A nurse who is fit runs less risk of back injuries than one who is unfit. Warming up exercises can prevent muscle injuries. Keep the back straight and bend the kneesThe nurse must not over-exert herself in an attempt to keep patient erect. The nurse must prepare him\herself physically and psychologically before lifting a heavy object or a patientThe nurse must use her own weight to overcome the weight of the patient or object. Movement should be smooth and rhythmicThe working surface must be at a comfortable level

Procedure for transferring a patient from the bed to a wheelchairActionPush the wheelchair to the side of the bed and lock the brakes.Remove the armrest nearest the bedPush back the footplate Help the patient into a sitting position with his legs dangling over the edge of the bed.Make sure that the patient is not dizzyAsk the patient to move forward and sit on the edge of the bed. He should lean forward from the hips and put the foot of the strongest leg behind the otherAsk the patient to place his arms on your shouldersPlace your hands on both sides of his chest or behind her scapulaeFlex your hips, knees and ankles and stand with one foot in front of the otherContract your abdominal, gluteal, femoral and arm musclesCount to three while you and the patient stand up together. Help the patient to sit deep in the wheelchairReplace the armrest and footplate.

Procedure for helping a patient from a wheelchair to the bed. Action Push the wheelchair to the bed with its front forming a slight angle with the bed.Lock the brakes and push the footplate backRemove the armrest nearest the bedThe taller nurse stands behind the wheelchair with one foot in front of the other. Bend the front kneeAsk the patient to fold his arms across his chest while the nurse places her arms an in his axillae, firmly grasping his armsThe other nurse stands at the side of the wheelchair with the armrest in place, also with one foot in front of the other. Place one arm under the patients thighs and support his lower back your other arm.Both nurse contract their abdominal, gluteal, femoral and arm musclesCount to three and lift the patient simultaneously, while moving to the bedPosition the patient on the bed and position comfortably .

Procedure for one nurse to help a patient onto a bedpanPut the bedpan on the stool at the foot of the bed and remove the cover.The patient may lie on back with two pillows or supine. Pull down his pants and fold down the bedclothes without completely exposing the patientStand at the right side of the bed opposite the patients buttocksBroaden your base of support by placing the left foot in front of the right Ask the patient to flex his knees and pull his legs as close as possible to his trunkPlace your left hand under the patients sacrum with the palm uppermost, while resting the forearm on the bedPlace the bedpan on the bed next to the patient and ask him to dig in his heels and lift his buttocks when you have counted to three.Contract your abdominal, gluteal , femoral and arm muscleCount to three, bend your knees and sink downPush the bedpan into the position with your right hand

Procedure for transferring a patient from a stretcher to a stretcherAction Three persons are needed to transfer an adult patient horizontallyThe tallest person takes the head and shoulders (upper thorax). The shortest one takes the legs and the middle one the trunk ( the heaviest part of the body).The stretcher or trolley must be at the same level as the bed and is placed at the right angle to the bed, head almost at foot of the bed. Check to make sure the brakes of the trolley and bed are onCo-ordinated movements of the helpers are essential.All three of them stand at the side where the trolley has been pushed at right angles to the foot of the bed, facing the patient. Feet nearest the patients feet in front. Fold the patients arms on his chest.

Carrying methods and log rollBy: Mr. GJ Thamae

Objectives:The objectives of the log roll procedure is to maintain correct anatomical alignment in order to prevent the possibility of further, catastrophic neurological injury and the prevention of pressure sores.

Procedure:The log rolling procedure is implemented at various stages of the trauma patients\ the casualty management\interventions include the following:As part of the primary and secondary survey to examine the casualtys backAs part of bed to bed transferTo apply a cervical collar or pressure area careTo facilitate chest physiotherapy

What is required????1staff member to hold the casualtys head 2 staff members to support the chest, abdomen and lower limbs. An additional staff member may be also required when log rolling trauma casualtys who are obese, tall, or have lower limb injuries1 staff member to perform the required procedure ( e.g. assessment of the patients back.

Steps:1Explain the procedure to the patient regardless of conscious state and ask the patient to lie still, and refrain from assisting. Ensure that the collar is well fitting prior to commencement.

Step 2. If applicable, ensure that devices such as indwelling catheters, intercostal catheters, ventilator tubing etc. are repositioned to prevent overextension and possible dislodgement during repositioning.

Step:3If the patient is intubated or has a tracheostomy tube, airway suctioning prior to log rolling is suggested, to prevent coughing which may cause possible anatomical malalignment during the log rolling procedure.

Step:4

The bed must be positioned at a suitable height for the head holder and assistants.

step:5The patient must be supine and anatomically aligned prior to commencement of log rolling procedure.

Step:6The patients proximal arm must be adducted slightly to avoid rolling onto monitoring devices eg. arterial or peripheral intravenous lines. The patients distal arm should be extended in alignment with the thorax and abdomen or bent over the patients chest if appropriate ie. if the arm is uninjured. A pillow should be placed between the patients legs

Step:07Assistant 1, the assistant supporting the patients upper body, places one hand over the patients shoulder to support the posterior chest area, and the other hand around the patients hips.

Step:08Assistant 2, the assistant supporting the patients abdomen and lower limbs, overlaps with assistant 1 to place one hand under the patients back, and the other hand over the patients thighs .

Step:09On direction from the head holder, the patient is turned in anatomical alignment in one smooth action.

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