Active ROM PDF

Active ROM exercise Steps 1 2 3 4 5 Neck pivot joint Flexion: Move the heads from the upright midline position forward, so that the chin rest on the chest. (45 degree from Midline) Extension:...

Active ROM exercise Steps 1 2 3 4 5 Neck pivot joint Flexion: Move the heads from the upright midline position forward, so that the chin rest on the chest. (45 degree from Midline) Extension: move the headfrom the flexion position to upright position. (45 degree from Midline) Hyperextension: move the head from the upright position back as far as possible.. (45 degree) Lateral flexion: move the head laterally to the right and the left shoulders, while facing front. (40 degree from Midline) Rotation: turn the face as far as possible to right and left.(70 degree Midline) shoulder –ball-and socket joint. Arms: 41 Flexion: raise each arm froma position by the side forward and upward to a position beside the head.( 180 degree from the side) Extension: move each armfrom a vertical position beside the head for word and down to arresting position at the side of the body.( 180 degree from vertical position beside the head) Hyperextension: move eacharm from arresting side position to behind the body.(50 degree from side position) Abduction: move each armlaterally from arresting position at the side to a side position above the head, palm of the hand away from the head.(180 degree) Adduction:(anterior) Move each arm from apposition beside the head down ward laterally and across front of the body as far as possible.(50 degree) 42 Horizontal flexion: extend each arm laterally at shoulderheight and move it through a horizontal plan across thefront of the body as far aspossible. (135 degree) Horizontal extension: extend each arm laterally at shoulder height and move it through a horizontal plan across the behind the body as far as possible. (45 degree) Circumduction: move each arm forward up, back and down in a full circle (360 degree) Externalrotation: with each arm held out to the side at the shoulder level and theelbow bent to a right angle,finger point down move the arm upward so that the fingers point up.(90 degree) Internalrotation: with each arm held out to the side at shoulder level and the elbow bent to a right angle, finger point up bring the arm forward and down that the finger point down.(90 degree) 43  Elbow-hinge joint Flexion: bring each lower arm forward and upward so that the hand is at the shoulder.(150 degree) Extension: bring each lower arm forward and down ward, straightening the arm.(150 degree) Rotationsupination :turn each hand facing forearm so that the palm is facing upward.(70-90 degree) Rotationpronation: turn each hand and forearm so that the palm is facing downward.(70-90 degree) 44 Flexion: bring the finger of each hand toward the inner aspect of the forearm.(80-90 degree) Extension: straighten each hand toward the inner aspectof the forearm. Extension: straighten the finger of each hand. (80-90 degree.) thumb side with hand Hyperextension: bend the finger of each hand back asfar as possible.(70-90 degree) Radialflexion(ulnarhyperextension): (Abduction): bend each wrist laterally toward the supinated.( 0-20 degree) Ulnarflexion (adduction):bend each wrist laterally to word the fifth finger with the hand supinated, the behind the body as far as possible (30-50 degree) 45  Hand and finger Metacarpophalangeal Joint-condyloid: interphalanggeal joins –hinge Flexion: make a first with each hand.( 90 degree) Extension: straighten the fingers of each hand. ( 90 degree) Hyperextension: bend the fingers of each hand back as far as possible.(30 degree) Abduction: spread the finger of each hand apart. (20 degree) Adduction: bring the fingers of each hand together.(20 degree) Thumb-saddle joint Flexion: move each thumb across the palmer surface of the hand toward the fifth finger. (90 degree) Extension: move each thumb away from the hand. (90 degree) Abduction: extend each thumb laterally.(30 degree) 46 Abduction: extend eachthumb laterally.(30 degree) Adduction: move each thumb back to the hand. Opposition: touch each thumb to the tip of each fingers of the same hand.(70 degree) Hip –ball and socket joint flexion: move each leg forward and upward, the knee may be extended or flexed. (90 degree) Extension: move each legback beside the other leg. (90-120 degree) Hyperextension: move eachleg back behind the body. (30-50degree) Abduction: move each legout to the side (45- 50 degree) Adduction: move each leg back to the other leg andbeyond in front of it. (20-30 degree) Circumduction: move each leg forward, lateral, backward , to the side and downin a circle. (360 degree) 47 Internalrotation: turn each foot and leg In ward that thetoes point as far as possible to ward the other leg. (40 degree) Externalrotation: turn each foot and leg out ward that the toes point as far as possible to ward the other leg. (45 degree) Knee- hinge joint Flexion; bend each legs bringing the heel toward the back of the thigh. (120-130 degree) Extension: straighten each leg returning the foot to its position beside the other foot. (120-130 degree) Ankle –hinge joint 48 Extension:( planter flexion)point the toes of each footdown word. (20 degree) Flexion :(dorsiflexion)Toes of each foot upward. (45-50 degree) Foot Eversion: turn the sole of each foot laterally. (5 degree) Inversion: turn the sole of each foot medially. (5 degree) Toes Interphalangael Joint king: Metatarsophalangeal. Joint hinge: intertarsel joint–gliding Flexion: curve the toes joint of each foot down ward. (35-60 degree) Extension: straighten the toes of each foot. (35- 60 degree)Abduction: spread the toes of each foot apart. Adduction: bring the toes of each foot to gather. 49  Trunk –gliding joint flexion: bend the trunk toward the toes. (70-90 degree) Extension: straighten the trunk from a flexed position. (70-90 degree) Hyperextension: bend the trunk back ward. (20- 30 degree) Lateral flexion: bend the trunk to the right and to the left. (35 degree) Rotation: turn the upper part of the body from side to side.(30-45 degree) 50 Passive ROM Exercises The nurse performs these exercises. Procedure: 1- Assist the patient to supine position near the nurse , and expose the body parts requiring exercise ,place the client feet together ,place the arms at the sides , and leave space around the head and the feet. Rational: positioning the client close to the nurse prevents excessive reaching. 2-Return to the starting position after each motion, repeat each motion three times. 3-Throughout the exercise assess: a - ability to tolerate the exercise. b - range of motion of an affected joint. Upper Extremity Passive ROM Exercises Upper extremity, passive ROM exercises teach someone else how to stretch your arms if you are unable to move your arms by yourself. These exercises should be done slowly and gently, and can be done with the person sitting in a chair or lying down. Do each exercise ten times. 51 Steps 1 2 3 4 5 Neck Rotation and laterally: Turn head slowly to look over left shoulder then turn to look over right shoulder, touching the chin to the Shoulder if possible. Place the heels of the hands on each side of the client checks. Move the top of the head to the right and left. Neck Flexion and extension: place the palm of one hand under the client head and the palm of the other hand on the client chin. Move the head forward until the chin rest on the chest , then back to the resting supine position without the head pillow Shoulder Flexion and Extension Hold the upper arm with one hand and forearm with the other hand. Bend the arm at the elbow so that the hand touches the shoulder. Then straighten the arm all the way out. 52 Move Shoulder Internal and External Rotation Place one hand under the Elbow. With your other Hand, hold the forearm. Bring arm out to the side to shoulder level. Turn arm so that the hand points to the Ceiling. Then turn arm back down so that hand points to floor and the upper arm is twisting in the shoulder joint. Horizontal Shoulder Abduction Place hands behind or Above head. Gently touch elbows to bed and hold as Tolerated. Stretch felt in Chest.Pull arm across chest. Stretch is felt in back of arm and shoulder. Elbow Flexion and Extension Hold the wrist with one hand. With the other hand, grasp the elbow joint to Stabilize it. Turn the palm inward, facing the body, and keep the elbow relatively straight 53 Finger and Wrist Flexion and Extension Hold the forearm above the wrist with one hand and grasp the fingers with your other hand. Holding the hand in this way, bend the wrist back, about 90 degrees, while straightening the fingers Out. Then bend the wrist the opposite direction, about 90 degrees, while curling the fingers into a Fist. Thumb Flexion and Extension Move thumb to little Finger. Then bend and straighten the thumb out to the side to stretch the "web space" hip and leg 54 flexion and extension supporting the lower leg.flex the leg toward the chest and then extend the leg internal and external rotation supporting the lower leg angle the foot inward and outward knee flexion and extension supporting the lower leg ,flex and extend the knee Ankle 55 flexion and extension supporting the lower leg ,flex and extend the ankle Foot adduction and abduction supporting the ankle ,spread the toes apart and then bring them close together flexion and extension supporting the extend the toes upward and then extend the toes downward 56 Lower Extremity Passive ROM Exercises 1. Wash your hands. 2. Explain what you are going to do. 3. Provide privacy. Make sure client is wearing adequate clothing. 4. Raise bed to a comfortable working height if possible. 5. Assist client into supine position. Lower Extremity Passive ROM Exercises Lower extremity passive exercises are for someone else to stretch your hips, legs, and Knees if you are unable to do this yourself. These exercises should be done slowly and gently while you are lying on your back. Each exercise should be done ten times on each leg each day. Steps 1 2 3 4 5 Hip and Knee Flexion Cradle the leg by placing one hand under the bent Knee. With the other hand, grasp the heel for Stabilization. Lift the knee and bend it toward the chest, with the kneecap Pointed toward the ceiling. Do not allow the hip to twist during this Movement. The foot should stay in a straight line with the hip and not swing in or out. The leg is then lowered to the starting position. 57 Hip Rotation Place one hand on the thigh and other hand just below the knee. Bend the knee halfway to the chest so that there is a 90 degree angle at the hip and knee. Pull the foot toward you and then push it away. Remember; do not go beyond the point of resistance or pain. lower leg to starting position. 1. Support the leg under the knee and heel. 2. Bend the knee halfway to the chest so that there is a 90 degree angle at the hip and knee. 3. Push the foot away from you. 4.Pull the foot toward you Hip Abduction 58 Cradle the leg by placing your hand under the knee and holding it. Place the other hand under the heel to stabilize the hip joint. Keeping the knees straight, move the leg along the surface of the bed, toward you and away from the other leg, approximately 45 degrees. Then bring the leg back to the other leg Ankle Rotation With the knee straight and one hand holding the ankle steady, place the hand around the foot and turn foot inward, then outward Toe Flexion and Extension With one hand, stabilize the foot just below the toes. With the other hand, gently move each or all of the toes forward and backward 59 Heel-Cord Stretching Cups or cradle the heel with your hand and place your forearm against the ball of the foot. Push the ball of the foot forward, bending the foot toward the knee and stretching the muscles in the back of the leg Cup the heel of the foot into the palm of your hand. Gently push the foot down to “point the toes.” Do this with knee bent, then repeat with knee straight 60 Lumbar Rotation Bend knees up and keeping them together, lower than to one side as far as they comfortably go. Repeat to the other side. Hamstring Stretch With the knee and heel supported slowly raise the leg up, keeping the knee straight. Return to starting position 61 Procedure 1 2 3 4 5 Hand washing and wearing gloves. To prevent infection Prepare equipment to save time and effort Maintain patient privacy To reduce embarrassment Place the patient on back with pillow under the head, arms and hands in the sides ,knees flexed and separated. To pressure on skin, increase comfort and prevent bed sores Place air ring under the hips and cotton or foam pads under the heels to reduce pressure. To promote circulation and prevent bed sores Place footboard under the bottom of feet. To maintain dorsiflexion of the foot and prevent foot drop. If the patient is paralyzed place hand roll in hand. To keep hand in functional position and prevent finger contracture. Put tronchonter roll lf needed. To prevent external rotation of legs. Align the patient‘s body in good position Record procedure and response of patient. Reassure patient ,remove gloves and hand washing Prone position: 69 Indication: 1.Patient with pressure sores, burns, operation on back 2. To relieve abdominal distention. 3. Renal biopsy. 4. Examination of back. 5. in postoperative patient Procedure 1 2 3 4 5 Hand washing and wearing gloves. To prevent infection Prepare equipment to save time and effort Maintain patient privacy To reduce embarrassment Explain the Procedure to the patient. Place the patient flat on abdomen with one pillow under the head to promote comfort and relaxation Turn the patients head to one side and align the body in good position. Place both arm at the side of the head and support the arm in a flexed position at level of the shoulder. Support lower legs with pillow to elevate toes and decrease pressure. -reassure the patient, removing gloves and hand washing. Side-Lying or lateral Position: 70 Indication: 1. Patient require position changes 2. Immediate postoperative care. 3. used for examination of the perineum. 4. Inserting suppositories. 5. Taking rectal temperature. 6. Giving back care. 7. Giving enema and colonic irrigation. Procedure 1 2 3 4 5 Hand washing and wearing gloves. To prevent infection Prepare equipment to save time and effort Maintain patient privacy To reduce embarrassment -place the patient on his side with both arms forward and his knees flexed To maintain comfort and relaxation -The upper leg is flexed more than the lower leg -The upper knee and hip should be at the same level -Put small pillow between knees To reduce pressure and promote comfort -Put small pillow under head and neck, one hand rested on bed and put pillow under other Hand that rested on chest -put air rings under the patient and hand roll lf needed To prevent finger contracture and prevent bed sores Raise side rails to prevent falling -Reassure the patient, remove the gloves and hand washing. -record the procedure and response of patient. 72 Knee-Chest or Genu-Pectoral:  The patient rests on the knees and the chest.  The body is at 90◦ angle to the hip with back straight, the arm above the head and head turned to one side.  The abdomen remains un supported. Indication : 1. To examine the bladder. 2. To help correct retroversion of the uterus. 3. To administer caudal and sacral anesthesia. 4. Vaginal and rectal examinations. 5. Operative procedures on the vagina, rectum and perineum. Operative deliveries 6.. Dorsal lithotomy Procedure: Steps 1 2 3 4 5 Hand washing and wearing gloves. To prevent infection Prepare equipment to save time and effort Maintain patient privacy To reduce embarrassment -Make the patient on bed and rest on the knees and chest. To allow for examination to bladder, vagina or rectal. -The head is turned to one side with cheek on pillow -The body at90 angle to the hip and back straight. To maintain a correct position for examination. 73  -The arms should be extended on the bed at the elbow to support the patient partially -The abdomen remains un supported Fowlers and Semi-Fowler’s Position: It is a sitting position in which the head is elevated at45◦ to 60◦ and the client knees are slightly elevated, avoiding pressure on popliteal vessels. Indication: 1. To relieve dyspnea. 2. To improve circulation. 3. To relax the muscle of the abdomen back and thigh. 4. To relieve tension on the abdominal suture. 5. To facilitate breathing in patients with cardiac or respiratory embarrassment. Procedure : Steps 1 2 3 4 5 -Hand washing and wearing gloves. To prevent infection -Prepare equipment to save time and effort -Maintain patient privacy To reduce embarrassment -Elevate The head of the bed to 45angle to semi fowler, 60angle for high fowler -Rest the patient against mattress or small pillow. To maintain comfort and relaxation. 74  -put pillows under the arms, put hand roll if needed, put small pillow under lower back. -Place foot board at the bottom of the foot To prevent foot drop. -Place pillow under knees. -Place trochanterroll if needed. To prevent external rotation of legs. -Raise side rails To prevent falling. -Reassure the patient, remove gloves and hand washing. -Record procedure and response of patient. Orthopedic position High Fowler’s Position with over bed table to be placed across the front of the patient to rest both hands over bed table /on pillow placed in it and lean forward Leaning forward facilitate respiration allowing maximum chest expansion by reducing pressure of abdominal organs on the diaphragm. 75 Indication: 1. Patient with sever dyspnea. 2. Cardiac patient. 3. Position for thoracocentesis. 4. Patient with chest drainage tube. Procedure Steps 1 2 3 4 5 -Hand washing and wearing gloves. To prevent infection -Prepare equipment to save time and effort -Maintain patient privacy To reduce embarrassment -Raise the head of bed to 90angle, Place over bed table in front of the patient To rest his hands over it. -Place Pillow over the bed table abd ask patient to lean forwardon pillows To facilitate breathing to patient. Raise side rails of bed to prevent falling. -Reassure the patient, remove gloves and hand washing. -Record procedure and response of patient. Semis position or semi prone position: Indication: 1. Vaginal and rectal examination. 2. Administration of enema and suppository. 3. For relaxation in antenatal exercises 4. Position for sigmoidoscopy and protoscopy 76 procedure Steps 1 2 3 4 5 -Hand washing and wearing gloves, To prevent infection -Prepare equipment to save time and effort -Maintain patient privacy, To reduce embarrassment -Place the patient on left or right side. -the lower arm behind the body and upper arm is bent and rest on bed. To Maintain comfort and relaxation -The knees are both flexed with upper knee more flexed. -Place pillow under the upper arm. To support arm level with shoulder. -Place Pillow under upper knee. To support leg with hip -place sand bags parallel to planter surface. -Raise side rails of bed to prevent falling. -reassure the patient, remove gloves and Hand washing. -Record procedure and response of patient. Trendelenburg Position:. 77 Indication: 1. Gynecological surgery and supra-pubic prostatectomy cases. 2. To prevent shocks. 3. To prevent or relieve post-partum hemorrhage. steps 1 2 3 4 5 -Hand washing and wearing gloves, To prevent infection -Prepare equipment to save time and effort -Maintain patient privacy, To reduce embarrassment Place the patient I horizontal recumbent position,well padded shoulder braces and knees. Raise the foot of the bed at45angle. To prevent shocks and post partumhemorrage. -If on operating table, adjust the table so the patient's head is low and the knee is flexed. -Apply pillow under knees -apply restraints to arms and legs. Lithotomy position Indication: 1. For delivery of the baby. 2. For rectal examination and surgeries. 3. For vaginal examination and hysterectomy. 78 Procedure: Steps 1 2 3 4 5 -Hand washing and wearing gloves, To prevent infection -Prepare equipment to save time and effort -Maintain patient privacy, To reduce embarrassment Explain the Procedure to the patient. Position the patient on his back with a pillow under the head. Keep the leg well separated and the thigh flexed on the abdomen and the legs on the thighs buttocks are kept on the edge of the table and the legs are supported with stirrups Lumbar puncture position  Is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Examples of these conditions include meningitis  The patient should be positioned in a left lateral (for a right handed physician) or right lateral position (for a left handed physician) for LP or be in sitting position. This will in turn create the greatest interspinous distance (opens the gap) through which to access the intrathecal space and put a pillow under the head will provide comfort and keep the spine in a horizontal plane. 79  1-Moving a patient in bed toward you: Purpose: 1- To change patient's position. 2- To make an occupied bed. Steps 1 2 3 4 5 Stand at the side of the bed toward which you wish to move the patient. Consider the patient's body is divided into 3 segments upper, middle and lower Place one arm under the shoulder and neck of the patient and the other arm under the waist. move the patient toward you: a) Move the upper part of the patient's body toward you to the side of bed. b) Move the middle part of the patient's body toward you by placing one arm under patient back and arm under the thighs. c) Move the lower part of the patient's body toward you by placing one arm under the thighs and other under the feet. Moving a patient in bed toward you 85 Log rolling a Client Logrolling the Client : Logrolling is a technique for moving a client whose body must remain in straight alignment. Situations requiring total alignment of the spine include spinal injury or recovery from spinal surgery Logrolling is accomplished by two or three nurses working in a coordinated fashion. Equipment - Hospital bed with side rails -Turn sheet or draw sheet - Pillows Steps 1 2 3 4 5 Inform client of reason forthe move and how to assist(if able) Rationale Reduces anxiety; helps increase comprehension cooperation; Promotes client autonomy. Elevate hospital bed to highposition. Rationale A voids strain on nurses backmuscles. Using one or more staffmembers; place a turn /draw sheet under the clients back and head Rationale Reduces shearing force whichcan precipitate pressure ulcerformation. The lead nurse tells theclient and other personnelthe direction of the move. Rationale Cooperation and coordinationplace less strain on client andpersonnel. One person stands on eachside of bed. The lead nursegives the signal for themove. The staff member onside of the bed in thedirection of the move holdsthe turn\draw sheet to guidethe move pressure on clients bake toward the direction ofthe move , assisting client toroll. 86  Rationale Two persons give moresupport to client than oneperson could and are betterable tomaintain properalignment of clients spine andneck. Tuck pillows at clients back and abdomen Rationale Maintains side- lyingposition. Assess the client for comfortand proper alignment. Rationale Comfort is subjective Elevate side rails and lowerthe bed height. Rationale Promotes client safety. This procedure can bereversed to a position clientson their backs. Rationale Repositioning can preventdevelopment of pressuresores and promote circulation 2-Raising the patient's shoulders: Objective: - To arrange pillow. - To help the patient change his gown. - To assist the patient in a sitting position. Steps 1 2 3 4 5 Stand facing head of bed. Place hand of patient under your armpit and around your near shoulder. Place your hand under patient shoulder. Place free hand under patient shoulder and neck. Raise patient from pillow and support with locked arms. Remove pillow with free hand and move patient. 87  Raising the person's head and shoulders with assistance. A, two nursing assistantslock arms with the person. B, the nursing assistants have their arms under theperson's head and neck. C, the nursing assistants raise the person to a semi-sittingposition. D, one nursing assistant supports the person in the semi-sitting positionwhile the other gives care. 3-Moving the patient up in bed Objective: To promote the client’s comfort. Steps 1 2 3 4 5 1. Explain procedure to patient. 2. Lower the head of the bed and remove pillow from under the head to reduce resistance as possible. Place the pillow against the bed frame to protect the patients head. (N.B): If patient has trouble breathing, raise the head of the bed. Ask the patient to flex the knees & brace the feet on bed. Stand with one-foot in front of other & face head of bed. Place one arm under patient neck & shoulder, the other arm under his thighs & bend your knees. If the patient can assist: a) Using a headboard: Have the patient grasp the headboard and bend his knees,Place your forearms under his shoulders and knees, Lift at the count of three. b) Using a trapeze: if the patient has a trapeze on the bed have the patient graspthe trapeze and bend at the knees. Instruct patient to pull the bars at the head of bed with arms and pushes with feet while you at the same time move patient by shifting your weight from the back to front foot. 89  c) Using a lift sheet to moving patient up in the bed: a lift sheet makes liftingeasier helps prevent friction against the patient’s skin takes two persons to lift if patient can help him bend his knees. Turning the patient away from you Objective : - -To change patient's position. -To make an occupied bed. - To make back care. Steps 1 2 3 4 5 -Explain to the patient what you are going to do -Help the patient to move the near side and assist him to flex the near knee - Arm under patient shoulder a- place the patient's arm across her chestand the leg that is farther from you over the other leg b- turn the patient toward you onto her side - Pull lower buttock toward you 90 Turning the patient toward you Objective : - -To change patient's position. -To make an occupied bed. Steps 1 2 3 4 5 -Explain to the patient what you are going to do -Move patient to far side to allow enough space to turn the patient -Assist patient to flex the far knee -Firmly but gently , grasp the shoulder with one hand and the hip with other hand. -Turn patient and smoothly toward you. if the patient has , any drainage be sure that it is in correct place and position - Move pillow to a comfortable position under head and shoulder - Flex the patient upper leg and support it with a pillow , leave the lower leg extends on the bed. - Side rails for unconscious patient to prevent falling 91  Transferring Definition of transferring: Moving a patient from place refer to moving a patient from bed to a chair or stretcher, or wheelchair with maximum comfort and safety for patient and nurse Purpose for transferring: - Improvement of the patient’s condition (from ICU to medicine unit. - The need for surgery or X ray. - Transfers at the patient’s request. Methods of transferring: - By wheel chair - By stretcher - By a movable bed 6-Transferring patient between a bed and stretcher: Objective: - To transfer supine client from one location to another. Equipment: - Stretcher - Sliding board: Optional Steps 1 2 3 4 5 Lower the head of the bed until it is flat. Raise the bed so that it is slightly higher than the surface of the stretcher. Ensure that the wheels on the bed are locked. Pull the draw sheet out from both sides of the bed and roll it as close the patient sides as possible. Move the client to the edge of the bed, and position the stretcher. Transfer the client securely to thestretcher ensure client comfort and safety. Cover the patient with a sheet or both blanket. 93 Place the stretcher parallel to the bed and lock its wheels. Fill the gap that exist between the bed and the stretcher loosely with bath blankets. Two nurses press their bodies tightly against the stretcher to prevent its movement. Roll the pull sheet tightly against the client. The nurses flex their hips and pull the client on the pull sheet directly toward themselves and into the stretcher. Ask the patient to flex the neck during the transferring if possible and place the arms across the chest to prevent injury to these body parts. Make the patient comfortable. Unlock the stretcher wheels and move the stretcher away from the bed. Immediately raise the stretcher side rails to prevent falling, as the stretcher is high and narrow. 94 7-Lifting patient into wheel chair: Objective: - To put patient in sitting position. - To transfer patient from bed. Steps 1 2 3 4 5 Wash your hands Explain the procedure to the patient Position the wheelchair next to the bed and prepare it with blanket and top sheet. Lock the wheel brakes and remove the food rests or move them to the “up” position. Prepare to move the client: a. Assist the client with patting on robe and slippers. b. Obtain help from another person if the client is immobile, heavy, or connected to multiple pieces of equipment. Raise the head of the bed so that the client is in the sitting position. Assist the client to sit on the side of the bed a. Support the head and neck with one arm. b. Use your other arm to move the client’s leg over the side of the bed. c. Allow the client’s feet to rest on the floor. d. Maintain the client in this position for a short time Prepare to raise the client to a standing position a. Apply a transfer belt if necessary. b. Spread the client’s feet and brace your knees against client’s knees. c. Place your arms around client’s waist. Cover with top sheet and blanket if necessary 95  - To turn patient to bed place chair in original position and reverse step of procedure. 8-Transferring patient from bed to a chair using a hydraulic lift : Purpose: Safely transfer a patient from a bed to a chair when safe transfer is not possible without using a hydraulic lift. Procedure: Steps 1 2 3 4 5 Identify client and any mobility restrictions. Explain procedure andpurpose to patient. Place the sling evenly under the patient. Position the hydraulic lift so the frame can centered over the patient.Attach the sling to the frame. Have a nurse on each side of the hydraulic lift. Engage the hydraulicsystem to raise the patient from the bed. Carefully wheel the patient in hydraulic lift away from the bed,supporting limbs as needed. Position patient over chair and gentlylower to chair using the hydraulic lift. The sling remains in place under the patient and reattached to the frame when the patient is moved back to bed. 99 Assisting a client with Ambulation Steps Rationale 1 2 3 4 5 Inform client of the purposes Reduces client anxiety and and distance of the walking increase cooperation. exercise. Elevate the head of the bed Prevents orthostatic and wait several minutes. hypotension Lower the bed height, Legs , Reduces distance client has move the client into to step …….. thus the dangling position. decreasing risk of injury Encourage client to dangle at Prevents orthostatic side of bed for several hypotension. Allows for minutes. assessing tolerance for the sitting position. Stand in front of client with Prevents client from sliding your knees touching clients forward if dizziness or knees faintness occurs. Place arms under clients Axillae Supports clients trunk Assist client to a standing position allowing client time to balance Reduces risk of fall. Assist the client from a Help the client move into supine to a seated position A. the Place one arm under theclients dangling position back and one arm under the clients legs. Help client ambulate desired Provides assistance in distance or distance of achieving ambulatory tolerance by placing your goals. hand under the clients forearm and ambulating close to the client. 101 Assisting a client with Crutch walking Equipment:  One pair of crutches  Measuring tape  Gait belt (optional) Steps Rationale 1 2 3 4 5 Inform client that youwill Reduces anxiety ; help increase be assist withambulation comprehension and cooperation using promotes client autonomy. crutches. Assess client forstrength, Helps determine the mobility, rangeof motion , capabilities of client andamount visual acuity,perceptual of assistance required. difficulties,and balance. Adjust crutches to fit Provides broad base of theclient. With the supportfor client Space between clientsupine, measure the from the crutch pad and the heel to the axillae. axillaeprevents pressure on Withthe client standing, radialnerves. The elbow setthe crutch position at a flexionallows for space between point 4 to 5 in. lateral the tothe client and 4 to 6in crutch pad and axillae. front of the client. The crutch pad axillae. Thehand grip should beadjusted to allow for the client to have elbowsbent at 30 flexion. Lower the height of Allows client to sit with feet on thebed floor for stability. Dangle the client at Allows for stabilization of blood theside of bed for pressure , thus severalminutes. Assess preventingorhostatichypotension for vertigo Instruct client on Increase client methodto hold the comprehensionand cooperation crutches; thatis , with elbows bent 30and pad 1.5 102 to 2 in.below the axillae.instruct client to position crutches lateral to and forward of feet.Demonstrate correctpositioning. Apply the gait beltaround Provides support; the clients waistif balance Promotesclient safety and positionwith crutches. preventing orthostatic Support asneeded hypotension Four-point Gait Position the crutches 4.5to The four- point gait (used 6 in to the side and infront fourpartial on full weight of each foot. Movethe bearing) right crutch forward 4 provides greater stability to 6 in. and move the Weight bearing is on threepoint leftfoot forward ,even (two crutches and one withthe left crutch. Move foot on two feet and one theleft crutch forward 4 to crutch)at all times the client 6 and move the must beable to bear weight with rightcrutch. Repeat the bothlegs. four-point gait Three- Point Gait Advance both crutchesand The three-point gait (used the weaker legforward forpartial or non- Weight together 4 to 6 in Move bearing)Provides a strong the stronger legforward, baseof support. This gait can even with thecrutches. beused the client has a weak Repeat thethree- point gait ornon- weight bearing leg. Two- Point Gait Move the left crutch The two- point gait (used andright leg forward 4 to forpartial ….. weight bearing) 6in. Move the right provides a strong base of crutchand left leg forward support 4 to6 in Repeat the two- The client must be able point gait. bearweight on both legs. This gait faster than the four- point gait. Swing- Through Gait Move both The swing- through gaitpermits crutchesforward together a faster pace. This gait requires 4 to 6 in 103  Move both legs weight bearing on bothlegs , forwardtogether in a greater balance. And swingingmotion , even more strength with thecrutches. Repeat theswing- through gait Set realistic goals Crutch walking takes up to andopportunities 10times the energy required for forprogressive unassisted ambulation ambulationusing crutches Consult with a The physical therapist is physicaltherapist for theexpert on the health care clientlearning to walk teamfor crutch-walking withcrutches. techniques References: Graven,F.Rand HIRNLE,J.C92003).fundamentals of nursing.Ch37 4TH – ED.LONDON awotters company. Craven.R.&hirnle.c. (2008):fundmental of nursing human health and function ,3rd edition ,Lippincott company ,new yourk ,22,371-375. Rosdable,C.(2008):basic nursing,Lippincott company7th ed.pp470-80. Follow up activities: 1- Define turning , moving and transferring 2 - Enumerate guidelines before turning and moving 3- Discuss technique of Log rolling 4- List purpose of transferring 5- Discuss methods of transferring 104