4 TYPES OF POSITIONING:

1. SUPINE/DORSAL RECUMBENT
- flat in bed, face up towards the ceiling, back or spine aligned in bed

MATERIALS:
*3 pillows
*3 trochanter rolls
*2 flat trochanter
*2 hand rolls
*footboard

Corrective measure Problem to be solved

1. client on back, supine, in straight alignment *exaggerated curvature of spine
(on firm supportive mattress) *FLEXION of hips
2. pillow under head, neck, and upper shoulder FLEXION contracture/extension of neck

3. arms elevated with pillows (prone hand) *INTERNAL ROTATION of shoulders

*EXTENSION of elbows
4. hand rolls *EXTENSION of fingers
*ABDUCTION of thumb
5. trochanter rolls along hips and upper thigh EXTERNAL ROTATION of femur
6. trochanter roll between legs INTERNAL ROTATION of femur

7. flat trochanter under knees HYPER EXTENSION of knees

8. flat trochanter under heel Pressure sore on heel

9. footboard *PLANTAR FLEXION

*footdrop

2. FOWLER’S/SEMI-SITTING
-trunk and head elevated in bed from 45°-60°, bended knees with pillow underneath for support
- the position of choice for people who have difficulty breathing and for some people with heart problems
- COMMON ERROR OF NURSES-----> placing an overly large pillow or more than one pillow
- Semi-Fowler’s (15°- 45°)
- High Fowler’s (60°-90)

MATERIALS:
*1 small pillow
*2 big pillows
*3 trochanter rolls
*1 flat trochanter
*2 hand rolls
*footboard

Corrective measure Problem to be solved

1. client on back, supine

2. elevate head over 15° (angle of elevation exaggerated curvature of spine

starts at the HIPS)
3. small pillow on head Contracture of neck

4. arms elevated with pillows (prone hand) *DISLOCATION of shoulder

*FLEXION CONTRACTURE of wrist
*EDEMA of hands
 5. hand rolls *EXTENSION of fingers
*ABDUCTION of thumb
6. trochanter rolls along hips and upper thigh EXTERNAL ROTATION of femur
7. trochanter roll between legs INTERNAL ROTATION of femur

8. flat trochanter under heel Pressure sore on heel

9. footboard *PLANTAR FLEXION

*footdrop

3. SIDE LYING
- left or right side flat in bed, pillow on the opposite side for support, usually with straight body alignment, with or without
supporting pillow
- the greater the flexion of the top hip and knee, the greater the stability and balance in this position
- reduces lordosis and promotes good back alignment
- good for resting and sleeping clients.
- helps to relieve pressure on the sacrum and heels

MATERIALS:
*4 pillows
*2 hand rolls
*footboard

Corrective measure Problem to be solved

1. client on side

2. pillow under head and neck LATERAL FLEXION of head

3. pillow at the back, under tuck *MISALIGNMENT of spine
*danger of falling backward
4. flex top arm, rest on pillow *INWARD ROTATION of arm
*interference with respiration/breathing

5. hand rolls *EXTENSION of fingers

*ABDUCTION of thumb
6. flex top leg, rest on pillow (in between 2 legs) *INTERNAL ROTATION of femur
*ADDUCTION of femur

7. footboard *PLANTAR FLEXION

*footdrop

4. PRONE
- chest and abdomen flat in bed, face on the side, back and spine towards the ceiling
- promotes drainage from the mouth and is especially useful for unconscious clients or those clients recovering from
surgery of the mouth or throat
- NOT recommended for people with problems of the cervical or lumbar spine, respiratory, and heart
- can cause plantar flexion
- used only for a short period of time

MATERIALS:
*1 big pillow
*1 small pillow (for abdomen)
*2 small towels (optional)
*3 trochanter rolls
*2 flat trochanter
*2 hand rolls
*footboard

Corrective measure Problem to be solved

1. client on abdomen

2. pillow on side of head, head facing sideways FLEXION of cervical spine

3. straighten spine HYPER EXTENSION of spine

4. folded towel under shoulders (optional) Added comfort

5. flex arms at elbow, rest by head Added comfort

6. flat trochanter/pillow under abdomen *Added comfort

*facilitates breathing
6. hand rolls *EXTENSION of fingers
*ABDUCTION of thumb
6. trochanter rolls along hips and upper thigh EXTERNAL ROTATION of femur
7. trochanter roll between legs INTERNAL ROTATION of femur

8. flat trochanter under ankles Pressure sores

9. footboard *flexion
*footdrop

Activity-exercise pattern - a person’s routine of exercise, activity, leisure, and recreation.

INCLUDES:
*activities of daily living (ADLs) that require energy expenditure (ex: hygiene, dressing, cooking, shopping, eating, working,
and home maintenance)
*the type, quality, and quantity of exercise, including sports.

Mobility - the ability to move freely, easily, rhythmically, and purposefully in the environment

Intervention with contractures of both lower extremities

-Range of motion exercises to prevent worsening of contractures

Newly pregnant client exercises

-Exercise at least 30 minutes on most if not all days

Intervention most applicable for the client with early Osteoporosis

*encourage daily weight-bearing exercises like walking (improves bone density and reduces risk for fall)
*strength training (to improve muscle mass and strength)
*environmental safety (removing fall hazards at home)
*use assistive devices (canes, walkers)

Osteoporosis
- common in older women and primarily affects the weight-bearing joints of the lower extremities and the anterior aspects of
spinal bones, causing compression fractures of the vertebrae and hip fractures

Body mechanics
-the efficient, coordinated, and safe use of the body to move objects and carry out the ADLs.

PRINCIPLES OF BODY MECHANICS:

1. Balance is maintained and muscle strain is avoided as long as the line of gravity passes through the base of support.
2. The wider the base of support and the lower the center of gravity, the greater the stability.
3. The closer the line of gravity to the center of the base of support, the greater the stability
4. Objects that are close to the center of gravity are moved with the least effort.
5. Balance is maintained with minimal effort when the base of support is enlarged in the direction in which the movement will
occur.

4 BASIC ELEMENTS OF BODY MECHANICS:

1. Body alignment/Posture
-Brings body parts into a position that promotes optimal balance and body function
-Balance maintained as long as line of gravity passes through center of gravity and base of support

2. Joint mobility
- Flexors stronger than extensors
-Without exercise, joints flex, muscles shorten, joints may become permanently flexed (contracture)
-Range of motion (ROM) is maximum movement possible for joint

ROM IS DETERMINED BY:

*Genetic make-up
*Developmental patterns
*Presence or absence of disease
*Physical activity

TYPES OF ROM: (a.k.a. exercises)

1. Active ROM - the patient performs the exercises himself
2. Active-assisted ROM - done by the patient with the nurse’s assistance
3. Passive ROM - patient unable to do the exercise by himself and the nurse helps the patient to perform the exercise.
4. Resistive ROM - when the patient is performing the exercises, and someone resist the movement

TYPES OF JOINT MOBILITY:

1. Flexion - Decreasing the angle of the joint
2. Extension - Increasing the angle of the joint
3. Hyperextension - Further extension or straightening of a joint
4. Abduction - Movement of the bone away from the midline of the body
5. Adduction - Movement of the bone toward the midline of the body
6. Rotation - Movement of the bone around its central axis
7. Circumduction - Movement of the distal part of the bone in a circle while the proximal end remains fixed
8. Eversion/External rotation- Turning the sole of the foot outward by moving the ankle joint
9. Inversion/Internal rotation - Turning the sole of the foot inward by moving the ankle joint.
10. Pronation - Moving the bones of the forearm so that the palm faces downward when held in front of the body
11. Supination - Moving the bones of the forearm so that the palm faces upward when held in front of the body

3. Balance
- A person maintains balance as long as the line of gravity passes through the center of gravity and the base of support

Line of gravity
- an imaginary vertical line drawn through the body’s center of gravity
- begins at the top of the head and falls between the shoulders, through the trunk, slightly anterior to the sacrum, and
between the weight-bearing joints and base of support
Center of gravity
- the point at which all of the body’s mass is centered or concentrated (ex: waist line level)
Base of support - the foundation on which the body rests (ex: when standing (feet), when sitting (buttocks), when lying supine
(spinal column)
Proprioception - awareness of posture, movement, and changes in equilibrium and the knowledge of position, weight, and
resistance of objects in relation to the body.

4. Coordinated Movements - Balanced, smooth, purposeful

RESULT OF PROPER FUNCTIONING OF:
*Cerebral cortex - initiates voluntary movement
*Cerebellum - coordinates motor activity
*Basal ganglia - maintains posture

TYPES OF EXERCISES:
1. According to the type of muscle contraction:
a. Isotonic/Dynamic
- Muscle shortens to produce muscle contraction and active movement
- Increases muscle tone, mass, and strength
- Maintains joint flexibility and circulation
- Heart rate (HR) and cardiac output (CO) quicken to increase blood flow
b. Isometric/Static/Setting
- Muscle contraction without moving the joint (muscle length does not change)
- Involves exerting pressure against a solid object
- Produces a mild increase in HR and CO
- No apparent increase in blood flow to other parts of the body
c. Isokinetic/Resistive
- Muscle contraction or tension against resistance
- Can be isotonic or isometric
- Person moves (isotonic) or tenses (isometric) against resistance
- Increases blood pressure and blood flow to muscles
2. According to the source of energy:
a. Aerobic
- Activity during which the amount of oxygen taken into the body is greater than that used to perform the activity
- Improves cardiovascular conditioning and physical fitness
- Intensity measured by: target heart rate, talk test, Borg scale of perceived exertion
b. Anaerobic
- Activity in which muscles cannot draw enough oxygen from the bloodstream
- Anaerobic pathways are used to provide additional energy for a short time
- Used in endurance training for athletes

Orthopneic position
- the client sits either in bed or on the side of the bed with an overbed table across the lap
- this position facilitates respiration by allowing maximum chest expansion
- place client on this position if they have dyspnea (difficulty breathing)

Dorsal Recumbent position

- the client’s head and shoulders are slightly elevated on a small pillow
-this position and supine position are used interchangeably

Preventing back injury

- avoid lifting more than 35 lbs
- use assistive devices
- no solo lifting of clients is permitted in the facility
- when sitting, keep knees higher than hips
- avoid movements that cause pain or require spinal flexion with straight legs or spinal rotation
- use firm mattress

ROM OF HAND AND ARM (refer to pic on slides)

EFFECTS OF IMMOBILITY:
*Paresis – paralysis
*Spastic – having too much muscle tone
*Flaccid – having too little muscle tone

EFFECTS OF IMMOBILITY ON THE MUSCULOSKELETAL SYSTEM:

*Disuse osteoporosis – bone demineralization from lack of use
*Disuse atrophy – muscle atrophy from lack of use
*Contractures - permanent shortening of the muscle)
*Joint pain and stiffness

EFFECTS OF IMMOBILITY ON THE CARDIOVASCULAR SYSTEM:

* Orthostatic hypotension (Postural hypotension)
- Decrease in blood pressure when moving from supine to standing
-can be due to dehydration as well
*Diminished cardiac reserve
*Increased use of Valsalva maneuver
Valsalva maneuver - holding the breath and straining against a closed glottis. (ex: clients tend to hold their breath
when attempting to move up in a bed or sit on a bedpan)
*Venous vasodilation and stasis
*Dependent edema - most likely to occur around the sacrum or heels of a client who sits up in bed or in the feet and lower
legs of a client who sits in a chair
*Thrombus formation
Thrombophlebitis - a clot that is loosely attached to an inflamed vein wall
thrombus - clot
Embolus - an object that has moved from its place of origin, causing obstruction to circulation elsewhere

Bandaging
-the process of covering a wound or an injured part.
Bandage
-It is a strip of material used mainly to support and immobilize a part of the body
- a piece of cloth or other material used to bind or wrap a diseased or injured part of the Body
Dressing
- a sterile pad or compress applied to a wound to promote healing and protect the wound from further harm
- designed to be in direct contact with the wound, as distinguished from a bandage, which is most often used to hold a
dressing in place

PURPOSE OF BANDAGES:
1. Hold a dressing in place over an open wound
2. Apply direct pressure over a dressing to control bleeding
3. Prevent or reduce swelling
4. Provide support and stability for an extremity or joint
5. A bandage should be clean not sterile

PARTS OF A TRIANGULAR BANDAGE:

1. Base - longest side
2. Apex/Point - the corner directly opposite the middle of the base
3. End – the other 2 corners
4. Side – connects the ends to the apex
5. Body - the center of the triangular bandage

Splint
- a rigid or flexible device that maintains in position a displaced or movable part
- used to keep in place and protect, immobilize an injured part, restrict motion in a part