HC21 BODY Mechanics - hc21 PDF

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Body Mechanics Health Center 21 MODULE NOTES

SAFETY GUIDELINES •

BODY MECHANICS ◦

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Physically Demanding Careers:Careers in health care are physically demanding. Health care workers are often required to lift, carry, and push patients or objects. If health care workers do not use their bodies correctly, their muscles may be injured. Injuries, such as pulled muscles and strained backs, make daily tasks difficult and painful. For this reason, it is important for all health care workers to learn the principles of body mechanics Body mechanics is moving and positioning the body in ways that prevent injury to oneself and to others. Specifically, body mechanics focuses on certain muscle groups that are useful for lifting, carrying, and pushing. Health care workers must learn to use the correct muscle groups with good alignment, proper positioning, and steady balance. When muscles are used correctly, body movements become more effective. In addition, using correct body mechanics decreases the amount of strain that is placed on the body. As a result, the body becomes tired less quickly, and the risk of injury is reduced. What is body mechanics?Moving and positioning the body in ways that prevent injury Which of the following is important to body mechanics?Good alignment Steady balance Proper positioning Health Risks: Health care workers must take good care of their bodies by eating nutritious meals, getting enough rest, staying physically active, and using common sense. In addition, they must use correct body mechanics at work and outside of work. When health care workers do not take care of themselves and use proper body mechanics, they are at risk of serious injuries. Injuries may include muscle strains and sprains, fatigue, disc strain, disc bulge, or disc herniation. Even minor injuries can prevent health care workers from doing tasks at work. For example, straining a muscle may prevent a health care worker from moving patients, lifting objects, or standing all day. If health care workers cannot do their required tasks, they are at risk of losing their jobs. Fortunately, these types of injuries are usually preventable. Back Injury: Injury to the back is the most common injury to health care workers. Back injury may be caused by any of these actions: Poor physical condition Fatigue Staying in one position for too long Incorrect posture while sitting or standing Maintaining a bent position Heavy lifting Repeated lifting of awkward items Lifting with forceful movements,Twisting, bending, or reaching while lifting. Pulling instead of pushing Principles of Body Mechanics: Posture: Body mechanics begins with posture. Good posture should be used when standing, sitting, walking, or lying. Follow these principles to practice good posture: Stand up straight with your shoulders back and your chin up. Do not slouch. Keep your spine in line with its

natural curves. Do not twist.Provide a wide base of support by keeping your feet shoulder-width apart. Distribute weight evenly on both feet.Bend your knees slightly. Locking the knees may cause you to lose balance. •

Principles of Body Mechanics: Lifting and Carrying: Health care workers are often required to lift heavy items, such as medical equipment or boxes of supplies. Lifting and carrying heavy items may cause injury if these actions are done incorrectly. Follow these principles to show good body mechanics:Bend at your hips and knees. Keep your head parallel to the trunk of your body. Do not bend at your waist or arch your back.To lift an item from a squatted position, tighten your abdomen and focus the lifting motion on the muscles in your thighs. This action will avoid straining the weaker muscles in your back.Use two hands to lift and carry items. Using only one hand will alter your body's balance and cause unneeded strain.Carry items close to your body and at chest level. This action will keep your body balanced and aligned.Use common sense, and know your limits. Never lift or carry an item that is too heavy for you. Ask a co-worker for help when lifting large objects. ◦ Principles of Body Mechanics: Moving and Pushing: Health care workers are often required to push items, such as wheelchairs and stretchers. To avoid injury, health care workers should follow these guidelines when moving or pushing objects.Use the weight of your body to lean into a push. Do not rely on the strength of your arms, and do not arch your back.Use two hands to push items. Using only one hand will alter your body's balance and cause unneeded strain. In addition, the push will be more forceful when two hands are used.Pivot your feet to change directions. Do not twist your body. Equipment safety ◦ One of the most important tasks for a health care worker is to provide safety for all patients. One aspect of safety is proper use of equipment, including wheelchairs, beds, stretchers, and transfer belts. It is the responsibility of each health care worker to learn and practice safety guidelines for each of these items. ◦ Wheelchair Safety:Wheelchairs are used to transport patients who cannot walk or who have difficulty walking. When using wheelchairs, health care workers must follow basic safety guidelines in these areas:Preparing the wheelchair Positioning the patient Transporting the patient ◦ Preparing the Wheelchair: Before transporting a patient in a wheelchair, health care workers must prepare the wheelchair.Before using a wheelchair, inspect it. Check for flat or loose tires, and make sure the wheel spokes are intact. Test the wheel locks, and make sure they work properly. Also check for damaged seats, armrests, and footrests.Make sure both wheels are locked before transferring a patient into or out of a wheelchair.To prevent tripping, move the footrests to the side before transferring a patient into or out of a wheelchair. ◦ Positioning the Patient:After preparing the wheelchair, health care workers should follow these guidelines to position patients in the wheelchair:Make sure the patient's feet fit comfortably on the footrests. Never let the patient's feet drag on the floor. In addition, do not let the patient stand on the footrests.Make sure the patient has the needed wheelchair accessories, such as cushions, elevated armrests, and elevated footrests. A supervisor will tell you which accessories are appropriate for the patient's condition. ◦

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Transporting the Patient:During a wheelchair transport, health care workers should follow these guidelines:Whenever possible, use handicap ramps and elevators. Do not use wheelchairs on stairways. When a patient must be transported down a ramp, gently pull the wheelchair backwards. This will prevent you from losing control of the wheelchair and possibly injuring the patient.Always push the wheelchair forward. Avoid pulling it backward, except when you are using a ramp. Pulling may cause strain in back muscles, and walking backward may cause you to lose your balance. Bed Safety:Bed types vary among medical facilities. Some beds are raised and lowered with hand cranks or foot pedals. However, most beds have electric controls. Health care workers are responsible for learning how to use the type of bed at their facility.Beds are important pieces of equipment for patient comfort, but they also may create safety hazards. Health care workers must follow basic safety guidelines.The wheels on a bed should be locked at all times, except when the bed is being moved from one place to another.Beds should be raised to a high horizontal position for certain procedures. This will create less strain on the health care worker's back. Beds should be returned to a low horizontal position when the procedure is finished. Never leave a patient alone with the bed in a raised position.Special attention should be given to side rails. Side rails may present the risk of strangulation, entrapment, bruises, cuts, and feelings of isolation. To help prevent injury, check that side rails are secure and sturdy before leaving a patient alone. In addition, never attach intravenous lines, catheters, or restraints to side rails. Stretcher Safety:Stretchers are used to transport patients who cannot sit up in a wheelchair. When using stretchers, health care workers should follow these basic safety guidelines:Lock the wheels when transferring a patient to and from a stretcher.Keep the side rails up when transporting a patient on a stretcher. Be sure to keep the patient's arms and legs clear of the side rails.Always use two health care workers when transporting a patient on a stretcher. One worker should stand at the head of the stretcher, and the other worker should stand at the foot of the stretcher. Always move the patient feet first.Never leave a patient alone on a stretcher. Legal Implications:According to the Omnibus Budget Reconciliation Act, or OBRA, side rails and safety straps on equipment may be considered restraintsbecause they prevent a patient from moving freely. Side rails, in particular, should only be used when they are needed to treat a patient's medical symptoms. Side rails and safety straps should be used under the direction of a physician or nurse. The reasons for using these items must be clearly stated in a patient's medical record. A transfer belt, or gait belt, is a piece of equipment used to help patients stand and walk. Transfer belts are also helpful during transfer procedures, such as moving a patient from a bed to a wheelchair. A transfer belt is put on a patient over the clothing and around the waist. During a procedure, health care workers can grab onto the belt to help support the patient. Transfer belts are helpful for most patients, especially the elderly. However, some patient conditions do not allow the use of a transfer belt. Or, if the belt can be used, special considerations must be made. Health care workers must check with their supervisor before using a transfer belt on patients with the following

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conditions:Abdominal or rib injuries,Abdominal aneurysms,Certain types of back injuries,Advanced heart or lung disease,Pregnancy,Colostomy,Gastrostomy tube. In addition, transfer belts should only be used on patients who have the ability to stand and bear weight. The belts should not be used to lift or pull patients. Where should transfer belts be positioned? Around the waist, over the clothing How should the transfer belt be grasped?Underhand grasp

MOVING PATIENTS

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PRESSURE ULCERS Bed-ridden patients are at risk of developing pressure ulcers. Pressure ulcers, also called decubitus ulcers or bedsores, are skin and tissue injuries that are caused by unrelieved pressure on specific areas of the body. If the body is left in one position for too long, ulcers can form. Pressure ulcers are much easier to prevent than to treat. For this reason, health care workers must take every precaution to turn patients regularly and to promptly report changes in patients' skin condition. ◦ The primary cause of pressure ulcers is unrelieved pressure on the body over a period of time. The following conditions may increase a patient's risk of developing pressure ulcers:Prolonged pressure that prevents circulation to an area of the body. Pressure on a bony prominence of the body.Friction against the bed linens or mattress.Shearing, which is when the skin is pulled in the opposite direction as the bone.Moisture, dry skin, or irritation by urine or feces ◦ Location of Pressure Ulcers:Health care workers should regularly observe patients' skin for signs ofpressure ulcers. Special attention should be given to bony areas of the body called pressure points. Pressure points bear the weight of the body when the body is in certain positions. Pressure points include heels, knees, shoulders, shoulder blades, elbows, tailbone, and the back and sides of the head.In addition, pressure ulcers may occur wherever skin is in contact with other skin. This is especially true in obese patients. In these cases, health care workers should look for pressure ulcers between abdominal folds, the legs, the buttocks, and the breasts. ◦ High Risk Patients:All patients are at risk of getting pressure ulcers. However, pressure ulcers are especially common in patients who are:Elderly or very thin, because their bodies may be frail and more likely to bruise.Obese, because their weight may cause increased pressure on the body and because ulcers often develop between folds of skin.Diabetic, because their bodies have poor circulation.Poorly nourished or dehydrated, because their bodies may be unable to heal or sustain pressure.Incontinent, because they are more likely to have areas of wetness next to their bodies.Confined to a bed or wheelchair, because they are unable to move their bodies or eliminate pressure ◦ Stages of Pressure Ulcers: A pressure ulcer starts as small mark on the skin. However, it may develop into a serious wound if left untreated. Health care workers should be aware of the four stages of pressure ulcers.Stage 1: The skin is intact, but is red or bluish-grey in color. Color does not return to normal when the skin is relieved of pressure.Stage 2: Tissue damage is visible on the top layer of skin. The

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skin has cracked, blistered, or peeled over the wound.Stage 3: A deep, open crater forms and reveals damaged, underlying tissue. Drainage from the wound is likely.Stage 4: Muscle, tendon, and bone are exposed and are visibly damaged. Drainage is likely. ◦ When a pressure ulcer is found on a patient's skin, health care workers must take special care to observe the ulcer for changes. All observations must be reported to the supervisor. The following observations should be made:Location,Appearance,Size and depth,Drainage,Odor,Condition of the surrounding skin ◦ Preventing Pressure Ulcer: Health care workers must follow certain techniques to reduce the risk ofpressure ulcers. The key to preventing pressure ulcers is to:Decrease skin pressure,Promote cleanliness ◦ Health care workers should apply these techniques to decrease skin pressure:Follow a turning schedule. Patients should be turned in bed at least every 2 hours.Separate body parts that are likely to rub together. Use pillows, towel rolls, and foam wedges according to your supervisor's instructions.Use protective devices according to your facility's policies. Protective devices include elbow protectors, heel elevators, bed cradles, flotation pads, and alternating-pressure mattresses.Encourage patients who are sitting in chairs to reposition themselves every 15 minutes. Assist patients who are unable to reposition themselves.Perform range-of-motion exercises at least twice a day to promotecirculation ◦ Health care workers must apply these techniques to promote cleanliness:Provide good skin care. Bathe the patient regularly, and keep the skin moisturized. Clean out bedpans immediately after use, and make sure the skin is free of urine and feces.Keep bed linens clean and dry. Change sheets regularly, especially for patients who perspire heavily MOVING UP IN BED ◦

Moving Up In Bed

When the head of the bed is raised, it is easy for a patient to slide down. Sliding down causes shearing on the tailbone, which may lead topressure ulcers. In addition, sliding down in bed creates poor body alignment and is uncomfortable for patients. Health care workers must learn the procedure for moving a patient up toward the head of the bed. Two techniques for this procedure are moving a patient with a draw sheet and moving a patient without a draw sheet. ◦

Procedure for Moving Up In Bed: With a Draw Sheet

A draw sheet is used to move patients who cannot move themselves, are unconscious or paralyzed, have spinal cord injuries, or are elderly. Two health care workers are needed for this procedure. Individual agencies may have specific procedures that their employees must follow. The following process is an example of a moving procedure that might be found at any agency.

Prepare for Procedure

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Cleanse your hands.

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Ask a co-worker to assist you.

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Knock on the door before entering the room.

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Address the patient by name and introduce yourself.

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Identify the patient by checking the identification bracelet.

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Explain the procedure to the patient.

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Provide the patient with privacy.

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Procedure for Moving Up In Bed: With a Draw Sheet (continued)

Prepare the Equipment

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A health care worker should stand on each side of the bed.

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Prepare the bed:

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Make sure the bed wheels are locked.

Make sure that the bed is flat. Then, raise the bed horizontally so that it is at waist level. This will reduce strain on your back.

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If side rails are used, lower them.

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Place a pillow against the headboard to protect the patient's head.

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Procedure for Moving Up In Bed: With a Draw Sheet (continued)

Move the Patient

Grasp the edge of the draw sheet with both hands. Use an underhand grip with palms facing up. One hand should be by the patient's shoulder and the other hand by the hips.

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On the count of 3, lift up and move the patient toward the head of the bed. Shift your weight from your rear leg to your front leg and move in one swift motion.

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Repeat these steps as needed until the patient is positioned.

4. Remove the pillow from against the headboard. Place it beneath the patient's head and neck.

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Post-Procedure

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Lower the bed horizontally.

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Position the side rails according to instructions.

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Raise the head of the bed according to the patient's needs.

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Check that the patient is comfortable and safe.

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Place the call signal within the patient's reach.

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Cleanse your hands.

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Report all actions taken and any observations.

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Sometimes a patient may be moved up in bed without a draw sheet. Two health care workers are needed for this procedure. Individual agencies may have specific procedures that their employees must follow. The following process is an example of a moving procedure that might be found at any agency. Prepare for Procedure ◦

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Cleanse your hands.

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Ask a co-worker to assist you.

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Knock on the door before entering the room.

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Address the patient by name and introduce yourself.

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Identify the patient by checking the identification bracelet.

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Explain the procedure to the patient.

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Provide the patient with privacy.

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Prepare the Equipment

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A health care worker should stand on each side of the bed.

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Prepare the bed:

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Make sure the wheels of the bed are locked.

Make sure that the bed it flat. Then, raise the bed horizontally so that it is at waist level. This will reduce strain on your back.

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If side rails are used, lower them.

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Place a pillow against the headboard to protect the patient's head.

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Move the Patient

Have the patient bend both knees.

Place one arm under the patient's shoulder and the other arm under the patient's thigh. Grab your co-worker's forearms beneath the p...