Patient Transfer and Positioning PDF

Positions and transferring Objectives : At the end of this lecture the student will be able to:  Describe the individual positions in patients according to their purpose.  Apply the basic terms related to limb movement.  Explain the importance of preventive positioning for preventing immob...

Positions and transferring Objectives : At the end of this lecture the student will be able to:  Describe the individual positions in patients according to their purpose.  Apply the basic terms related to limb movement.  Explain the importance of preventive positioning for preventing immobilization syndrome.  Lay the patient in the correct diagnostic position depending on the type of examination.  Able to perform patient care transfere. Firstly; Basic Patients’ Positions; Positioning a client in good body alignment and changing the position regularly and systematically are essential aspects of nursing practice.  Purpose of patient positioning and transferring: 1.To increase muscle strength 2.To prevent some potential problems of immobility 3.To stimulate circulation 4.To assist a patient who is unable to move by him self 5.To prevent fatigue and injury 6.To maintain good body alignment  Guideline for positioning the patient: 1. Maintain functional client body alignment. (Alignment is similar whether client is standing or in bed) 2. Maintain client safety 3. Reassure the client to promote comfort and cooperation 4. Properly handle the client's body to prevent pain or injury 5. Follow proper body mechanics 6. Obtain assistance, if needed, to move heavy or immobile clients. 7. Follow specific physician orders 8. Do not use special devices (e.g. splint, traction) unless ordered.  When positioning clients in bed ensure proper alignment and promote client comfort and safety by: 1- Make sure the mattress is firm and level yet has enough given to fill in and support natural body curvatures. 2- Ensure that the bed is clean and dry. 3- Avoid placing one body part, particularly one with bony prominences, directly on top of another body part. 4- Plan a systematic 24-hour schedule for position changes. Frequent position changes are essential to prevent pressure ulcers in immobilized clients.  During positioning of the patients ensure Proper body mechanics by: Observe good body mechanics for your and your patient’s safety. 1. Position yourself close to the client. 2. Avoid twisting your back, neck, and pelvis by keeping them aligned. 3. Flex your knees and keep your feet wide apart. 4. Use your arms and legs and not your back. 5. Tighten abdominal muscles and gluteal muscles in preparation for the move. 6. A person with the heaviest load coordinates the efforts of the nurse and initiates the count to 3  Patient examination and treatment positions The purpose of laying the patient in the examination position is to facilitate better access to an organ or body part. Treatment position contributes to successful patient treatment.  Examination (diagnostic) positions: a)Supine position b)Prone position c)Fowler’s position d)Orthopneic position e)Trendelenburg position f) Reverse Trendelenburg position g)Side position (lateral) h)Sims’ position i) Gynecological position (Dorsal recumbent position) j) Genupectoral (knee-chest), genucubital (knee-elbow) positions  Supine position(Dorsal position) (Back lying) (Horizontal recumbent) patient lay on his back and legs may be extended or slightly bent with arms up (on the chest) or down (along side of the body). It provides comfort in general for patients under recovery after some type of surgery and in general assessment examination Support for supine position. Small pillows may be placed under the head to lumbar curvature. Heels must be protected from pressure by using a pillow or ankle roll. Prevent prolonged plantar flexion and stretch injury of the feet by placing a padded footboard. Dorsal recumbent position: Is used for variety of examinations and procedures (e.g. rectal examination, childbirth). The client lies on the back, with knees flexed and the soles of the feet flat on bed.  Fowler’s Position; Fowler’s position, also known as semi-sitting position, is a bed position where in the head of the bed is elevated 45 to 60 degrees. Variations of Fowler’s position include low Fowler’s (15 to 30 degrees), semi-Fowler’s (30 to 45 degrees), and high Fowler’s (nearly vertical 90 degree). -Adjust the head rest to the desired height, and raise the bed section under the client’s knees. -Place a rolled pillow between the client’s feet and use the foot of the bed as a brace, if desired. This positions useful for; Promotes lung expansion. For patient feeding (nasogastric feeding). Used in some surgeries. (Fowler’s position is usually used in surgeries that involve neurosurgery or the shoulders) Prone position (face lying position) In prone position, the patient lies on the abdomen with their head turned to one side and the hips are not flexed. To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen. When positioning a patient in prone, surgical staff should use safe practices and guidelines: Use chest supports that extend from the clavicle to the iliac crest Ensure the breast, abdomen, and genitals are free from pressure Pad the patient’s knees Elevate the patient’s toes off the bed with padding under the shins Use a face positioner when the patient’s head is in midline Prevent direct pressure on the patient’s eyes The prone position is often used for spine and neck surgeries, neurosurgery, colorectal surgeries, vascular surgeries, and tendon repairs.  Lateral Position (side lying position) In lateral or side-lying position, the patient lies on one side of the body with the top leg in front of the bottom leg and the hip and knee flexed. A pillow is under the head and neck. The upper leg, ankle, and thigh are supported with pillows. A pillow is positioned against the person’s back. A small pillow is under the upper arm and hand How to turn your patient from back to lateral position; Sims’ Position (Stabilized (Sims’, large lateral position) side position ) Sims’ position or semi-prone position is when the patient assumes a posture halfway between the lateral and the prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. The upper leg is more acutely flexed at both the hip and the knee than is the lower one.  Trendelenburg’s Position Trendelenburg’s position involves lowering the head of the bed and raising the foot of the bed of the patient. The patient’s arms should be tucked at their sides.  This position is used after:  short-term collapse, in gynecology to sustain the fetus,  in urology during prostate or bladder surgery. The Trendelenburg position worsens pulmonary ventilation, increases intracranial pressure, and the venous return to the heart as well as increases central venous pressure.  Reverse Trendelenburg’s Position Reverse Trendelenburg’s is a patient position wherein the head of the bed is elevated with the foot of the bed down. It is the opposite of Trendelenburg’s position.  This position is used for arterial circulation disorders in lower limbs.  Orthopneic position It is typical for patients with left-sided heart failure, and mainly occurs at night. The patient is restless and anxious. When in the orthopneic position, the patient sits on the bed, holding onto the headboard (thus involving auxiliary respiratory muscles), the legs are dropped off the bed. Sometimes, the patient leaves the bed, and either sits or stands bent slightly forward using the surface to support the hands. The reason for Orthopneic position: improve ventilation increase vital lung capacity; when in the seated position, the patient involves the auxiliary respiratory muscles, and the legs being lowered result in the accumulation of blood, thus complicating the venous return to the congested pulmonary vascular bed.  Lithotomy position A common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a common position for childbirth. The lithotomy position involves the positioning of an individual's feet above or at the same level as the hips (often in stirrups), with the perineum positioned at the edge of an examination table. The patient is laid on the back with knees bent, positioned above the hips, and spread apart through the use of stirrups.  Genupectoral (knee-chest), genucubital (knee- elbow) positions This is a position in which the patient kneels down and leans forward on their elbows with a curved spine and chest and elbow rested on the bed , the client's head is turned to the side. The thighs are straight up and down, and the lower legs are flat on the bed. This is used during endoscopic examinations of the rectum and intestines, vaginal examination and as treatment to bring the uterus into normal position.  Patient Transfer Patient care transfer defined as moving a patient from one flat surface to another. The most common patient transfers are from a bed to a stretcher and from a bed to a wheelchair.  Before transferring the patients :  Perform proper hand hygiene  Introduce yourself to the patient, explain procedure to the patient.  Confirm the patient’s identification  Ensure patient privacy  Assess the patient condition, vital signs, hemodynamics  Ensure that all tubes, attachments, monitors, attached machines, patient wristbands, and lines are placed properly  Obtain necessary equipment (slider board, full-size sheet/reducing sheet, etc.) A.Moving The Client from Bed to Wheeled Stretcher, Using A Transfer Board. Supplies and Equipment  Lifting sheet  Bath blanket  Transfer board Wheeled stretcher  B-Dangling Dangling refers to allowing the client to sit on the edge of the bed, with the legs down and the feet supported on a footstool or on the floor. Allow the person to sit in the bed for a few minutes before assisting him or her out of bed. (It may be necessary to raise the head of the bed.)  This helps the client who has been in bed to prepare to sit in a chair and eventually, to walk. Purpose of Dangling The client may experience light-headedness or weakness due to a temporary fall in blood pressure (orthostatic or postural hypotension). He or she may be strong enough only to dangle and then lie down again.  B. Dangling Supplies and Equipment Stethoscope Blood pressure cuff Bath blanket Pillow  A.Moving The Client into A Wheelchair or Chair (if patient can help you) Supplies and Equipment  Wheelchair or chair  Sturdy slippers or shoes (non-skid soles) Robe  Bath blanket  Transfer belt (optional)  D.Moving The Client into A Wheelchair or Chair (if patient cannot help you) Supplies and Equipment  Wheelchair or chair  Sturdy slippers or shoes (non-skid soles)  Robe  Bath blanket  Lifting sheet or transfer pad  Transfer belt (if needed)