CNA Body Mechanics Bed Making Comfort Care

8/3/2019 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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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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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

CNA Body Mechanics Bed Making Comfort Care

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