cna body mechanics bed making comfort care
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Body Mechanics
Bed making & Comfort care
Certified Nursing Assistant
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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
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General Guidelines to
Remember
Correct bodyalignment for patient
Reduce friction andshearing betweenpatients skin andsheets
Get help from
coworkers (team work) Encourage patients to
assist with positioning
Speak calmly andreassuringly todecrease anxiety
Make allowances forspecial equipmentsuch as oxygen tubing,IVs, urinary catheters,and tube feedings
Think smart and planyour move
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Principles of Body Mechanics
Use thigh muscles
when lifting or
moving, and keepback 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
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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: aretucked 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
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Body Positioning
Fowlers:
(45-60 degree sittingup in bed (while
eating/ reading) Allow patients
with breathing orheart problems tobreathe better
Semi-fowlers: (30-45 degree) helpsprevent slidingdown in bed
Supine: lying flat onback
Prone: lying flat onabdomen
Lateral: side-lying
Sims: partly side-lying and partlyprone
Trendelenburg:head of mattress istilted (head is belowthe level of feet)
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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)
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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 heavypatients will require two workers
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Turning a Patient
Points to remember:
Side-rails raisedon side to which
patient is turning Consider how
close the patientwill be to the siderail once turned
Have the patientassist as much aspossible
Crossing thepatients legs willmake task easier (if
no hip problems Remember to
adjust and extendequipment (IV)
Check to be sure
the new positiondoes not interferewith the functioningof new equipment
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Positioning patient in Chair Out of bed will help:
patients muscle tone,exercise the joints,aid circulation, and
prevent respiratoryillnesses
provide skinprotection devices:such as (pads to be
placed on elbows,ankles, and heels)
transfer belt for weakor helpless patients
postural supportprevent sliding:(jackets and pelvicsupports).
Check patient usingsupports frequentlyfor comfort andbreakdown
Safety/body
mechanics: if patientis heavy,unconsciousness
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Preparing to Move
Sudden change from lying to sitting can cause
a drop in blood pressure
Dangling patients feet allow the patient toadjust for a few moments to being upright
Watch for signs of dizziness and drop of blood
pressure
Help the patient back down, if dizziness doesnot go away after 1 or 2 mins
Report problem to supervisor
Never continue the move if patient feel dizzy
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Transferring a Patient Remember the following points
when transferring from bed to
chair:
the patient should wear
footwear with nonskid solesto avoid slipping
always get help if the
patient is unable to assist
cover vinyl-covered chair
with a blanket or pillow forcomfort
determine if patient
has a weaker side. If
so, allow patient to
lead with the strongside
CNA must bend at the
hips and knees to
help patient stand
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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
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Transferring a Patient (Contd) From bed to a stretcher:
Get help: (two co-workers)
Use safetydevices: alwaysattach safetystraps once thepatient ispositioned
Use turningsheets: alwaysuse three workers
From stretcher to bed:
Lock both bed andstretcher wheels
before transfer.Head of bed in flatposition
Raise bed to sameheight as stretcherbefore transfer
Cover patient withbath blanket toprevent exposure
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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
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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
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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 legand then the other is moved forward (physicaltherapist involved)
Crutches: used when a patient needs to lessenthe weight borne by one or both legs
Gait belt: (transfer belt): used for a patient whois just beginning to ambulate or who is weak orunsteady
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Assisting with Ambulation
(Contd) Safety Guidelines:
Check equipment forgood repair (check
rubber tips for cracksand bolts forlooseness)
Always explain theambulation procedure
ahead of time Make sure all devices
are fitted properly tothe patient
Make sure the tips ofwalking aids are placedflat on floor
Make sure the patientis not placing thewalker too far ahead
Nonskid shoes orslippers fit well and are
in good repair Watch for signs of
patient discomfort orfatigue. Provide placesto sit and rest
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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 ill-
fitting clothing, or environmental obstacles
Patients who are just rising to stand or those
who are just beginning to ambulate
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Falling Patient (Contd) Care of a falling patient:
Maintain wide base of support and keep yourback 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
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Methods of Bedmaking Four basic methods:
Closed bed: made after a patient leaves.The top will stay closed until a new patient isassigned to the unit
Open bed: made for a new patient or for apatient who will be out of bed for only a shorttime
Occupied bed: used when a patient is bedconfined.
Surgical bed: prepared for a patient who isreturning to the unit after surgery. Made toease the transfer between stretcher and bed
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Hygiene & Grooming
These activities
include:
Dressing and
undressing Bathing
Shampooing the
hair
Oral hygiene
Hair care
Back care
Shaving
Nail care
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Hygiene & Grooming (Contd)
Oral hygiene involveskeeping the mouth andteeth clean. Propercleansing helps:
Prevent bad breath andinfections
Prevent cavities, toothdecay, and gumdisease
Increase the patientscomfort and appetite
Report to the nurse:
Extremely badbreath
Bleeding
Loose or brokenteeth
Damaged dentures
Sores in or aroundmouth
A coated tongue Complaints of
discomfort
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Hygiene & Grooming (Contd)
Back rubs: Stimulate the patients
circulation
Prevent skin breakdown
Soothe and refresh thepatient
Given before patientgoes to bed, changingthe position of a patient,
to relax muscles, orwhen a physician ordersspecial back care
Guidelines:
Keep fingernails shortto prevent scratchingpatient
Warm lotion beforeapplying, and uselong, smooth strokesfor relaxation
Use short, circularstrokes to stimulate
Rub for about 3 to 5minutes; Reportreddened or brokenareas
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Hygiene & Grooming (Contd)
Four main types of bathing:
Complete bed bath
Partial bed bath
Tub bath
Shower
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Bathing the patient (Contd)
Bathing guidelines:
Provide privacy at alltimes
Close windows,drapes, and doors toreduce drafts
Keep patient coveredwith bath blanket forprivacy
Use good bodymechanics foryourself and patient
Keep the watertemperature atyour facility (105)
Rinse the patient
completely, andPat skin dry. Dontrub; Apply lotionto dry skin areas t
Report redness,
rashes, brokenskin, or tenderplaces to yoursupervisor
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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 themwithin easy reach, when not in use
Helping patients insert their hearing aids
Caring for hearing aids by checking the
batteries regularly, wax build-up, keepingthem away from moisture and heat, andstoring them properly in containers whentheyre not in use
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Special Skin Care Decubitus ulcers:
bones lie close to theskin surface(pressure points)
These points include: Toes, heels,
ankles, and knees
Elbows andshoulder blades
Spine, especiallythe tailbone area
Back of the headover the ears
Ulcers also developwhere body parts rubtogether. These
areas are: Under the breasts
Between folds ofabdomen
Between the
buttocks Between the
thighs
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Skin Breakdown Four stages include:
Stage one: redness lastinglonger than 30 minutes
Stage two: skin is
reddened with blister likelesions, or skin surface isbroken
Stage three: layers of skindestroyed and a deepcrater has formed.
Stage four: skin and othertissue is eroded, to wheremuscles and bone can beseen
Care of skinbreakdown include:
Removing allpressure from area
Massaging the skinsurrounding theaffected area
Keeping area cleanand dry; Keepingbroken skin covered
Washing the area,or removal of deadtissue can beordered by an MD
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Prevention Devices A specialty bed: turns the patient without friction
An electrically operated alternating pressuremattress
Bed cradles: relieves pressure
Gel-filled flotation pads or cushions for chairs orwheelchairs
Foam rubber or sheepskin heel and elbowprotectors
A foam mattress or wheel chair cushion (eggcrate)
Sheepskin or foam padding: shields the skin
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Rest and Sleep Vital to physical and
mental well being
Patterns of sleepvaries from
person to person Pain or anxiety
alters sleep
Older people tendto sleep more
lightly and oftenawake un-rested
Help patients by:
Encouraging themto rest or sleep
Provide acomfortable,relaxedenvironment, andleave them alonewhen they appear
tired Be considerate
and careful aboutnoise
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AM and PM Care AM care:
performed when thepatient first awakens inthe morning
To awaken patient, gentlyplace your hand on thepatients arm and saypatients name
Do not awaken patients
early if they cannot eatdue to surgery ordiagnostic tests
Offer a bedpan or urinal
PM care:
Care performedbefore patients go tosleep
Measures will help topromote patientscomfort andrelaxation (backrub)
Straighten the bed
linen, and assist thepatient with finding acomfortable position
Turn off the lights
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