all right so we're going to talk about immobility here for a bit it becomes really important for you as a student nurse especially to understand the effects of immobility on your patient and also the role that you can have in helping your patient to be as mobile as possible this is something that you can do almost immediately in clinical is help your patient reposition help your patient do some exercises that can strengthen their muscles help get your patients out of bed so it becomes really important for you to kind of take an active role in that and it's something that unfortunately some of our nurses don't focus enough attention on or don't have time to focus enough attention on so as a student you can have a really critical role in helping your patients with this and it really becomes important not just for your patients physiological Health but also their psychological Health that we try to keep our patients moving it's really important for a patient's self-worth for their well-being and you can take an active role in that so that is um that's a nice role that you can take immediately moving into the hospital if we get you educated enough to know what to do the objectives for this presentation are listed right here just as usual make sure that at the end you go back and you take a look at these and make sure that you can address all of them if not then refer back to your book or refer back to this but make sure that you can address all those objectives as far as just the basic scientific knowledge base I'm going to whiz through quite a bit of this because I don't think any of it is news to you if there's any of it that doesn't make sense then please go back to your book and look at that again some of the terms I want you to be familiar with so when we talk about body mechanics we're really just talking about how we hold ourselves so that we can avoid injury to ourselves and to our patients so just that coordinated effort between our musculoskeletal and nervous system is important when we look at alignment and balance then we're really looking at how can we reduce the strain on our musculoskeletal structures how can we maintain adequate muscle tone promote Comfort all of that so that becomes important for ourselves and then also for our patients if we're responsible for repositioning them whether it's positioning them in a chair or it is positioning them in bed then making sure that we have proper alignment for them becomes a really big deal we don't want to leave somebody in a position that where they're not alone mind and especially our patients who can't communicate that to us it's really important that we take a look at that and make sure that we have done the best that we can as far as aligning them the um the square down in the bottom left hand corner that says gravity when you go into the PowerPoint slides that I have uploaded for you in Blackboard you can actually click on that and it is an article that was written actually a little while ago it's not a terribly recent article but I thought it was really good because it talks about the effects of gravity particularly on our astronauts so the effect of zero gravity what does that have um so for our for our astronauts if they are in space for each day that they are in space it takes a day of recovery on Earth to regain whatever muscle mass they have lost so six weeks in space is six weeks of active recovery to get back to where they were before they left for bone loss it's a lot more so if an astronaut is in space for three to six months it's typically a two to three year recovery and that's an active recovery working with physical therapy doing all of that to regain the lost the Lost bone so what does that mean for our patients who are not astronauts well the first thing is they're not usually in as good a shape as an astronaut is going into it so they're going to be affected even more by the loss of bone bone mass and and muscle strength and then also while they're not in a zero gravity environment you know we usually take those beds and we stick the feet up and we put the head up and we essentially put them in a zero gravity position if we were to leave somebody there for a long time patients can actually lose muscle mass at a rate as high as five percent a week so if we have somebody recovering from back surgery and we tell them they need to stay on bed rest for two weeks we're now looking at somebody who has 10 percent less muscle mass than they did before they went into surgery that's going to make the recovery so much more difficult so that's one of the reasons that we're really looking to get our patients up and moving so much quicker because we really want to make sure that we are not we're not hindering them in that aspect friction is a concept that's really difficult to explain without a visual I just realized that I always explain this in person and so trying to figure out how to explain this to you without you being able to see me is a little bit difficult so I'm going to ask you to play along for a second please take your left hand and kind of lay it out flat in the air with your palm facing upward and then take your right hand and put it on top of your left hand and then I want you to imagine that bottom hand is the mattress and the top hand is the patient and I want you to take the Top Hand the patient and move that patient upward as if they had slid down in the bed and you want to move them up in the bed but keeping your palms together and then you can kind of feel that friction that is caused where the hand is moving one way but the skin is still kind of stuck in the position it was in originally that can really damage frail skin especially on our elderly patients on our really debilitated patients so we want to be really careful how we reposition somebody and how we move them up in bed because we can do more harm than good if we create friction and essentially that shearing of the skin that can happen when we're repositioning somebody so hopefully that kind of makes sense with that when we look at um basically the function of our skeletal system then really we're just looking at um you know how this how the system can help us with movement um you know obviously the bones are long short flat irregular we've got all of that but it really just becomes important to kind of understand that the skeletal system plays a big role in um your patient's alignment how they're able to move all of that some of the other Basics here as far as um you know the skeletal system goes make sure that you know the different kinds of um a bone joints I guess is what I'm trying to say so the synostic the cartilaginous the fibrous and the synovial make sure you look those up in your textbooks that you can kind of think of an example of each of those and there's pictures here so it shouldn't be too difficult for you but just talking about exactly what they are so like the synovial which is a freely moving joint kind of like your hip joint would be an example of that so just kind of look through your book and make sure you understand what those are when we look at the um the ligaments and the tendons they have similar but different functions so the ligaments are going to bind joints together connect bones and cartilage and the tendons usually connect the muscles to Bone um so there's a couple you know picture examples there as well when we move into looking at um the role of our muscles as far as with leverage and posture and all of that then we're also looking for um you know the muscle tone and how that can help us and when we look at our patients who are immobile or on bed rest like I said then that muscle tone is going to decrease at a rapid rate and that becomes a really big deal for our patients so we want to try and prevent that as much as possible the nervous system has a role as well so it also helps us regulate movement and posture and it's regulated in the voluntary motor area of the cerebral cortex so information and you guys remember from your um prerequisite courses that the opposite side of the brain so if you had a stroke if you had what we call a right-sided stroke then it's left-sided weakness that you would see on your patient and vice versa so that becomes important to understand too so if you are you know day one in clinical and someone says your patient had a right-sided stroke then which side are you going to be helping them with you know don't immediately go to the right side because that's not the side that they need help with so you know just that background knowledge is going to help you be more active when you get into clinical there's a couple terms on this slide right here none of them I think are news to you so Mobility is the ability to move about freely immobility is the inability to move and then bed rest is sort of our medical term for it's basically an intervention so the physician can order bed rest for your patient or you can determine that's what's best for your patient for therapeutic reasons so we want to try and limit that as much as possible so a couple different pictures here that'll show you I'll start with the bottom left picture where you can see a patient who is not moving a whole lot and you can see they don't have the rails up so that's a safety issue but we're going to ignore that looks like the patient is on a ventilator that still is not a patient that we're just going to leave immobile unless they are so physiologically unstable that every time we try to lift their head up their blood pressure disappears it but we're even with that patient we're going to try to very very gradually increase what activity we can do with them because despite the fact that this patient looks fairly young they're going to lose an incredible amount of muscle mass of bone structure and then every single system within the body is affected by immobility and so we can see complications with blood clots or urinary calculi lots of different issues that can come from immobility so we want to try and prevent that as much as possible the pictures on the right are a couple different ways that we can move patients the top one here almost looks like a pool float right I was joking about that a couple semesters ago with a student because I had never seen this type of device in use in the hospital and so I was picturing wow if I ever worked Home Health you know I think that would be a great idea I'd put a pool float in the back of my car do deflated and if I have a patient that I can't move around you know roll that underneath them and then use it to be able to position them around I think that would be great and then one of my students said they had actually seen this in use in the hospital which twice about which I thought was interesting I've seen more of the devices that are similar to the one that is in the bottom picture which have pulleys and all kinds of systems up in the ceiling so again each hospital is going to have different resources but find out what resources the hospitals that you guys are at have to help you maintain the alignment for your patients to protect you yourself through good body mechanics but do find a way to get those patients active and moving it's a really really big deal so the next slide kind of goes into all of the different systemic effects so you can see that every single system it can be affected negatively by immobility and we'll kind of whiz through some of those in the next few slides in more specific but just know that it's not just the musculoskeletal system that is affected every single body system is affected by immobility and so we want to try and get the patients mobile as soon as possible so here if we think about metabolic changes if you go back to your your science classes as well um you know if you have somebody who's immobile that body is going to excrete more nitrogen than it is ingesting protein which is going to cause a negative nitrogen balance which is going to lead to weight loss decreased muscle mass and weakness resulting from tissue breakdown so basically um catabolism right so that's not a positive thing we don't we want to try and prevent that from our patients um and then when we look at respiratory you guys probably already in health assessment have learned how to use your incentives parameters have received your own individual incentive spirometers that's something that we can do to prevent um respiratory issues with our patients who are immobile because when you get up and you move you naturally take deeper breaths so if I get a patient out of bed and I have them walk down the hallway they're naturally going to take deeper breaths than if they're just laying in their zero gravity position in bed if we can't get them up and move them around what else could we do we could have them use an incentive spirometer that would be an effective thing to do we could have them turn cough and deep breathe ctdb is how we usually write that so again having them take take move around in the bed and having them do a little cough to just kind of clear the lungs a little bit and having them take a couple of exaggerated deep breaths that all helps exercise the respiratory system so that we're looking at less pooling of secretions um so that we're looking at um you know less collapse of the alveoli less inflammation from stasis so we're just trying to prevent all of that from happening there's obviously going to be a lot of cardiovascular effects and changes as well so orthostatic hypotension I'm thinking you probably cover that in health assessment but that is where that sudden body change so especially if you've had somebody laying supine so laying flat for a really long time and then all of a sudden you say okay it's time to get you up out of bed and yes sit them up and stand them up guaranteed they're going to go down because the body has gotten used to circulating the blood on a flat surface essentially not working against gravity up and down if that makes any sense so we want to gradually move them from one position to the other to avoid orthostatic hypertension and a fall which would be quite negative and then as I said the body has gotten used to circulating that blood on a flat so plane basically so when we stand our patient up then all of a sudden there's a big increased cardiac workload and so we gradually have to work our way up to that and then just not having a lot of movement also can lead to blood clot formation which is also you know obviously really dangerous and negative for our patients so again more reasons to get your patient up if you didn't have enough reasons already as far as the musculoskeletal we talked a little bit about this about how you're going to lose muscle mass lose bone mass it's gonna again like I said cause that impaired calcium metabolism um and so there's a lot of negative effects that can occur from that one of them is foot drop which that's our actual medical term for it which happens really easily if the patient loses um doesn't use those calf muscles then the foot sort of goes down into that position that you see where the foot is kind of relaxed down and it all of a sudden the muscles deteriorate to the point where they cannot lift that foot back up into the starting position so then when you get that patient up later to walk that foot it becomes incredibly difficult for them to walk because the foot is in that relaxed position all the time so we want to prevent that from happening as well even your urinary system is affected by lack of Mobility so without gravity the renal pelvis just fills up with urine before the urine enters the ureters which kind of leaves it just sitting there because now you don't necessarily feel the need to go your bladder is filling but it's not generating that Sensation that when you're up and your ureters are in a different position you get that Sensation that you need to go and that can also cause calculi which are basically calcium stones that can Lodge either in the pelvis or pass through the ureters so our immobilized patients they frequently have conditions that increase likelihood of renal calculi they'll have hypercalcemia concentrated urine due to dehydration so there's a lot of different ways that this all works together and then urinary catheters are not necessarily the answer because when you put a urinary catheter in then there's so much higher risk for infection so it's kind of a catch-22 with all these different things so the biggest best thing that you can do is get your patient moving the system that you would obviously assume is going to be affected by immobility is the skin so the integumentary system so certainly you can imagine that patients would be at risk for pressure ulcers um you know especially your older adults would be at risk for that so kind of take a look at the pressure points that are shown here and kind of think about that for your patient even things that I know you've probably talked about this in health assessment even things just like the ears or the shoulder blades it's not always just on the coccyx or the sacrum where you might think it might be or the heels or the elbows that seem like kind of obvious areas there's a lot of different areas that your patient can be at risk for developing pressure ulcers and even your patients that you get up in a chair they're actually at higher risk if that's the extent of their Mobility so like our nursing home patients where a lot of times at the nursing home they get them up and they set them in a chair and there they sit you know for the majority of the day while you can't reposition a person in a chair as well as you can in a bed we can turn them from the right side to the left side to the back and you know such if they're in the bed but in the chair you're in the chair so for those patients if it's somebody who's alert you know just asking them to shift their body weight probably like you guys are doing if you're sitting in a you know desk chair or dining room chair listening to this you immediately kind of go to shift your weight a little bit because you become uncomfortable a lot of our patients maybe that sensation isn't there but if you remind them to shift their weight they can do that and if you can't do that then find out a way can you prop them with a towel can you do something to shift so that those pressure points are not always in the same place because otherwise they're definitely going to develop skin breakdown and then I talked about this uh it on the intro slide as far as the psychosocial effect of immobility so if you have somebody who previously was fully mobile you can imagine that they might have some emotional behavioral responses you know this is not most people are not going to be excited about having limited Mobility so they might get angry and be hostile they might be inappropriately giddy like just you know not really knowing how to deal with it they might have a lot of fear they might have a lot of anxiety I would probably have all those things because I'm used to being an active person so if all of a sudden I'm just stuck in a hospital bed that's going to cause a lot of these feelings you hear it a little bit when we read I'm here because we're talking about a young 19 year old kid who's used to being very very active who all of a sudden you know his world is the size of his bed and that is absolutely going to have some psychosocial effects it can affect um patients sleep habits you know again if all you do is lay in a bed you doze off many many many many many many times during the day then when it's lights off in time to go to bed at night are you really tired anymore can you sleep we see it a lot with our ICU patients where they get Delirious because in the ICU the lights never go down the noise level never decreases and so these patients can barely tell day from night because everybody is running around and everything is alarming and people are yelling get me this code that and it really affects our patients sleep so we're trying to be much more aware of that and trying to create a calm environment some of our hospitals have quiet zones they have quiet times maybe from two to four in the afternoon and same thing in the middle of the night where we're really trying to be aware of the noise level because those sensory alterations can really have a big effect on our patient and then obviously changes in coping again if if all of a sudden and I was not able to be mobile guaranteed I'd be depressed sad dejected all of those terms because that's not the state that anyone hopes to be in what I want you guys to think about is what's on this slide here and I'll ask you when you come to class to share a couple of things that you as a student nurse immediately could do to help prevent the complications of immobility so kind of think back to those different complications that we saw in the next few slides forward you'll see some tips and tricks as well so just kind of think of I want you to be willing to share some things that you could do and especially things that you could do day one as a student nurse we really want you to get in there and be active when you head into clinical um all right so now we're looking through the nursing process so last week we learned the nursing process so now we're going to kind of work our way through that so if we're looking at assessment we want to assess their gait um so you want to look at how they are moving how they are walking we want to look at what is their normal physical activity what is their physical activity in the hospital are they able to maintain that activity in activity tolerance so you know when they get up and walk across the room do they get short of breath um you know what are they able to do I want you guys to look in your book as well and we'll do some of this when we meet as a group as well but look at those range of motion ROM exercises and c I want you to be able to see what is the difference between active and passive on those so I want you guys to be able to talk about that when we meet back and then the visual here again is the alignment that we were talking about in one of those first slides where you can see here this spine is well aligned the hips are well aligned that becomes important and unfortunately our patients don't come with a diagram like that on the back so you kind of have to get used to looking and seeing what would what do you think would be good alignment for your patient but being aware of that is important then this slide here shows just a few of the nursing diagnoses that could pertain to a patient with decreased Mobility so obviously impaired physical Mobility we just said that um but as you look at all of these you can see it goes from physical diagnoses to things like social isolation some risk for diagnoses risk for impaired skin integrity so there's a lot of different things that could be the primary concern for you on a patient that has decreased Mobility when we move into planning then this again is where we in kind of reinforcing what we talked about last week this is where you're looking at goals and outcomes you're setting priorities you're deciding who you need to collaborate with so if we're going to look at impaired physical Mobility then remember how we set up our nursing diagnosis so impaired physical Mobility what is it caused by why are they not able to physically move around their environment I'm going to say I think it is because because they are weak and they have an unsteady gait so that's my related to and then what is my proof that they have impaired physical Mobility I think it is that inability to move they can't even walk 10 feet so that's my as evidenced by then I'm going to come up with a couple of goals so for my short term patient will be able to transfer to chair with assistive device by end of shift good solid little goal that we can get to by the end of the shift not huge and then my long-term goal is that patients going to be able to walk 100 feet using a walker by discharge that would not be an appropriate short-term goal because we already said the patient can't walk more than 10 feet or can't even walk 10 feet so to think that by the end of the shift you could get them to 100 feet is unrealistic so making sure that your goals also are realistic for your patient is important and then looking at oh sorry sorry sorry um looking at some of the implementation that we can do so if we were concerned about the metabolic effects of immobility then providing a high protein diet and so on and so forth so read through these kind of on your own as far as respiratory cardiovascular musculoskeletal I don't want to read all these to you because that seems kind of silly but think about for each of those systems that are affected what how could you help prevent those complications so that's what I want you to come to class with is being able to say if you are concerned about cardiovascular what can you do to help your patient um some of the abbreviations on here that you guys need to know um so scds are sequential compression stockings CPM is continuous passive motion um TED hose are thrombo embalotic um oh good lord D okay that one didn't come to me right away it's going to come to me in a second but they're like those tight stockings that we put on our patients to help them with their circulation I promise it'll come back to me um all right so then um as far as implementation goes here we go we're looking at again continuing looking at what can you do for the integumentary system what can you do for the elimination system so there's different interventions based on where you think the complications are for your patient and that becomes important this right here is a picture of the SCD so these are the patients sometimes call them squeezy boots um so these are those plastic sheet sleeves that with air they hook to a machine and the air inflates and deflates which sort of mimics what your muscles naturally do to your blood vessels when you walk so the you know movement that you get for the blood flow this becomes important for you to know as a student because in order to assess your patient so like you're learning to do in health assessment you need to turn the machine off and you need to take these all the way off of your patient and take a look at your patient's skin underneath there and then put them back on and turn it back on before you leave the room if you look at the picture at the very bottom where you can see um kind of how the edge of that plastic material it's really sharp which I don't understand why it can't be made differently so you also when you take them off you really want to assess all those areas where that material is in direct contact with the skin to make sure that it's not digging in and that if it is you maybe give it a little bit longer without being on the patient and then when you put it back don't put it back in exactly the same place because otherwise they're going to have skin breakdown right on that spot so really being aware of that is important as well um and then here are the um those Ted hoes that I was talking about the anti-embolic stockings um which like I said at some point the D is going to come to me but we'll see same thing these have to come off when you do your shift assessment and then just make sure you put them back on before you leave again I usually do this as one of the first things when I start my assessment so I know you guys are learning your to start your assessment at the head and work your way down but because I think it's kind of pleasant for a patient to have this off for a bit I usually will take the scds and the teds off go wash my hands do whatever I need to do and then start my assessment and that way they get to be off for a little bit longer period of time and give the skin a chance to breathe um so again Different Different Strokes for different folks on that but make sure that you do check circulation and take those stockings off as far as helping your patient move around the top picture here is um a bar that we a lot of times use with our patients who have orthopedic surgery so if they have good upper body strength but they have had hip surgery or knee surgery they can help reposition themselves up in bed and avoid that friction by using this bar because then they're lifting their body up off the bed and they're not just hoisting their skin up along that and getting that friction that we talked about at the beginning and then the bottom picture is just an example of positioning somebody using towels or sheets or pillows which is also something that we do quite a bit this slide right here looks a little bit busy but it is just pictures of some diff there's different equipment that we can use for transferring so this is just one of them one of the reasons that I try to include these pictures for you is I don't want you to be intimidated by this equipment so all the hospitals are going to have different equipment but find out what they use at the facility that you're at have somebody show you how to use it the first few times you use it have somebody there to back you up because certainly you don't want to get in a position where you don't know what to do and you're stuck with a patient you know halfway between the bed and the chair but this equipment is there to keep you safe and to keep your patients safe so if you look at this type of lift here this is for somebody who doesn't necessarily maybe they don't have the leg muscle strength to get themselves to standing but this is somebody who has to have enough strength to maintain standing so it's not appropriate for all patients if they're just legs just completely Buckle underneath them then they're not going to make it to the chair so you have to assess your patient and what equal equipment is appropriate to use to help them move as well and then here we're just looking at um you know if we're going to be doing so the the range of motion that I told you guys to look up one of the things that becomes important if you are doing um passive range of motion which is where you're doing it for the patient I'm kind of giving you your answers now is to support the joints so you can see in all of these pictures that the nurse is supporting the joints you're not just randomly taking the patient's hand and straightening that elbow joint without supporting the elbow joint as well because we don't want to hyper extend or do anything like that with the patient's joints all right so this next slide here uh might seem a little bit random but it has a purpose for me um so this right here I think I put it in here as an eye opener for you guys to see so if you see this patient here she's really young um she was incredibly incredibly sick in an ICU for almost a year she was a really really sick very immobile and when they finally got to the point where she was able to communicate with them she wanted two things she wanted pizza and she wanted to get out of bed and walk and she is one word they had kept her on bed rest for a fair amount of time because she was so physiologically unstable so you can see this is not your average patient basically the the large large large IV type tubing that you see going into her neck up there that is attached to what we call an ECMO machine that basically does the work of her heart and her lungs so her body is not doing the work of her heart and her lungs there's a machine on the outside that is doing that if one of those tubes were to become dislodged or fall out she would die there's no way that you could quickly enough manage that that it would be okay so the risk of moving her was really really high but the risk of not moving her was really really high as well so there were all of the physiological considerations that we went through in every body system but also the psychosocial part of it if you're thinking of a 16 year old girl you can't just say lay here and you know we'll get back to you you that's just not for somebody who's alert that's just not feasible so I have great admiration for this nursing team because they advocated and again terms that we've used in this class they advocated for this girl so much there's actually one of the nurses who kind of took on that role and just went to battle for her and was talking to every physician because you can imagine she didn't have one person who was her physician right she had a pulmonologist a cardiologist a nephrologist you name it all of these Physicians and for them the risk of moving her was really high and so they took a lot of convincing to say we want to get her out of bed because it sounded a little crazy at first if you look at how many IV pumps and how many different machines and oxygen and tubes are attached to this girl that was not a simple thing to get her out of bed and that one nurse was actually with her team but you know took the lead on that was able to convince all of that team of Physicians that yes you can try to get her up the first time they got her up in this top left picture is not even the first time that they got her up um the first time they got her up it was a huge team there was probably 15 people helping to get her up because somebody had to as you can see just hold those tubes and make sure nothing happens to those somebody else has to look at the vital signs and the EKG monitoring somebody else has to move the medication up and down up and down increasing and decreasing the dosages because being upright is different than laying flat and then you can see when you look at the next picture down where she's wearing pink you know now the team is a whole lot smaller they've got this figured out she still has the same equipment but they've got it figured out a little bit better how they can move her and she's a little bit stronger at that point too and then the pictures over on the right hand side this was a lot of the children's hospitals will have proms um for their patients who are there and so this was the prom and she was she was able to go now she has a team of nurses who I love it they've got their dresses and one of them still got her tennis shoes on which is awesome but they were able to get her there and um I love this this bottom picture right here that's not actually a tattoo it's one of our transparent dressings that we put on if you've ever seen those on patients but one of the nurses boyfriends went through and just kind of colored it so that it looks like a tattoo just so you don't see those really large bore um huge Ivy type things going into her neck and kind of terrify everyone else so I thought that was really sweet as well so again if these if this team can get this young lady up then there's no excuse for not getting pretty much every patient that we have up and moving um we used to wait our open heart patients used to wait almost 24 hours after open heart surgery before we would get them up having seen the research as far as the effects of immobility we get those patients up within two to four hours now so open heart surgery two to four hours you're up and out of bed so really it is a huge Focus as far as trying to make sure that we are keeping our patients as active as possible now we're still working our way through so that was a little detour but we're still working our way through the nursing process so now we're at the evaluation step where we're again looking to see where the goals and outcomes met and if not then how can we alter those goals how can we alter our interventions what can we do to help our patients and these questions are very patient focused as far as you know if you had an active alert patient then finding out how you can partner with them becomes really important not just do stuff for them but partner with them becomes really important this slide right here just looks that again if you're going to move somebody then we're also talking about safety this week so how can we safely do that communication is huge so if you looked at the you know pictures of z um you know you can imagine the communication that had to happen between those 15 team members and her the first time they got her up they have to make sure that everybody knows each step of the way what they're doing you don't just say okay let's get up now I'm sure they mentally rehearse this many many times before they attempted that and figured out who needs to be where and if I move here what happens over there so again the more complicated it is the more exaggerated this becomes but for you guys as novices you know mentally rehearsing just a simple getting somebody up out of bed becomes important as well um being able to make sure they do a good assessment of mobility and strength before getting somebody up is important because you don't want to be halfway there and find out they don't have the strength that they need determining what assistance that you need um you know making sure that for body mechanics you're raising and lowering the bed and the rails and arranging your equipment that becomes really important and then if you do have equipment that you can use making sure you understand how to use that and then huge piece making sure that the patient is involved in this and they understand their role they understand the importance of getting up so that education piece becomes a really big deal as well and then a lot of our hospitals have what we call Safe patient handling so this is that ergonomics that I was talking about so if they provide equipment that you are to use to mobilize your patient then that's what they expect you to use so the top picture here with the green sling that's fairly common a lot of our hospitals use that system there and it can either be used with the slides that are in the ceiling so there's actually hooks that can attach to bars in the ceiling and we can move the patients around the room or if the hospital doesn't have that then there's this mobile device that we can use so we can take those patients from the bed and move them to the chair the other picture on the bottom here is actually a system I have not only seen it used once and that hospital discontinued it while we were there so this is actually a group of students that I brought in there and we couldn't figure out how this worked so we actually went through and um and tested it out so this is one of the students using it here and you can see it looks very awkward it looks almost like a body bag type of thing um but the little up up at the top the two pieces that look like seat belt hooks actually come down and click into the pieces that are on the metal bar below and what you use to lift the patient up is a sheet and we all thought that seemed very strange because Hospital sheets they get used a lot and so some of them are stronger than others we tried to use a blanket to kind of have a little more strength but then the metal bar couldn't snap together with that in between so we we quickly found out why the nurses were not using it in the hospital and so you know that that becomes important if you're in a hospital where you have equipment and this is what you're supposed to use but you don't think it's safe for either you or your patient then you have to Advocate that you have to go and speak to whoever ordered the equipment whatever Department that is and so that's what the nurses eventually did and then this was discontinued even before our rotation was over they stopped using that equipment because it wasn't safe for the patients or for the nurses and then um just finally some terms for you guys to know um again we're working on abbreviations this week so make sure that you are looking at these terms here and then also for positioning as far as looking in your book make sure you know what Fowlers is semi-fowlers trendelenberg reverse trendelenberg supine all those positions make sure you understand what those are because again I want you to know when you go into clinical when somebody says I want you to put that patient in Trendelenburg that you don't stand there and say I have no idea what that means so these are some very basic things that not only do you need them as far as knowledge that you're going to want for the test but this is knowledge you need to bring with you to clinical so don't just memorize it and then forget it make sure that you take that with you when you go into clinical as well that's all I have as far as Mobility we'll go over some more stuff when we come into class but this is at least a start so make sure you are familiar with all of this and then I will see you when we meet