Lifts, Transfers, Mobility Aids & Body Mechanics PDF

Lifts, Transfers, Body Mechanics, & Mobility Aids PN1 Lab NRSG 10143 Created by Holly Cowan Professor:  Discuss Impaired mobility Describe & demonstrate how to maintain proper body mechanics Discuss the importance of no-lift policies for clie...

Lifts, Transfers, Body Mechanics, & Mobility Aids PN1 Lab NRSG 10143 Created by Holly Cowan Professor:  Discuss Impaired mobility Describe & demonstrate how to maintain proper body mechanics Discuss the importance of no-lift policies for clients and healthcare providers. Describe the equipment needed for safe client handling; fall Demonstrate assisting a client to walk with a gait belt, walkers, canes & crutches Overview Discuss risk factors related to position and transfers for both the nurse and client Demonstrate transfer techniques from bed to wheelchair, and wheelchair to bed (one person & two person assist) Demonstrate moving & positioning a patient in bed Demonstrate safe use of hoyer lifts & sit to stand Assess for correct & impaired body alignment and mobility while lying, sitting and standing 2 Impaired Mobility Impaired mobility due to muscle weakness, paralysis or poor coordination or balance is a major factor in patient falls. Immobilization predisposes a patient to additional physiological and emotional hazards, which can further restrict mobility & independence. Potter & Perry, 2019 3  Safe Patient Handling Nurses are exposed to hazards related to lifting and transferring patients in many settings. In most healthcare organizations, a no-lift policy exists Manually lifting and transferring patients contributes to a high incidence of work-related musculoskeletal problems & back injuries. (Potter & Perry, 2019) 4  Many safe patient handling programs include the following: Ergonomics assessment Patient assessment criteria and algorithms for safe patient handling & movement Special equipment to assist with patient transfers i.e. transfer belt No lift policies Safe Patient It is the nurse's responsibility to implement Handling existing safe handling policies within the workplace & to advocate for enhancements Programs to safety (Potter & Perry, 2019) 5  Arrange for adequate help Use patient-handling equipment i.e. height adjustable beds, ceiling mounted lifts, friction- reducing slide sheets) Safe Client Encourage patient to assist as much as possible Take position closest to patient or object being Handling lifted Tighten abdominal muscles & keep back, neck, for Health pelvis & feet aligned. Avoid twisting Use arms & legs (not back) Care Slide patient toward your body, using a pull sheet or slider board Worker Person with heaviest load coordinates efforts for the team by counting to three before move Potter & Perry, 2019 6 Body Mechanics More than half of all back pain is associated with health care settings. Back injuries are often direct result of improper bending & lifting. Before repositioning a patient, assess the weight to & determine the assistance needed. Never attempt to lift a patient without assistance. Potter & Perry, 2019 7  Second person ALWAYS needed Mechanical Organization specific education often needed Lifts One person spots & 2nd person operates the mechanical lift Potter & Perry, 2019 8  Factors Influencing Activity & Exercise – Older Person Progressive loss of bone mass -> result of decreased activity, hormonal changes & increased osteoclastic activity. Bone loss leads to weaker bones. Vertebrae becomes softer & long bone shaft bones become less resistant to bending. Changes in muscle tissue also occur as adults age. Muscle fibers shrink & have reduced tone & contractility. Strength & endurance change Older persons may walk more slowly & overall energy maybe reduced. (Potter & Perry, 2019) 9  Orientation Strategies Clear communication Sensory aids (glass, hearing aids) Comfort rounds (toileting, hydration, position changes) Teach patient & family about fall risk & prevention strategies Ensure call bell & walking aids are within reach Fall Assess patient's understanding of the call bell & if able to use call bell Prevention Remind patient to call for help when transferring, ambulating & toileting Protocol Assess whether patient is using assistive devices correctly Ensure non-slip footwear Clear barriers 10 (Potter & Perry, 2019)  Using principles of safe pt transfer & positioning during routine activities decreases work effort & places less strain on Principles of Body musculoskeletal structures. Mechanics, Safe Pt transfers & Positioning Techniques Potter & Perry, 2019 11 Body Alignment - Standing Is the head erect & midline? Are body parts symmetrical? Do the arms hang comfortably at the sides? Is the patient's center of gravity midline? Are feet planted flat on the floor, with a wide base of support? The nurse needs to identify deviations from expected findings. (Potter & Perry, 2019) 12  Helping a Patient to Walk Preparation Assess pt's strength & coordination, baseline VS & balance to determine how much assistance is needed. Assess orientation & determine if there is any distress. Evaluate environment for safety, non-slip footwear. Assist to a sitting position if lying in bed (dangle legs over side of bed x2 min before standing. Assess for orthostatic hypotension Potter & Perry, 2019 13  If the patient gets dizzy Return to bed/chair nearby If patient has a wheelchair, have someone follow behind with wheelchair so patient can quickly sit down. If fall is imminent, widen your base of support by placing one foot in front of other Goal is to protect patient’s head Extend front leg and slide patient down leg to floor Potter & Perry, 2019 14  Helping a Pt to Walk Provide support at waist with a gait belt so ctr of gravity remains midline. A gait belt encircles the pt's waist snuggly. The nurse holds the back of the belt behind the pt. Potter & Perry, 2019 15  Assistive Devices for Walking Important to teach proper use of canes, walkers or crutches. Walker - lightweight, movable device that stands waist high. Provides great stability Walkers with wheels are useful for pts who have difficultly lifting & advancing the walker. To determine if correct sz, instruct pt relax arms at side of body & stand straight. The top of the walker should line up with the crease on the inside of the pt's waist. Elbows showed be flexed about 15-30 degrees when standing inside the walker with hands on the hand grips. Potter & Perry, 2019 16 Walking With A Walker To ambulate using a walker, the pt holds the handgrips on the upper bars, takes a step, moves the walker forward & takes another step. Potter & Perry, 2019 17  Canes Provide less support than a walker & are less stable. To determine the correct cane length, measure the distance from greater trochanter to the floor. Straight legged cane - used to support * balance a pt with decreased leg strength. Potter & Perry, 2019 18  Walking With a Cane Keep cane on stronger side of body Teach following 3 steps: Place the cane forward 15 cm to 25cm, keeping body wt on both sides Coach for pt to move weaker leg forward to the cane so body wt is divided between cane & stronger side Have pt advance stronger leg past the cane so the cane supports the body weight & weaker leg Potter & Perry, 2019 19  Crutches Often needed to increase mobility Often temporary Two types – double adjustable or forearm crutch (axillary wood or metal) Metal band & handgrip are adjusted to fit pt's height. Axillary crutch has a padded curved surface on the top A handgrip in the form of crossbar is held at the level of the palms to support the body Potter & Perry, 2019 20 Patient Teaching: Crutches Basic crutch stance, provides wider base of support Erect head & neck, straigh vertebrae, hips & knees extended Non-slip shoes, inspect rubber crutch tips Dangers of too much pressure on axilla Teach all pts how use stairs even if none are in the home Potter & Perry, 2019 21  22 Position in centre of chair, with posterior legs touching chair Transfer both crutches to strong side Reach for arm of chair Sitting in a Chair - Lower self into chair, supported by crutches both hands and strong leg Reverse steps to stand Potter & Perry, 2019  Ascending Stairs - Crutches Patient uses a modified 3-point gait Pt stands at bottom of stairs & transfers body wt to crutches. Pt then advances the unaffected leg between the crutches & stairs. Pt shifts wt from crutches to the unaffected leg. Finally, pt aligns both crutches on the stairs. Potter & Perry, 2019 23 This Photo by Unknown author is licensed under CC BY-SA. Descending Stairs A three-point sequence is also used to descend stairs. Pt transfers body wt to unaffected leg, then places crutches on the stairs & begins to transfer body wt to the crutches, moving the affected leg forward. Finally, the pt moves unaffected leg to the stairs with the crutches & repeats PRESENTATION TITLE 24  Measuring Crutches Axillary crutch – includes pt's ht, angle of elbow flexion & distance between crutch pad & the axilla. When crutches are fitted, the length of crutch needs to be two to three finger widths fr axilla & the tips positioned approximately 5cm lateral & 10 to 15 cm anterior the from to pt's shoes Position handgrips so the axillae are not supporting the pt's body wt. When determining the ht & placement of the handgrips, verify that the distance between the crutch pad & axilla is two to three fingerwidths Potter & Perry, 2019 25 Wheelchairs Position wheelchair on patient’s strong side Ensure brakes are on & foot plates raised Should back wheelchairs into and out of elevators If on ramp or incline, turn so chair pushes against your body Assess client comfort & body alignment once in wheelchair Potter & Perry 26 Patient Transfers PRESENTATION TITLE 27 (Potter & Perry, 2019) Nurses often provide care for immobilized patients whose position must be changed i.e. move up in bed, bed to wheelchair, bed to stretcher. Before any transfer, it is helpful to encourage maximum patient involvement. Use the patient's strength when lifting, transferring or moving when possible. Using principles of safe patient transfer & positioning during routine activities, decreases work effort & Transfer places less strain on musculoskeletal structures Techniques 28 Potter & Perry, 2019 Assess physiological capacity to transfer Joint mobility, range of motion & contracture formation? Paralysis? Bone continuity Assess for weakness, dizziness, orthostatic hypotension Activity tolerance – fatigue? Transfer Assess proprioceptive function (awareness of posture & Techniques equilibrium Sensory status Level of comfort Assess VS Level of motivation Risk for falling Transfer equipment needed 29  Moving Patients Up in Bed Drawsheet extends from shoulders to thighs under patient Hold sheet with palms facing up Feet apart, one slightly in front of other Flex knees and hips On count of 3, shift weight from back to front leg while lifting to move patient toward head of bed PRESENTATION TITLE 30 Turning Pads & Sliders Sliding pad, turning sheet, transfer sheet, lift pad Sometimes inaccurately called drawsheet Some are waterproof Sliders are used to move and reposition clients PRESENTATION TITLE 31 Planning Gather equipmet Determine # of people needed to assist Perform hand hygiene Very bed brakes are on (risk for injury) Explain procedure to patient PRESENTATION TITLE 32 Assisting to a Sitting Position in bed Raise head of bed (HOB) to waist level. Place pt in supine position Face head of HOB at 45-degree angle & remove pillows Place your feet in wide base of support with one foot closer to bed in front of other foot Palce arm near HOB under pt's shoulders, supporting head & cervical vertebrae Place other hand on HOB surface Raise pt to sitting position by shifting weight from front to back leg Push against bed using arm that is placed on bed surface Potter & Perry, 2019 33 This Photo by Unknown author is licensed under CC BY. Bed to Chair Patient MUST be able to help Move obstacles, place chair beside bed Use a transfer belt – should be snug, no buckle over spine Patient should sit at side of bed and stand first before moving Transfer should be toward strong (unaffected) leg if injury exists Potter & Perry, 2019 34 This Photo by Unknown author is licensed under CC BY. Bed to Chair Ensure patient wearing non-slip footwear Apply transfer belt Flex hips and knees, support patient’s weaker leg with your own Rock patient to standing on count of 3, ask patient to push up with hands Pivot on your back foot toward chair Ask patient to tell you when back of knees touch chair, then to reach for armrests to lower self into chair Lower patient by flexing hips and knees (not with your back) Assess alignment and position once seated Potter & Perry, 2019 35  Sit to Stand device Allow pt to transfer independently if able to wt bear Stand by as needed to promote safe transfer If pt has partial wt bearing with upper body strength & if caregiver needs to lift more than 115.9 kg of pt wt use a sit to stand device & follow manufacture instructions Potte 36 PRESENTATION TITLE Wrap up Questions & Plan Refer to your canvas shell for readings & videos for next wk! for Next Week! 37 References Potter, P. A., Perry, A.G., Stockert, P.A., & Hall, A.M. (Eds.). (2019). Canadian fundamentals of nursing (6th Ed.) (J.C. Ross- Kerr, M.J. Wood, B.J. Astle & W. Duggleby, Cdn. Adapt.). Toronto, ON: Elsevier Canada: PRESENTATION TITLE 38