Body Mechanics Bed making & Comfort care

Certified Nursing Assistant

Body Mechanics
Involves good posture, balance, and using the strongest and largest muscles (shoulders, upper arm, hips and thighs) Body alignment (posture) head, trunk, arms, and legs are aligned Base of support is needed for balance (stand with feet apart for more balance) For good body mechanics:  Bend your knees and squat to lift an object  Hold items close to body

General Guidelines to Remember

Correct body alignment for patient Reduce friction and shearing between patients skin and sheets Get help from coworkers (team work) Encourage patients to assist with positioning Speak calmly and reassuringly to decrease anxiety Make allowances for special equipment such as oxygen tubing, IVs, urinary catheters, and tube feedings Think smart and plan your move

Principles of Body Mechanics

Use thigh muscles when lifting or moving, and keep back straight Turn with pivoting motion Hold load close to body Keep feet 12 inches apart to broaden support base Use signals to patient and coworker for immediate movement

Comfort and Positioning Devices

Pillows: support arms, head, or other body parts or to relieve pressure on them Folded or rolled towels or blankets are used like pillows for support  Trochanter rolls: are tucked along patients sides to keep hips and legs from turning out Bedboard: wooden board placed under the mattress for extra support Footboard: padded board placed upright at the foot of the bed. Soles of feet are placed flat against it Turning sheets: Used to move a helpless patient in bed

Body Positioning
Fowlers: (45-60 degree sitting up in bed (while eating/ reading)  Allow patients with breathing or heart problems to breathe better  Semi-fowlers: (3045 degree) helps prevent sliding down in bed Supine: lying flat on back Prone: lying flat on abdomen Lateral: side-lying Sims: partly sidelying and partly prone Trendelenburg: head of mattress is tilted (head is below the level of feet)

Body Positioning (Contd)

Reverse Trendelenberg:  mattress is tilted so the patients feet are below the level of the head


Support patients body so that it does not slip out of bed (pillow against head board)

Moving/turning Patient
Head of bed in raised position:  Patient may slide downward in bed


Position is uncomfortable Shearing forces can lead to skin breakdown Helpless patients as well as very heavy patients will require two workers

Turning a Patient
Points to remember:  Side-rails raised on side to which patient is turning  Consider how close the patient will be to the side rail once turned  Have the patient assist as much as possible


Crossing the patients legs will make task easier (if no hip problems Remember to adjust and extend equipment (IV) Check to be sure the new position does not interfere with the functioning of new equipment

Positioning patient in Chair

Out of bed will help:  patients muscle tone, exercise the joints, aid circulation, and prevent respiratory illnesses  provide skin protection devices: such as (pads to be placed on elbows, ankles, and heels)  transfer belt for weak or helpless patients


postural support prevent sliding: (jackets and pelvic supports). Check patient using supports frequently for comfort and breakdown Safety/body mechanics: if patient is heavy, unconsciousness

Preparing to Move
Sudden change from lying to sitting can cause a drop in blood pressure Dangling patients feet allow the patient to adjust for a few moments to being upright Watch for signs of dizziness and drop of blood pressure Help the patient back down, if dizziness does not go away after 1 or 2 mins Report problem to supervisor Never continue the move if patient feel dizzy

Transferring a Patient
Remember the following points when transferring from bed to chair:  the patient should wear footwear with nonskid soles to avoid slipping  always get help if the patient is unable to assist  cover vinyl-covered chair with a blanket or pillow for comfort


determine if patient has a weaker side. If so, allow patient to lead with the strong side CNA must bend at the hips and knees to help patient stand

Transferring a Patient (Contd)

Transfer belt: supports a patient during transfer When using a transfer belt:  Make sure the belt is around patients waist


Insert two fingers between the belt and the patients clothing Be sure the buckle is fastened securely

Transferring a Patient (Contd)

From bed to a stretcher:
 

From stretcher to bed:



Get help: (two coworkers) Use safety devices: always attach safety straps once the patient is positioned Use turning sheets: always use three workers

Lock both bed and stretcher wheels before transfer. Head of bed in flat position Raise bed to same height as stretcher before transfer Cover patient with bath blanket to prevent exposure

Mechanical Lift
Electric or hydraulic device: used to perform transfers with helpless or very heavy patients One worker assistance required before lifting Make sure you are familiar with your facilitys policy and procedures

Transporting a Patient
Several guidelines include:  Reassure the patient
    

Be aware of special equipment safety devices Safeguard extremities Cover the patient Stay with the patient; Move safely

Assisting with Ambulation

Ambulation equipment:
Cane: used by patients who have weakness on one side of body Walker: lean on walker for support as one leg and then the other is moved forward (physical therapist involved) Crutches: used when a patient needs to lessen the weight borne by one or both legs Gait belt: (transfer belt): used for a patient who is just beginning to ambulate or who is weak or unsteady

Assisting with Ambulation (Contd)

Safety Guidelines:  Check equipment for good repair (check rubber tips for cracks and bolts for looseness)  Always explain the ambulation procedure ahead of time  Make sure all devices are fitted properly to the patient Make sure the tips of walking aids are placed flat on floor Make sure the patient is not placing the walker too far ahead Nonskid shoes or slippers fit well and are in good repair Watch for signs of patient discomfort or fatigue. Provide places to sit and rest

Falling Patient
Patient may fall for a number of reasons:  Dizziness or lightheadedness  Fainting  Slipping on spilled liquids, waxed floors, or throw rugs  Stumbling or tripping over objects such as improper foot wear, improperly worn or illfitting clothing, or environmental obstacles  Patients who are just rising to stand or those who are just beginning to ambulate

Falling Patient (Contd)

Care of a falling patient:  Maintain wide base of support and keep your back straight (use leg muscles)  Draw falling patient close to you.  If a gait belt is on, use it to pull patient to you  Lower patient to the floor as gently as possible  Call for help. Do not leave the patient  Return to bed with assistance, after patient is examined  Position comfortably, raise the side rails if necessary  Place signal cord where patient can reach it

Methods of Bedmaking
Four basic methods:  Closed bed: made after a patient leaves. The top will stay closed until a new patient is assigned to the unit  Open bed: made for a new patient or for a patient who will be out of bed for only a short time  Occupied bed: used when a patient is bed confined.  Surgical bed: prepared for a patient who is returning to the unit after surgery. Made to ease the transfer between stretcher and bed

Hygiene & Grooming

These activities include:  Dressing and undressing  Bathing  Shampooing the hair  Oral hygiene


Hair care Back care Shaving Nail care

Hygiene & Grooming (Contd)

Oral hygiene involves keeping the mouth and teeth clean. Proper cleansing helps:  Prevent bad breath and infections  Prevent cavities, tooth decay, and gum disease  Increase the patients comfort and appetite Report to the nurse:  Extremely bad breath  Bleeding  Loose or broken teeth  Damaged dentures  Sores in or around mouth  A coated tongue  Complaints of discomfort

Hygiene & Grooming (Contd)

Back rubs:
   

Stimulate the patients circulation Prevent skin breakdown Soothe and refresh the patient Given before patient goes to bed, changing the position of a patient, to relax muscles, or when a physician orders special back care

Guidelines:  Keep fingernails short to prevent scratching patient  Warm lotion before applying, and use long, smooth strokes for relaxation  Use short, circular strokes to stimulate  Rub for about 3 to 5 minutes; Report reddened or broken areas

Hygiene & Grooming (Contd)

Four main types of bathing:  Complete bed bath


Partial bed bath Tub bath Shower

Bathing the patient (Contd)

Bathing guidelines:  Provide privacy at all times  Close windows, drapes, and doors to reduce drafts  Keep patient covered with bath blanket for privacy  Use good body mechanics for yourself and patient


Keep the water temperature at your facility (105) Rinse the patient completely, and Pat skin dry. Dont rub; Apply lotion to dry skin areas t Report redness, rashes, broken skin, or tender places to your supervisor

Eyeglasses and Hearing Aids

CNA will be responsible for:
    

Encouraging patient to wear them Marking the containers with patients name Keeping eyeglass clean and storing them within easy reach, when not in use Helping patients insert their hearing aids Caring for hearing aids by checking the batteries regularly, wax build-up, keeping them away from moisture and heat, and storing them properly in containers when theyre not in use

Special Skin Care

Decubitus ulcers: bones lie close to the skin surface (pressure points) These points include:  Toes, heels, ankles, and knees  Elbows and shoulder blades  Spine, especially the tailbone area  Back of the head over the ears Ulcers also develop where body parts rub together. These areas are:  Under the breasts  Between folds of abdomen  Between the buttocks  Between the thighs

Skin Breakdown
Four stages include:  Stage one: redness lasting longer than 30 minutes  Stage two: skin is reddened with blister like lesions, or skin surface is broken  Stage three: layers of skin destroyed and a deep crater has formed.  Stage four: skin and other tissue is eroded, to where muscles and bone can be seen Care of skin breakdown include:  Removing all pressure from area  Massaging the skin surrounding the affected area  Keeping area clean and dry; Keeping broken skin covered  Washing the area, or removal of dead tissue can be ordered by an MD

Prevention Devices
A specialty bed: turns the patient without friction An electrically operated alternating pressure mattress Bed cradles: relieves pressure Gel-filled flotation pads or cushions for chairs or wheelchairs Foam rubber or sheepskin heel and elbow protectors A foam mattress or wheel chair cushion (egg crate) Sheepskin or foam padding: shields the skin

Rest and Sleep

Vital to physical and mental well being  Patterns of sleep varies from person to person  Pain or anxiety alters sleep  Older people tend to sleep more lightly and often awake un-rested Help patients by:  Encouraging them to rest or sleep  Provide a comfortable, relaxed environment, and leave them alone when they appear tired  Be considerate and careful about noise

AM and PM Care
AM care: PM care:  performed when the  Care performed patient first awakens in before patients go to the morning sleep  To awaken patient, gently  Measures will help to place your hand on the promote patients patients arm and say comfort and patients name relaxation (backrub)  Do not awaken patients  Straighten the bed early if they cannot eat linen, and assist the due to surgery or patient with finding a diagnostic tests comfortable position  Offer a bedpan or urinal  Turn off the lights