Ambulation, Patient transfer, Restraints, ROM

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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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!!!!!!

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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

21. 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

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

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

24. 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!!!

25. 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

26. 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

27. If absolutely necessary to use • R espond to the present, not the past • e valuate the potential for injury • speak with family members/caregivers • t ry alternative measures • reasses need for restraints frequently • alert physician and family • I ndividualize restraint use • n ote important information in chart • t ime the use of restraints