Biomechanics: concept, types of patient position in bed. Various positions of the patient in bed Positions in the patient's bed types

Depending on the general condition the patient takes one position or another 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 the patient who is in unconscious, or a neurological patient with motor paralysis. The patient takes a forced position himself to alleviate his condition. At pain syndrome peptic ulcer the patient takes a forced knee-elbow position, in case of myocardial infarction - a supine position, with 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 unilateral process in the lungs, then he lies on the opposite side, i.e., on the healthy side: at the same time, expectoration of sputum from 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 one prescribed by the doctor motor mode. Activity mode (motor mode):
General (free) - the patient stays in the department without restrictions motor activity within the hospital and hospital grounds. 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.
When diseases are observed various changes patient's position. Yes, when 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 painful sensations. An example of a forced position is the so-called orthopnea - sitting position a 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 general care for the sick. 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, most he spends his time in bed. That's why important For wellness the patient and his recovery have bed comfort.
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 summer time screened windows around the clock, in winter time 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.
Great value for successful treatment ensures that patients observe personal hygiene, including timely change of bed linen and underwear, care for skin, 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 severe illness are quite long time continue to work and lead active image life, 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 discomfort. An active position is typical for patients with light current diseases.
The patient is in a passive position with certain serious illnesses. Sometimes it can be very uncomfortable for him (head hanging, legs tucked in), but due to severe weakness or loss of consciousness, or due to large loss of blood, 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, the patient bronchial asthma sits in bed, leaning forward, rests against 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 lower limbs), the diaphragm lowers slightly, the pressure in chest, lung excursion increases, gas exchange and outflow improves venous blood from the brain.

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). 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 affected side to reduce pain and facilitate 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).

In immobilized patients who are unable to independently change the position of the body or individual parts of the body, there is a risk of disorders 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 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

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.
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.
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 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 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.

In inpatients, there are active, passive and forced positions in bed:

active: the patient can independently, without outside help change the position of the body in bed, on a chair, in an armchair, etc.; By at will or upon request medical personnel moves freely around the ward and outside it, independently applies personal hygiene products, eats food without assistance; active position most often indicates a favorable course of the disease and satisfactory physical state patient;
passive: the patient is not able to independently change position in bed, take personal hygiene measures, or eat food; The patient acquires a passive position of the body in case of loss of consciousness, with a severe course of the disease, severe physical weakness, significant blood loss, in a state of severe exhaustion of the body, with excessive weight loss (cachexia)
forced - a position that the patient acquires in order to weaken painful sensations; at the same time, painful or other unpleasant sensations are reduced - shortness of breath, pain, dyspeptic symptoms, and the general condition of the patient is alleviated. Basically, the forced position is compensatory physical reaction sick with illness.

There are active-forced and passive-forced positions:

active-forced: the patient acquires it in order to alleviate his condition, that is, half-sitting in bed or in a chair with his legs down (orthopnea) with shortness of breath (suffocation) cardiac origin. This position facilitates the movement of the diaphragm, improves the outflow of venous blood, and helps reduce the amount of circulating blood. The patient takes a sitting or standing position with the hands fixed on stationary objects (window sills, table, bed) during an attack of bronchial asthma. The position lying on the side with the legs brought to the stomach and the head tilted back is taken by patients with meningitis (outside a pointing dog), knee-elbow (outside a lying cow) - in case of exacerbation of a peptic ulcer with localization of the ulcer on the back wall stomach; the pose of a Bedouin who prays - with adhesive and exudative pericarditis. Patients with intense abdominal pain, for example, with peritonitis, purulent appendicitis, are forced to lie on their back; lying on the stomach is often characteristic of diaphragmatic pleurisy, tuberculous lesions of the spine, and pancreatic cancer. With pneumonia, pulmonary tuberculosis, exudative and dry pleurisy, patients usually lie on the affected side in order to free up the air for breathing as effectively as possible. healthy lung, lying on the painful side also reduces cough reflexes. A forced lying position on the right side is often observed in patients with heart failure, caused largely by significant dilatation (expansion) of the cavities of the heart; this position facilitates the contractile activity of the left ventricle;
passive-forced; this body position is prescribed to the patient in order to ensure a more favorable course of the disease, for example, in case of myocardial infarction - lying on the back with the head end of the functional bed slightly raised, in case of left-sided exudative pleurisy - on the right side with the head slightly raised; lying on your back with your head slightly lowered and your legs raised - in an unconscious state.

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, 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 rules (laws) mechanical movement bodies 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 musculoskeletal efforts, 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.

Save vertical position bodies in space is possible only by preserving 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.