Body Mechanics

The efficient, coordinated, and safe use of the body to

produce motion and maintain balance during activity.
Major purpose: facilitate safe and efficient use
of appropriate groups of muscles.
3 Basic Elements
Body alignment (posture): geometric arrangement of
body parts in relation to each other.
Balance (stability): state of equipoise (equilibrium) in
which opposing forces counteract each other.
Coordinated body movement: integrated functioning
of the musculoskeletal and nervous system as well as
joint mobility.

Important Concepts
The center of gravity of an object is the center of its
mass. In humans, it is at the center of the pelvis about
midway between the umbilicus and the symphysis
pubis.
The line of gravity is the vertical line passing through
the center of gravity.
The base of support is the foundation that provides the
object/persons stability.
Principles of Body Mechanics
a. Spread your feet
apart to provide a wide
base of support
b. Place your feet
appropriately in the
direction in which the
movement occurs.
c. Keep objects to be
moved close to the body
d. Push, pull, roll, or slide
objects rather than lifting
them, whenever possible.
Principles of Body Mechanics
e. When pushing or pulling
an object, use the bodys
weight to counteract the
weight of the object.
f. Avoid twisting the spine
by pushing or pulling
objects directly away from
or toward the body and
squarely facing the
direction of movement.
g. When lifting objects,
distribute the weight
between large muscles of
the legs and arms.
Other Strategies
to Prevent Back Injuries
1. Wear low-heeled shoes that provide good foot
support
2. When standing for long periods, occasionally flex
one hip and knee and rest your foot on an object if
possible
3. Sit with knees slightly higher than hips
4. Exercise regularly, including exercises to strengthen
the pelvic, abdominal, and lumbar muscles
5. Sleep on a firm mattress
Poor Body Mechanics
Complications Related to
Poor Body Mechanics
1. Muscle fatigue
2. Joint strain
3. Lower back injuries- most
common injury among
nurses
4. Repetitive motion injuries
Ergonomics
Ergonomics
Ergonomics
Complications
of Immobility
1. Pressure Ulcers -
A pressure ulcer is a specific tissue
injury caused by unrelieved
pressure that results in ischemia in
and damage to the underlying
tissue.
Pressure ulcers occur most
commonly over bony prominences.
Risk factors include:
1.immobility
2.malnutrition
3.incontinence
4.compromised peripheral
circulation.
The elderly are especially at risk
because of a loss of lean body mass
and changes in body tissues and
peripheral circulation.
Bed Sore
Pressure Ulcer
Stage 1
redness of intact
skin
Pressure Ulcers
Stage2
abrasion, crater, or
blister; ulcer is shallow
Pressure Ulcers
Stage 3
damage to
subcutaneous
tissue
extending
down to fascia;
deep crater,
possibly with
drainage
Pressure Ulcers
Stage 4
damage to
muscle, bone,
tendon or
joint capsule;
small or large
surface
wound, but
with extensive
tunneling, and
foul smelling
discharge.
Nursing Measures to prevent
Pressure Sores:
Frequent turning of immobile clients every 2 hours
Instruct patients to do weight shifts (pressure relief ) at
least every 15-20 minutes when sitting in your
wheelchair.
If your injury is at levels C4 and higher you can use a
power tilt wheelchair for regular pressure relief.
With an injury at levels C5 or C6 you can usually lean
forward or side-to-side for regular pressure relief.
If your levelof injury is C7 and below you can usually
perform a wheelchair push-up for regular pressure relief.
Nursing Measures to prevent
Pressure Sores:
Provide for good nutrition with diet high in protein,
carbohydrates, fluids, vitamin C and zinc
Use alternating-pressure air mattress, flotation pads,
elbow and heel pads, sheepskin pads
Do not use donuts or rubber rings
Protect from infection
Nursing Measures to prevent
Pressure Sores:
Wash skin gently, pat dry to prevent skin abrasion
Use clean, dry, wrinkle-free bed linens and pads
Promote circulation by gently massaging skin with
lotion that does not contain alcohol
Remove dead tissue and debris for stages 2-4
Dead tissue in the pressure sore can delay healing and
lead to infection. Removing dead tissue is often painful.
The client may be given pain-relieving medicine 30 to 60
minutes before these procedures.
Nursing Measures to prevent
Pressure Sores:
Procedure
Rinsing (to wash away loose debris).
Wet-to-dry dressings.
Enzyme medications to dissolve dead tissue only.
Special dressings
Complications of pressure sores include localized (i.e.
osteomyelitis, cellulitis) and even systemic infection
(i.e. sepsis)
Bone Demineralization and
Hypercalcemia
Prolonged bedrest
absence of weight-bearing
Osteoporosis
hypercalcemia
Bone Demineralization and
Hypercalcemia
Nursing Measures:
Prevent injury related to dec. bone strength
Encourage weight-bearing on long bones, if possible
Correct Body alignment, firm mattress
Encourage self care, ROM, avoid fatigue
Assume wt. bearing positions (Tilt Table)
Decrease calcium intake, provide balanced diet
Diet: high CHON, Vit.C, Dec. Ca
May be given estrogen, as necessary, and medications like
biphosphonates (i.e. alendronate, residronate) to retard
demineralization
Encourage fluids, acid ash diet
Negative Nitrogen Balance
Negative nitrogen balance is aggravated by anorexia. It
represents depletion of protein stores that are essential
for building muscle tissue and for wound healing.
Nursing Measure: Give high protein diet in small,
frequent feedings
Orthostatic Hypotension
Orthostatic hypotension is decrease in BP > 20/10 mmHg
and it happens when there is decreased ability of the
autonomic nervous system to equalize the blood supply
when position is changed from recumbent to upright.
Another contributing factor is the pooling of blood in the
lower extremities due to the decrease in muscle action that
causes pressure on the veins and assisting in venous return.
May lead to faintness, weakness, or dizziness in an attempt
to stand. The patient is at high risk for injury due to falls.
Orthostatic Hypotension
Nursing Measures:
Increase activity gradually
Encourage ROM and leg exercises
Teach patient to rise from bed slowly and dangle legs
before getting up
Elastic stockings
Tilt table
Sitting & lying BP
Increased Cardiac Workload
When the body is recumbent, the
total blood volume that would be in
the legs due to gravity is redistributed
to other parts of the body, increasing
the circulating volume and workload
of the heart.
With prolonged immobility the
sympathetic nervous system takes
over resulting to tachycardia
Increased Cardiac Workload
Valsalva maneuver further increases cardiac workload
Nursing Measures: Goal is to prevent injury and
further ischemic damage to cardiac tissue by
decreasing workload of heart:
Semi-recumbent position when in bed, pillows between
legs when side-lying
Passive & Active ROM exercises
Turn every 2 hour, dangle legs
Avoid Valsalva maneuver: use overhead trapeze when
moving in be
Encourage slow, deep breathing when moving in bed
Contractures
Contractures are joint abnormalities
due to abnormal shortening of muscle
tissue, rendering the muscle highly
resistant to stretching.
Due to lack of active or passive ROM
and improper positioning of joints
On assessment: fixed, shortened
extremities with pain on manipulation
Leads to difficulties in performing ADL

Contractures
Nursing Measures:
Promote frequent change in position
Use pillows, trochanter rolls, and
foot board to promote proper body
alignment
Avoid knee gatch
Perform therapeutic ROM exercises
as appropriate
Promote proper body alignment
Position: Functional, correct
alignment
Thrombus Formation
This is development of clot in a
vein due to venous stasis,
increased coagulability of blood
and damage to the endothelial
wall of the vessel
DVT present as groin or calf
tenderness, pain, warm and
edematous extremities. It poses the
danger of throwing off an emboli
leading to pulmonary infarction
Thrombus Formation
Nursing Measures:
Prevent by leg exercises: flexion and extension of toes
for 5 minutes every hour
Ambulate patients as appropriate
Avoid using knee gatch on bed or pillows to support
knee flexion
Use anti-thromboembolic stockings
Check for Homan sign
Stasis of Respiratory Secretions
Due to inability of cilia to move normal secretion out
of bronchial tree due to ineffective coughing, lack of
thoracic expansion or effects of medications
This leads to hypostatic pneumonia (frequent
nosocomial infection)
Stasis of Respiratory Secretions
Nursing Measures:
Teach patient the importance of turning,
deep breathing, coughing
Teach patient how to use incentive
spirometry
Hold the spirometer upright
Teach patient to exhale first and seal the lips
tightly around the mouthpiece
Take in a slow, deep breath to elevate the balls or
cylinder. Hold the breath initially for 2 seconds
and then increasing to 6 seconds.
Repeat the procedure four or five times hourly.
Practice increases inspiratory volume, maintains
alveolar ventilation and prevents atelectasis.
Postural Drainage
Administer postural drainage
This is drainage by gravity of secretions from various lung segments
Scheduled 2-3 times daily before meals and at bedtime
Before the procedure, patient may be given a bronchodilator
medication or nebulization therapy to loosen the secretions
Sequence: positioning, percussion, vibration, and removal of secretions
by coughing or suction. Positions are assumed for 10-15 minutes
depending on patients tolerance
Position for draining middle to lower lung field: head is lower than a
chest; patient may be placed in Trendelenburg position
Position for draining upper lung field: sitting position at about 45
degrees
Postural drainage should not be performed on pregnant women; on
those with rib or chest injuries; on those with dizziness, fainting, head
or neck injuries; on those with pulmonary embolism or abdominal
surgery
Postural Drainage
Postural Drainage Postural Drainage
Postural Drainage
Middle and Lower Portions
Postural Drainage
Sitting position at about 45 degrees
Upper portions of lungs
Sitting position at about a 45 angle
Postural Drainage
3. Lay on back
2. Lay on stomach
1. Turn side to side
When you are in the proper postural drainage position,
change your position while following this sequence:
Remain in each position approximately five to
ten minutes. Use suction or assisted cough
before changing position.
Postural Drainage
Nursing Management Nursing Management
Should not be performed in:
Increase oral fluid intake to liquefy secretions
Reinforce coughing and deep breathing exercises
Pregnant women Patients with rib or chest injuries
Patients with dizziness, fainting, head or neck injuries
Patients with pulmonary embolism or abdominal surgery
Constipation
Constipation is due to stasis of fecal
material in the rectum and sympathetic
nervous system activity
May present as ribbon-like diarrhea and
fecal smearing
Nursing Measures:
Promote ambulation early
encourage high fiber, high fluid diet
Ensure privacy with the use of bedpan or
commode
Administer stool softeners as necessary
Urinary Stasis
Immobility leads to inability to
completely empty the bladder
Leads to urinary tract infection and
renal calculi formation
Nursing Measures:
Have patient void in normal position,
if possible
Low calcium diet, increase fluid intake
and increase acid ash residue
Depression
Sensory Input
Changes
This may lead to confusion and
disorientation
Orient patient frequently and
place clock/ calendar within sight
Encourage self care that starts
with simple gross activities then
advancing to complex, fine motor
movements
Support patient with positive
feedback for his efforts and
accomplishments
Schedule OT and allow visitors as
appropriate
ASSISTIVE DEVICES
Crutches
Height of crutch measure two to three fingers or 2.5 -5
cm below the axilla
Patient should support weight on the handpiece and not
at the axilla: to prevent brachial plexus palsy
Tripod stance: proper standing position with crutches;
crutches are placed about 15 cm (6 inches) infront of the
feet and out laterally, about 15 cm, creating a wide base
Elbows should be flexed at 20 -30 degrees angle for
correct placement of hand grips
Crutch Walking Gaits
Using Crutches:
Sitting and Standing
To sit on a chair
Stand with the back of the unaffected
leg centered against the chair.
Transfer the crutches to the hand on
the affected side and hold the
crutches by the hand bars.
The client grasps the arm of the chair
with the hand on the unaffected side
to support himself.
Lean forward. Flex the hips and
knees, and lower into the chair.
stand up from a chair
Hold the hand grips of both
crutches in one hand.
Push off from the chair with
the other hand.
Stand and check your balance.
Crutch walking Gaits
Up with the good, down with the bad Up with the good, down with the bad Up with the good, down with the bad
Note: Note: Note: Note:
To go down stairs, advance
crutches with affected leg
first, followed by good leg.
To go up stairs, advance good
leg first followed by crutches
and affected leg.
Cane
Cane
Types: straight cane and quad cane
Tips should have concentric rings as shock absorber and to
provide optimal stability
Flex elbow 20-30 degrees angle and hold handle
Tip of cane should be 15 cm lateral to the base of the fifth
toe
Procedure:
Hold cane on the good side
Advance cane and affected leg
Lean on cane when moving good leg
When going up the stairs, follow up with the good, down
with the bad
Walker
Lift and move walker forward 8-10 inches
With partial or non-weight bearing, put weight on
wrists and arms and step forward with affected leg,
supporting self on arms, and follow with good leg
Nurse should stand behind patient, hold onto gait belt
at waist as needed for balance