6.2 Mobility and Positioning

Mobility and Positioning

Immobility threatens nearly every body system, so the NCLEX-PN frequently asks you to prevent harm before it occurs. The classic right answer protects skin integrity, airway, and circulation while keeping both patient and nurse safe.

Body Mechanics

Musculoskeletal injury is a leading cause of nurse disability. Apply these principles, and remember the exam favors mechanical lifts over manual lifting for dependent patients.

Therapeutic Positions

Match position to diagnosis. The exam reuses these pairings constantly.

Pressure Injury Prevention

Immobility is the primary driver of pressure injuries. High-risk bony prominences: sacrum, coccyx, heels, occiput, scapulae, elbows, greater trochanters, and malleoli. The supine patient loads the sacrum and heels; the side-lying patient loads the trochanter and malleolus.

Staging (NPIAP):

• Stage 1: non-blanchable erythema, intact skin.
• Stage 2: partial-thickness loss, exposed dermis (shallow open ulcer or intact blister).
• Stage 3: full-thickness loss with visible fat.
• Stage 4: full-thickness loss exposing muscle, tendon, or bone.
• Unstageable: base obscured by slough/eschar.

Braden Scale (6 subscales; lower total = higher risk): <=18 at risk, <=15 moderate, <=12 high, <=9 very high. Worked example: a paraplegic patient with a Braden of 12 and a non-blanchable sacral red area already has a Stage 1 injury; your priorities are turn every 2 hours, float the heels off the bed, use a pressure-redistributing surface, and keep skin clean and dry. Chair-bound patients should shift weight every 15 minutes.

Assistive Devices and Range of Motion

Range of motion (ROM): active ROM is patient-driven, passive ROM is nurse-performed for the immobile patient. Support the joint above and below, move through pain-free range, repeat 3-5 times, and never force a joint. Apply a gait belt for ambulatory transfers and clear the path first.

Hazards of Immobility by System

The NCLEX-PN often asks which complication to prevent first, so know how immobility harms each system and the matching intervention. In the respiratory system, shallow breathing and pooled secretions cause atelectasis and pneumonia; teach coughing, deep breathing, and incentive spirometry, and reposition often. In the cardiovascular system, venous stasis raises the risk of deep vein thrombosis (DVT) and pulmonary embolism; encourage leg exercises, apply sequential compression devices as ordered, and never massage a suspected clot.

In the musculoskeletal system, disuse produces contractures, foot drop, and muscle atrophy; use ROM, a footboard or high-top shoes, and trochanter rolls to keep the hips neutral. In the gastrointestinal and urinary systems, immobility slows peristalsis and promotes constipation and urinary stasis with stone formation; increase fluids, fiber, and activity. Orthostatic hypotension is common after prolonged bed rest, so dangle the patient on the edge of the bed and check for dizziness before standing.

Safe Patient Handling and Transfers

Manual lifting is the single largest cause of nurse back injury, which is why modern facilities follow safe-patient-handling programs that favor mechanical lifts. Before any transfer, assess the patient's ability to bear weight and follow commands, decide how many staff are needed, lock all wheels, lower the bed, and position the chair on the patient's strong side. Apply a gait belt for an assisted stand, instruct the patient to push up with their arms, and let them do as much as they safely can. For a patient who cannot bear weight, use a full-body Hoyer or ceiling lift with two staff, inspecting the sling for fraying first.

Never let a falling patient be caught by lifting; instead, ease the patient down the length of your own body to the floor, protecting the head, and then assess before moving. These principles protect both patient and nurse and appear repeatedly in safety-and-infection-control items as well.