Importance of Proper Body Alignment
Proper Body Alignment means that the joints, tendons, ligaments and muscles are in line with the pull of gravity. When the body is aligned properly sitting, standing or lying down carry no excessive strain. Patients who are immobile may experience disuse osteoporosis, disuse atrophy, contractures, reduced skin turgor and skin breakdown.
The mentioned complications can be avoided when a patient is positioned to maintain a proper body alignment. Thus, joint contractures and deformities are prevented. Improper positioning of the client can result in pressure ulcers which can develop in just 24 hours but requires months to heal. Proper posture must ne maintained as near as normal to an upright position if patients are immobile or confined to bed. A properly position and aligned body should meet the following criteria:
- Spine should be straight
- The head is neutral
- All extremities are in functional positions
Alignment and Pressure-reducing Devices
Positioning devices are used to maintain the functional position of the wrists, hands, fingers, ankles and other extremities. To prevent hip and knee contractures, the major joints should be placed in extension. These devices include:
- Cradle boots
- Abduction pillow
- Trochanter rolls
- Hand rolls
CRADLE BOOTS
cradle boot
Cradle boots are used to protect the heels and help to prevent skin breakdown and footdrop. These devices are made of rubber with heel cutouts. It cushions the ankle and foot without completely enclosing it.
How to apply cradle boots?
- Place the patient’s heel in the circular cutout area of the opened slit on the superior surface of the boot.
- When the patient is on a lateral position, apply the boot only to the bottom foot and support the flexed foot with a pillow.
- Apply the second boot to the other foot.
- To prevent strain on the ligaments of the hip and pressure on the bony prominences the patient’s legs should be positioned properly.
abduction pillow
ABDUCTION PILLOW
Abduction pillows are wedge-shaped sponge rubber with lateral indentations for the patient’s thighs and straps that wrap around the thighs to maintain a proper position and body alignment. It helps to prevent internal hip rotation after a femoral fracture, hip fracture or surgery.
TROCHANTER ROLLS
trochanter roll
Trochanter rolls can be improvised by using a rolled towel or blankets. However, commercial rolls are made of sponge rubber. These devices help prevent external hip rotation.
HAND ROLLS
Hand rolls, like trochanter rolls, can be improvised by using a rolled washcloth that is secured with roller gauze and an adhesive tape. These devices are used to prevent hand contractures and are available in hard and soft materials.
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What Do You Think?
18.The nurse plans to use a trochanter roll when repositioning a patient. Where should thenurse place the trochanter roll?a.Under the small of the backb.Behind the knees when supinec.Alongside the ilium to mid-thighd.In the palm of the hand with fingers flexedANS:CThe nurse should place the trochanter roll alongside the ilium to mid-thigh. The trochanterroll is a rolled wedge, pillow, or sandbag placed by the lateral aspect of the leg between theiliac crest and the knees to prevent external hip rotation.
DIF:Cognitive Level: ApplicationREF:Text reference: p. 286OBJ:Describe the use of the trochanter.TOP:Trochanter RollsKEY:Nursing Process Step: ImplementationMSC:NCLEX: Physiological IntegrityMULTIPLE RESPONSE1.Patients at risk for complications and/or injury from improper positioning include patientswith which of the following? (Select all that apply.)
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DIF:Cognitive Level: ComprehensionREF:Text reference: p. 271OBJ:Describe body mechanics and its importance in caring for patients.TOP:Risks for ComplicationsKEY:Nursing Process Step: AssessmentMSC:NCLEX: Physiological Integrity
Alignment and Pressure-Reducing Devices
Various assistive devices can be used to maintain correct body positioning and to help prevent complications that commonly arise when a patient must be on prolonged bed rest. Alignment and pressure-reducing devices, or pressure-redistribution devices, include boots to protect the heels and help prevent skin breakdown and footdrop; abduction pillows to help prevent internal hip rotation after femoral fracture, hip fracture, or surgery; trochanter rolls to help prevent external hip rotation; and hand rolls to help prevent hand contractures. Several of these devices—cradle boots, trochanter rolls, and hand rolls—are especially useful when caring for patients who have a loss of sensation, mobility, or consciousness.
Cradle boots, made of sponge rubber with heel cutouts, cushion the ankle and foot without completely enclosing it. Other commercial boots are available, but not all help to prevent external hip rotation. Footboards with anti-rotation blocks help prevent footdrop and external hip rotation, but they don’t prevent heel pressure. High-topped sneakers may be used to help prevent footdrop, but they don’t prevent external hip rotation or heel pressure. The abduction pillow is a wedge-shaped piece of sponge rubber with lateral indentations for the patient’s thighs. Its straps wrap around the thighs to maintain correct positioning. Although a properly shaped bed pillow may temporarily substitute for the commercial abduction pillow, it’s difficult to apply and fails to maintain the correct lateral alignment. The commercial trochanter roll is made of sponge rubber, but it can also be improvised from a rolled blanket or towel. The hand roll, available in hard and soft materials, is held in place by fixed or adjustable straps. It can be improvised from a rolled washcloth secured with roller gauze and adhesive tape. (See Common preventive devices.)
If you’re using a device that’s available in different sizes, select the appropriate size for the patient.
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