NCM 103

FUNDAMENTALS OF NURSING PRACTICE

SKILLS

MOBILITY
 BODY MECHANICS
Definitions:

Body mechanics - is the utilization of correct muscles to

complete a task safely and efficiently, without undue
strain on any muscle or joint.

Mobility – the ability to move freely, easily, rhythmically,

and purposefully in the environment.
 ADVANTAGES
Maintains good body alignment.
• Maintains balance of the body.
• Prevents fatigue and.
• Promotes physiological functions of the body.
• Reduces expenditure of energy.
• Prevent and reduces the risks of musculoskeletal
injury.
Improper Body Mechanics results to:

• Excessive fatigue
• Muscles strains or tears
• Skeletal injuries
• Injury to the patient
• Injury to assisting staff members
Principles of Good Body Mechanics
1. When planning a transfer or move, free the surrounding
area of obstacles. It will prevent injury and promote safety
of patient and equipment.
2. The heavier the object the greater the force needed to
move the object. Use of mechanical devices or assistance to
move object reduces muscular effort and prevent injury.
3. Effective use of major muscle groups while carrying heavy
objects minimizes strain on abdomen and back. Facing the
direction of the movement avoids twisting and helps to
maintain body balance.
4. Balance is maintained. Standing as close as possible prevents
overstretching and twisting.
• Maintain a stable center of gravity
- keep your center of gravity low
- keep your back straight
- bend at the knees and hips
• Maintain a wide base support.
- keep your feet apart
- place one foot slightly ahead of the other
• Maintain the line of gravity
- Keep your back straight
- Keep the object being lifted closed to your body.
• Maintain proper body alignment
- Keep your weight forward and supported on the
outside of your feet.
• Continuous muscle exertion can result in muscle
strain, injury and fatigue.
Positioning &
Transferring
Techniques
Moving and Turning Patients
Objectives
• To provide increased comfort
• To provide optimal lung excursion and ventilation
• To prevent contractures due to constraint joint
flexion
• To promote optimal joint movement
• To help maintain intact skin
• To prevent injury due to improper movement
• To move and transfer clients using mechanical
devices
 Body Alignment
• Refers to correct positioning of the client’s body. The
client’s body should be straight and properly supported
to promote safety and comfort.

• Proper body alignment can be seen as proper standing

posture. When people lie in bed, it is often necessary to
use pillows and rolled-up towels to keep this alignment.
Factors affecting body alignment
• Growth and development
• Physical health
• Mental health Nutrition
• Personal values and attitudes
• External factors
• Prescribed limitations
T - POSITION or
TRENDELENBERG

Reverse Trendelenberg
Supine Position
The patient lies flat on the back with the head and shoulders
slightly elevated with a pillow unless contraindicated, such as
spinal anesthesia or surgery on the spinal vertebra.
Lateral or Prone Position
Purposes:
• Ensure comfort of the patient
• To perform procedures such
as changing linen and bed pan.
• To offer relief of pressure
points in supine position.
The patient lies on the
side the main weight of
the body is borne by the
lateral aspect of the
lower scapula and the
lateral aspect of the
lower ileum. This is a
comfortable alternate to
the supine position for
the patient on bed rest.
Sims’ Position
It is a modified form of prone or
lateral recumbent position where
the patient is positioned at
his/her side such that the upper
leg is bent inside towards the
chest while the upper arm is bent
at the elbow. It gives a clear view
of rectal area, vaginal area, cervix
or genital area.
GENERAL POSITIONING RULES:
• A rolled-up washcloth makes an excellent support for the
hand.
• If an arm or leg is swollen, try to keep the part higher
that the heart. Gravity will help the extra fluid drain from
the limb.
• Any open skin will heal more quickly if pressure is
reduces and air is allowed to circulate around it.
• Position and support only nonfunctional parts of the
body. The rest should be left free to move. This will help
the blood to circulate.
• Proper positioning can help a client maintain or recover
his best possible state of health.
 Assistive Devices
• Gait belts - is a device used for transferring patients and assisting
with ambulation.
• Friction reducing sheet - used under patients to prevent skin
shearing when moving patients in bed and when assisting with
lateral transfer. It reduces friction force required to move patients.
• Trapeze bar - is a handgrip suspended from a frame near the head
of the bed.
• Mattresses
• Adjustable bed
• Foot board
• Side rails
• Hand rolls – to keep the thumb in correct position
 PATIENT TRANSFER

•A transfer is the safe movement of the patient from one

place to another, like from bed to wheelchair and by the
used of assistive devices. The nurse must teach patient
and ask for his or her participation for successful results.
 Purposes
a. To move patient who cannot sit up
b. To move patient with appliances or casts that
would not fit into a wheelchair, or that would
be discharged.
c. To move patient to the operating room or the
x-ray department, or to other rooms for special
tests, treatments or examinations.
d. To transfer patients from one unit to another.
The nurse should choose an
appropriate technique for the
patient by taking into
considerations his or her
disabilities and abilities. It is
very helpful if the nurse
demonstrates the technique
first before the transfer. During
the transfer the nurse coaches
and assist the patient.
Mechanical Lift – used if a person cannot bear
weight
Draw Sheet – used to lift or move
Gait Belt
patient.
Unsafe Handling Of Patient
Assisting client to sit on the side of the
bed (Dangling)
PURPOSE
• The client assumes a sitting position on the edge of
the bed before walking, moving to a chair or
wheelchair, eating, or performing other activities.
 Procedure
1. Introduce self and verify the client’s identity using agency protocol.
Explain the procedure to the client.

2. Perform hand hygiene and observe other appropriate infection

prevention procedures.

3. Provide client privacy.

4. Position yourself and the client appropriately before performing

the move. Assist the client to a lateral position facing you, using an
assistive device depending on client assistance needs.
5. Raise the head of the bed slowly to its highest position. This decreases the
distance that the client needs to move to sit up on the side of the bed.

6. Position the client’s feet and lower legs at the edge of the bed. This
enable the client’s feet to move easily off the bed during the
movement, and the client is aided by gravity into a sitting position.

7. Stand beside the client’s hips and face far corner of the bottom of
the bed. Assume a broad stance, placing the foot nearest the client.
Lean your trunk forward from the hips. Flex your knees, and ankles.
8. Move the client to a sitting position. Place the arm nearest to the
head of the bed under the client’s shoulders and the other arm
over both of the client’s thighs near the knees. This will prevent
client from falling backward during the movement. Supporting
client’s thighs reduce friction of the thighs against the bed
surface.

9. Pivot on the balls of your feet in the desired direction facing the
foot of the bed while pulling the client’s feet and legs off the bed.
Pivoting prevents twisting of the nurse’s spine.

10. Keep supporting the client until the client is well balanced and
comfortable.
11. Assess vital signs as indicated by the client’s health status.
12. Document and record the ability of client to assist in moving and
turning.
 Assisting Client in Logrolling
PURPOSE
• is a technique used to turn a client whole body must
at all times be kept is straight alignment (like a log),
indicated for client with back surgery or spinal injury.
 Procedure
1. Introduce self and verify the client’s identity using agency protocol.
Explain the procedure to the client.

2. Perform hand hygiene and observe other appropriate infection

prevention procedures.

3. Provide client privacy.

4. Position yourselves and the client before the move. Place the client’s
arm across the chest.
5. Pull the client to the side of the bed. Stand with another nurse on
the same side of the bed. Assume a broad stance with foot
forward, and grasp the rolled edge of draw sheet. On a signal, pull
the client toward both of you.

6. One nurse counts, “One, two, three, go.” in unison pull the client to
the side of the bed by shifting their weight to the back foot.
Moving client in unison maintains the client’s body alignment.

7. One person moves to the other side of the bed, and places
supportive devices for the client when turned.
8. Place a pillow where it will support the client’s head after the turn.
This will prevents lateral flexion of the neck and ensures
alignment of the cervical spine.

9. Place one or two pillows between the client’s legs to support the
upper leg when the client is turned. This will prevents adduction
of the upper leg and keeps the legs parallel and aligned.

10. Roll and position the client in proper alignment.

11. Go to the other side of the bed (farthest from the client), and
assume a stable stance.

12. Reaching over the client, grasp the draw sheet and roll the client
toward you.
13. One nurse counts: “One, two, three, go.” Then, all nurses roll the
client to a lateral position.

14. The second nurse (behind the client) helps turn the client and
provides pillow supports to ensure good alignment in the lateral
position.

15. Support the client’s head, back, and upper and lower extremities
with pillows.

16. Raise the side rails and place the call bell within the client’s reach.

17. Document and record response of client to moving and turning

such as anxiety, discomfort, dizziness.
 Procedure
1. Wash hands and observe standard precautions as necessary.
2. Gather needed supplies:
a. Wheelchair
b. Blanket
c. Gown/robe
d. Slippers/shoes
e. BP apparatus
3. Knock and introduce yourself.
4. Identify the person
5. Explain the procedure.
6. Provide privacy.
7. Determine the person’s strongest side, and then place the
wheelchair alongside of the bed. Position the wheelchair so that
the person will move toward the chair “strong side first”.

8. Fanfold the top linens to the foot of the bed.

9. Check the strength of your patient hand and feet, use the right to
right hand technique by clapping your arm and the patient to
squeeze your hand to assess the amount of strength in the upper
extremities. Assess the strength of the lower extremities by asking
the patient to push down on your hand and note any different in
strength. To determine the weak side from the other.
10. Position the wheelchair or chair on the patient strong side so that the
patient can grab by her strong arm and move to the strong side

11. Lock the wheelchair wheels and either remove the footrest or swing
them to the side.
12. Put on the patient shoes or slipper to provide base of support.
13. Put the side rail down towards where you are working on

14. Help the person to move toward the side of the bed where the
wheelchair is located. Raise the head of the bed to a sitting position
30-45 degrees.
15. Assist the person to dangle. Slip one arm behind the patient’s
neck and shoulder, grasping the far shoulder. Slip your other arm
under the patient’s knees. As you support the patient’s upper body
in the erect position, slide his legs over the edge of the mattress.
Support the patient’s shoulder and bring him to a sitting position.
14. Allow the persons to rest on the edge of the bed. The person
should be sitting squarely on both buttocks, with her knees apart
and both feet flat on the floor. The person’s arms should rest
alongside her thighs. Watch for signs of dizziness or fainting.
Position yourself in front of the person so that you can offer
assistance in case she loses balance. This will provide a strong
base of support.

15. Help the person to stand. Instruct the patient to lean forward and
pass your arms under the person’s arms and rest your hands on
her upper back.
16. Position your feet alongside the person’s feet, flexing your knees.
Place your shins against the person’s shins to lock the person’s feet
and keep her knees from buckling as she stands up.
17. Have the person push down on the bed with her hands and stand
on the count of three. Assist the person into a standing position by
gently pulling her up and forward as you straighten your knees.
Continue to block the person’s feet and knees with your feet and
knees.

18. Instruct the patient to reach the arm rest of the chair by his strong
hand. Remember to use proper body mechanics.

19. Help the person to turn by pivoting on the stronger leg toward the
chair. This will allow the person to grasp the far arm of the
wheelchair.

Pivoting – A technique in which the body is turned to avoid twisting

of the spine.
20. Lower the person into the wheelchair by bending your hips and
knees. Make sure the person is comfortable and in good body
alignment.

22. Position the person’s feet on the footrests of the wheelchair.

Buckle the wheelchair with safety belt and cover the person’s lap
and legs with a lap blanket, if desired. Place a call bell on the
patient lap. Lock the wheelchair.

23. Position the wheelchair according to the person’s preference.

24. Confirm comfort and good body alignment.

25. Wash your hands and document.

 Procedure
1. Wash hands and observe standard precautions as necessary
2. Knock and introduce yourself.
3. Identify the person, let him state his name and compare it to the
patient’s ID band.
4. Explain the procedure
5. Provide privacy
6. Pull the stretcher near the bed. Call for two assistant to help you
assist for transfer. Position the stretcher at the head of the bed.
7. Adjust the height of the bed slightly higher than the stretcher.
Lock the wheels of the stretcher and lower the head of the bed.
Put the side rail down.
8. If the patient is able instruct him to move at the edge of the bed.
If unable utilize the draw sheet to pull the patient’s hips toward
the edge of the bed.
9. Roll the patient away from you keeping the opposite side rail up.
10. Place the slide board under the patient sheet making a bridge
between the pad and the stretcher. Have the patient roll back and
position on him the sheet. Put the other side rail down.
11. Using the draw sheet instruct the assistant that at the count of
three slide the patient over the slide board to the stretcher.
Remove the pillow.
12. Instruct the patient place the arm on the chest. Instruct the
patient that you will move him at the count of “one, two. Three”
and slide him over the stretcher. Position the patient on the
stretcher and raise the side rail up.
13. Assess the patient condition from dizziness following the transfer.
Cover the patient with blanket, put a pillow and raise the head of
the stretcher according the patient comfort.
14. Wash hands and document.
 RANGE OF MOTION EXERCISES

• Range of motion exercises refers to activity

aimed at improving movement of a specific joint.
 TYPES
Active – performed by the patient without help. Movement can
help your joints flexible, reduce pain, and improve balance and
strength.

Passive – not performed by the patient and the health care

worker moves each joint through its ROM. Helps prevent weak
muscles or stiffness caused by non-use. (stroke, paralysis, bed
ridden)

Active-Assistive – assistance is provided manually or

mechanically by an outside force because the prime mover
muscles need assistance to complete the motion.
General Rules for ROM
• Use good mechanics
• Expose only the body part being exercised.
• Explain to the patient what you are going to do and teach the
patient how to do.
• Support the extremity being exercised to prevent strain/injury
• Move each joint slowly, smoothly and gently
• Reach the joint to a neutral position after the movement
• Repeat each exercise 3-5times and should be done once per
day.
• Joints are exercised sequentially, starting with the neck and
moving down.
• Don’t continue the exercise to the point that the patient
develops fatigue.
• If muscle spasticity occurs during movement, stop the
movement temporarily, but continue to apply slow, gentle
pressure on the part until the muscle relaxes.
• If a contracture is present, apply slow firm pressure, without
causing pain, to stretch the muscle fibers.
PASSIVE ROM EXERCISES
 JOINT MOVEMENTS
• Abduction – moving a body part away from the
midline of the body
• Adduction – moving a body part toward the midline
of the body
• Extension – straightening a body part
• Flexion – bending a body part
• Rotation – turning the joint
• Internal rotation – turning the joint inward
• External rotation – turning the joint outward
• Plantar flexion – bending the foot down at the ankle
• Pronation – turning the joint downward
• Pronation – turning the joint upward
• Inversion – turning the sole of the foot towards
the midline
• Eversion – turning the sole of the foot away from
the midline
Effects of Immobility
• Venous stasis by prolong inactivity
• Thrombus and embolus- a formation caused by slow flowing blood
which begin clotting within hours.
Homan’s sign – pain in the calf upon dorsiflexion
• Orthostatic hypotension
• Hypostatic pneumonia
• Atelectasis – collapse of lung tissue
• Muscle atrophy – decreased muscle size
• Contracture – decreased joint movement leads to permanent
shortening of muscle tissue
• Altered sensation caused by prolong pressure
• Renal calculi caused by stagnation of urine in the renal pelvis
• Decreases metabolic rate
Exercises
• Isotonic exercise (Dynamic) – it increases muscle tone,
strength and joint felxibilty. E.g. running, swimming, cycling,
ROM exercise.
• Isometric exercise (static) – there is muscle contraction
without moving the joint. E.g. squeezing a towel or pillow at
knees.
• Isokinetic (resistive exercise) – Special machines or devices
provide resistance to the movements
 Using Canes
• Canes are light weight, easily movable devices that
are made of wood or metal.
Types of canes:
• Single ended canes with half circle handle
• Single ended canes with straight handles
• Canes with 3 or 4 prongs (qwad canes)
 Procedure
• Instruct patient to stand with weight, evenly distributed
between the feet and the cane.
• The cane is held on the patient’s stronger side, instruct
patient to position cane 6 inches (15 cm) anterior of the foot.
• Move the affected leg forward to the cane while the weight is
borne by the cane and stronger leg.
• Next move the unaffected leg forward ahead of the cane and
weak leg while the weight is borne by the cane and weak leg.
• Repeat the steps.

Remember: “Up with the Good; Down with the Bad.”

 Using Walkers
• A walker is a light weight metal frame with four legs.
• Patient’s requirements to use walker:

1. Partial strength in both hands and wrist

2. Strong elbow extensors such as triceps brachia
3. Strong shoulder depressors such as the pectoralis
minor
4. Ability to bear at least partial weight on both legs
• Explain the method of using walker
• Instruct patient to wear no-skid shoe or slipper
• Instruct patient not to use walker on stairs
• Have patient stand in center of walker and grasp handgrips on
upper bars
• Lift walker and move it 6-8 inches forward, making sure all 4
feet of the walker stays on the floor, take a step forward with
one foot follow through with other leg.
IF ONE LEG WEAKER THAN THE OTHER:
• Move the walker and the weak leg ahead together about 6
inches while your weight is borne by the stronger leg.
• Then move the stronger leg ahead while weight is borne by the
affected leg and both arms.
Standard Walker Two-wheeled Walker
 Special Considerations

• The patient should be taught to examine the frame daily.

• Use caution when attempting to ambulate a patient who has
already been given an antihypertensive or analgesic
medication, this may cause dizziness or instability.
• Caution should be used if the patient uses a walker or inclines
• Care must be taken if the patient has IV line, urinary catheter
etc.
 Assisting with Crutch Walking
Assisting patient to walk using crutches while providing
support and balance and as a convenient method of getting
from one place to another.

Types of Crutches:
Axillary Crutch
Loftstand crutch – it has a handgrip and metal band that fits
around the patient’s forearm.
Platform crutch – it is used by the patients who are unable to
bear weight on their wrists.
 Purposes
1. To improve balance
2. To either relieve weight bearing fully or partially on a lower
extremity.
3. To increase the base of support
4. To improve lateral stability
5. To permit functional ambulation while maintaining a
restricted weight bearing status.
 Crutch Measurement:
1. The client lies in supine position and the nurse measures from the
anterior fold of the axilla to the heel of the foot and add 2.5 cm
(1in.)
2. The client stands erect and the shoulder rest of the crutch is at
least three fingerwidths, approximately 2.5 to 5 cm (1 to 2 in.)
below the axilla.
To determine the correct placement:
1. The client stands upright and supports the body weight by the
hand grips of the crutches.
2. The nurse measures the angle of elbow flexion about 30 degrees
using goniometer.
Crutch Gaits – is the gait a person assumes on crutches by alternating
body weight on one legs and the crutches.
 Procedure
Review patient’s chart. Medical history, previous and current
activity.
Assess patient’s physical readiness: Vital signs, orientation to time,
place and person.
Assess patient for any visual, perceptual, or sensory deficits.
Place bed in low position and slowly assist patient to upright
position, let patient sit or stand for a few minutes until balance is
gained.
Assist patient in crutch walking by choosing appropriate gait.
Four point gait: This is the most stable of crutch gaits because it
provides at least 3 points of support at all times.
• Begin in tripod position: crutches are placed 6 inches in front and
6 inches to side of each foot.
• The right crutch is advanced 10-15 cm. (4-6 in.)
• The left front foot forward, preferably to the level of left crutch.
• Move the left crutch forward. Move the right foot forward.
Three point gait
• The client must be able to bear the entire body weight on
affected leg the nurse asks the client to:
1. Move both crutches and the weaker leg forward.
2. Move the stronger leg forward.
Swing to gait
• Used by patients whose lower extremities are paralyzed or
wear supporting braces on the legs.
1. Move both crutches forward.
2. Lift and swing leg crutches, letting crutches support body
weight.
3. Repeat previous steps.
• Swing through gait; requires that patient have the ability to
sustain partial weight bearing on both feet.
- Move both crutches forward
- Lift and swig legs through and beyond crutches.
 Assist patient in climbing stairs
1. Begin a tripod position
2. Patient transfers body weight to crutches
3. Patient advances unaffected leg to stair
4. Then advance affected leg and crutches
5. Repeat sequence until patient reaches top of stairs.
Assist patient in descending stairs with
crutches
• Begin in tripod position
• Patient transfer body weight to unaffected leg
• Move crutches to stairs and instruct patient to begin to
transfer weight to crutches and move affected forward.
• Patient moves unaffected leg to stair and align with crutches.
• Repeat sequence until stairs are descended.
• Record in nurse’s progress notes type of gait patient used,
amount of assistance required, distance walked, patient’s
tolerance of activity
 Special Consideration
• Inspect rubber tips on bottom of ambulation device
frequently.
• If wooden crutch is used, examine it for cracks.
• Remove obstacles from pathways. Avoid large crowds.
• Instruct patient to continue muscle strengthening exercise at
home.
• Teach patient with axillary crutches about the dangers of
pressure on the axillae.
• Instruct patient to routinely inspect crutch tips.
• Explain that crutch tips should remain dry.
Antiembolism Stocking
• Antiembolism stocking are often used for patient’s at risk for deep
vein thrombosis, pulmonary embolism, and to help prevent
phlebitis.
• It increases the velocity of blood flow in the superficial and veins
and improve venous valve function in the legs, promoting venous
return to the heart.
Size Measurement:
• Measure the length of bothe legs from the heel to the gluteal fold.
• Measure from the heel to popliteal space.
• Measure the circumference of each calf and thigh at the widest
point.
Pneumatic compression device – an air pump connecting
tubes,extremitiy sleeves.
 Procedure
• Apply antiembolic stockings before your patient stands in the
morning, when edema is less likely and legs elevate for 15-30
minutes to aid venous return.
• Gather equipment.
• Check order and assess the skin condition note any abnormalities
and latex allergy.
• Explain procedure, provide privacy and wash hands.
• Dust his ankles with talcum powder unless he has a breathing
problem or sensitivity.
• After application. Have the patient wear the stockings continuously,
but check his toes at least 4 hours or more often if he has edema.
• Remove stockings at least daily to provide skin care.
• Record the date and time you apply, the condition of legs, toes and
any complications such as cyanosis, coolness of skin indicate
impairment in circulation.