WOLLO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF ADULT HEALTH NURSING

BY: ADEM HUSSEIN (BSc, MSc)

DEC, 2022
12/15/2022 Functional health pattern 1
 GENERAL CARE OF PATIENTS….

2. BODY MECHANICS AND MOVING

By Adem H. (BSc, MSc)

DEC,2022

12/15/2022 By Adem H General Care of Patients 2

 2.1. Maintaining Body Alignment

Definition
 Body alignment (posture) refers to the relative
position of body parts in relation to each other.

 Is an individual’s ability to maintain equilibrium.

12/15/2022 By Adem H General Care of Patients 3

Purpose of body alignment

To promote client comfort

To prevent contractures
To promote circulation
To lessen stress on muscle, tendons, nerves,
and joints
To Prevent foot drop (plantar flexion)
Gives an appearance of confidence and
healthy.

12/15/2022 By Adem H General Care of Patients 4

 2.1.1. Checking Normal Alignment of
Spine

Definition
Proper/normal alignment of the spine refers
to cervical concavity, a thoracic convexity, and
a lumbar concavity in standing patients’
position.
Purpose
To check the normal posture of spine.

12/15/2022 By Adem H General Care of Patients 5

12/15/2022
Figure 1.By Proper
Adem H
Spinal Posture
General Care of Patients 6
 2.1.2. Checking proper standing body
alignment
Definition: Proper standing alignment is characterized by:
 Head upright,
 Face forward,
 Shoulders square,
 Back straight,
 Abdominal muscles tucked/fold/ in,
 Arms straight at side,
 Palm forward,
 Legs straight and feet forward with the center of gravity
in the middle of the pelvis
Purpose
 To check the normal posture in standing posture
12/15/2022 By Adem H General Care of Patients 7
 Figure 2. Proper Alignment and Posture: Standing
Male and Female
12/15/2022 By Adem H General Care of Patients 8
 2.1.3. Checking proper sitting posture

Definition
 Proper/normal alignment on sitting posture
has similar characteristics with standing
posture except the hips and knees are flexed.
Purpose
• To check the normal posture on sitting
posture

12/15/2022 By Adem H General Care of Patients 9

 Figure 3: Proper sitting posture and center of
gravity
12/15/2022 By Adem H General Care of Patients 10
 2.1.4. Checking Proper Alignment Of
Client In Lying Posture
Definition
Proper/normal alignment on lying posture has similar
characteristics with standing posture except that the
patient is in supine position.
Purpose
To check the normal posture on lying position

Equipment
Pen
Documentation/charting format
Bed or examination couch

12/15/2022 By Adem H General Care of Patients 11

 Figure 4: Proper lying posture with center of
gravity

12/15/2022 By Adem H General Care of Patients 12

 2.2. Application Of Principles Of Body
Mechanics
Definition
• Body mechanics is the coordinated use of the body
parts to produce motion and maintain balance.

Purpose
 Promotes the efficient use of muscles and conserves
energy

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2.2.1. Lifting the patient
2.1.1. Dangling
 Is sitting on the side of the bed with their feet
hanging down.

Purpose
• To prepare the patient before walking, moving to a
chair or wheelchair, or performing others
• To relieve pressure in case of pulmonary edema
Indication
 Moving the patient out of bed
12/15/2022 By Adem H General Care of Patients 14
Contraindication
• Unconscious patient
• Spinal injury
Precaution
 Do not leave the patient alone when dangling
 If the patient becomes dizzy lie him down.
 Have the patient cough, deep breath, and
exercise their leg muscles when dangling
 Check the person’s pulse and respirations

12/15/2022 By Adem H General Care of Patients 15

2.2.2. Log rolling

Is a technique used to turn a patient whose

body must at all times be kept in a straight
alignment.
Purpose
• To turn a patient to the side of bed
Indication
 Spinal injury

Note: logrolling is accomplished by two or three

nurses working in a coordinated fashion.
12/15/2022 By Adem H General Care of Patients 16
 Cont…

Figure … Log rolling

12/15/2022 By Adem H General Care of Patients 17

 2.2.3. Moving patient up in bed with two nurses using
draw sheet
Definition
It refers to returning the patient to previous
correct position in bed if he/she slides to the foot
side of the bed.
Purpose
• To make patients in comfortable position in bed
• To maintain good body alignment
Indication
 Patient slides to the foot of the bed
12/15/2022 By Adem H General Care of Patients 18
 2.3. Positioning the patient
Positioning
 Is turning or putting the patients in a proper
body alignment for the purpose of
Preventive,

Promotive,

Curative and

 Rehabilitative aspects of health

12/15/2022 By Adem H General Care of Patients 19
Purpose of positioning
To relief pressure or lessen possible stress
To prevent formation of deformity
To improve circulation
Preserve muscle function
To provide comfort, support, and good body
alignment
To make the patient ready for different procedures

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 Type of Positioning

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 2.3.1. Front lying (Prone)
Definition
• Prone position is putting the patient in a flat
on the abdomen, legs extended, feet over the
edge of the mattress, and toes pointing to the
floor.
Purpose
 To Promote drainage from mouth
 To prevent contractures of hips and knee
 To examine the spine and the back
12/15/2022 By Adem H General Care of Patients 22
Indication
 Patient with excessive secretion from mouth
 Patient with potential risk of knee and hip
contracture.
Contraindication
• Cervical –spine fracture
• Respiratory impairment/breathing difficulties
• Foot drop
• Pregnant women
• Clients with abdominal incisions
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 Figure. ----- Proper prone position

12/15/2022 By Adem H General Care of Patients 24

 2.3.2. Semi-prone position (or Sims’
position)
Definition
• Semi-prone position is putting or assisting
patients with upper arm flexed at shoulder and
elbow; lower arm positioned behind client and
both legs flexed in front of client with more
flexion in upper leg either of body side

12/15/2022 By Adem H General Care of Patients 25

 Cont’d….
Purpose
 To promotes drainage from mouth
 To prevents aspiration
 Comfortable for sleeping.
Promotes comfort especially in pregnant clients
Indication
 For rectal examination
 Pressure sore on the buttocks/sacrum and hips
Contraindication
• lumbar lordosis
• Foot drop
client with leg injuries
•12/15/2022 By Adem H
or arthritis
General Care of Patients 26
 Figure.--- Proper Semi prone position

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 2.3.3 Supine (back lying)
 Is putting patient in back lying with a small pillow
to support the head and shoulder
Purpose
• Promote comfort
• To help healing after certain abdominal operations
Indication
 After abdominal, chest and neck surgery
 For physical examination of anterior part of the
body
 Usual position for the patient
12/15/2022 By Adem H General Care of Patients 28
Contraindication
• Spinal injury
• Cardiac patient (CHF)
• Breathing impairments
• Pressure sore (buttock, sacrum, heal and
shoulder )

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 Figure….Proper supine position

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 2.3.4. Dorsal recumbent position
Definition: Dorsal recumbent position is putting
patient in back lying position with knees are
flexed and the soles of the feet flat on the bed.

Purpose
Promote comfort
For visualizing the perineum
To insert urinary catheter
To relief pressure from ileum, knee and ankle

By Adem H General Care of Patients 32

Indication
• Rectal , vulva and vaginal examination
• Pelvic surgical procedure/ hemorrhoidectomy
• Vaginal douche/irrigate/
• Perianal care
• Catheterization
• Supra-pubic puncture

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Contraindication
• Spinal injury
• Cardiac patient (CHF)
• Breathing impairments
• Pressure sore (buttock, sacrum, heal and
shoulder )

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 Figure ….. Proper dorsal recumbent position

12/15/2022 By Adem H General Care of Patients 35

 2.3.5. Lateral recumbent (on either side)
• Is putting patient on either side with legs
flexed at knee( the upper leg is more flexed
than the lower leg).
Purpose
 To perform back care
 To relieves pressure on sacrum and heels
 To perform enema
 To take rectal body temperature
 To insert suppositories
12/15/2022 By Adem H General Care of Patients 36
Indication
• Enema and colonic irrigation
• Pressure sore on heel and sacrum
• Rectal examination
• To measure rectal temperature
Contraindication
 Arm and rib fracture
 Spinal injury
 Flank injury

Equipments
 Pillow of different size (4)
 Bed with side rails
 Draw sheet or turn sheet
 Documentation format
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 Figure….. Proper Lateral Recumbent position

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 2.3.6. Knee chest/kneeling position
• Is putting a patient on the Knee and the chest
with the head turned one side, arms above the
head and one cheek on a pillow

Purpose of knee chest position

1. Used for vaginal and rectal examination
2. Used in first aid treatment in cord prolapse
or retroverted uterus.
3. Assumed for postpartum and gynecologic
exercises
12/15/2022 By Adem H General Care of Patients 39
Indication
• Sigmoidoscopic examination
• Vaginal and rectal examination
• Cord Prolepses
• Retroverted uterus

Contraindication
 Cardio-pulmonary problem
 Upper arm, spine and ribs fracture
 Increased intra-cranial pressure (ICP)

Equipments
1. Pillow (1)
2. Drape/ Bath Blanket or sheet
3. Screen
4. Documentation format
12/15/2022 By Adem H General Care of Patients 40
 Figure …..Proper knee chest position

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 2.3.7. Fowler's position
Also called (semi-upright with back and knee rests
elevated)

• Fowler's position is sitting position in which

the head is elevated at different angle (15-90)
degree angle and may have knees either bent or
straight.
• This type of positioning has d/t sub-types.

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Types of fowler’s position

1. High Fowler's position is when the patient's head

is raised 80-90 degrees,

2. Fowler's which is 45-60 degrees

3. Semi-Fowler's position is when the patient's head

is elevated 30-45 degrees.

4. Low Fowler's position is when the head of bed is

elevated 15-30 degrees

12/15/2022 By Adem H General Care of Patients 43

Purpose
To relive dyspnea
To improve circulation
To prevent thrombosis
To prevent aspiration during the introduction of
feeding tubes
To facilitate drainage from abdomen and pelvic
cavity post operatively
To relax the muscle of the abdomen, back and
thighs
To relive tension on abdominal suture
To promote comfort
To Increase comfort during eating
To relieve edema of the chest and abdomen
12/15/2022 By Adem H General Care of Patients 44
 Cont’d…
Indication
 Cardio-pulmonary problem (Respiratory
distress, CHF, pulmonary edema..)
 Increased intra abdominal pressure
 Thrombosis
 Abdominal, back and thigh muscle strain
 Nasal or oral passageway procedures (e.g.
NGT…)

12/15/2022 By Adem H General Care of Patients 45

 Cont…
Contraindication
• Comatose/unconscious patients
• Spinal injury
• Foot drop
• Head injury
• Shoulder dislocation
Equipment
1. Small pillow (3)
2. Foot rest/foot board
3. Back support
4. Hand wrist support
5. Screen if necessary
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 Figure …..Proper fowler’s position

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2.3.8. Trendelenburg position
Defn: is putting the patient in a flat on the back
with the feet higher than the head by 15-30
degree
Purpose
• To increase cerebral perfusion pressure
• To allow better access to the pelvic organ
during pelvic surgery
• To help in the surgical reduction of hernia
• To enhance access to the central venous line
12/15/2022 By Adem H General Care of Patients 48
 cont’d….
Indication
• Hypotension/shock
• Abdominal and gynecologic surgery
• Placing central venous line
• Surgical reduction of hernia

Contraindication
 Cervical –spine fracture
 Respiratory impairment/breathing difficulties
 Brain injury with increased intracranial pressure
12/15/2022 By Adem H General Care of Patients 49
 Cont…
Spinal injury
Cardiac patient (CHF)
Breathing impairments
Pressure sore (buttock, sacrum, heal and shoulder )
Equipments
Bed block(if necessary)
Drape
Screen
Documentation format

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2.3.9. Lithotomy Position
 Is positioning the client feet above or the same
level as hips with perineum positioned at the
edge of examination table.

12/15/2022 By Adem H General Care of Patients 51

Purpose
• To provide good visual and physical access to
perineum
• To perform simple pelvic procedures to major
surgeries
• To conduct delivery

Indication
 Pelvic medical examination and surgeries
 Delivery
Contraindication
 Spinal injury
 Breathing impairments
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 4. Patient Ambulation
• Is assisted or unassisted walking.
• It is encouraged soon after the onset of illness
or surgery to prevent the complications of
immobility.

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Purpose
• To Keeps client more active
• To prevent the complications of immobility
• To improve muscle tone and strength
• To slow down loss of bone mass and density
related to osteoporosis
• To improves appetite , peristalsis and
circulation
• To give a sense of accomplishment
• Maintains greater independence for
clients(psychological wellbeing)
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Indication
• Immobile patients
• Postoperative patient
Contraindication
Unstable vital sign
Spinal fracture
Patient with traction
Equipment
• Assistive devices (Gait belt, Cane, Walker
and Crutch

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4.1. Preparing Client to Walk/Ambulate

Precaution for Ambulation

• Determine the client’s activity level and
tolerance for physical exertion.

• Assess for factors that may negatively affect

ambulation
(e.g., mental status, fatigue, pain, medications).

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 Cont…
• Evaluate the environment for safety (e.g.,
presence of obstacles in walkway, adequate
lighting, nonslip floor, handrails).
• Check assistive devices for safety hazards

• Check client’s clothing (e.g., nonslip shoes,

adequate covering for privacy and warmth).

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Procedure
• Inform client about the purposes and distance
exercise
• Elevate the head of the bed and wait several
minutes to prevents Orthostatic hypotension
• Lower the bed height
• With one arm under the client’s back and one
arm under the client’s upper legs, move the
client into the dangling position
• Encourage client to dangle at side of bed for
several minutes
12/15/2022 By Adem H General Care of Patients 58
Cont’d…
• Stand in front of client with your knees
touching client’s knees
• Place arms under client’s axilla
• Assist client to a standing position, allowing
client time to balance

• Help client ambulate desired distance or

distance of tolerance by placing your hand
under the client’s forearm and ambulating
close to the client
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 4.2. Assisting Patient With Assistive
Devices

• Assistive Device Is A Material Used To Support a

Patient Who Is Unable To Walk Independently.
Common Types
1. Gait Belt
2. Cane
3. Walker
4. Crutch

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 4.2.1. Gait belt
• Is an assistive devise used during simple
assisted ambulation.
Purpose
• To aid patient/client in ambulation
Indication
 One body part weakness
Equipment
• Gait belt

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 Figure …..Gait belt

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 4.2.2. Cane
• Is assistive devices used by clients who can bear
weight on both legs but have some weakness in
one leg or hip.
Type
1. Standard Cane
2. T-handle Cane
3. Tripod Cane
4. Quad (Quadruped) Cane
12/15/2022 By Adem H General Care of Patients 63
 A B C D
A. Standard Cane
Figure : B. T-handle Cane
Canes C. Tripod Cane
D.Quad (Quadruped) Cane
12/15/2022 By Adem H General Care of Patients 64
Indication
• Some weakness in one leg or hip
Purpose
 To support the patient during walking

Equipment
• Appropriate type of cane
• Gait belt
• Documentation format

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 4.2.3. Walker
• Is a waist-high metal tubular device with a
handgrip and four legs.
• Characterized by the presence of rubber tips on all
four legs or have wheels on the two front legs
Purpose
 To provide extra support, sense of security, and
independence
Indication
• Weakness in lower Limbs
• Disability
• Postoperative ( as needed)
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 Figure …..walker

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 4.2.4.Crutch
• Is walking aids made of wood or metal in the
form of a shaft which reaches from the ground to
the client’s axilla.

• It helps the client to stand and walk with the

help of crutch.

Purpose
 Reduces anxiety and promotes client’s
autonomy.
 To improve muscle strength

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Types of Crutch
1. Axillary:
 Fits under the axilla with the weight being placed
on the handgrips

Figure …. Axillary crutch

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2. Forearm:
• It has a handgrip and a metal cuff that fits
around the arm
• More convenient but provides less stability
than the axillary crutch

Figure ….Forearm crutch

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 Types of Crutch walking gaits

A. Two-point gait
B. Three point gait
C. Four point gait
D. Swing to gait
E. Swing through gait
F. Up and down stair gait

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 A. Two-Point Gait
Is an assisted gait used for partial weight
bearing on each leg which provides a strong
base of support.
Purpose
• To reduces anxiety and promotes client’s
autonomy
• To improve muscle strength
• To helps clients able to cope with disabilities
• To Support patient during walking
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Indication
 Weakness of the leg with partial ability to bear
weight.

Contraindication
Patients unable to bear weight fully on each leg

Equipment
• Properly fitted crutches
• Regular, hard soled street shoes
• Gait /Safety belt, if needed

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 B. Three Point Gait
Assisted gait with weak/non weight bearing one
leg supported with two Crutches
Purpose
• Reduces anxiety and promotes client’s
autonomy
• To assist weak or non weight bearing one leg
• Helps clients able to cope with disabilities

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Indication
Patients having weakness in one leg or
amputated one leg
Contraindication
• Patients having weakness in both legs
Equipment
1. Properly fitted crutches
2. Regular, hard soled street shoes
3. Safety belt, if needed
4. Documentation chart/format

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 C. Four Point Gait
• Very stable but slow gait for weight bearing
with both legs.
• Follows the pattern of right crutch forward, left
foot forward ;left crutch forward, then right
foot forward.
Purpose
 Reduces anxiety and promotes client’s
autonomy
 To improve muscle strength
 Helps clients able to cope with disabilities
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Indication
Weight bearing difficulties on both legs

Contraindication
 Patients able to bear weight on both leg
 Bearing weight on axilla

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 D. Swing to Gait
 Crutch walking gait in which both crutches move
together then lift body weight by the arms and
swing to the crutches
Purpose
• To relax and strengthen muscle
• To promote the client/autonomy
• To support the disability
Indication
 Weakness of both legs
Contraindication
 Improper body balance
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 E. Swing through gait
 Pattern of crutches forward, then legs swing
forward together through the crutch.
Purpose
• To relax and strengthen muscle
• To promote the client/autonomy
• To support the disability
• To speed up the walking
Indication
 Weakness of both legs
Contraindication
 Improper body balance
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 F. Up and down stair gait
 Crutch walking gait helps to climb up and move
down stair.
Purpose
• To promote clients level of activity in moving up
and down stair
• Relax and strengthen muscle
• To promote the client/autonomy
• To support the disability
Indication
 Musculoskeletal injury
Contraindication
• Improper body balance
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 5. Range of motion
exercise/ROM
 It refers to activities aimed at improving
movement of specific or group of joints.
Purpose
• To maintain the current joint function,
• To restore joint function that has been lost
through disease or injury, or lack of use
• To maintain muscle tone and strength
• To prevent contractures
• To improve circulation
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 Types of ROM
1. ACTIVE ROM:- Movements of the joints
independently by the client/patient on a
nonfunctioning joints.

2. ACTIVE - PASSIVE ROM:- Movement of

nonfunctioning joint from partial assistant from
others.

3. PASSIVE ROM:- Movement applied by a nurse

or other person or passive motion machine on a
pt’s immobilized joint.
For A pts’ who can’t move his joint by himself.
12/15/2022 By Adem H General Care of Patients 82
 Indication
 Unable to move joints
 Part of daily living activities

Contraindication
• Dislocation in specific joints
• Heart & respiratory disease and
• Swollen or inflamed joints or
musculoskeletal injury.

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 Procedure For Passive Range Of Motion
Exercise (PROM)
1. Wash hands
2. Explain the procedure to the client
3. Adjust the bed to a comfortable height.
4. Select one side of the bed to begin PROM exercises.
5. Uncover only the limb to be exercised
6. Support all joints during exercise activity.
7. Use slow, gentle movements when performing exercises.
8. Repeat each exercise three times.
9. Stop if the client complains of pain or discomfort.
10. Begin exercise with the client’s neck and work down
ward.
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11. Exercise the neck
a. Flex, extend and rotate the client’s neck.
b. Support his or her head with your hands.
12. Exercise the client’s shoulder and elbow.
 Support the client’s elbow with one hand and
grasp the client’s wrist with your other hand.
 Raise the client’s arm from the side to above the
head.
 Perform internal rotation by moving the client’s
arm across his or her chest.
 Externally rotate the client’s shoulder by moving
the arm away from the client.
 Flex and extend the client’s elbow.
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13. Perform all exercises on the client’s wrist and fingers
a. Flex and extend the wrist.
b. Abduct and adduct the wrist.
c. Rotate and pronate the wrist.
d. Flex and extend the client’s fingers.
e. Abduct and adduct the fingers.
f. Rotate the thumb.
14. Exercise the client’s hip and leg.
a. Flex and extend the hip and knee while supporting the
leg.
b. Abduct and adduct the hip by moving the client’s
straightened leg toward you and then back to median
position.
c. Perform internal and external rotation of the hip joint
by turning the leg
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inward
By Adem H
and then outward.
General Care of Patients 86
 15. Perform exercises on ankle and foot
a. Doris flex and plantar flex the foot
b. Abduct and adduct the toes
c. Evert and invert the foot
16. Move to the other side of the bed and repeat
exercise.
17. Position and cover the client. Return the bed to
low position.
18. Wash your hands.
19. Document completion of PROM exercise

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