Key Takeaways
- Use proper body mechanics: wide base, bend at knees, keep load close, avoid twisting
- Reposition immobile patients at least every 2 hours to prevent pressure injuries
- High Fowler's or orthopneic position is best for respiratory distress
- Use the Braden Scale to assess pressure injury risk
- Support joints above and below during ROM exercises; never force movement
Mobility and Positioning
Mobility and proper positioning are essential nursing interventions that prevent complications, promote healing, and maintain patient independence. LPN/VNs must understand body mechanics, positioning techniques, and mobility assessment to provide safe patient care.
Principles of Body Mechanics
Body mechanics refers to the efficient use of the body to produce motion while preventing injury.
| Principle | Application |
|---|---|
| Wide Base of Support | Keep feet shoulder-width apart, staggered stance |
| Lower Center of Gravity | Bend at knees and hips, not the waist |
| Keep Load Close | Hold patient/object close to your body |
| Use Large Muscle Groups | Use legs and arms rather than back |
| Avoid Twisting | Turn with your feet, move as a unit |
| Push, Don't Pull | Pushing uses less energy and reduces strain |
Patient Positions
Common therapeutic positions serve specific purposes:
| Position | Description | Indications |
|---|---|---|
| Supine (Dorsal Recumbent) | Lying flat on back | Assessment, rest, post-procedure |
| Prone | Lying on stomach, head turned | ARDS, pressure relief to posterior, promotes lung expansion |
| Lateral (Side-Lying) | Lying on side with support | Pressure relief, unconscious patients, prevents aspiration |
| Fowler's | HOB elevated 45-60 degrees | Cardiac/respiratory distress, eating, conversation |
| Semi-Fowler's | HOB elevated 30-45 degrees | Tube feeding, post-surgery, mild respiratory issues |
| High Fowler's | HOB elevated 60-90 degrees | Severe respiratory distress, thoracentesis |
| Trendelenburg | Head lower than feet | Shock (controversial), venous access, some surgeries |
| Reverse Trendelenburg | Feet lower than head | Gastric reflux prevention, post-brain surgery |
| Sims' (Semi-Prone) | Between lateral and prone | Rectal procedures, unconscious patients |
| Lithotomy | Supine with legs in stirrups | Pelvic exams, catheterization, childbirth |
| Orthopneic | Sitting, leaning forward on table | Severe breathing difficulty, COPD exacerbation |
Pressure Injury Prevention
Immobility is the primary risk factor for pressure injuries (pressure ulcers/bedsores).
High-Risk Areas:
- Sacrum and coccyx
- Heels
- Occiput (back of head)
- Scapulae
- Elbows
- Greater trochanters
- Malleoli (ankles)
Prevention Strategies:
- Reposition every 2 hours (or more frequently for high-risk patients)
- Use pressure-redistributing surfaces (specialty mattresses, cushions)
- Keep skin clean and dry
- Minimize friction and shear during transfers
- Maintain adequate nutrition and hydration
- Use barrier creams for incontinence
- Perform regular skin assessments
Braden Scale is used to assess pressure injury risk:
- Score ≤ 18 = At risk
- Score ≤ 15 = Moderate risk
- Score ≤ 12 = High risk
- Score ≤ 9 = Very high risk
Mobility Aids and Assistive Devices
| Device | Purpose | Nursing Considerations |
|---|---|---|
| Cane | Mild balance/stability issues | Held on stronger side, moves with weak leg |
| Walker | Moderate balance support | Move walker first, then step into it |
| Crutches | Non-weight-bearing or partial weight-bearing | Proper axillary pad placement (2-3 finger widths below axilla) |
| Wheelchair | Limited mobility/endurance | Lock wheels before transfer, remove footrests |
| Hoyer Lift | Dependent transfers, heavy patients | Check sling condition, ensure proper positioning |
Range of Motion (ROM) Exercises
ROM exercises maintain joint flexibility and prevent contractures:
- Active ROM (AROM) - Patient moves joints independently
- Active-Assisted ROM (AAROM) - Patient moves with nurse assistance
- Passive ROM (PROM) - Nurse moves patient's joints (for immobile patients)
Key Points:
- Support the limb above and below the joint
- Move joints through full, pain-free range
- Perform each movement 3-5 times
- Never force a joint beyond comfortable range
- Stop if patient reports pain
Transfer Techniques
Safe transfer requires assessment and planning:
- Assess patient's ability to assist
- Determine number of staff needed
- Use mechanical lifts for dependent patients
- Clear the path and lock all wheels
- Apply gait belt for ambulatory transfers
- Give clear, simple instructions
- Allow patient to assist as much as possible
An LPN/VN is repositioning a patient. Which action demonstrates proper body mechanics?
How often should an immobile patient be repositioned to prevent pressure injuries?
A patient is having severe difficulty breathing. Which position should the LPN/VN place the patient in?