Chapter 16 Moving and Positioning Patients Hazards of Immobility Blood clots, Pneumonia, Bone demineralization, Kidney stones Body Systems Affected by Immobility Musculoskeletal Atrophy Footdrop Contractures Osteoporosis Preventing Musculoskeletal Complications Maintain proper body alignment Keep the head, trunk, and hips in a straight line Prevent the legs from rotating in the hip socket medially or laterally Maintain arms in correct alignment with the shoulders Nursing Actions to Prevent Contractures and Osteoporosis Perform ROM exercises every 8 hours Support the weight of the extremity at the joints Apply any supportive or therapeutic devices for maintaining body alignment Footdrop splint, Trochanter roll, Foot board, Footdrop boots Assist with ambulation as soon as orders permit Body Systems Affected by Immobility Cardiovascular Orthostatic hypotension (postural hypotension) Syncope Blood clots (embolus/thrombus) (Venous thromboembolism (VTE)) Pulmonary embolus (PE) Myocardial infarction (MI) Cerebrovascular accident (CVA Embolus is found to be the most preventable cause of death during hospitalization.) Nursing Measures to Prevent Cardiovascular Complications Encourage the movement of extremities Apply ordered devices to prevent pooling of blood in the legs Gradually move the patient from lying to sitting or to a standing position Change the patient’s position frequently Remain with the patient the first few times getting out of bed and dangling Body Systems Affected by Immobility Respiratory, Atelectasis, Hypoxemia, Hypostatic pneumonia, & (HAIs) Nursing Measures to Prevent Respiratory Complications Turn the patient from side to side every 2 hours, Elevate the head of the bed 45 degrees, Encourage coughing and deep breathing AND Encourage use of the incentive spirometer Body Systems Affected by Immobility Gastrointestinal: Constipation, Flatulence, Distention Nursing Measures to Prevent Gastrointestinal Complications Assist the patient with early ambulation-peristalsis Reposition the patient every 2 hours; encourage ROM exercises Place the patient in a sitting position on the bedpan Inquire about food likes and dislikes and plan balanced meals Encourage fiber and fluid intake Administer a laxative or stool softener PRN Body Systems Affected by Immobility Urinary Urinary tract infection OR Renal calculi Nursing Measures to Prevent Urinary Complications Encourage fluids to prevent concentrated urine Assist female patients to urinate in a sitting position Assess the patient’s output Body Systems Affected by Immobility Integumentary Pressure Injuries Nursing Measures to Prevent Integumentary Complications Provide adequate nutrition Reposition the patient every 2 hours Inspect bony prominences for redness every 2 hours and massage the area around the redness Use mild soaps for cleansing skin Provide an appropriate surface for the patient Shearing-patient positioning Skin pulled across muscle and bone in one direction while the skin slides over another surface, such as a bed sheet Body Systems Affected by Immobility Neurological Compression neuropathy Footdrop Impaired LOC Confusion Nursing Measures to Prevent Neurological Complications Determine the patient’s level of consciousness by asking specific questions relating to person, place, and time Use a footboard to keep feet in a natural position Perform neurological checks Provide clues in the room to the correct date and time Psychological Effects of Immobility Depression Anxiety Hostility Fear Isolation Restriction of self-image and independence Sensory deprivation Difficulty sleeping Nursing Measures to Prevent Psychological Complications Minimize sensory deprivation Involve patient senses when with the patient Encourage the patient to remain awake during the day and do as much for the self as possible Allow the patient to express concerns Encourage visits from family and friends Position of Function Places the extremities in alignment Maintains the potential for their use and movement Helps prevent undue pressure on the nerves Helps prevent discomfort, pain, and nerve damage Uses devices including pillows, hand rolls, arm boards, and foot boards Common Patient Positions Supine: Lying on back, arms at side Dorsal recumbent: Lying on back, arms at sides, legs apart, knees bent, feet flat Trendelenburg: Lying on back, arms at side, feet higher than head Reverse Trendelenburg: Lying on back, arms at side, head higher than feet Lateral: Lying on back or right side, supported by pillows Common Patient Positions (cont.) Left Sims: Left side semi-prone, right leg drawn up to chest, left arm along patient back Right Sims: Right side semi-prone, left leg drawn to chest, right arm along patient back Low, semi-, and high Fowler’s: Semi-sitting with various degrees of head elevations Orthopneic: Sitting upright, leaning slightly forward, arms supported on overbed Prone: On stomach with head to side Lithotomy: On back, legs in stirrups Log rolling Transfer belts Devices Used to Move Patients Nylon friction reducing devices Slide boards Partial or full weight-bearing assist devices Overhead ceiling lift devices Support Surfaces and Specialty Beds (p. 286-287) Mattress overlays Specialized mattresses Specialty beds Air-fluidized bed Low air-loss bed Combination air-fluidized and low air-loss bed Continuous lateral-rotation bed Positioning Devices (p. 290) Box 16.3 Table 16.4 Pillow, Arm board, Blanket roll, Hand roll, Foot splint, Stirrups, and Trochanter roll
