Creating a comfortable position in bed. The concept of the biomechanics of the body of the patient and the nurse. The patient is in a passive position

The patient's position usually indicates the severity of the disease. (You should know that sometimes patients with a serious illness continue to work for quite a long time and lead an active lifestyle, while suspicious patients with a mild illness prefer to go to bed.) The patient’s position can be active, passive, forced.

The active position is a position that the patient can voluntarily change, although he experiences painful or unpleasant sensations. The active position is typical for patients with a mild course of the disease.

The patient is in a passive position with certain serious illnesses. Sometimes it can be very uncomfortable for him (his head hangs down, his legs are tucked in), but due to severe weakness or loss of consciousness, or due to large loss of blood, he cannot change it.

A forced position is a position that relieves pain and improves the patient's condition. One or another feature of the disease forces him to such a position. For example, in the event of an attack of suffocation, a patient with bronchial asthma sits in bed, leaning forward, resting on the bed, table, thereby including auxiliary muscles in the act of inhalation (Fig. 1, a). During an attack of cardiac asthma, the patient sits slightly leaning back and rests his hands on the bed, his legs are lowered. In this position, the mass of circulating blood decreases (some of it is retained in the lower extremities), the diaphragm lowers somewhat, the pressure in the chest decreases, the excursion of the lungs increases, gas exchange and the outflow of venous blood from the brain improves.

The Fowler's position can be called a half-lying, half-sitting position. The patient is placed in the Fowler position in the following sequence:

1) bring the patient’s bed into a horizontal position;
2) raise the head of the bed at an angle of 45-60o (in this position the patient feels more comfortable, it is easier for him to breathe and communicate with others);
3) place the patient’s head on a mattress or low pillow to prevent flexion contracture of the cervical muscles;
4) if the patient is unable to independently move his arms, pillows are placed under them to prevent shoulder dislocation due to stretching of the shoulder joint capsule under the influence of the downward force of gravity of the arm and to prevent flexion contracture of the muscles of the upper limb; biomechanics sick patient medical
5) a pillow is placed under the patient’s lower back to reduce the load on the lumbar spine;
6) place a small pillow or cushion under the patient’s thigh (to prevent hyperextension in the knee joint and compression of the popliteal artery under the influence of gravity);
7) a small pillow is placed under the lower third of the patient’s shin to prevent prolonged pressure of the mattress on the heels;
8) place a support for the feet at an angle of 90° to support their dorsiflexion and prevent “sagging”.

Placing the patient in the Sims position is intermediate between the prone and lateral decubitus positions. Manipulation is carried out in the following sequence:

1) lower the head of the bed to a horizontal position;
2) place the patient on his back;
3) transfer the patient to a position lying on his side and partially lying on his stomach (only part of the patient’s abdomen is on the bed);
4) place a pillow under the patient's head to prevent excessive flexion of the neck;
5) the nurse places a pillow under the upper arm, bent at the elbow and shoulder joint at an angle of 90°; the lower arm is placed on the bed without bending to maintain correct body biomechanics;
6) place a floor mat under the bent upper leg so that the lower shin is at the level of the lower third of the thigh, to prevent inward rotation of the thigh, prevent hyperextension of the limbs, and prevent bedsores in the area of the knee joints and ankles;
7) place support for the feet at an angle of 90° to ensure correct dorsiflexion of the feet and prevent them from “sagging.”

The patient's position in bed should be changed every 2 hours. Having placed the patient in any of the listed positions, you should make sure that he feels comfortable.

Medical functional beds are designed to provide the necessary conditions for caring for patients with severe diseases of the neuromuscular and cardiovascular systems. With their help, the patient can be given the most optimal position depending on his disease. The beds are used both for inpatient care and for transporting patients within health care facilities. The advantage of the beds is the use of hydropneumatic shock absorbers (gas springs), which allows you to easily and smoothly adjust the lifting angle of the bed sections.

Types of patient positions relative to the bed Active - the patient can independently change his position, moves easily, serves himself, takes any position. This situation is typical for patients with a mild course of the disease. Passive – the patient cannot perform active movements. Causes: depression of consciousness, extreme weakness, intoxication, damage to the nervous and muscular systems. Forced - the patient takes this position to alleviate his condition (reduce shortness of breath, cough, pain)

Examples of forced positions For abdominal pain associated with inflammation of the peritoneum, the patient lies or sits with his legs bent, avoiding any touch to the abdomen. With pleurisy, the patient lies on the affected side to reduce pain and facilitate the excursion of the healthy lung. In case of suffocation - sitting, resting your hands on the bed to facilitate breathing, turning on the auxiliary muscles (orthopnea position).

Patients who are unable to independently change body position or who are completely immobilized have a risk of developing: bedsores - ulcerative-necrotic changes in the skin and other soft tissues that appear as a result of prolonged compression, shear or friction;

Fowler's position (half-lying/half-sitting) - lying on your back with the head of the bed raised at an angle C. Provides prevention of bedsores, easier breathing, easier communication and patient care. Types of functional positions of the patient in bed

Trendelenburg position - lying horizontally on your back, without a pillow, with your legs elevated. Promotes the outflow of blood through the veins of the lower extremities and the flow of blood to the head. Recommended for the prevention of thromboembolism, in case of acute vascular insufficiency (fainting, collapse, shock), signs of bleeding from the gastrointestinal tract. Types of functional positions of the patient in bed

To create a comfortable stay for the patient, a functional bed is used, equipped with three movable sections, side rails, silent wheels and a brake handle. The bed is equipped with a bedside table, nests for a bedpan and a urinal, and other additional devices that facilitate the patient’s condition and care for him.

The concept of biomechanics of the body Biomechanics is a science that studies the rules (laws) of the mechanical movement of the body in living systems. Living systems can be: a holistic system - a person; its organs and tissues; a group of people taking action together. Proper body biomechanics ensures the most efficient movement with the least amount of muscle tension, energy consumption and stress on the skeleton.

Maintaining a vertical position of the body in space is possible only by maintaining balance. This will avoid falls, injuries, and reduce the load on the spine. It is possible to maintain a stable position at a certain ratio of the body's center of gravity to the area of support. In a standing position, the area of support is limited to the soles of your feet. The center of gravity is approximately at the level of the second sacral vertebra.

Rules of biomechanics In a standing position: Balance is more stable if you increase the area of support. In a standing position, the distance between the feet should be 30 cm, one foot should be moved forward slightly. The balance will be more stable when the center of gravity shifts closer to the support area. This is achieved by slightly bending the knees. Correct posture will help maintain body balance and reduce the load on the spine - the curves of the spine, the position of the shoulder girdle, the condition of the joints of the lower extremities: shoulders and hips in the same plane; back straight; the joints and muscles of the lower extremities perform maximum work during movement, sparing the spine. Turn your whole body, which will prevent the danger of non-physiological displacement of the spine.

In a sitting position: Your knees should be slightly lower than your hips, which will redistribute body weight and reduce the load on the lumbar spine. The back should be straight and the abdominal muscles tense. The shoulders should be symmetrical to the hips. You should turn around while in a sitting position with your entire body.

When following the rules of biomechanics, you must remember. That a sudden change in body position in space can cause inadequate physiological reactions in the body: postural reflex - the appearance of dizziness, tinnitus, palpitations, sometimes loss of consciousness when changing body position; The Valsalva effect is a disturbance of heart rhythm and coronary blood flow as a result of straining at the height of inspiration. injury due to a fall.

Nursing staff are exposed to significant physical stress when caring for critically ill patients - moving them in bed, propping up a bedpan, moving gurneys and heavy equipment. Workplace safety must ensure the prevention of musculoskeletal injuries

Osteoporosis is a systemic disease that damages bones, reducing their density and strength. Associated with the body's loss of minerals, especially calcium. Physical stress on the spine and joints causes compression and pain. Progression of the disease leads to fractures and deformities. Osteochondrosis is a degenerative process in bone and cartilage tissue. Osteochondrosis of the spine is caused by thinning and degeneration of the intervertebral discs. Constant physical activity leads to their thickening and thinning, to the formation of bone growths and, as a result, to compression of the blood vessels and roots of the spinal cord.

Ergonomics is the science of the relationship between people and the environment for safe work. When choosing a chair, you need to consider: the level of the upper backrest is located under the shoulder blades; 2/3 of your thighs should be on the seat; legs should reach the floor, feet should be free, use a stand if necessary.

When lifting weights, you should: place your feet shoulder-width apart, push one leg forward; bend your knees; keep your back straight; when turning, first lift the load, then turn smoothly without bending your torso; turn your whole body; do not make sudden movements; use ergonomic devices; If possible, replace heavy lifting with rolling and turning - this will reduce muscle work and the load on the spine.

When moving a patient, you should: make sure what the patient’s condition and body weight are, whether it can help, whether the patient has drains or IVs, whether an assistant is needed; create a safe environment - remove unnecessary objects, put the bed or gurney on the brake, raise or lower the bed; choose the best way to restrain the patient; select lifting aids; get as close to the patient as possible; keep your back straight; make sure that the team and the patient perform movements in the same rhythm.

Types and rules for transporting a patient: On a gurney is the best option - the nurse experiences minimal physical activity, the patient experiences maximum muscle relaxation. It is necessary, after setting the brake, to carefully place the patient on a gurney covered with a sheet. Place the unconscious patient on his side and fix or hold him while moving. On a wheelchair - it is necessary to ensure that the patient’s arms and legs do not hang down when moving. On a stretcher - you need to walk out of step, in short steps, slightly bending your knees and holding the stretcher at the same level. On hands. Walking with an escort – it is necessary to hold the patient’s arm and monitor his well-being.

When caring for a seriously ill patient, it is necessary to be able to give the patient a comfortable position in bed with the help of additional pillows (2 pillows under the back in a “reclining” position, 3 pillows under the back when the patient is in a “half-sitting position in bed”). The patient's legs should be slightly bent at the knees. To do this, place a folded blanket. The patient's feet should be supported; place small pads under the patient's elbows.
When moving a patient in bed, it is necessary to remember the displacement force that causes the formation of bedsores. To do this, when moving the patient, it is necessary to transfer it. The patient participates in moving in bed (it is advisable to move together).

Moving the patient in bed:

turn the patient onto his back;
remove the pillow and blanket;
place a pillow at the head of the bed to prevent the patient’s head from hitting the headboard;
Invite the patient to clasp his elbows with his hands;
one person should stand at the upper part of the patient’s torso, bring the arm closest to the patient’s head, bring the upper part of the patient’s shoulder under the neck;
move the hand further to the opposite shoulder;
with the other hand, clasp the patient’s nearest arm and shoulder (hug);
the second assistant, standing at the lower part of the patient’s torso, places his hands under the patient’s lower back and hips;
invite the patient to bend his knees without lifting his feet from the bed;
bend the patient's neck, pressing the chin to the chest (this reduces resistance and increases the patient's mobility);
ask the patient to push off the bed with his heels on the count of three and assist the assistants, raise his torso and move to the head of the bed;
one of the assistants, located at the head of the bed, lifts the patient’s head and chest, the other puts pillows;
help the patient find a comfortable position in bed;
cover with a blanket;
make sure the patient is comfortable;
Wash the hands.

For preventing the formation of bedsores It is necessary to change the patient’s position every 2 hours: from the “lying on his back” position to the “lying on his side” position.

To do this you need:

bend the patient’s left leg at the knee joint (if you want to turn the patient on the right side), placing the left foot in the right popliteal cavity;
place one hand on the patient's thigh, the other on his shoulder;
turn the patient on his side, towards himself (thus, the action of the “lever” on the thigh facilitates turning);
place a pillow under the patient’s head and body (thus reducing the lateral bending of the neck and tension in the neck muscles);
give both the patient’s arms a slightly bent position, with the arm on top lying at the level of the shoulder and head; the hand located below lies on the pillow next to the head;
place a folded pillow under the patient’s back, slightly sliding it under the back with an even edge (this way you can “keep” the patient in the “sideways” position);
place a pillow (from the groin area to the foot) under the patient’s slightly bent “upper” leg (this prevents bedsores in the area of the knee joint and ankles and prevents hyperextension of the leg);
provide support at an angle of 90° for the lower foot (this ensures the dorsiflexion of the foot and prevents it from “sagging”).

From the patient's position "lying on his side" it is easy to transfer him to the position "lying on his stomach" (Fig.).

To do this you need:

Types of patient positions relative to the bed

1. Active – the patient can independently change his position, moves easily, serves himself, takes any position. This situation is typical for patients with a mild course of the disease.

2. Passive – the patient cannot perform active movements. Causes: depression of consciousness, extreme weakness, intoxication, damage to the nervous and muscular systems.

3. Forced – the patient takes this position to alleviate his condition (reduce shortness of breath, cough, pain). For example:

· for abdominal pain associated with inflammation of the peritoneum, the patient lies with his legs bent, avoiding any touch to the abdomen;

· with pleurisy, the patient lies on the sore side to reduce pain and facilitate the excursion of the healthy lung;

· in case of suffocation - sitting, resting your hands on the bed to facilitate breathing, engage auxiliary muscles (position orthopno e).

Immobilized patients who are unable to independently change the position of the body or individual parts of the body have risk of violations on the part of many organ systems, including the skin and musculoskeletal system:

· bedsores – ulcerative-necrotic changes in the skin and other soft tissues that appear as a result of their prolonged compression, shear or friction;

· joint contractures – persistent restriction of movement in joints;

· muscle wasting – gradual thinning, damage to muscle fibers and a decrease in their contractility as a result of disruption of their nutrition.

When placing a patient, he must be given functional provisions , promoting the physiological arrangement of body parts, reducing the risk of developing potential complications due to immobility.

Types of functional positions of the patient in bed

1. Fowler's position (reclining/half sitting) – lying on your back with the head of the bed raised at an angle of 45-60 0 C. Prevention of bedsores, easier breathing, easier communication and patient care.

2. Sims' position - intermediate between the position lying on the stomach and on the side. Recommended for the prevention of bedsores.

Lying on your back.

Lying on your stomach.

Lying on your side.

6. Trendelenburg position – lying horizontally on your back, without a pillow, with your legs raised. Promotes the outflow of blood through the veins of the lower extremities and the flow of blood to the head. Recommended for the prevention of thromboembolism, in case of acute vascular insufficiency (fainting, collapse, shock), signs of bleeding from the gastrointestinal tract.

When placing the patient in the desired position, it is necessary to use additional pillows and bolsters, foot rests and other devices. To create a comfortable patient experience, use functional bed , equipped with three movable sections, side rails, silent wheels and a brake handle. The bed is equipped with a bedside table, nests for a bedpan and a urinal, and other additional devices that facilitate the patient’s condition and care for him.

Concept of body biomechanics

Biomechanics– a science that studies the rules (laws) of the mechanical movement of a body in living systems. Living systems can be:

· an integral system - a person;

· its organs and tissues;

· a group of people performing joint actions.

In medicine, biomechanics studies the coordination of efforts of the musculoskeletal, nervous systems and vestibular apparatus aimed at maintaining balance and ensuring the most physiological position of the body at rest and during movement: when walking, lifting weights, bending, sitting, standing, lying down. Proper body biomechanics ensures the most efficient movement with the least amount of muscle tension, energy consumption and stress on the skeleton.

Maintaining the vertical position of the body in space is possible only by maintaining equilibrium. This will avoid falls, injuries, and reduce the load on the spine. Maintaining a stable position is possible with a certain ratio of the body's center of gravity to the area of support. In a standing position, the area of support is limited to the soles of your feet. The center of gravity is approximately at the level of the second sacral vertebra. When changing posture, the center of gravity may move beyond the support area, which will disrupt balance and may lead to a fall.

The nurse must know the rules of biomechanics and teach the patient and his family to effectively meet the need to move, avoiding falls and injury.

Depending on the general condition, the patient takes one or another position in bed. There are active, passive and forced positions.
An active position is considered to be one in which the patient can turn, sit and make active movements in bed, but cannot stand up or walk independently. The active position does not yet indicate a mild course of the disease. Passive is the position of an unconscious patient or a neurological patient with motor paralysis. The patient takes a forced position himself to alleviate his condition. In case of pain syndrome of peptic ulcer, the patient takes a forced knee-elbow position, in case of myocardial infarction - position on the back, in case of exudative pleurisy - on the sore side, etc.
The forced position is especially pronounced in patients with shortness of breath. They try to sit up, lean their hands on the edge of the bed, and lower their legs. In such cases, 2-3 well-fluffed pillows should be placed under the patient’s back, a headrest should be placed, or the head end of the functional bed should be raised. If the patient is leaning against a wall, then a pillow is placed under his back and a bench is placed under his feet. If there is an abscess in the lungs or bronchi, it is necessary to create a position for better discharge of sputum. This is the so-called bronchial drainage. The patient can take a kneeling position and rest his forehead on the bed (the pose of a praying Mohammedan) or lower his head below the edge of the bed (the pose of someone looking for shoes under the bed). If the patient has a one-sided process in the lungs, then he lies on the opposite side, that is, on the healthy side: in this case, expectoration of sputum from the diseased lung increases.
Patient's position in bed
When sick, the patient takes different positions in bed. There are:
active position - the patient easily and freely performs voluntary (active) movements;
passive position - the patient cannot perform voluntary movements, maintains the position that was given to him (for example, in case of loss of consciousness, or the doctor forbade him to perform them, for example, in the first hours after a heart attack);
forced position - the patient takes it himself in order to reduce (lower the level) of pain and other pathological symptoms.
The patient's position in bed does not always coincide with the movement regimen prescribed by the doctor. Activity mode (motor mode):
General (free) - the patient stays in the department without restriction of physical activity within the hospital and hospital territory. You are allowed to walk freely along the corridor, climb the stairs, and walk around the hospital grounds.
Ward - the patient spends a lot of time in bed, free walking around the ward is allowed. All personal hygiene activities are carried out within the ward.
Semi-bed resting - the patient spends all the time in bed, can sit on the edge of the bed or a chair to eat, perform the morning toilet, and can go to the toilet accompanied by a nurse.
Bed resting - the patient does not leave the bed, can sit and turn around. All personal hygiene measures are carried out in bed by medical personnel.
Strict bed rest - the patient is strictly prohibited from active movements in bed, even from turning from side to side.
In diseases, various changes in the patient's position are observed. Thus, in a satisfactory condition, patients are active, they easily and freely carry out certain movements. If active movements of patients are impossible (with unconsciousness, severe weakness, etc.), they speak of the patient’s passive position. In some diseases, there is a forced position that patients must take to reduce pain. An example of a forced position is the so-called orthopnea - a sitting position of the patient with his legs down. It is taken by patients with circulatory failure and blood stagnation in the pulmonary circulation. In a position of orthopnea, a redistribution of blood occurs with its deposition in the veins of the lower extremities, as a result of which the stagnation of blood in the vessels of the lungs decreases and shortness of breath weakens.

The patient's position does not always coincide with the movement regime assigned to the patient - strict bed (the patient is not even allowed to turn), bed (you can turn in bed without leaving it), semi-bed (you can get up) and general (without significant limitation of motor activity). For example, patients on the first day of myocardial infarction must observe strict bed rest, even if they are in an active position. And fainting, leading to a short-term passive position of the patient, is not at all an indication for subsequent restriction of motor activity.
The need to create a comfortable position in bed for a seriously ill patient determines a number of requirements for the design of the bed. For this purpose, the so-called functional bed is best suited, the head and foot ends of which can, if necessary, be moved to the desired position - raised or lowered. (Her bed net has several sections, the position of which can be changed by turning the corresponding knob.) Now there are more advanced beds that provide built-in bedside tables, stands for IVs, nests for storing vessels and a urine bag. The patient can raise or lower the head of the bed himself by pressing a special handle.
In some cases, headrests, additional pillows, bolsters, and footrests are used to give the patient a comfortable position. For patients with spinal injuries, a hard shield is placed under the mattress. Children's beds, as well as beds for restless patients, are equipped with side nets. The beds in the wards are installed so that they can be easily approached from any side.
Position of the patient in bed
Great importance in the treatment of any disease is given to general patient care. The patient's position in bed largely depends on the severity and nature of the disease. In cases where the patient can get out of bed, walk, and sit independently, his position is called active. The position of a patient who is unable to move, turn, raise his head and arms is called passive. The position that the patient takes on his own, trying to alleviate his suffering, is called forced.
Whatever the position of the inpatient, he spends most of his time in bed. Therefore, bed comfort is important for the patient’s well-being and recovery.
It is better if the ward has functional beds that help create a comfortable position for the patient. The functional bed consists of three movable sections, the position of which can be changed using special devices or handles.
The mesh on the bed should be well stretched and have a flat surface. A mattress without bumps or depressions is placed on top of it. Caring for patients becomes more convenient if you use a mattress consisting of separate parts, each of which can be replaced as necessary.
For patients suffering from urinary and fecal incontinence, an oilcloth is attached across the entire width of the mattress cover to prevent contamination. The mattress cover is covered with a sheet, the edges of which must be tucked under the mattress so that it does not roll or bunch up.
The pillows are placed so that the bottom (feather) pillow lies parallel to the length of the bed and protrudes slightly from under the top (down) pillow, which should rest against the headboard. White pillowcases are put on the pillows. Persons with allergies to feathers and down are given foam (or cotton) pillows. To cover the patient, use (according to the season) flannel or woolen blankets placed in a duvet cover.
In the absence of a functional bed, special headrests are used to give the patient a semi-sitting position. In this case, a stop is placed in the legs so that the patient does not slide off the headrest.
The patient's bed should be changed regularly, morning and evening (sheets, blankets are straightened, pillows are fluffed). If the patient cannot be turned over, then special devices are used to bring the surface of the bed into proper order.
A bedside table or bedside table is placed near the patient's bed, the height of which must correspond to the height of the bed. For seriously ill patients, special bedside tables are used, located above the bed and providing convenience during meals.
Ventilation of the rooms depends on the season.
In the summer, the windows are closed around the clock; in the winter, the windows or transoms are opened 3-4 times a day for 15-20 minutes. In this case, it is necessary to ensure that there are no drafts.
Of great importance for successful treatment is patient compliance with personal hygiene, including timely change of bed and underwear, skin care, eyes, oral cavity, and hair. It should be remembered that the sicker the patient, the more difficult it is to care for him and perform any manipulations.
The patient's position usually indicates the severity of the disease. (You should know that sometimes patients with a serious illness continue to work for quite a long time and lead an active lifestyle, while suspicious patients with a mild illness prefer to go to bed.) The patient’s position can be active, passive, forced.
The active position is a position that the patient can voluntarily change, although he experiences painful or unpleasant sensations. The active position is typical for patients with a mild course of the disease.
The patient is in a passive position with certain serious illnesses. Sometimes it can be very uncomfortable for him (his head hangs down, his legs are tucked in), but due to severe weakness or loss of consciousness, or due to large loss of blood, he cannot change it.
A forced position is a position that relieves pain and improves the patient's condition. One or another feature of the disease forces him to such a position. For example, in the event of an attack of suffocation, a patient with bronchial asthma sits in bed, leaning forward, resting on the bed, table, thereby including auxiliary muscles in the act of inhalation (Fig. 1, a). During an attack of cardiac asthma, the patient sits slightly leaning back and rests his hands on the bed, his legs are lowered. In this position, the mass of circulating blood decreases (some of it is retained in the lower extremities), the diaphragm lowers somewhat, the pressure in the chest decreases, the excursion of the lungs increases, gas exchange and the outflow of venous blood from the brain improves.