Ambulation, Patient transfer, Restraints, ROM
description
Transcript of Ambulation, Patient transfer, Restraints, ROM
![Page 1: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/1.jpg)
Ambulation, Patient transfer, Restraints, ROM
PN 1 Nursing Skill Labs
![Page 2: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/2.jpg)
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
![Page 3: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/3.jpg)
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
![Page 4: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/4.jpg)
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
![Page 5: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/5.jpg)
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
![Page 6: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/6.jpg)
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
![Page 7: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/7.jpg)
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
![Page 8: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/8.jpg)
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
![Page 9: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/9.jpg)
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!!!!!!
![Page 10: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/10.jpg)
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
![Page 11: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/11.jpg)
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
![Page 12: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/12.jpg)
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
![Page 13: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/13.jpg)
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
![Page 14: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/14.jpg)
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
![Page 15: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/15.jpg)
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
![Page 16: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/16.jpg)
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
![Page 17: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/17.jpg)
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
![Page 18: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/18.jpg)
Harness the principles
Safer patient moves & transfers by staff with:
1.COM-centre of mass 2.leverage 3.friction reduction vs. muscle mass & strength
![Page 19: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/19.jpg)
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
![Page 20: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/20.jpg)
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
![Page 21: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/21.jpg)
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
![Page 22: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/22.jpg)
Fingers - flexion, extension, abduction, adduction, opposition of thumb to fingers
Hip - flexion, extension, abduction, adduction, internal rotation, external rotation
Knee - flexion, extension
![Page 23: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/23.jpg)
Ankle - dorsiflexion, plantar flexion, inversion, eversion
Toes - flexion, extension, abduction, adduction
![Page 24: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/24.jpg)
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!!!
![Page 25: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/25.jpg)
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
![Page 26: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/26.jpg)
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
![Page 27: Ambulation, Patient transfer, Restraints, ROM](https://reader036.fdocuments.net/reader036/viewer/2022081421/56814473550346895db10638/html5/thumbnails/27.jpg)
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