Ambulation, Patient transfer, Restraints, ROM PN 1 Nursing Skill Labs

Before you ambulate the pt………. assess pt capabilities administer pain med if needed plan what you are going to do and make sure you have the right number of helpers, the right equipment etc. explain to patient what is going to happen and what their role is

make sure the area is free of obstacles elevate bed, lock wheels etc. watch body mechanics of both you and your patient protect patient from harm if dependent avoid friction on patients skin move smoothly using a rhythmic motion

use mechanical devices as indicated but make sure you know how to use them safely !!!! be realistic about what you can do safely and without injury dangle patient prior to standing to avoid incidents related to postural hypotension

Ambulating with one nurse……... always dangle before you get pt up stand patient and remind to stand erect start with short walk if first time up if patient starts to faint, have wide base of support, encircle pt under arms and gently lower to floor if wearing belt use it to lean pt back and to floor

stand at patients side and place both hands at patients waist if not using belt place belt securely on patient and grasp at back walk behind and slightly to side of patient if pt weak on one side, stand on that side and put arm around waist support weak arm with other arm

Ambulating with two nurses…….. Two methods: 1. Each nurse stands at pts side and grasps interior aspect of pts upper arm holding pts lower arm or hand with other hand

2. Nurses place arms under pts axillae and grasp each others forearms behind pt while patient puts arms over nurses shoulders and nurse grasps pt hand with free hand - all three must be same height

Transferring from bed to chair - one nurse place bed in low position prepare patient if patient not impaired, place chair close to bed facing foot of bed if patient impaired, place chair facing head of bed lock wheels!!!!!!

get foot pedals out of the way raise head of bed to highest position assist pt to sit on side of bed assist pt to stand (may use belts for this) face patient and brace his feet and knees with yours place your hands around the pts waist

pivot the patient into position in front of the chair with legs up against back of chair have patient place one arm on chair to steady self while lowering to chair while you continue bracing feet and knees with yours position for comfort, call bell, blanket

Transferring from bed to chair - two nurses prepare equipment and patient move pt to side of bed and cross pts arms across chest lock wheels on bed put chair next to bed with back of chair parallel to head of bed lock wheels on chair

adjust bed to comfortable level for nurses first nurse stands behind chair and slips arms under pts axillae grasping pts wrists securely second nurse faces wheelchair and supports pts knees by placing arms under them on prearranged signal, lift together

Transferring from bed to stretcher prepare patient and room raise bed to same height as stretcher place draw sheet under pt and use it to move patient to side of bed position stretcher parallel to bed lock wheels on bed and stretcher nurse 1 kneels on bed on far side of pt at upper torso and grasps draw sheet

nurse 2 reaches across stretcher and grasps draw sheet securely at head and chest area nurse 3 reaches across stretcher and grasps draw sheet at waist and thigh area have patient hold arms across chest on count of three, move patient put up siderails and cover patient

transfer boards are sometimes used for this purpose and they make it much easier as you simply slide the patient on a draw sheet over to the stretcher a three carrier lift may also be used

Therapeutic mobility techniques - SMART MOVES Concepts: discal load, COM, leverage, friction reduction, normal movements Equipment needed: velcro belts, beds, drawsheets, garbage bags, towels, w.chair,stretcher board

Harness the principles Safer patient moves & transfers by staff with: 1.COM-centre of mass 2.leverage 3.friction reduction vs. muscle mass & strength

Safety Strategies for Transferring patients plan ahead equipment set up communications consistency symmetrical movements don’t block pt. knee, cradle them transfer belts/slider bags

use center of mass and leverage to move patient (shift your weight) place your knee on bed to assist with movement - this will save your back!!! keep a wide stance and your knees bent

Range of Motion positions Head - flexion, extension, lateral flextion Neck - rotation Shoulder - flexion, extension, abduction, adduction, internal and external rotation Elbow - flexion, extension Forearm - supination, pronation Wrist - flexion, extension, hyperextension

Fingers - flexion, extension, abduction, adduction, opposition of thumb to fingers Hip - flexion, extension, abduction, adduction, internal rotation, external rotation Knee - flexion, extension

Ankle - dorsiflexion, plantar flexion, inversion, eversion Toes - flexion, extension, abduction, adduction

Restraints……….. anything that limits movement - tables, bed rails, towels, jackets etc. must have MD order must have pt. permission least restraint policy how can restraints cause harm? restraints don’t guarantee safety and probably do more harm than good!!!

check patient at least once an hour remove restraints, massage area, check for skin breakdown or redness, perform ROM, reapply only if necessary pad bony prominences under restraint should allow two fingers under restraint use least restrictive form of restraint possible

maintain restrained extremity in normal anatomical position use appropriate tie fasten to bed frame not side rail reassure patient frequently DOCUMENT reason for restraint, alternate measures tried, date and time of application, type of restraint, times when removed and ongoing assessment

If absolutely necessary to use R espond to the present, not the past e valuate the potential for injury s peak with family members/caregivers t ry alternative measures r easses need for restraints frequently a lert physician and family I ndividualize restraint use n ote important information in chart t ime the use of restraints