2. 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. 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.


4. 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/person’s stability.

5. Principles of Body Mechanics
a. Spread your feet b. Place your feet
appropriately in the
apart to provide a wide
direction in which the
base of support movement occurs.
c. Keep objects to be d. Push, pull, roll, or slide
moved close to the body objects rather than lifting
them, whenever possible.

6. Principles of Body Mechanics
e. When pushing or pulling f. Avoid twisting the spine
an object, use the body’s by pushing or pulling
weight to counteract the objects directly away from
weight of the object. 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.

7. 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

8. Poor Body Mechanics

9. 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

14. Ergonomics

15. Ergonomics

16. Ergonomics

17. Complications
of Immobility
 1. Pressure Ulcers - “Bed Sore”
 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.

18. Pressure Ulcer
Stage 1
redness of intact
skin

19. Pressure Ulcers
Stage2
abrasion, crater, or
blister; ulcer is shallow

20. Pressure Ulcers damage to
Stage 3
subcutaneous
tissue
extending
down to fascia;
deep crater,
possibly with
drainage

21. Pressure Ulcers
damage to
Stage 4 muscle, bone,
tendon or
joint capsule;
small or large
surface
wound, but
with extensive
tunneling, and
foul smelling
discharge.

22. 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.

23. 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

24. 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.

25. 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)

26. Bone Demineralization and
Hypercalcemia
 Prolonged bedrest
 absence of weight-bearing
 Osteoporosis
 hypercalcemia

27. 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

28. 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

29. 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.

30. 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

31. 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

32. 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

33. 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


34. 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

35. 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

36. 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

37. 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)

38. 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.

39. 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 patient’s 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

40. Postural Drainage
Postural Drainage
Postural Drainage

41. Middle and Lower Portions

42. Postural Drainage
•Upper portions of lungs
•Sitting position at about a 45 angle
Sitting position at about 45 degrees

43. Postural Drainage
When you are in the proper postural drainage position,
change your position while following this sequence:
1. Turn side to side
2. Lay on stomach
Remain in each position approximately five to 3. Lay on back
ten minutes. Use suction or assisted cough
before changing position.

44. Postural Drainage
Nursing Management
Should not be performed in:
Pregnant women Patients with rib or chest injuries
Patients with dizziness, fainting, head or neck injuries
Patients with pulmonary embolism or abdominal surgery
 Increase oral fluid intake to liquefy secretions
 Reinforce coughing and deep breathing exercises

45. 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

46. 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

47. Sensory Input Depression
Changes • Encourage self care that starts
• This may lead to confusion and with simple gross activities then
disorientation advancing to complex, fine motor
movements
• Orient patient frequently and • Support patient with positive
place clock/ calendar within sight feedback for his efforts and
accomplishments
• Schedule OT and allow visitors as
appropriate

48. 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

49. Crutch Walking Gaits

50. 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.

51.  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.

52. Crutch walking Gaits
Note: To go up stairs, advance good
leg first followed by crutches
and affected leg.
To go down stairs, advance
crutches with affected leg
first, followed by good leg.
“Up with the good, down with the bad”
“Up bad”

53. Cane

54. 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”

55. 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