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Ambulation, Patient transfer, Restraints, ROM.ppt

This document provides guidance on various nursing skills related to ambulation, patient transfers, range of motion exercises, and restraints. Key points include: - Assess patient's capabilities and explain the plan before ambulating or transferring a patient - Use proper body mechanics and any necessary equipment to move patients safely - For ambulation, two nurses can support the patient under the arms or each take an arm - When transferring from bed to chair, position the chair close to the bed and pivot the patient while bracing their legs - Use draw sheets and leverage techniques to transfer a patient from bed to stretcher safely - Obtain a physician's order and use the least restrictive restraints possible, checking the patient regularly

Health & Medicine◦
Ambulation, Patient transfer, Restraints, ROM PN 1 Nursing Skill Labs
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
 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
 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
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
 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
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
 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
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!!!!!!
 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
 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
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
 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
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
 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
 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
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
Harness the principles  Safer patient moves & transfers by staff with:  1.COM-centre of mass  2.leverage  3.friction reduction  vs. muscle mass & strength
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
 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
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
 Fingers - flexion, extension, abduction, adduction, opposition of thumb to fingers  Hip - flexion, extension, abduction, adduction, internal rotation, external rotation  Knee - flexion, extension
 Ankle - dorsiflexion, plantar flexion, inversion, eversion  Toes - flexion, extension, abduction, adduction
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!!!
 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
 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
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