exercise, transfers and ambulations lect morganites

8/10/2019 Exercise, Transfers and Ambulations Lect Morganites

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ABILITYTOMOVE

The ability to move & function is a function most people take for granted.

The level of mobility has a significant impact on an ind.s physiological,

psychosocial, & developmental well-being (Hamilton & Lyon, 1995).

When there is an alteration in mobility, many body systems are at risk for

impairment.

Cardiovascular functioningorthostatic hypotension

Pulmonary complicationspneumonia

Promote skin breakdown, muscle atrophy etc

Such changes can lead to altered self-concept & lowered self-

esteem.


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An activityexercise patternrefers to a person's

routine of exercise, activity, leisure, and

recreation. It includes:

Activities of daily living (ADL) that require

energy expenditure such as hygiene, cooking ,

shopping, eating , working.

Type, quality, and quantity of exercises,

including sports.


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PHYSIOLOGYOFMOVEMENT

Skeletal system; the bones and cartilage that protectour organ and allow us to move are called skeletalsystem. The function of this system include:

Maintain body posture by supporting the soft tissue

Protect the delicate structures of the body such asbrain, heart and spinal cord

Furnishes surface for attachments of musclestendons and ligaments

Storage areas of minerals salts and fats. Produce blood cells


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Ligaments; tough fibrous bands that bind joints together

& connect bones & cartilages.


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Tendon;strong, flexible, inelastic fibrous band that attach

muscle to bone.


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Cartilage; nonvascular connective tissue found in the joint

s as well as in the nose, ear, thorax, trachea and larynx


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Muscular system; provide functions for the body through

contraction

Motion Maintenance of posture

Heat production

The 3 types of muscles are 1) Skeletal 2) Cardiac 3)

Smooth or visceral muscles.

Muscles have two different points of attachments:

The attachment of a muscle to the more stationary bone is

called the Point of Orig in.

The attachment to the more movable bone is the Point of

Insert ion


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Nervous System; the nerve impulses stimulate muscles to

contract.

Body Mechanics; is the efficient use of the body as a machineand as a mean of locomotion, correct body mechanics lead to

health promotion and illness prevention so the responsibility of

the nurse to apply the body mechanics and to teach others .


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MEDICALCONDITIONSTHATCANALTER

MOBILITY

Fractures/sprains

Neurological conditionsspinal cord injury, head

injury

Degenerative neurological conditionsMyasthenia

gravis, Huntingtons chorea


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NURSINGMEASURES

Attempt to maintain and/or restore optimal mobility as well as todecrease the hazards assoc. with immobility.

Muscle & joint exercises

Frequent repositioningq 2 hrs fluid intake/fiber intake

Guidelines: Check activity order

Know clients past medical history & limitations

Baseline vital signs are necessary

Become familiar with assistive devices


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Major concern during transfer = Safety of both the

client and the nurse


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Types of exercise:

Exercise can be classified according to the type of

muscle contraction to:-

I sotonic exercise; in which the muscle shortens to

produce muscle contraction and active movement.

Example; running, swimming, walking. This increasemuscle mass, tone and strength, increase cardiac and

respiratory and circulatory functions.


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I sometr icexercise; in which there is muscle contraction without moving

the joint shortening. An example includes squeezing a towel or pillow

between the knees. These exercises are useful for strengthening

abdominal, quadriceps and gluteal muscles so the nurse encourage bothisotonic and isometric exercises for the hospitalized clients.


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Isokineticexercises; involve muscle contraction with resistance example

include rehabilitation exercises for the knee and elbow injuries.


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OR exercise can be classified according to the source of energy

to:-

Aerobic exercise is activity during which the amount of oxygentaken in the body is greater than that used to perform the

activity. An example walking, running.


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Anaerobic exercise involves activity in which the muscles cannot

draw out enough oxygen from the bloodstream, and anaerobic

pathways are used to provide additional energy for a short time.

An example weight lifting.


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TYPESOFJOINTMOVEMENT

Flexion: decreases the angle of the joint" bending theelbow"

Extension: Increasing the angle of the joint "straightening the arm at the elbow"

Hyperextension: further extension or straightening of ajoint " bending the head backward"

Abduction: movement of the bone away from themidline of the body

Adduction: movement of the bone toward the midline ofthe body

Rotation: movement of the bone around its central axis


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Circumduction: movement of the distal part of the bone

in a circle while the proximal end remains fixed.

Eversion: Turning the sole of the foot outward bymoving the ankle joint

Inversion: Turning the sole of the foot inward by

moving the ankle joint.Pronation: moving the bones of the forearm so that the

palm of the hand faces downward when held in front

of the body.

Supination: moving the bones of the forearm so that thepalm of the hand faces upward when held in front of

the body.


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RANGEOFMOTIONEXERCISE(ROM)

- ROM exercises, in which a body part is

moved through a range of motion, are

carried out to promote circulation, maintainmuscle tone & promote flexibility.

- In doing this, joint stiffness & debilitating

contractures are prevented.


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ROM(CONT.)

- ROM exercises are planned as a regular part of

nursing activities. During a bath, for example, the

nurse has an excellent opportunity to move the

patients limbs through their full range of motion.

- The patient is encouraged to exercise actively

those muscles that can be used. However, in

certain cases, the nurse may need to assist the

patient in performing ROM (active assisted ROM),

or to perform passive ROM.


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ROM (CONT.) The maximum movement that is possible for a joint is its range of

motion.

If a joint is not moved sufficiently it begins to stiffen within 24 hrs &eventually becomes inflexible, flexor muscles contract & pull tightcausing contractures or fixed joint flexion.

To preventjoint contractures & muscle atrophy(wasting ordecrease in size of a normally developed organ or tissue), exercisemust be performedROM exercise.

Contractureabnormal flexion & fixation of joints caused by the

disuse, shortening & atrophy of muscle fibers.

Correcting contractures requires intensive therapy over a prolongedperiod of time, and may be impossible. Prevention is the key.


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CONTRAINDICATIONSTOROM

ROM requires energy & increased circulation, any

illness/disorder where increased use of energy or

increased circulation is hazardous is

contraindicated; puts strain/stress in soft tissues of

the joint & bony structures, therefore not done withswollen, inflamed joints.


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TWOPURPOSESOFROM

1. Maintain joint function

2. Restore joint function

Do not exercise joints beyond the point of

resistance or to the point of fatigue or pain


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PERFORMEXERCISESINHEADTOTOE

FORMAT

Start with the head and move down, always do bilaterally

Do not grasp the joint directly

Cup the joint gently (prevents pressure)

Do not grasp fingernail or toenail

Important jointsthumb, hip, knee, ankle

Return to correct anatomic position

Move joint through movement 5 times/session


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STARTATTHENECK

Neck Flexionlook @ the toes

Extensionlook straight ahead

Hyperextensionlook up @ ceiling

Lateral flexionlook straight ahead, tilt head to shoulder

Shoulder Flexionraise arm forward & overheadExtensionreturn arm to side of body

Abductionraise arm to side to position above head with palm

away from head.

Adductionreturn arm & bring across chest

Internal rotation elbow flexed, rotate the shoulder by moving

arm til thumb is turned inward & toward the back (fingers to thefloor)

External rotation elbow flexed, move arm until thumb is upward

& lateral to head. (fingers point up)

Circumduction move arm in full circle (arm straight out, movehand as if to draw a circle.


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ELBOW

Elbow Flexionbend elbow

Extensionstraighten elbow

Hyperextensionbend lower arm back as far as possible

Forearm Supinationturn lower hand so palm is up

Pronation - turn lower hand so palm is down

Wrist Flexionbend wrist forward

Extensionstraighten wrist (fingers, wrist & arm in same

plane)

Hyperextensionbring dorsal surface of hand as far backas possible

Abduction (radial flexion)bring wrist medially towardsthe thumb

Adduction (ulnar flexion)bend wrist laterally towards 5thfinger


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FINGERS& THUMB

Fingers & thumb Flexionbend fingers & thumb into palm make a fist

Extensionstraighten fingers & thumb

Hyperextensionbend fingers as far back as possible

Abductionspread fingers apart / extend thumb

laterally

Adductionbring fingers together/ thumb back to hand

Circumductionmove finger/thumb in circular motion

Oppositiontouch thumb to each finger of same hand


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HIP

Hip Flexionmove leg forward (ROM 90-120 deg)Extensionmove leg back beside other leg

Hyperextensionmove leg backwards (ROM 30-50

deg)

Abductionmove leg laterally away from body (ROM30-50 deg)

Adductionmove leg back to medial position &beyond if possible (ROM 30-50 deg)

Knee Flexionbring heel toward back of thigh (120-130deg)

Extensionreturn leg to floor


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ANKLE

Ankle Dorsiflexionmove foot so toes are pointed upwardPlantarflexionmove foot so toes are pointed downward

Foot Inversionturn sole of foot medially (ROM 10 deg)Eversionturn sole of foot laterally (ROM 10 deg)

Flexioncurl toes downward (ROM 30-60 deg)

Extensionstraighten toes (ROM 30-60 deg)

Abductionspread toes apart

Adductionbring toes together


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TYPESOFROM EXERCISES

Activeexercises the client is able to performindependently. It is a form of isotonic exercise & assuch, it maintains strength, tone & flexibility.

Passiveexercises performed for the client bysomeone else. Passive exercise helps to maintain joint

flexibility & prevent stiffness & contractures. Becausethis type of exercise involves no active movement on thepart of the muscles, it does not contribute to muscletone or strength.

Active assistedperformed by a client with someassistanceclient can move a limb partially through itsROM, but needs help completing the ROM.

FACTORS AFFECTING BODY ALIGNMENT


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FACTORSAFFECTINGBODYALIGNMENT

ANDACTIVITY

Growth and development; according to person age the nurseshould be familiar with the differences of the neuromuscular

development of the client in order to facilitate coping.

Physical health; because any problems in the musculoskeletal

or nervous system can have negative influence on the bodyalignments and movement.

Mental health; bodily processes tend to slow down in

depression

Lifestyle variables; such as exercise, food, smoking,occupation, culture.

Attitude and values; such as swim, fitness, many individual

values also influence the exercise options people make.


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Fatigue and stress; chronic stress may deplete body energy to

the point that fatigue makes even the thought of exercise

overwhelming

External factors; environment which influence, humidity,

support people, lack of free time, unsafe environment.

Nutrition; both undernutritioin and overnutrition can influence

body alignment and mobility.


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Effects of exercise on major body system

Musculoskeletal system

Increased muscle efficiency' strength andflexibility

Increased coordination, stability, gait andposture

Increased efficiency of nerve impulsestransmission

Improve range of motion

Maintained bone density and strength


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Cardiovascular system;

Meet the demands for oxygen

Increase blood flow

Increase efficiency of the heart

Decreased blood pressure

Increased blood flow to all body parts

Improved heart rate, improved circulation,

and selfreported stress reduction

Decreased cholesterol level


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GI system; exercises lead to

Increased intestinal tone, facilitatingperistalsis

Improve digestion and elimination

Improve the appetite


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Metabolic system; exercise elevates the

metabolic rate, thus increasing theproduction of body heat and wasteproducts and calorie use.

Increased efficiency of metabolic

systemIncreased efficiency of bodytemperature regulation

Reduce level of serum triglycerides andcholesterol.


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Urinary system; regular exercise

increase blood circulation including

improved blood flow to the kidneys

which allows the kidneys tomaintain the body's fluid balance and

acid-base balance more efficiently

and to excrete body waste.


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Skin; regular exercise increase circulation

which lead to promote good health

Psychosocial outlook; regular exercise

have psychological effects such as

increase energy, improve sleep, bodyimage, improve self-concepts and

increase positive health behaviors,

improve general well being.


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EFFECTSOFIMMOBILITYONMAJORBODY

SYSTEM

Musculoskeletal system

Disuse osteoporosis; demineralization process, known as

osteoporosis, the bones become spongy and may graduallydeform and fracture easily.


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Disuse atrophy; atrophy in muscles losing most

of their strength and normal function.

Contractures; when the muscle fibers are not

able to shorten and lengthen (permanent

shortening of the muscle) forms limiting joint

mobility. This process eventually involves the

tendons, ligaments, and joint capsules.


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Cardiovascular system

Diminished cardiac reserve

Orthostatic hypotension; is a common result of

immobilization. The blood pools in the lower extremities,and central blood pressure drops. Cerebral perfusion is

seriously compromised, and the person feels dizzy or

light headed and may even faint.


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Venous vasodilation and stasis; the skeletal muscles do not

contract sufficiently, and the muscles atrophy, so the skeletal

muscles can no longer assist in pumping blood back to the

heart against gravity. Blood pools in the leg veins, causingvasodilation and engorgement.


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Dependent edema; when the venous

pressure is sufficiently great, some of

serous part of the blood is forced out of

the blood vessel into the interstitial spacessurrounding the blood vessel, causing

edema.

Thrombus formation


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3. Respiratory system

Decreased respiratory movement; in immobile client,

ventilation of the lungs is passively altered. The bodypresses against the rigid bed and curtails chest

movement. The abdominal organs push against the

diaphragm, restricting lung movement and making it

difficult to expand the lungs fully.


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Pooling of respiratory secretions; secretions of the respiratory

tract are normally expelled by changing positions or posture

and by coughing. Inactivity allows secretions to pool by

gravity, interfering with the normal diffusion of oxygen and

carbon dioxide in the alveoli.


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Atelectasis; is the collapse of a lobe or of an entire lung, when

ventilation is decreased, pooled secretions may accumulate in a

dependent area of a bronchiole and effectively block it.

Immobile elderly, postoperative clients are at greatest risk ofAtelectasis.


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Pneumonia; pooled secretions provide excellent media for

bacterial growth. Under these conditions, a minor upper

respiratory infection can evolve rapidly into severe infection of

the lower respiratory tract.

M t b li t


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Metabolic system

Decreased metabolic rate; in immobile clients, the basal

metabolic rate and gastrointestinal motility and secretions of

various digestive glands decrease as the energy requirements ofthe body decrease.

Negative nitrogen balance

Anorexia; loss of appetite occurs because of the decreased

metabolic rate and the increased catabolism that accompanyimmobility.

Negative calcium balance


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5. Urinary system

Urinary stasis; in a mobile person, gravity plays an

important role in the emptying of the kidneys and thebladder. When the person remains in abed, gravity

impedes the emptying of urine from the kidneys and

the urinary bladder, so emptying is not as complete

and urinary stasis occurs after few days of bed rest.


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Urinary retention, which is accumulation ofurine in the bladder, bladder distention, and

occasionally urinary incontinence (involuntary

urination). The decreased muscle tone of theurinary bladder inhibits its ability to empty

completely.

Urinary infection, static urine provides anexcellent medium for bacterial growth


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7. Integumentary system

Reduced skin turgor. Skin turgoris an abnormality in the

skin's ability to change shape and return to normal (elasticity).The skin can atrophy as a result of prolonged immobility.

Skin breakdown. Normal blood circulation relies on muscle

activity. Immobility impedes circulation and diminishes the

supply of nutrients to specific areas. As a result skinbreakdown and formation of pressure ulcers can occur.


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PRESSUREULCERS


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8. Psychoneurologic system

Lower the persons self esteem Increased risk of depression

Decreased social interaction


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Nursing management

Assessing

Nursing HistoryPhysical examination

Body Alignment

Appearance and movement of joints

Capabilities and limitation for movement Muscle mass and strength

Activity tolerance

Problems related to immobility


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Activity Intolerance related to bed rest and immobility,

generalized weakness, sedentary lifestyle, and imbalance

between oxygen supply and demand.

Impaired Physical Mobility related to intolerance to activity or

decreased strength and endurance, pain, perceptual or cognitive

impairment, neuromuscular impairment, musculoskeletal

impairment, and depression or severe anxiety.


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Risk for Falls related to impaired mobility. Alterations in family

and social processes may also result from immobility andinactivity. Disruption in activity and mobility leads to

impairment of the ability to perform ones usual social,

vocational, educational, and family roles.

There are often changes in the clients perception of role


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There are often changes in the client s perception of role.DisturbedBody Image and Situational Low Self-Esteem canresult from:

1. Changes in physical abilities2. Changes in family responsibilities

3. Lack of knowledge regarding rehabilitation

Fear (of falling)

Ineffective coping Low self esteem

Powerlessness


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Planning

Implementing

Nursing strategies to maintain or promote body alignment andmobility involve positioning clients appropriately, moving and

turning clients in bed, transferring clients, providing ROM

exercises, ambulating clients with or without mechanical aids.


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Use the weight of the body as a force for pulling or pushing by

rocking on the feet or leaning forward or backward

Work as closely as possible to an object that is to be lifted or

moved.

Flex the knees, put on the internal girdle and come down to an

object that is to be lifted.

Spread the feet apart to provide a wider base of support whenincreased stability of body


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BENEFITSOFPROPERPOSITIONING

Maintains body alignment & comfort

Prevents injury to musculoskeletal system, prevents

strain

Provides sensory, motor & cognitive stimulation

Prevents pressure sore (decubitus ulcer) & jointcontractures


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TRANSFERS

Transferring is a nursing skill that helps the client withrestricted mobility attain/maintain mobility & independence.

Benefits of transfers

Maintains & improves joint motion Increases strength

Promotes circulation

Relieves pressure on the skin

Improves urinary/respiratory function

Increases social activity

Increased mental stimulation


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TRANSFERS- SAFETY

Safety is a major concern when transferring. Falls are acommon hazard. If a patient starts to falldo not try to stopthe fall, instead assist the patient to the floor while protectingthe head from injury. This will reduce the risk of patient aswell as staff injury.

Complete a thorough nursing assessment before you movethe patient to determine if she/he has suffered any injuries.

Prevention of injury is the key, be aware of the clients motordeficit, ability to support their body weight and use effectivebody mechanics & lifting techniques.

When in doubt regarding the patients ability-GETASSISTANCE

TRANSFER & AMBULATION:


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TRANSFER& AMBULATION:

CLIENT BENEFITS

maintains / improves joint motion

increases balance, strength, endurance

promotes circulation & relieves pressure improves respiratory function; appetite; bowel & urinary

function

increases social activity & mental stimulation


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C lf l d b h f


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Calf pumps, move legs, deep breaths- assess for

hypotension

put on shoes or nonskid slippers (may be donepreviously!)

widen stance, bend knees & supporting clients knees,

grasp belt or put arms behind their scapulae- Not

under axilla!

straighten your knees as they push off the bed, assist

to stand, client pivots, places hands on armrest and

sits down


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TRANSFERRING FROM BED TO CHAIR


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TRANSFERRING FROM CHAIR TO BED


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MECHANICAL LIFTS

when a client is heavy

and has little ability to

weight bear or assist, use

the mechanical lift

at least 2 nurses must

assist with the use of all

mechanical lifts to ensure

safety

(Portable or ceiling lifts)


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AMBULATION

Clients who have been immobile even for a short time mayrequire assistance

A client may require the use of an assistive device to aid in

ambulation.

Assistive devices

Increase stability

Support a weak extremity

Reduce the load on weight bearing structures; hip,knees


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ASSISTINGTHEPATIENT

Simple assist / One person assisted1. Place arm near patient under the arm & at the elbow &

grasp pts hand, synchronize walking with the pt(move inside foot forward at same time as pts insidefoot)

2. Grasp pts left hand in nursesleft hand & encircle ptswaist with the rt hand & synchronize walking

3. Using a transfer belt (held at the waist from the rear bythe belthelps maintain balance)

Nurse to stand on the pts weak side. The nurse provides

support with his/her leg to the pts weakened one ifnecessary. Do not allow the pt. to place their arm aroundyour shoulder.

Walk slowly, even gait, synchronize your steps.


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WALKERS AND CANES

Walkers and canes are generally used as mobilization aids for patients who

can bear weight on the affected leg, but require so

me support


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CANE

Helps maintain balance by widening the base of support increases a pt ssecurity.

Should be held on stronger side

Should have rubber tipprevent slipping

Height (from greater trochanter to the floor allowing 15-30 deg ofelbow flexion.

The patient should hold a cane on the unaffected side with his elbow slightlyflexed and the cane tip about 6 inches in front of and6 inches to the side of his foot. (Acane is used for balance, ratherthan physical support. It is held on the unaffected side

to prevent the patient from "leaning" on it for support.)

Stand from sitting Cane in hand opposite affected leg, grasp arm of chair & cane in

other, push to stand, gain balance

CANES


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STANDARDCROOK;

TRIPOD; QUADCANE

cane moves ahead approx. 15 to 25cm (6-10

in)

weak leg moves forward in line with cane

strong leg moves ahead past cane & other leg

sequence repeated

Cane weak leg strong leg

Sit-Down


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Sit Down

client reaches back with free hand and grasps

arm of chair

lowers self while most wt bearing done on

stronger leg (chair must be heavy, solid chair orclient must use both hands on armrests at same time)

Stand-Upboth hands push down on armrests OR

hand with cane on strong side and opposite

hand pushing down on armrest


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WALKER

Wide base of support, provides greatstability & security. Used for clients who areweak or who has problems with balance.

Patient should have at least one weight bearing leg andarm

Pick up walker is more stable, walker with wheels easierfor pts who have difficulty with lifting or balance,however can roll forward when weight is applied.

Heightupper bar of walker should be slightly below theclients waist with arms flexed 15-30 deg


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WALKER(CONT.)

To standwalker in front of seat, push up off armsof chair (walker is less stable, chair is lower pt. canpush with more force. Hands move to walker oneat a time.

To sitback up to chair, reach back with one arm toarm of chair, then with the other arm and lower tochair.

Gaitwalker ahead 6-8 inches, weight on arms.Partial weight on affected leg first.

Walker weak leg strong leg


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WALKER

When utilizing a walker, the patient should use themuscles of the arms andupper body to help support

his weight. After placing the walker in front of the p

atient,

instruct the patient to ambulate with a walker using the following sequence of moves.

(1)Firmly grasp the hand grips.

(2)Move the walker and the affected leg forward ab

out 6 inches. (3)Move the unaffected leg forward, parallel to the a

ffected leg.

(4)Repeat the sequence for each step.


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Lofstrand or forearmcrutches

Axillary wooden/

metal crutches


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be cautious regarding crutchpalsydamage to the radial nerve in axilla area-

numbness, tingling, muscle weakness andparalysis

PLACETHECRUTCHTIPSABOUT6 TOTHESIDEAND IN FRONT OF EACH FOOT. STAND ON YOUR


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ANDINFRONTOFEACHFOOT. STANDONYOUR

"GOOD" FOOT


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CRUTCHES

Gait depends on persons ability to support theirweight and balance

Types of gait with use of crutches:

2 point

3 point 4 point

Swing to

Swing through

T St d


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To Stand

Hold both crutches on strong side (hands on

handgrips)

Lean ahead with stronger leg close to chair, and

weak leg extended out front

Push hand down on armrest and raise body tostanding position

If chair is tipsy, use both arm rests to push to

standing position rather than holding crutches

To SitSame technique used, in reverse direction


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2 POINTGAIT

Requires at least partial weight bearing of both legs:

Lt foot & Rt crutch move together ahead 10-15 cm

(4-6 inches)

Rt. foot & Lt crutch move together ahead


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2 POINTGAIT


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3 POINTGAIT

able to wt. bear on one foot, full wt. on unaffectedleg then on both crutches

begin in tripod position -> move crutches &

affected leg ahead -> move stronger leg forward

and repeat.


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3 POINTGAIT

The 3-point gait (see figure 1-9) is used when thepatient should not bear any weight on the affected leg.

Place the patient in the tripod position and instruct him

to do the following.

(1) Move the affected (non-weight bearing) leg and both

crutches forward together.

(2) Move the unaffected (weight bearing) leg forward.

(3) Repeat this sequence for desired ambulation.


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4 POINTGAIT

Provides best balance & stability for person butmust be able to weight bear on both legs

Rt. crutch forward

Lt. foot forward

Lt. crutch forward

Rt. foot forward


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4 POINTGAIT

The 4-point gait (see figure 1-8) is used when the patient canbear some weight on both lower extremities. Place the patientin the tripod position and instruct him to do the following.

(1) Move the right crutch forward.

(2) Move the left foot forward.

(3) Move the left crutch forward.

(4) Move the right foot forward.

(5) Repeat this sequence of crutch-foot-crutch-foot for desiredambulation.


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SWING-THROUGHGAIT

is used for patients with lower extremitiesthat are paralyzed and/or in braces. Place the patie

nt in the tripod position and instruct him to

do the following:

(1)Move both crutches forward together about 6 inches.

(2)Move both legs forward together about 6 inches.

(3)Repeat the sequence in rhythm for desired ambu

lation.


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GOING UP & GOING DOWN THE STAIRS


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SUMMARY : USE OF ASSISTIVE DEVICE


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MOVING AND POSITIONING THE

PATIENT


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MOVINGTHEPATIENT: UPINBED

Move close to the side of thebed

Back straight, knees bent, one foot forward (broadbase of support)

Up in bed (1 nurse)

(Patient alert & cooperative)

Encourage independence & foster self-esteem.

Patient bends knees, feet firmly on the bedgrasps side rail @ shoulder level. Nurse positionshand & arms under patients hips, back straight,bend knees, feet apart, count to 3. Nurse pullspatient up in bed & pt pulls arms & pushes feet upinto bed.

Up in bed (2 nurses)

(heavy patient or one whocannot help)

Patient bends knees, feet firmly on bed, 1stnurseat HOB arms under head & shoulders, face foot ofbed, 2ndnurse under hips facing foot of bed, onsame sidecount to 3.


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MOVINGTHEPATIENT: LIFTER

Up in bed using the pull sheet/lifter(2 nurses)

Do not lift, always slide

One nurse on each side of the bed, firmlygrasp the lifter in both hands, ask the patientto lift their head. Slide the patient up in bedon the count of 3.

Benefit: 1. movement b/w 2 layers of clothhas less friction than skin on cloth.

2. Much easier to grasp sheet firmly than it isto hold a patients body.

3. Lifter supports the entire body (except thehead) making it easier to keep the patientstraight.


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MOVINGTHEPATIENT: LATERAL

From the back to the side(lateral) position

Move the patient to the side of the bed, sothe patient will be in the center whencomplete.

Raise rail, move to other side of bed, roll

patient toward you far ankle over near ankle,far knee over near knee. Place one hand onclients hip and one hand on his/her shoulder

and roll pt. onto side toward you. Placepillow under head & neck, bring shoulderblade forward, position both arms in slightly

flexed positions (protects joints).Upper arm supported by pillow.

Place pillow behind patients back & pillow

under semi flexed upper leg

Assess need to support feet (footboard, high

top sneakers).


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MOVINGTHEPATIENT: PRONE

From the back to theabdomen (prone)

Move to the extreme edge of the bed, raise rail on thatside, move to other side.

Pillow for support under abdomen, near arm over head,turn face away, roll as above, check arm & face, continuerolling.

Prone - infrequently used because respirations can becompromised

Good position for pressure sores on hips/buttocks.

Important to turn head to the side, no pillow b/c it hyperextends the neck can use small towel, small folded towel

under each shoulder to prevent slumping, flat pillow atabdomen (esp. women with large breasts)

Arms at either sides or flexed by head, hand rolls, feet indorsiflexionsandbags under ankles.


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TIPSFORPOSITIONINGTHEPATIENT

After turninguse aids i.e. pillows, towels, washcloths,blankets, sandbags, footboards etc.

Joints should be slightly flexed b/c prolonged extensioncreates undue muscle tension & strain

Supine Low or flat pillow (prevents neck flexion)

Trochanter role (supports hip joint prevents external rotation)

Hand rollused if hands are paralyzed (thumb & fingers flexed aroundit)

High top sneakers, foot board, sandbags (support feet with toespointing upward. Prolonged plantar flexion leads to foot drop(permanent plantar flexion & inability to dorsiflex)


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exercise, transfers and ambulations lect morganites

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