Online Companion: Fundamentals of Nursing Standards and Practice 2E

Frequently Asked Questions

Why is body alignment and body mechanics so important for the both the client and the nurse?

Proper alignment and body mechanics are important for both the client and the nurse, as they will help to maintain balance and prevent stress or injury. Proper alignment promotes comfort, prevention of contractures, promotion of circulation, less stress on body parts and prevention of foot drop. Good posture helps to maintain a base of support and promote muscle tone. The proper use of body mechanics helps to coordinate the use of body part and position during activity. The nurse using proper body alignment (posture) and body mechanics is less likely to suffer injury or strain during transfer and/or assist activities with clients in the work setting.

What information does a Functional Assessment provide for a client who may have alterations in mobility?

A Functional assessment tool focuses on a client’s ability to perform ADLs (activities of daily living). It examines how the individual client is able to feed, dress, toilet, move, transfer, and ambulate self independently or with some degree of assistance. An accurate assessment of the client’s ability will help to define the client’s baseline and is critical for planning care outcomes and coordinating a treatment plan that is both realistic and adequate to meet the client’s needs. Clients who have alterations in mobility may be at increased risk for falls or injury related events and an accurate description of their abilities would alert health care workers as to their expected level of function and the amount of assistance that is required.

What are the most common assistive devices that can be used to promote mobility? Briefly discuss how they are used by the client to improve mobility and activity.

The most common assistive devices used to promote ambulation are canes, walkers and crutches. Canes are utilized by clients who are able to perform weight bearing but experience some weakness in either one leg or hip and therefore require assistance. Canes come in different styles – straight or with points that form a more supportive base. The cane must be at the proper height for the client with suction grips at the bottom to prevent the cane from slipping so as to avoid the risk of falls. The cane is used on the client’s unaffected side. Walkers are utilized for clients who require a broader base of support and have exhibit some restriction in weight bearing. Walkers are available with and without wheels and the client advances the walker and steps normally. Crutches are utilized by clients who have restrictions in weight bearing (no weight bearing, partial and full weight bearing) depending on the nature of the event or trauma and require upper body strength for proper utilization. There are different types of crutches – axillary (fit underneath the axilla) and forearm (hand grip and metal cuff that fits around the arm). A client must receive adequate instruction regarding the use of all assistive devices in order to prevent further stress or potential injuries.

How can the therapeutic intervention of bed rest be both beneficial and cause potential complications for a client in the hospital setting?

Bed rest is considered a therapeutic intervention for clients who require rest due to exhaustion or fatigue, require decreased oxygen consumption to improve cardiac function and minimize workload of the heart and lungs, and as a relief measure for pain and discomfort. The critical factor is the duration of bed rest as prolonged bed rest can lead to effects of immobility and translate into a variety of physiological reactions affecting the entire body system. Sensory deprivation, alterations in elimination, skin integrity, respiratory effort, and gastrointestinal systems can occur. Prolonged bed rest can lead to muscle atrophy and development of contractures. Psychological effects of immobility can lead to increased anxiety, depression, helplessness, loss of control and increased dependency. Even though bed rest may be ordered for your client, it does not mean that the client should be completely immobile. Exercises (both passive and active depending on the client’s functional ability) should be instituted on a daily basis. Frequent change of positioning should be encouraged and the client’s skin should be given adequate massage in order to promote circulation. The nurse should perform a thorough skin assessment on a daily basis noting potential breakdown areas and coordinating care with ET (enterostomal therapist) nurse as warranted.