Study Tips
Body Mechanics
Proper body movements in daily activities, the prevention and correction of problems,
associated with posture, and the enhancement if coordination and endurance.
OSHA - recommends a no lift policy. It recommends using lift and transfer aids such
as slick boards, roller boards, Hoyer lifts, etc
Good Body Mechanics include:
· Wide set base
· Bends at the knees
· Keep objects close to your body
· Move with the pt. do not bend or twist when moving pt.
· Assess need of help
ROM - Range of Motion
Extent of movements of which a joint is normally capable.
When a pt. does ADL’s they are using ROM to keep joints active.
If a pt. is unable to perform ADL’s it is the nurses responsibility to do ROM.
Active ROM – pt. does it themself
Passive ROM – is when the nurse performs ROM
Allow the pt. to do as much as possible
Exercises should be start ASAP, due to quick onset of changes to ROM, with
immobility.
· Flexion – ex chin to chest
· Extension – ex straightening arms
· Lateral Extension – headed to shoulder
· Rotation – neck rolls
· Circumduction – arm circles
· Abduction – moving away the body
· Adduction – moving toward the body
· Supination – palms up
· Pronation – palms down
· Dorsal flexion – toes towards the face
· Planter flexion – pointed toes
Positioning
Prone – lying on stomach
Supine – lying on back
Fowler’s – sitting up 15-30 degrees
Semi Fowler’s - sitting up at 45 degrees
High Fowler’s – sitting straight up
Lateral - lying on right or left side
Sims – side lying with top leg bent
Trendelenburg – head down, feet up
Reverse Trendelenberg – head up, feet down
Restraints
The patient has the right to be free of restraints that are not medically necessary. They
must not be used for convenience to the staff or punish the patient. Always involve the
family. Alternatives to restraints and less restrictive interventions have failed. All
alternatives used must be documented. Must have an order and cannot be on PRN
basis. Once the restraint is placed the patient needs to be monitored often. Vital signs
and patient must be observed every hour or according to the hospital policy. Physician
must reevaluate and assess the patient every 24 hours. Personal needs must be met.
Provide fluids, nutrition, and toileting assisting every 2 hours. Skin integrity and
ROM must be assessed every 2 hours. Documentation regarding why, how, where,
and for how long the restraints were placed and patient monitoring is vital. Restraints
can be applied to the hands, wrist, or ankles.
Different Restraints - Physical restraints, Chemical Restraints, Seclusion.
When applying restraint
Always ensure that the you can put two fingers between the restraint and the patient’s
extremities.
Always ensure you have an order for restraints.
This order needs to be renewed every 24 hours.
Maintain restrained extremity in the normal anatomical position.
Use a quick release know to tie restraint to the bed frame not the side rail. It needs to
be attached to a part of the bed that will move with the patient (i.e. bed frame)
Assess the patient every hour
Remove the restraint at least every 2 hours or according to agency policy or patient
need
Keep the call bed within patient’s easy reach.
BED MAKING
Unoccupied Bed
When – generally after a bath. Some facilities only change bed when soiled.
If the patient can get out of bed, it should be made when unoccupied. This task can be
delegated to nursing assistive personnel.
Steps:
1. Gather supplies: flat sheet, fitted sheet, draw sheet, blanket, pillow case, Chux,
hamper, bedside chair, and PPE
2. Assess pt. preference for a bed change, physical limitations, check for any
belongings in bed
3. Hand hygiene
4. Explain what you are doing
5. Adjust to the bed to a comfortable working height
6. Disconnect all tubes and call bells from linens
7. Loosen linens as you move around the bed and roll into a ball keep the fitted sheet
on the outside and deposit into a dirty laundry hamper. Do Not place on the floor.
8. Remove gloves
9. Then remake the bed starting with the fitted sheet followed by the draw sheet then
the flat sheet and blanket making hospital corners with the top sheet including toe
box. NO SHAKING the sheets or flipping them around.
10. Pillow case – gather the pillow case over one hand and firm grasp the corner of the
pillow and pull the case over the pillow. No shaking the pillows.
11. Turn down the top sheet over the blanket forming a cuff.
Occupied Bed
When - usually done after a bath or when linens are soiled.
Steps:
1.Gather supplies equipment well be the same
2. Assess pt. preference for linen change, check any precautions that may prevent a
linen change and personal belongings in the bed.
3. Hand hygiene.
4. ID pt. and explain procedure
5. Close curtain to allow for privacy
6. Adjust bed to comfortable work height
7. Apply Gloves
8. Place bath blanket over pt. and when covered remove top linens
9. Shift the mattress up if needed
10. Roll the patient to their side opposite of you.
11. Loosen all linens while moving around the bed,
12. Fan fold or roll up linens as close to patient as possible.
13. Use clean linens and make a bed roll. Careful to not touch linens to the ground or
contaminate them with the dirty linens.
14. Place bed roll onto bed and attach fitted sheet at the corners.
15. Unroll the clean sheet up to the dirty sheets.
16. Roll patient over the 2 large rolls.
17. Once the patient is lying on clean linens remove soiled and unroll clean linens and
continue to make bed as previously described
Once finished reposition pt. to position of comfort, put up side rails and place bed in
the lowest position.
Bed Baths
Some patient must remain in bed as part of the recovery process and cannot be moved
out of bed. Other patients are unable to ambulate thus requiring a bed bath to be
performed.
Partial bath – Pt. can do some of their own cleaning but require help for difficult to
reach areas. It can also refer to only washing the parts that absolutely must be cleaned.
Full bath is just that an entire bath to be done the bed.
You can delegate this to nursing assistive personnel, but lots of good assessment of
the skin can be done during a bath.
Equipment needed:
Wash basin and warm water
Soap, deodorant, lotion, etc.
Skin barrier as indicated
Towels
Washcloths
Bath blanket
Gown or PJ’s
Bedpan or urinal
Laundry bag
PPE (gloves)
Steps for a bed bath:
1. Assess the pt. for understanding of hygiene, physical limitations, ability to bathe
self.
2. Review chart for any limitations.
3. Assemble equipment
4. Provide privacy, adjust room temperature
5. Remove SCD, ted hose
6. Put on gloves and offer toileting
7. Change gloves.
8. Place a bath blanket over patient and remove all other top linens
9. Remove pt. gown
10. Place warm water and soap into basin.
11. Create a mit.
12. Lay a towel on chest
13. Cleanse eyes with water only on soap starting at the inner eye and sweeping out
the outer eye. Rinse and turn cloth before cleansing the other eye
14. Place a towel under arm, has the hand, arm then axilla, RINSE and DRY then
move to the opposite arm.
15. Then wash the chest then abdomen with attention to the fold and under breast
16. Move to the legs starting with the ankle and moving up
17. Wash the feet, pay attention to the area between the toes.
18. Roll on to back and clean back paying attention to the sacral area.
19. Clean the Perianal area last.
20. Replace clean gown, Change linens if needed.
21. Upon completion place patient in the position of comfort, side rails up, bed in
lowest position and call light within reach.