Assisting With Moving and Positioning Clients in Bed

Assisting With Moving and Positioning Clients in Bed A, Pressure points in lying position. B, Pressure points in sitting position.

Shearing forces against sacrum cause tis­sue damage. The skill of moving and positioning clients with acute spinal cord trauma requires critical thinking and knowledge application unique to a nurse.

Assisting With Moving and Positioning Clients in bed Moving client with one nurse Moving client with aid of trapeze.

1. Ad|just position of IV pole, tubes, and catheters. 2. Provide client with hearing aid and glasses if used. 3. Lower the head of the bed to the lowest position. Place the pillow near headboard. 5. Assist client to supine position with knees Hexed so that soles of one or both feet are flat on the bed. 6. If there is no trapeze, slide arm nearest the head of the bed under client's shoulders, reaching under and supporting client's opposite shoulder. Place other arm under client's upper back (see illustration). Have lient push with feet as you lift on the count of three. 7.If there is a trapeze, assist client with grasping it. Slide one arm under thighs and one arm under trunk (see illustration). 8. Have client lift with trapeze and/or push with feet on the count of three. Repeat if needed to move up farther in the bed. 9. Ask client about level of comfort, and ad­just as necessary

Positioning in semi-Fowler's and Fowler's posi­tion. For the semi-Fowler's position the head of the bed is raised 45 to 60 degrees. The high-Fowler's position, with the head of the bed raised 90 degrees, is recommended for eating. With client in supine position, raise the head of the bed to the appropriate level (45 to 90 degrees) (see illustrations). Use pillows to support client's arms and hands if upper body is immobilized. Position a pillow under client's head if desired, and raise the knee break of the bed slightly. Avoid pressure under the popliteal space (back of the knee). Change the degree of elevation of the head of bed 5 to 10 degrees frequently. Identify potential pressure points, including scapulae, elbows, sacrum or coccyx, and heels (implement pressure ulcer prevention.

Side-lying position with pillow placement Moving dependent client to 30-degree lateral (side-lying) position. This move removes pres­sure from bony prominences of entire back. Lower the head of the bed as much as lient can tolerate, keeping head of bed delow 30-degree angle. Lower side rail. Using a pull sheet, move client to the side of the bed opposite to the one toward which client will be turned. Raise side rail. Go to opposite side of the bed, and lower side rail. Prepare to turn client onto side. Flex client's knee that will not be next to mat­ tress once turned. Assist client with raising arm nearest you above head, adjusting pil­ low if needed. Place one hand on client's hip and one hand on client's shoulder and hip, and as­ sist client with rolling toward you onto side. Flex both client's knees after the turn, and support upper leg from knee to toot using a pillow or folded blanket. F.ase lower shoulder forward, and bring upper shoulder back slightly. Check client's comfort. Support upper arm with pillows so that arm is level with shoulder. Optional: Place pillow behind client's back and under so that it is tucked smoothly against back (see illustration). Make sure client's back is straight without evidence of twisting. Adjust as needed for comfort. Pressure points to check include the ear, shoulder, anterior iliac spine, trochanter, lateral side of the knee, malleolus, and foot

Promoting Activity and Mobility Logrolling to maintain neck and spinal align­ment following injury or surgery (1) Determine number of staff required to logroll client. Lower the head of the bed as much as client can tolerate. Place a pillow between the legs. Use of a pull sheet placed between shoulders and knees can facilitate turning. Cross client's arms on chest. Position two nurses on side of bed to which the client will be turned. Position third nurse on the other side of bed (see illustration). Fanfold or roll the drawsheet or pullsheet. Using the count of three, turn client as one unit with a continuous, smooth, and coordi­nated effort. Support client with pillows along the length of the client. Gently lean client as a unit back towards the pillows for support.

Assisting With Moving and Positioning Clients in Bed

Positioning dependent client in supine position Step 5f(1) Sims' (semiprone) position. (2) Pillow placement for supine position Positioning dependent client in supine position Place client on back with head of bed flat. Place pillow under upper shoulders, neck, and head (see illustration). To position trochanter roll at client's hips, place a folded bath blanket under hips and roll ends under until toes point directly up (see illustration) Place small support under ankles to mini­ mize pressure on heels. A footboard or use of high top tennis shoes may be used to prevent footdrop. Shoes should be removed at least 3 times a day for ROM exercises to prevent contractures. Place small supports under forearms with hand-wrist splints or small rolls to support fingers and thumb in a functional position. Pressure areas to check include the back of the head, scapulae, elbows, posterior iliac spine, sacrum or coccyx, ischium, Achilles tendons, and heels

Promoting Activity and Mobility Steps 5h(3) and 5h(4) Prone Step 5h(6).Prone position with pillows supporting lower legs position with pillows in place

Roll client to one side. Roll client over arm positioned close to body, with elbow straight and hand under hip. Position client on abdomen in center of bed. Turn client's head to one side, and support head with small pillow (see illustration). Place small pillow under client's abdomen below level of diaphragm (see illustration). Support arms in flexed position level at shoulders. Support lower legs with pillow to elevate toes (see illustration).