MODULE 6: RESPIRATORY CARE, OXYGENATION THERAPY, CPT, DEEP BREATHING

ALTERATIONS IN RESPIRATORY FUNCTION

Patency (open airway)
• The movement of air into or out of the lungs
• The diffusion of oxygen and carbon dioxide between the alveoli and the pulmonary capillaries
• The transport of oxygen and carbon dioxide via the blood to and from the tissue cells.
Assessing for and maintaining a patent airway is a nursing responsibility, one that often requires immediate action.
- Partial obstruction of the upper airway passages is indicated by a low-pitched snoring sound during inhalation.
- Complete obstruction is indicated by extreme inspiratory effort that produces no chest movement and an inability
to cough or speak.
- Lower airway obstruction is not always as easy to observe. Stridor, a harsh, high-pitched sound, may be heard
during inspiration. The client may have altered arterial blood gas levels, restlessness, dyspnea, and adventitious
breath sounds (abnormal breath sounds)
Nursing interventions should be directed toward achieving optimal respiratory effort, gas exchange, self-care habits,
and wellness. Additionally, nurses play an important role in chronic disease management by assisting clients to cope
with and minimize the effects of illnesses such as COPD.
Promoting Healthy Respiration
Interventions by nurse to maintain the normal respiration of clients includes;
Teachings
• Positioning the client to allow for maximum chest expansion
• Assume a posture that permits full expansion
• Exercise regularly
• Breaths through the nose
• Breaths in so as to expand the chest fully
• Do not smoke cigarette, cigar or pipes
• Eliminate or reduce the use of housed hole pesticides and irritating chemical substance
• Do not incinerate garbage in the house avoid exposure to second hand smoke
• Make sure furnaces, ovens, and wood stoves are correctly ventilation
• Support a pollution- free environment
POSITIONS
1. Fowler’s position
- The bed angle is between 45 degrees and 60 degrees. The legs of the patient may be straight or slightly bent.

2. Semi Fowlers position or high fowler position

- the patient is usually on their back. The bed angle is between 30 degrees and 45 degrees. The legs of the patient
may be straight or bent.

- Maximum chest expansion in bed- confined clients

3. High fowler

- patient is usually seated upright with their spine straight. The upper body is between 60 degrees and 90 degrees.
The legs of the patient may be straight or bent

4. Orthopneic Position

-Adaptation of high fowler position

-The client in this position can press the lower part of the chest against the table to help in exhaling

-Advantage unlike to high fowlers position, the organ are not pressing the Diaphragm
• Encourage or providing frequent changes in position
a. Turn side to side
- Alternate sides of the chest are permitted maximum expansion
• Orthopneic Position
- Adaptation of high fowler position
- The client in this position can press the lower part of the chest against the table to help in exhaling
- Advantage unlike to high fowlers position the organ are not pressing the Diaphragm
b. Encouraging ambulation
- Implementing measures that promotes comfort such as giving pain medication
BREATHING EXERCISES
• Breathing ex and ventilatory training are the fundamental interventions for the prevention for acute and chronic
pulmonary disease, patients with high spinal cord lesion, and who underwent thoracic and abdominal surgery, and
bedridden patients.
• Studies indicate that breathing exercise and ventilatory training have affect and alter a patient’s rate and depth of
ventilation, so these technique is used to improve the pulmonary status and increase patients overall endurance.

GOALS OF BREATHING EXERCISE

- Improve ventilation
- Increase the effectiveness of cough and promote airway clearance
- To prevent post operative pulmonary complications
- To improve the strength endurance coordination of the muscles of ventilation
- Maintain and improve chest and thoracic spine mobility
- Promote relaxation and relive stress
- To teach the patient how to deal with episodes of dyspnea

TYPES OF BREATHING EXERCISES

1. ABDOMINAL or DIAPHRAGMATIC BREATHING
- It permits full breaths with little efforts
PROCEDURE:
1. Prepare the patient in relaxed and comfortable position in which the gravity assist the diaphragm such as semi
fowlers position.
2. If you notice any accessory muscle activation stop him and do relaxation techniques (shoulder roll or shrugs
coupled with relaxation)
3. Place your hands over the rectus abdominis just below the anterior costal margin, ask the patient to breath slowly
and deeply via nose by keeping the shoulder relaxed and upper chest quiet allowing the abdominal to rise now
ask him to slowly let all the air out using controlled expiration through mouth.
4. Have him to practice this for 2-4 times if he finds any difficulty in using diaphragm have the patient inhale several
times in succession through the nose by using sniffing action this facilitates the diaphragm
5. For self monitor have the patients hand over the ant costal margin and feel the movt: (hand rise and fall) by placing
one hand over abdomen he can also feel the contraction of abdominal muscles which occurs with controlled
expiration or coughing.
6. After he understands and able to do the controlled breathing using a diaphragmatic pattern keep the shoulder
relaxed and practice in verity of positions (supine sitting standing) and during activity (walking and climbing stair).

2. GLOSSOPHARYNGEAL BREATHING
- It is a means of increasing a patients inspiratory capacity when there is a severe weakness of the muscle of
inspiration
- It is taught to patients who have difficulty in deep breathing.
- It is used primarily for ventilatory dependent patients due to absent or incomplete innervation of diaphragm
because of high cervical cord injury or neuromuscular disorders.
- Glossopharyngeal breathing with inspiratory action of neck muscles can reduce ventilatory dependence or can be
used as an emergency procedure for malfunctioning of ventilator.
PROCEDURE
1. Patient take several gulp of air (6 to 10), then by closing the mouth the tongue pushes the air back and trap it in
the pharynx the air is then forced to lungs when the glottis is opened. This increases the depth of inspiration &
patient’s inspiratory & vital capacity.

3. PURSED-LIP BREATHING
- Helps the client develop control over breathing.
- The pursed lips create a resistance to the air flowing out of the lungs, thereby prolonging exhalation and
preventing airway collapse by maintaining positive air pressure.
Procedure:
• The client purses the lips as if about to whistle and breathes out slowly and gently, tightening the abdominal
muscles to exhale more effectively.
• The client usually inhales to a count of three and exhales to a count of seven.

4. APICAL AND BASAL EXPANSION

- It is performed on a segment of lung, or a section of chest wall that needs increased ventilation or movement.
- Hypoventilation occur in certain areas of the lungs because of chest wall fibrosis, pain after surgery, atelectasis,
trauma to chest wall, pneumonia and post mastectomy scar
- Therefore, it will be important to emphasize expansion of such areas of the lungs and chest wall
- Are often required for clients who restrict their upper or lower chest movement because of pain from a severe
respiration disease chest surgery or upper abdominal surgery.
Advantage:
• Re-expand lung tissue
• Move secretions to promote effective elimination
 • Minimize flattening of the upper chest wall from disuse
Procedure:

➢ Place hand blow the clavicle, exerting moderate pressure

➢ Ask the client to: concentrate on expanding the upper chest forward and upward
➢ While inhaling to aerate apical lobes of the lungs
➢ Hold the breath for 3 to 4 seconds to promote aerotion of the alveoli
➢ Exhale passively and slowly through the mouth or nose
➢ Repeat the exercise for 5 respiration four time a day

2. BASAL EXPANSION EXERCISES

- For basal expansion exercises the client follow these steps.
Procedure:

➢ Place the palm of the hands in the lower ribs along the mid-axillary lines, and exert moderate pressure
➢ Concentrate on moving the lower chest outward on inhalation
➢ Exhalation slowly, quickly and passively

DEEP BREATHING EXERCISE

Purpose:

• Facilitate respiratory functioning by increasing lung expansion and preventing alveolar collapse.
• Encourage expectoration of mucus and secretions that accumulate in the airways after general anesthesia and
immobility.
Assessment
• Assess client's risk factors for development of respiratory complications (e.g., general anesthesia, history of
pulmonary disease or smoking, chest wall trauma, cold or respiratory infection within past week).
• Assess quality, rate, and depth of respiration.
• Auscultate breath sounds.
• Inspect placement of incision and evaluate whether or not it interferes with chest expansion.
• Evaluate client's physical ability to cooperate and perform pulmonary exercises:
- Level of consciousness
- Language or communication barriers
- Ability to assume Fowler's position
- Pain level (medicate as ordered)
Procedure:
➢ Assist client to Fowler's or sitting position.
➢ Have client place hands palm down, with middle fingers touching, along lower border of rib cage.
➢ Ask client to inhale slowly through the nose, feeling middle fingers separate. Hold breath for 2 or 3 seconds
➢ Have client exhale slowly through mouth. Repeat three to five times.

DIAPHRAGMATIC BREATHING

• Sit down
• Place your hands on your chest and abdomen
• Breathe in and breathe out
• Instruct, reinforce, and supervise deep breathing exercises every two to three hours postoperatively
• Document procedure.

TEACHING SPLINTING AND COUGHING

Purpose:

• Splinting - To minimize pain while moving and coughing.

• Coughing - Encourage expectoration of mucus and secretions that accumulate in the airways after general
anesthesia and immobility.

Coughing

▪ Raises respiratory secretions so they do not plug the bronchioles or provide a measure for bacterial growth.
▪ Patient may expectorate or swallow them.

Coughing exercise
Step 1
o Sit on the edge of a chair or bed. Or lie on your back with your knees slightly bent.
o Lean forward slightly. Hold a pillow firmly against your incision with both hands.
o Breathe out normally.
Step 2
o Breathe in slowly and deeply through your nose.
o Then breathe out fully through your mouth. Repeat.
o Take a third deep breathe. Fill your lungs as much as you can.
Step 3
o Cough 2 or 3 times in a row.
o Try to push all of the air out of your lungs as you cough.
o Then relax and breathe normally.
o Repeat as directed.

Procedure:

➢ Assist client to Fowler's or sitting position.

 ➢ If adventitious breath sounds or sputum is present, have client take a deep breath, hold for 3 seconds, and cough
deeply two or three times. Stand to the client's side to ensure the cough is not directed at you. Client must cough
deeply, not just clear the throat.
➢ If the client has an abdominal or chest incision that will cause pain during coughing, instruct the client to hold a
pillow firmly over the incision (splinting) when coughing.
➢ Inhale deeply and hold breath for a few seconds.
➢ Cough twice.
➢ For Huff coughing, lean forward and exhale sharply with a huff sound.
➢ Inhale by taking rapid short breaths in succession “sniffing”.
➢ Instruct, reinforce, and supervise deep breathing and coughing exercises every 2 to 3 hours postoperatively.
➢ Document procedure.

CHEST PHYSIOTHERAPHY

• It is a form of Airway Clearance Therapy that is generally performed by a Respiratory Therapist with the goal
of clearing mucus from the airways and lungs. It involves striking the lungs manually with your hands, with
a cuff, or with an automatic percussor.
• The rhythmic strikes and vibrations help loosen secretions from the airways. Then you can help propel them
forward by placing the patient in various postural drainage positions using gravity.

PERCUSSION
- Sometimes called “clapping”
Purpose:

▪ To loosen secretions in the lung segment immediately below the area struck.
- It is the forceful striking of the skin with cupped hands. When the hands are used, the fingers and thumb are
held together and flexed slightly to form a cup.
Procedure:
➢ Cover the area with towel or gown to reduce discomfort and decrease friction.
➢ Ask the client to breathe slowly and deeply to promote relaxation, prevent tensing of the chest and to assist with
the mobilization of secretion.
➢ Alternately flex and extend the wrist rapidly to slap the chest.
➢ Percuss each affected lung segment for 1 to 2 minutes.
• When done correctly, the percussion action should produce a hollow, popping sound.
• Percussion is avoided over the breast, sternum, spinal column and kidneys.
• Mechanical percussion devices at a set force are used by respiratory therapist.

VIBRATION

- Series of vigorous quivering produced by hands that are placed flat against the client’s chest wall.
- Vibration is used after percussion to increase the turbulence of the exhaled air and thus loosen thick
secretions.
- It is done alternately with percussion.

Procedure:
➢ Place hands, palms down, on the chest area to be drained, one hand over the other with the fingers together and
extended. Alternately, the hands may be placed side by side.
➢ Ask the client to inhale deeply and exhale slowly through the nose or pursed lips.
➢ During the exhalation, tense all the hand and arm muscle, and using mostly the heel of the hand, vibrate (shake)
the hands, moving them downward. Stop the vibrating when the client inhales.
➢ Vibrate during five exhalations over one affected lung segment. The vibration is transferred through the tissues
and loosen mucus.
➢ After each vibration, encourage the client to cough and expectorate secretions into the sputum container.
* Mechanical vibrator are place firmly against the chest wall over the area where secretions are retained.

POSTURAL DRAINAGE

- The drainage by gravity of secretions from various lung segment.

- Before postural drainage, the client may be given bronchodilator medication or nebulization therapy to loosen
secretions.
- Postural drainage treatments are scheduled 2 or 3 times daily.
- The best time include before breakfast before lunch, in the late afternoon and before bedtime.
Procedure:
Assessment
➢ Check the chart for a physician’s order.
➢ Identify the specific segment of the lung to be drained.
Planning
➢ Wash your hands for infection control.
➢ Plan how you will place the patient in the various positions.
➢ Obtain sputum cup and tissues for the patient to use for expectorated secretions. Obtain clean gloves if the patient
is unable to manage his or her own secretions.
Implementation

➢ Identify the patient to be sure you are performing the procedure for the correct patient.
➢ Explain to the patient the purpose and method of postural drainage, using the basic principles of health
teaching.
➢ Position the patient.
➢ Drain the upper lobes.
a. Have the patient sit up if possible(sit on a chair or raise the head of bed)
b. Have patient lean to the right side (45deg. angle for 5 mins to drain the left aspect of both upper lobes)
support the patient with pillows if necessary.
c. Then have the patient lean to the left side (45deg. angle for 5 mins. to drain the upper right lobes) support
the patient with pillows if necessary.
d. Have the patient lean forward (30 to 45 deg. angle and stay in this position for 5 mins to drain the posterior
segments of the upper lobe). Let the patient brace the elbows on the knees to maintain this position or
you can pad an over bed table for the patient to lean on.
e. Have the patient lean backward (30 to 45 deg. angle and stay in this position for 5 mins to drain the
anterior segments of the upper lobes.
f. Have the patient lie on the abdomen, back and both sides while horizontal to drain the remaining
segments of the upper lobes.
➢ Drain the lower lobes.
- Place the patient in the left side lying position in bed (use pillows or adjust the bed so that the patients
head and thorax are 30 degrees to 45 degrees down from the horizontal position. The 30 degrees position
is less tiring and creates fewer adverse circulatory effects than the 45 degrees position does.
- Remember that there are six position.
- Each can be achieved if the patient starts out lying on one side and gradually turns like a rotisserie. Use
the same sequence of position each time to help to help you remember them easily. The patient should
remain in each position for 5 minutes.
1. Have the patient lie on the left side, with the shoulders perpendicular to the bed. This position drains the
lateral basal segment of the right lower lobe. Use pillows to support the patient, and place a small pillow under
the head if essential to comfort.
2. Draining the right middle lobe. The shoulders are at a 45 deg. Angle to the bed.
3. Draining the anterior basal segments of both lungs. The patient is flat on the back (supine) with thorax 30
degrees to 45 degrees down from the horizontal position.
4. Draining the lingula of the left lower lobe. Pillows are used to support the shoulders at a 45 degrees angle to
the bed.
5. Draining the lateral basal segments of the left lower lobe. The shoulders are at a 90 degrees angle to the bed.
6. Draining the posterior basal segments of the lower lobes. This position is also used for coughing out
secretions.

➢ Have the patient cough forcefully (lying on the abdomen) to expel secretions.
➢ Return the patient to a comfortable position offer mouth care and allow for rest period.

Evaluation

➢ Evaluate the patients tolerance of postural drainage by:

- Assess stability of vital signs particularly pulse and respiratory rates and note signs of intolerance such as
pallor, diaphoresis, dyspnea, nausea and fatigue.
- Patient resting comfortably.

Documentation

➢ Position used for postural drainage.

➢ Secretions produced (amount, color and character).
➢ Any changes in respiratory status.
OXYGEN CARE
Oxygenation therapy
• Supplemental oxygen is indicated for clients who have hypoxemia due to the reduced ability for diffusion of oxygen
through the respiratory membrane, hyperventilation, or substantial loss of lung tissue due to tumors or surgery.
Others who may require oxygen are those with severe anemia or blood loss, or similar conditions in which there
are inadequate numbers of RBCs or hemoglobin to carry the oxygen
• When administering oxygen as an emergency measure, the nurse may initiate the therapy, and then contact the
primary care provider for an order

1. Low Flow Administration Devices

Nasal cannula (24-45% at 2-6LPM)
-may be used in clients with COPD at 2-3l/min if venturi mask is not available.
- The nasal cannula (nasal prongs) is the most common and inexpensive device used to administer oxygen
- Limitations of the plain nasal cannula include inability to deliver higher concentrations of oxygen, and that it
can be drying and irritating to mucous membranes.
Simple face mask (40-60% at 5-8 Lpm)
- Exhalation ports on the sides of the mask allow exhaled carbon dioxide to escape
Partial rebreathing Mask (60-90% at 6-10Lpm)
- The oxygen reservoir bag that is attached allows the client to rebreathe
about the first third of the exhaled air in conjunction with oxygen
Non- rebreathing mask (95- 100% at 6-15 Lpm)
-One-way valves on the mask and between the reservoir bag and the mask prevent the room air and the client’s exhaled
air from entering the bag so only the oxygen in the bag is inspired
Croupette / Oxygen tent
-The tent consists of a rectangular, clear, plastic canopy with outlets that connect to an oxygen or compressed air source
and to a humidifier that moisturizes the air or oxygen.

2. High Flow Administration Devices

• Venturi mask- low cooperation venture- type of mask is preferred for clients with COPD because it provides
accurate amount of oxygen. They require 2-3l/min or 28% oxygen.
• Oxygen Hood- can be used to low and high flow concentration
‒ An oxygen hood is a rigid plastic dome that encloses an infant’s head. It provides precise
oxygen levels and high humidity.
‒ The gas should not be allowed to blow directly into the infant’s face, and the hood should not
rub against the infant’s neck, chin, or shoulder.
• Incubator/ Isolette- can be used for low and high flow concentration.

• Note: Oxygen is colorless, odorless, tasteless, and dry gas that supports combustion.
NURSING IMPLICATIONS:
• Since oxygen is colorless, odorless, tasteless gas, leakage cannot be detected.
• Since oxygen is dry gas, it can irritate mucous membrane of the airways.
• Since oxygen supports combustion, it can cause fire.

NURSING PLANNING, INTERVENTIONS AND EVALUATION IN THE ADMINISTRATION OF OXYGEN THERAPY

1. Assess signs and symptoms of hypoxemia
2. Check doctor's orders.
3. Position patients, preferably semi-fowler’s. To enhance lung expansion.
4. Open source of oxygen before insertion of oxygen device. This is to check for malfunctioning of the device.
5. Regulate oxygen flow accurately. Excessive administration of oxygen can cause oxygen necrosis (respiratory
alkalosis).
6. Place a “NO SMOKING” sign at the bedside.
Strictly enforce this warning.
Oxygen greatly accelerates combustion and could cause a fire from a small spark.
7. Avoid use of oil, greases, alcohol and ether near the client receiving oxygen. These may further support combustion.

• Check electrical appliances before use. Small spark may cause a fire if there is leakage of oxygen.
• Avoid materials that generate static electricity, such as woolen blankets and synthetic fabrics. Use cotton
blankets.
• Humidify oxygen. Place sterile water into oxygen humidifier. To prevent dryness and irritation of mucous
membrane in the airways.
• Provide good oronasal hygiene. To prevent dryness and irritation of mucous membrane.
• Lubricate nares with water-soluble lubricant to soothe the mucous membrane. Do not use oil. Oil ignites when
exposed to compressed oxygen.
• Assess effectiveness of oxygen therapy. Check VS, especially RR, note quality of respiration, evaluation arterial
blood gas results (ABG analysis)
• Make relevant documentation.
 MODULE 7: MOBILITY, BODY MECHANICS AND
POSITIONING

MOBILITY
• MOBILITY – the ability to move freely, easily, rhythmically and purposefully in the environment.
• Ability to move without pain influences self-esteem and body images.
• Results to being helpless and compromised ADL
• Paralysis (Plegia), Paresis (partial weakness), amputation and motor impairment, spastic and flaccid muscle

NORMAL MOVEMENT

• Result of an intact musculoskeletal system, nervous system and inner structure responsible for equilibrium.

Four Basic Elements:

1. BODY ALIGNMENT (POSTURE)
• Promotes optimal balance and maximum body function during standing, sitting or lying
• A person maintains balance when the line of gravity, center of gravity and base of support are well maintained
• LINE OF GRAVITY
o An imaginary vertical line drawn through the body’s center of gravity. (top of the head, between
shoulders, anterior sacrum to the centered of the base of support)
• CENTER OF GRAVITY
o The point at which the body’s mass is centered
• BASE OF SUPPORT
o The foundation on which the body rest.

EFFECTS OF PROPER BODY ALIGNMENT:

• Minimize strain on joints, muscles and tendons are minimized
• Enhances lung expansion
• Promotes circulatory, renal, intestinal functions
• Good posture reflects good mood, self-esteem and personality.
2. JOINT MOBILITY
• Range of Motion (ROM) – joint at a maximum movement.
• When a person moves, the line of gravity shifts to the direction of the body.
• The closer the line of gravity is to the center of the base of support, the greater is the persons stability
• The closer the line of gravity to the edge of the base of support, the more precarious the balance is, the person
may fall.
3. BALANCE
• Labyrinth (inner ear)- The vestibule and semicircular canal are responsible for equilibrium
• Vision (Vestibulo-ocular input)
• Mechanism of equilibrium (Sense of balance)

*The broader the base of support and the lower the center of gravity, the greater the stability and balance.

HOW TO ENHANCE BALANCE?

• Widen the base of support
• lower the center of gravity

MOVEMENTS TO AVOID
• TWISTING- ROTATION of the thoracolumbar spine
• STOOPING- acute flexion of the back with hips and knees straight
4. COORDINATED MOVEMENTS
• Cerebral cortex: initiates voluntary motor activity
• Cerebellum: coordinates motor activities of movement
• Basal Ganglia: maintains posture
Positions and Directions
• Terms of position and direction describe the position of one body part relative to another, usually along one
of the three major body planes
• Superior
o Refers to a structure being closer to the head or higher than another structure in the body
• Inferior
o Refers to a structure being closer to the feet or lower than another structure in the body
• Anterior
o Refers to a structure being more in front than another structure in the body
• Posterior
o Refers to a structure being more in back than another structure in the body
• Medial
o Refers to a structure being closer to the midline or median plane of the body than another structure
of the body
• Lateral
o Refers to a structure being farther away from the midline than another structure of the body
• Distal (Reference to the extremities only)
o Refers to a structure being further away from the root of the limb than another structure in the limb
• Proximal (Reference to the extremities only)
o Refers to a structure being closer to the root of the limb than another structure in that limb
• Distal / Proximal
o When you divide the skeleton into Axial (Blue) and Appendicular (Yellow) you can better understand
the extremities and their roots.
• Superficial
o Refers to a structure being closer to the surface of the body than another structure
• Deep
o Refers to a structure being closer to the core of the body than another structure
• Ventral
o Towards the front or belly – You Vent out or your nose and mouth.
• Dorsal
o Towards the back – Like the Dorsal fin of a dolphin.

BODY MECHANICS

• Term used to describe the efficient, coordinated, and safe use of the body to move objects and carry out the
activities of daily living.
• Use of body mechanics reduces fatigue and risk of injury for both nurses and patient during lifting, transferring
and repositioning

PRINCIPLES:
1. The wider the base of support, the greater the stability.
2. The lower the center of gravity, the greater the stability.
3. The equilibrium of an object is maintained as long as the line of gravity passes through its base of support.
4. Facing the direction of movement prevents abnormal twisting of the body.
5. Dividing balanced activity between arms and legs reduces the risk of injury.
6. It is easier to pull, push or roll an object than to lift it.
7. Movements should be smooth and coordinated rather than jerky.
8. Less force is required when friction is reduced between the object to be moved and the surface on which it is
moved.
9. Less energy or force is required to keep an object moving than it is to start and stop it.
10. Use the arm and leg muscles as much as possible, the back muscles as little as possible.
 11. Keep the work as close as possible to your body. It puts less strain on your back, legs, and arms.
12. Keep the work at a comfortable height to avoid excessive bending at the waist.
13. Keep your body in good physical condition to reduce the chance of injury.
14. Rest between periods of work promotes work endurance.

FACT:
1. 25% OF NURSES COMPLAIN OF CHRONIC BACK PAIN.
2. 12% LEAVE THE PROFFESION DUE TO LOW BACK PAIN
3. 20% TRANSFER TO DIFERENT SETTING DUE TO LOW BACK PAIN
4. 25% CHANGE JOB DUE TO SHOULDER, NECK AND BACK PROBLEMS.
“NO MANUAL LIFT” “NO SOLO LIFT”

LIFTING
• Do not lift more than 51 pounds without assistance from equipment or from other persons.
• Use assistive equipment as much as possible
• Lift object as close as possible to the center of gravity
A. line of gravity falls close to the base of support – There is balance
B. Line of gravity falls at the edge of the base of support – Balance is precarious
C. Line of gravity is outside the base of support – No balance

LIFTING HEAVY OBJECTS

A. Stand close to the load and flex the back and knees, lowering the body to grasp the load
B. Begin lifting with the back flexed, and gradually straighten the knees so that the leg muscle bears the most of
the burden
C. To hold and walk with the object, maintain a less flexed but not a completely straight position

PULLING OR PUSHING
PUSHING
• Enlarge the base of support by moving the foot forward
PULLING
• Enlarge the base of support by moving the rear foot backward if the person is facing the object.
• Enlarge the base of support by moving the foot forward if the person is facing away from the object

It is safer to pull and object towards own center of gravity than to push it away. A person can control object’s movement
when pulling.

PIVOTING
• A technique in which the body is turned in a way that avoids twisting of the spine.
• Place one foot ahead of the other
• Raise the heel very slightly and put the body weight on the balls of the feet.
• Turn about 90 degrees into the desired direction

POSITIONING CLIENTS

Positioning prevents:
• Muscle discomfort
• Pressure ulcers
• Damage to nerves and blood vessels contracture
• It promotes muscle tone and stimulate postural reflexes
• Position patient every two hours

POINTS TO REMEMBER!
• Make sure mattress is firm
• Sagging mattress and under filled water bed contributes to low back pain and hip flexion
• Make sure bed is clean and dry. Wrinkle increase risk of pressure ulcer formation
• Place support devices. –pillows, mattress, footboard, bed boards, foot boot
 • Avoid placing one body part directly on top of another body part
• Plan a 24-hour systematic schedule for position changes.

SUPINE POSITION
• Patient lies flat on back. Additional supportive devices may be added for comfort.
• Also called dorsal position or back lying position
PRONE POSITION
• Patient lies on stomach with head turned to the side
• Prevents contractures on the hips and knees
• Promotes drainage of the mouth
• Can cause lordosis
LATERAL POSITION
• Patient lies on the side of the body with the top leg over the bottom leg. This position helps relieve pressure on
the coccyx.
• Also called side lying position
SIM’S POSITION
• Patient lies between supine and prone with legs flexed in front of the patient. Arms should be comfortably
placed beside the patient, not underneath.
• Used for patient undergoing enemas or examination of the perennial area
• Prevention of aspiration and pressure on the sacrum for unconscious patients
FOWLER’S POSITION
• Patient’s head of bed is placed at a 45–90-degree angle. Hips may or may not be flexed.
• common position to provide patient comfort and care.
LOW/ SEMI FOWLER’S POSITION
• Patient’s head of bed is placed at a 15-45-degree angle.
• Used for patients who have cardiac or respiratory conditions, and for patients with a nasogastric tube.
• HIGH FOWLER’s- 90 degrees
• Common error: Placing too much pillows on the head
TRENDELENBURG POSITION
• Place the head of the bed lower than the feet.
• This position is used in situations such as hypotension and medical emergencies.
• It helps promote venous return to major organs such as the head and heart.
ORTHOPNIEC POSITION
• Also called TRIPOD POSITION
• In this position, the patient is placed either in a sitting position or on the side of the bed with an over-bed table
placed in front to lean on. Several pillows are also placed on the table to rest on.
• Promotes maximum lung expansion
DORSAL RECUMBENT POSITION
• A position in which the patient lies on the back with the lower extremities moderately flexed and rotated
outward.
• It is employed in the application of obstetrical forceps, repair of lesions following parturition, vaginal
examination, and bimanual palpation
LITOTHOMY POSITION
• The lithotomy position involves the positioning of an individual's feet above or at the same level as the hips
(often in stirrups), with the perineum positioned at the edge of an examination table