Nursing SkillsNursing Skills

Positioning, Turning, Moving, Positioning, Turning, Moving, and Transferring patients.and Transferring patients.

Positioning, Turning, Moving, Positioning, Turning, Moving, and Transferring Patientsand Transferring Patients

►Must use correct body mechanicsMust use correct body mechanics►Alignment = Positioning body parts in Alignment = Positioning body parts in

relation to each other to maintain relation to each other to maintain correct body posturecorrect body posture

►Correct alignment helps pt. feel Correct alignment helps pt. feel comfortable; prevent fatigue, comfortable; prevent fatigue, decubitus ulcers and contractures.decubitus ulcers and contractures.

Decubitus UlcerDecubitus Ulcer

► Pressure sore or Pressure sore or bed sore.bed sore.

► Caused by pressure Caused by pressure that interferes with that interferes with circulation.circulation.

► Usually at bony Usually at bony prominences- prominences- coccyx, hips, knees, coccyx, hips, knees, heels, & elbowsheels, & elbows

► First signs is a pale First signs is a pale or reddened area on or reddened area on the skinthe skin

► Vesicle or blister may Vesicle or blister may form at the site.form at the site.

► Cells die, skin breaks Cells die, skin breaks down, and open sore down, and open sore (ulcer) develops.(ulcer) develops.

► EASIER TO PREVENT EASIER TO PREVENT THAN TO TREAT!THAN TO TREAT!

Prevent Decubitus Ulcers By:Prevent Decubitus Ulcers By:

►Good skin careGood skin care► Prompt cleaning of Prompt cleaning of

urine and feces urine and feces from skinfrom skin

►Massage in a Massage in a circular motion circular motion around reddened around reddened areaarea

► Light dusting of Light dusting of powder to prevent powder to prevent frictionfriction

Prevent Decubitus Ulcer By:Prevent Decubitus Ulcer By:

► Frequent turning Frequent turning and positioning and positioning

► Linen dry and free Linen dry and free from wrinklesfrom wrinkles

► Use of pressure Use of pressure relieving surfacesrelieving surfaces

Carefully observe the skin during bathing for evidence of pressure sores….

CONTRACTURESCONTRACTURES

► Tightening or Tightening or shortening of shortening of muscle due to lack muscle due to lack of movement or of movement or usageusage

► Foot drop common Foot drop common contracture contracture prevented by prevented by keeping foot at right keeping foot at right angle to legangle to leg

CONTRACTURESCONTRACTURES

► ROM will help ROM will help prevent prevent contracturescontractures

►Weakened body Weakened body parts must be parts must be supported with supported with pillows, bed cradles, pillows, bed cradles, footboards, rolled footboards, rolled blankets, or towelsblankets, or towels

► Patient must be Patient must be turned frequently.turned frequently.

TransferringTransferring

► Be sure to protect Be sure to protect patient and health patient and health care workercare worker

► Be sure you know Be sure you know how to operate the how to operate the wheelchair/stretcherwheelchair/stretcher

► Lock the wheelsLock the wheels

Mechanical LiftMechanical Lift

► Used to transfer Used to transfer weak or paralyzed weak or paralyzed pts.pts.

► Be sure you have Be sure you have been instructed on been instructed on the proper use the proper use

► Reassure patient Reassure patient during transfer.during transfer.

When Turning and When Turning and Transferring…Transferring…

►Before moving patient, obtain proper Before moving patient, obtain proper authorization from immediate authorization from immediate supervisorsupervisor

►Watch the patient closely-pulse rate, Watch the patient closely-pulse rate, respirations, and colorsrespirations, and colors

►Observe for weakness, dizziness, Observe for weakness, dizziness, increased perspiration, or discomfortincreased perspiration, or discomfort

► If you notice abnormal changes, return If you notice abnormal changes, return the patient to a safe and comfortable the patient to a safe and comfortable position and notify your supervisor.position and notify your supervisor.

Moving The Patient Up in BedMoving The Patient Up in Bed

► Lower the head of the bedLower the head of the bed► Place the pillow against the bed frame to Place the pillow against the bed frame to

protect the patient's headprotect the patient's head► If pt. has trouble breathing, raise the head If pt. has trouble breathing, raise the head

of the bedof the bed► Ask the patient to flex the knees and brace Ask the patient to flex the knees and brace

the feet on the bedthe feet on the bed► Place one arm under the patient’s head and Place one arm under the patient’s head and

shoulders.shoulders.► If the patient is unable to help, get someone If the patient is unable to help, get someone

to assist youto assist you

Moving the pt. Up in BedMoving the pt. Up in Bed

► Get a broad base of Get a broad base of support and as close to support and as close to the bed as possiblethe bed as possible

► Arrange a signal- “ on Arrange a signal- “ on the count of three, the count of three, push with your feet.”push with your feet.”

► ““On signal, shift your On signal, shift your weight forward”weight forward”

► Two people can use a Two people can use a draw sheet or lift sheet.draw sheet or lift sheet.

Turning Moving and Turning Moving and TransferringTransferring

►Dangling Dangling ► Sitting on side of bed Sitting on side of bed

prior to standingprior to standing► Allows patient time Allows patient time

to adjustto adjust► If the patient c/o If the patient c/o

vertigo, weakness, or vertigo, weakness, or diaphoresis-return pt. diaphoresis-return pt. immediately to immediately to supine position.supine position.

Turning the PatientTurning the Patient

► Lower the siderail nearest you-be sure the Lower the siderail nearest you-be sure the opposite side is upopposite side is up

► If the patient is lying in the center of the If the patient is lying in the center of the bed, place hands under the patient towards bed, place hands under the patient towards you you

► Place both hands under the hips and slide Place both hands under the hips and slide the hips towards youthe hips towards you

► Place both hands under the legs and slide Place both hands under the legs and slide the legs towards youthe legs towards you

► Cross the patient’s arms across his/her chestCross the patient’s arms across his/her chest

Cont.Cont.

►Move the leg closest to you over the Move the leg closest to you over the other legother leg

►Get close to the patient and roll the Get close to the patient and roll the patient away from youpatient away from you

►Explain what you are doing to the Explain what you are doing to the patientpatient

►Place your hands under the head and Place your hands under the head and shoulders, then the hips, drawing the shoulders, then the hips, drawing the patient to the center of the bedpatient to the center of the bed

CLOSED BEDCLOSED BED

►Made after the Made after the patient is patient is discharged and discharged and after terminal after terminal cleaning of the unitcleaning of the unit

► Purpose: Keep bed Purpose: Keep bed clean until new clean until new patient arrivespatient arrives

Bed made while patients in it.

Occupied Bed

Open BedOpen Bed

► Fanfold top sheets Fanfold top sheets to welcome new to welcome new patient or for patient or for ambulatory ambulatory patients.patients.

BED WITH CRADLEBED WITH CRADLE

► Cradle is placed Cradle is placed under top sheets to under top sheets to prevent linen from prevent linen from touching parts of touching parts of the patients body. the patients body. Used for patients Used for patients with burns, skin with burns, skin ulcers, blood clots, ulcers, blood clots, fractures, and other fractures, and other similar conditions.similar conditions.

BEDMAKING TIPSBEDMAKING TIPS

► Observe correct body Observe correct body mechanicsmechanics

► Keep linens arranged in Keep linens arranged in the order of usethe order of use

► Make one side of the Make one side of the bed completely, then bed completely, then on the other sideon the other side

► Roll dirty linens away Roll dirty linens away from your body and from your body and place in hamper place in hamper immediatelyimmediately

The End!The End!