Showing posts with label Mobility. Show all posts
Showing posts with label Mobility. Show all posts
Mar 30, 2013
May 15, 2011
Orthopedic Disorders......
Arthritis of the Knee
Osteoarthritis
Osteoarthritis (OA) is the most common form of knee arthritis. OA is usually a slowly progressive degenerative disease in which the joint cartilage gradually wears away. It most often affects middle-aged and older people.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an inflammatory type of arthritis that can destroy the joint cartilage. RA can occur at any age. RA generally affects both knees.
Post-traumatic Arthritis
Post-traumatic arthritis can develop after an injury to the knee. This type of arthritis is similar to osteoarthritis and may develop years after a fracture, ligament injury, or meniscus tear.
 A healthy knee |  An osteoarthritic knee |
The joint may become stiff and swollen, making it difficult to bend or straighten the knee.
Pain and swelling are worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing, or kneeling.
The pain may often cause a feeling of weakness in the knee, resulting in a "locking" or "buckling."
Many people report that changes in the weather also affect the degree of pain from arthritis.
Your doctor will perform a physical examination that focuses on your walk, the range of motion in the limb, and joint swelling or tenderness.
X-rays typically show a loss of joint space in the affected knee.
Blood and other special imaging tests, such as magnetic resonance imaging (MRI) may be needed to diagnose rheumatoid arthritis.
 Normal joint space between the femur and tibia. |  Decreased joint space due to damaged cartilage and bone spurs. |
The purpose of treatment is to reduce pain, increase function and generally reduce your symptoms. Patient satisfaction is a fundamental goal in treating osteoarthritis of the knee
In its early stages, arthritis of the knee is treated with nonsurgical measures. Nonsurgical treatments fall into four major groups: lifestyle modifications; exercise; supportive devices; other methods.
Lifestyle Modification
Lifestyle modifications can include losing weight, switching from running or jumping exercises to swimming or cycling, and minimizing activities that aggravate the condition, such as climbing stairs. Many, but not all, people with osteoarthritis of the knee are overweight. Simple weight loss can reduce stress on weight bearing joints, such as the knee. Losing weight can result in reduced pain and increased function, particularly in walking.
Exercise
Exercises can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Physical therapy and exercise are often effective in reducing pain and improving function. Your physician or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle
Supportive Devices
Using supportive devices, such as a cane, wearing energy-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. Some research studies have focused on the use of knee braces for treatment of osteoarthritis of the knee. They may be especially helpful if the arthritis is centered on one side of the knee. A brace can assist with stability and function. There are two types of braces that are often used. An "unloader" brace shifts load away from the affected portion of the knee. A "support" brace helps support the entire knee load. In most studies, the knee symptoms improved, with a decrease in pain on weightbearing and a general ability to walk longer distances.
Other Methods
Other measures may include applications of heat or ice, water exercises, liniments or elastic bandages.
Anti-inflammatory medications can include aspirin, acetaminophen or ibuprofen to help reduce swelling in the joint. Simple pain relievers such as Tylenol are available without a prescription and can be very effective in reducing pain. Pain relievers are usually the first choice of therapy for osteoarthritis of the knee. All drugs have potential side effects and simple analgesics are no exception. In addition, with time, your body can build up a tolerance, reducing the effects of the pain reliever. It is important to realize that these medications, although purchased over-the-counter, can also interact with other medications you are taking, such as blood-thinners. Be sure to discuss these issues with your orthopaedist or primary physician.
A more potent type of pain reliever is a nonsteroidal anti-inflammatory drug or NSAID. These drugs, which include brands such as Motrin, Advil and Aleve, are available in both over-the-counter and prescription forms. Like all pain relievers, NSAIDs can cause side effects including changes in kidney and liver function as well as a reduction in the ability of blood to clot. These effects are usually reversible when the medication is discontinued.
A COX-2 inhibitor is a special type of NSAID that is often prescribed if knee pain is moderate to severe. Common brand names of COX-2 inhibitors include Celebrex and Vioxx. It should be noted that Vioxx was recently withdrawn from the market by its manufacturer. COX-2 inhibitors reduce pain and inflammation so that you can function better. If you are taking a COX-2 inhibitor, you should not use a traditional NSAID (prescription or over-the-counter). Be sure to tell your doctor if you have had a heart attack, stroke, angina, blood clot or hypertension or if you are sensitive to aspirin, sulfa drugs or other NSAIDs.
COX-2 inhibitors can have side effects, including abdominal pain, nausea and indigestion. Antacids or a fatty meal can limit the body's ability to absorb and use COX-2 inhibitors, so do not take them together. These drugs are less irritating to the stomach than other NSAIDs, but abdominal bleeding can occur, sometimes without warning.
Glucosamine and Chondroitin
Glucosamine and chondroitin (kon-dro'-i-tin) sulfate are oral supplements may relieve the pain of osteoarthritis. These are two large molecules that are found in the cartilage of our joints. Supplements sold over-the-counter are usually made from synthetic or animal products.
Glucosamine and/or chondroitin sulfate may be particularly helpful in the early stages of osteoarthritis of the knee, provided they are used as directed on package inserts and with caution. Although glucosamine and chondroitin sulfate are natural substances, sometimes classified as food additives, they can cause side effects such as headaches, stomach upset, nausea, vomiting, and skin reactions. These supplements can interact with other medications, so keep your doctor informed about your use of them. These substances can help reduce swelling and tenderness, as well as improve mobility and function. If you decide to take this therapy, it is important not to discontinue too soon. At least two months of continuous use is necessary before the full effect is realized.
Corticosteroids
Corticosteroids are powerful anti-inflammatory agents that can be injected into the joint.
They are given for moderate to severe pain. They can be very useful if there is significant swelling, but are not very helpful if the arthritis affects the joint mechanics. Corticosteroids or cortison are natural substances known as hormones. They are produced by the adrenal glands in the human body. They can provide pain relief and reduce inflammation with a subsequent increase in quadriceps (thigh muscle) strength. However, the effects are not long-lasting, and no more than four injections should be given per joint per year.
In addition, there is some concern about the use of these injections. For example, pain and swelling may "flare" immediately after the injection, and the potential exists for long-term joint damage or infection. With frequent repeated injections or over an extended period of time, joint damage can actually increase rather than decrease.
Viscosupplementation with Hyaluronic Acid
Viscosupplementation involves injecting substances into the joint to improve the quality of the joint fluid. Complete coverage of this technique can be found in the article titled "Viscosupplementation Treatment for Arthritis."
Gold Salt Injections
Special medical treatments for rheumatoid arthritis include gold salt injections and other disease-modifying drugs.
Acupuncture uses fine needles to stimulate specific body areas to relieve pain or temporarily numb an area. Although it is used in many parts of the world and evidence suggests that it can help ease the pain of arthritis, there are few scientific studies of its effectiveness. Be sure your acupuncturist is certified, and do not hesitate to ask about his or her sterilization practices.
Magnetic pulse therapy is painless and works by applying a pulsed signal to the knee, which is placed in an electromagnetic field. Like many alternative therapies, magnetic pulse therapy has yet to be proven.
If arthritis does not respond to these nonsurgical treatments, you may need to have surgery.
There are a number of surgical options, including the following:
- Arthroscopic surgery uses fiber optic technology to enable the surgeon to see inside the joint and clean it of debris or repair torn cartilage.
- An osteotomy cuts the shinbone (tibia) or the thighbone (femur) to improve the alignment of the knee joint.
- A total or partial knee arthroplasty replaces the severely damaged knee joint cartilage with metal and plastic.
- Cartilage grafting is possible for some knees with limited or contained cartilage loss from trauma or arthritis.
Ankle Fracture info.....
A broken ankle is also known as an ankle "fracture." This means that one or more of the bones that make up the ankle joint are separated into pieces. There may be ligaments damaged as well. Simply put, the more bones that are broken, the more unstable the ankle becomes.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for three months.
Broken ankles affect all ages. Ankle fractures occur in 184 per 100,000 persons per year. During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of "baby boomers." In 2003, nearly 1.2 million people visited emergency rooms because of ankle problems.
Common complaints for a broken ankle include:
Depending on the type of ankle fracture, the doctor may put pressure on the ankle and take a special X-ray, called a "stress test." This X-ray is done to see if certain ankle fractures require surgery.
Sometimes, a computed tomography (CT, or CAT) scan is done to further evaluate ankle injuries.
For some ankle fractures, magnetic resonance imaging (MRI) may be done to evaluate the ankle ligaments.
The lateral malleolus fracture is a fracture of the fibula.
There are different levels at which that the fibula can be fractured. The level of the fracture may direct the treatment.
A "stress" X-ray may be done to see if the ankle is stable. You will have to see your physician regularly to repeat your ankle X-rays to make sure the fragments of your fracture have not moved out of alignment during the healing process.
A fractured ankle can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may require that you not put weight on it for three months.
- "Twisting" or rotating your ankle
- "Rolled" your ankle
- Tripping or falling
- Impact during a car accident
Broken ankles affect all ages. Ankle fractures occur in 184 per 100,000 persons per year. During the past 30 to 40 years, doctors have noted an increase in the number and severity of broken ankles, due in part to an active, older population of "baby boomers." In 2003, nearly 1.2 million people visited emergency rooms because of ankle problems.
- Three bones make up the ankle joint
- Tibia ("shin bone")
- Fibula (small bone on the outside of your ankle)
- Talus (a foot bone)
- The tibia and fibula have specific parts that make up the ankle:
- Medial malleolus: Inside part of the tibia
- Posterior malleolus: Back part of the tibia
- Lateral malleolus: End of the fibula
- Two joints are involved in ankle fractures:
- Ankle joint
- Syndesmosis: The joint between the tibia and fibula, which is held together by ligaments
- Multiple ligaments help make the ankle joint stable
Anatomy of the ankle
Common complaints for a broken ankle include:
- Immediate and severe pain
- Swelling
- Bruising
- Tender to touch
- Cannot put any weight on the injured foot
- Deformity ("out of place"), particularly if the ankle joint is dislocated as well
Depending on the type of ankle fracture, the doctor may put pressure on the ankle and take a special X-ray, called a "stress test." This X-ray is done to see if certain ankle fractures require surgery.
Sometimes, a computed tomography (CT, or CAT) scan is done to further evaluate ankle injuries.
For some ankle fractures, magnetic resonance imaging (MRI) may be done to evaluate the ankle ligaments.
The lateral malleolus fracture is a fracture of the fibula.
There are different levels at which that the fibula can be fractured. The level of the fracture may direct the treatment.
Different levels of lateral malleolus fractures
Michelson JD: Ankle Fractures Resulting From Rotational Injuries J Am Acad Ortho Surg 2003;11:403-412.
Nonsurgical Treatment
If the fracture is not out of place or just barely out of place and the ankle is stable, you may not need surgery. Some physicians let patients put weight on their leg right away, while others have them wait for 6 weeks.
Several different methods are used for protecting the fracture, ranging from a high-top tennis shoe to a short leg cast. Treatment may also be based on where the bone is broken. A "stress" X-ray may be done to see if the ankle is stable. You will have to see your physician regularly to repeat your ankle X-rays to make sure the fragments of your fracture have not moved out of alignment during the healing process.
Surgical Treatment
If the fracture is out of place or your ankle is unstable, your fracture may be treated with surgery. To make your ankle stable, a plate and screws on the side of the bone or a screw or rod inside the bone may be used to re-align the bone fragments and keep them together as they heal.
Body mechanics......
Preventing Back Pain at Work...
- Plan ahead what you want to do and do not be in a hurry.
- Position yourself close to the object you want to lift.
- Separate your feet shoulder-width apart to give yourself a solid base of support.
- Bend at the knees.
- Tighten your stomach muscles.
- Lift with your leg muscles as you stand up.
- Don't try to lift by yourself an object that is too heavy or an awkward shape.
- Get help.
Picking Up a Light Object:
| To lift a very light object from the floor, such as a piece of paper, lean over the object, slightly bend one knee and extend the other leg behind you. Hold on to a nearby chair or table for support as you reach down to the object. |  |
Picking Up a Heavy Object:
 | Whether you are lifting a heavy laundry basket or a heavy box in your garage, remember to get close to the object, bend at the knees, and lift with your leg muscles. Do not bend at your waist. When lifting luggage, stand along side of the luggage, bend at your knees, grasp the handle and straighten up. |
Holding An Object:
| While you are holding the object, keep your knees slightly bent to maintain your balance. If you have to move the object to one side, avoid twisting your body. Point your toes in the direction you want to move and pivot in that direction. Keep the object close to you when moving. |  |
Placing an Object on a Shelf:
 | If you must place an object on a shelf, move as close as possible to the shelf. Spread your feet in a wide stance, positioning one foot in front of the other to give you a solid base of support. Do not lean forward and do not fully extend your arms while holding the object in your hands. If the shelf is chest high, move close to the shelf and place your feet apart and one foot forward. Lift the object chest high, keep your elbows at your side and position your hands so you can push the object up and on to the shelf. Remember to tighten your stomach muscles before lifting. |
Supporting Your Back While Sitting:
| When sitting, keep your back in a normal, slightly arched position. Make sure your chair supports your lower back. Keep your head and shoulders erect. Make sure your working surface is at the proper height so you don't have to lean forward. Once an hour, if possible, stand, and stretch. Place your hands on your lower back and gently arch backward. |  |
Bone Fractures.....
Fractures: An Overview.........
A bone may be completely fractured or partially fractured in any number of ways (cross-wise, lengthwise, in the middle).
Fractures can happen in a variety of ways, but there are three common causes:
- Trauma accounts for most fractures. For example, a fall, a motor vehicle accident or a tackle during a football game can all result in a fracture.
- Osteoporosis also can contribute to fractures. Osteoporosis is a bone disease that results in the "thinning" of the bone. The bones become fragile and easily broken.
- Overuse sometimes results in stress fractures. These are common among athletes.
Doctors usually use an X-ray to verify the diagnosis. Stress fractures are more difficult to diagnose, because they may not immediately appear on an X-ray; however, there may be pain, tenderness and mild swelling.
- Closed or simple fracture. The bone is broken, but the skin is not lacerated.
- Open or compound fracture. The skin may be pierced by the bone or by a blow that breaks the skin at the time of the fracture. The bone may or may not be visible in the wound.
- Transverse fracture. The fracture is at right angles to the long axis of the bone.
- Greenstick fracture. Fracture on one side of the bone, causing a bend on the other side of the bone.
- Comminuted fracture. A fracture that results in three or more bone fragments.
As soon as a fracture occurs, the body acts to protect the injured area, forming a protective blood clot and callus or fibrous tissue.
New "threads" of bone cells start to grow on both sides of the fracture line. These threads grow toward each other.
The fracture closes and the callus is absorbed.
Doctors use casts, splints, pins, or other devices to hold a fracture in the correct position while the bone is healing.
- External fixation methods include plaster and fiberglass casts, cast-braces, splints, and other devices.
- Internal fixation methods hold the broken pieces of bone in proper position with metal plates, pins, or screws while the bone is healing.
Even after your cast or brace is removed, you may need to continue limiting your activity until the bone is solid enough to use in normal activity.
Usually, by the time the bone is strong enough, the muscles will be weak because they have not been used. Your ligaments may feel "stiff" from not using them.
Total Hip Replacement Exercise Guide for Patient Teaching...
Regular exercises to restore your normal hip motion and strength and a gradual return to everyday activities are important for your full recovery. Your orthopaedic surgeon and physical therapist may recommend that you exercise 20 to 30 minutes 2 or 3 times a day during your early recovery. They may suggest some of the following exercises.
These exercises are important for increasing circulation to your legs and feet to prevent blood clots. They also are important to strengthen muscles and to improve your hip movement. You may begin these exercises in the recovery room shortly after surgery. It may feel uncomfortable at first, but these exercises will speed your recovery and reduce your postoperative pain. These exercises should be done as you lie on your back with your legs spread slightly apart.
Slowly push your foot up and down. Do this exercise several times as often as every 5 or 10 minutes. This exercise can begin immediately after surgery and continue until you are fully recovered.
Continue until your thigh feels fatigued.
Soon after your surgery, you will be out of bed and able to stand. You will require help since you may become dizzy the first several times you stand. As you regain your strength, you will be able to stand independently. While doing these standing exercises, make sure you are holding on to a firm surface such as a bar attached to your bed or a wall.
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Soon after surgery, you will begin to walk short distances in your hospital room and perform light everyday activities. This early activity helps your recovery by helping your hip muscles regain strength and movement.
Stand comfortably and erect with your weight evenly balanced on your walker or crutches. Move your walker or crutches forward a short distance. Then move forward, lifting your operated leg so that the heel of your foot will touch the floor first. As you move, your knee and ankle will bend and your entire foot will rest evenly on the floor. As you complete the step allow your toe to lift off the floor. Move the walker again and your knee and hip will again reach forward for your next step. Remember, touch your heel first, then flatten your foot, then lift your toes off the floor. Try to walk as smoothly as you can. Don't hurry. As your muscle strength and endurance improve, you may spend more time walking. Gradually, you will put more and more weight on your leg.
A walker is often used for the first several weeks to help your balance and to avoid falls. A cane or a crutch is then used for several more weeks until your full strength and balance skills have returned. Use the cane or crutch in the hand opposite the operated hip. You are ready to use a cane or single crutch when you can stand and balance without your walker, when your weight is placed fully on both feet, and when you are no longer leaning on your hands while using your walker.
A full recovery will take many months. The pain from your problem hip before your surgery and the pain and swelling after surgery have weakened your hip muscles. The following exercises and activities will help your hip muscles recover fully.
These exercises should be done in 10 repetitions four times a day with one end of the tubing around the ankle of your operated leg and the opposite end of the tubing attached to a stationary object such as a locked door or heavy furniture. Hold on to a chair or bar for balance.
Resistive Hip Flexion |
Resistive Hip Abduction |
Resistive Hip Extensions |
Take a cane with you until you have regained your balance skills. In the beginning, walk 5 or 10 minutes 3 or 4 times a day. As your strength and endurance improves, you can walk for 20 or 30 minutes 2 or 3 times a day. Once you have fully recovered, regular walks, 20 or 30 minutes 3 or 4 times a week, will help maintain your strength.
Feb 18, 2011
Feb 5, 2011
Ambulating your Patient
Clic
This is from Sheri Taylor's Workshop Blog.....Best Workshop out there... Click the above link to go to her page.
Steps in preparing to ambulate the patient
- Review the patient’s medical record for an authorizing physician’s order or look at your kardex
- Review the patient’s nursing care plan, chart, or kardex for information regarding the following:
- Physical limitations
- Mechanical equipment being utilized; that is, IV infusion pumps, chest drainage set, urinary drainage sets
- Distance patient is to ambulate
- Length of time patient is to be out of bed
- Frequency patient is to get out of bed
- Review the most recent Nurse’s Notes to identify the patient’s previous tolerance of the activity specified
- Explain the rationale for getting out of bed to the patient
- Assess pain using designated scale, and pre-medicate for pain prior to getting out of bed, if necessary
- If the patient has been medicated, wait about 20 minutes before ambulating
- Ensure that the patient is appropriately clothed, including non-skid footwear
- Assist the patient to sit on the side of the bed (dangling) for a couple of minutes and assess for dizziness or weakness
- Assist the patient to stand (and if the patient has a weaker side, position yourself on the weaker side
- Have the assistive devices (if required) ready for the patient’s use
- Assist the patient to transfer to a chair, or to ambulate to the designated area or for the designated length or as tolerated
- When ambulating the patient in the hallway, the patient needs to be on the inside near the wall and you need to be positioned in the open hallway
- Assess the patient’s tolerance to the activity and pain level
- Chart what the patient did, the distance, assistive devices, and how they tolerated along with pain status using designated pain scale
Feb 2, 2011
Transfering your Client from Wheelchair to Bed....
This Info comes directly from Sheri Taylor, of the CPNEWORKSHOP.com site that she has for CPNE Help, and also her workshop details....see the link at bottom :))
Lying in bed for a long period of time is generally depressing and boring for most patients. To boost their spirits and make them more comfortable, you are required or patients will often ask for a change in position
and surroundings. The only way to do this is to safely transfer the patient from bed to chair or wheelchair. Being transferred to a chair enables the patient to execute some slight movements that is beneficial in improving circulation. Usisng a wheelchair serves as a way to transport a weak patient around the hospital areas for treatments such as x-ray, ultrasound, or to the lab. It is also beneficial in transporting the patient for a change of scenery that will help brighten his mood and increase his/her chance for socialization. This type of transfer should be done with extreme caution. Proper handling of the patient and proper body mechanics of the handler is instrumental regarding safety. If the patient has enough body strength to move, it is best to have them help you whenever possible.
Instructions
Equipment Needed:
Step 1- Assess the patients’ overall strength and check for cognitive impairment. Understanding where the patient’s weaknesses are will better allow you to execute the transfer properly. The patient’s cognitive level will help you realize if they have the capability of understanding or following instructions. Make sure the patient has their non skid socks on.
Step 2- Inform the patient on what you are about to do. If the patient wants to be transferred on a chair, explain the details of how the maneuver is done. And if there is a need for him to be transferred on a wheelchair, explain the purpose and destination of the transfer. Informing the patient about the actual maneuver will facilitate cooperation and will make them feel respected rather than controlled.
Step 3- Position the chair or wheelchair next to the bed facing the foot of the bed. Bring the chair as close as possible to reduce the distance of the transfer. If a wheelchair is used, make sure to lock its brake and fold the foot rests, as soon as you position it near the bed.
Step 4- Adjust the bed in its lowest position making it easier and safer for the patient to step down on the floor and decreasing the risk of falling. Lock the brake of the bed and then assist the patient in doing side lying position, facing the direction of the transfer.
Step 5- Lower the side rail of the bed and gradually raise the head of the bed up to a tolerable level. Constantly check the patient’s ability to tolerate the procedure
Step 6- Face the patient and place one arm under the shoulder of the patient and the other arm supporting the patients’ thigh on the opposite side. Count to three and then carefully swing the legs of the patient over the side of the bed and assist him in lifting his trunk and shoulders until he is in the sitting or upright position. If patient is strong enough to do some movements, allow the patient to participate in the maneuver as much as possible if tolerated. Then carefully swing both legs on the side of the bed and assist them in lifting his trunk and shoulders until he is in sitting position.
Step 7- Place your arms around the torso of the patient for support. Put one of the patient’s arms over your shoulder; while his other arm is extended on the bed, to help support the position. This means if the patient has a right sided weakness, you would have their left arm as the extended arm for support since it is the stronger arm. Instruct the patient to scoot over the edge of the bed until feet is flat on the floor. Let patient dangle for a minute while you are observing for dizziness.
Step 8- Widen the distance of your feet, with right foot forward, and the left foot back for an easy shift of your weight as you lift the patient. Maintain the position above, with your arms still supporting the torso of the patient. One arm of the patient should still be on your shoulder and his other arm should still be extended on the bed (palm flat on bed).
Step 9- Position your right foot alongside the patients’ left foot (the side to where the little toe is at) and position your leg on the level on his knee. The positioning of your foot and leg provides stability by preventing slipping of the patients’ foot and knee buckling when he is lifted to standing position.
Step 10- Slightly bend your knees and lean your body. Then instruct the patient to get ready to push from one arm that’s extended on the bed, as you lift them to standing position. Count to three as you assist the patient to standing position and he is pushing off from at the same time on three.
Step 11- Raise patient to standing position and keep your back straight as you do this maneuver. Pivot the patient so that his back is positioned in front of the chair or wheelchair; instruct him to grasp on the armrest for additional support, and then slowly assist the patient as he lowers himself on the seat of the chair. Remember to bend your knees, while keeping your back straight during the assist for ergonomic safety.
Step 12- Help the patient in positioning himself properly when seated. Make sure that his buttocks are entirely rested on the seat and his back firmly resting on the back support. When in a wheelchair, place his arms on the armrests and his feet on the footrests. Also make sure the clothing is straight and the patient is comfortable as well as how they tolerated the transfer.
Step 13- Document the safe transfer of the patient and the patient’s tolerance.
Click for more information on Sheri Taylor’s Workshop and how you can pass your clinical weekend your first time!
Lying in bed for a long period of time is generally depressing and boring for most patients. To boost their spirits and make them more comfortable, you are required or patients will often ask for a change in position
and surroundings. The only way to do this is to safely transfer the patient from bed to chair or wheelchair. Being transferred to a chair enables the patient to execute some slight movements that is beneficial in improving circulation. Usisng a wheelchair serves as a way to transport a weak patient around the hospital areas for treatments such as x-ray, ultrasound, or to the lab. It is also beneficial in transporting the patient for a change of scenery that will help brighten his mood and increase his/her chance for socialization. This type of transfer should be done with extreme caution. Proper handling of the patient and proper body mechanics of the handler is instrumental regarding safety. If the patient has enough body strength to move, it is best to have them help you whenever possible.
Instructions
Equipment Needed:
- Chair
- Wheelchair
- Non-skid socks
Step 1- Assess the patients’ overall strength and check for cognitive impairment. Understanding where the patient’s weaknesses are will better allow you to execute the transfer properly. The patient’s cognitive level will help you realize if they have the capability of understanding or following instructions. Make sure the patient has their non skid socks on.
Step 2- Inform the patient on what you are about to do. If the patient wants to be transferred on a chair, explain the details of how the maneuver is done. And if there is a need for him to be transferred on a wheelchair, explain the purpose and destination of the transfer. Informing the patient about the actual maneuver will facilitate cooperation and will make them feel respected rather than controlled.
Step 3- Position the chair or wheelchair next to the bed facing the foot of the bed. Bring the chair as close as possible to reduce the distance of the transfer. If a wheelchair is used, make sure to lock its brake and fold the foot rests, as soon as you position it near the bed.
Step 4- Adjust the bed in its lowest position making it easier and safer for the patient to step down on the floor and decreasing the risk of falling. Lock the brake of the bed and then assist the patient in doing side lying position, facing the direction of the transfer.
Step 5- Lower the side rail of the bed and gradually raise the head of the bed up to a tolerable level. Constantly check the patient’s ability to tolerate the procedure
Step 6- Face the patient and place one arm under the shoulder of the patient and the other arm supporting the patients’ thigh on the opposite side. Count to three and then carefully swing the legs of the patient over the side of the bed and assist him in lifting his trunk and shoulders until he is in the sitting or upright position. If patient is strong enough to do some movements, allow the patient to participate in the maneuver as much as possible if tolerated. Then carefully swing both legs on the side of the bed and assist them in lifting his trunk and shoulders until he is in sitting position.
Step 7- Place your arms around the torso of the patient for support. Put one of the patient’s arms over your shoulder; while his other arm is extended on the bed, to help support the position. This means if the patient has a right sided weakness, you would have their left arm as the extended arm for support since it is the stronger arm. Instruct the patient to scoot over the edge of the bed until feet is flat on the floor. Let patient dangle for a minute while you are observing for dizziness.
Step 8- Widen the distance of your feet, with right foot forward, and the left foot back for an easy shift of your weight as you lift the patient. Maintain the position above, with your arms still supporting the torso of the patient. One arm of the patient should still be on your shoulder and his other arm should still be extended on the bed (palm flat on bed).
Step 9- Position your right foot alongside the patients’ left foot (the side to where the little toe is at) and position your leg on the level on his knee. The positioning of your foot and leg provides stability by preventing slipping of the patients’ foot and knee buckling when he is lifted to standing position.
Step 10- Slightly bend your knees and lean your body. Then instruct the patient to get ready to push from one arm that’s extended on the bed, as you lift them to standing position. Count to three as you assist the patient to standing position and he is pushing off from at the same time on three.
Step 11- Raise patient to standing position and keep your back straight as you do this maneuver. Pivot the patient so that his back is positioned in front of the chair or wheelchair; instruct him to grasp on the armrest for additional support, and then slowly assist the patient as he lowers himself on the seat of the chair. Remember to bend your knees, while keeping your back straight during the assist for ergonomic safety.
Step 12- Help the patient in positioning himself properly when seated. Make sure that his buttocks are entirely rested on the seat and his back firmly resting on the back support. When in a wheelchair, place his arms on the armrests and his feet on the footrests. Also make sure the clothing is straight and the patient is comfortable as well as how they tolerated the transfer.
Step 13- Document the safe transfer of the patient and the patient’s tolerance.
Click for more information on Sheri Taylor’s Workshop and how you can pass your clinical weekend your first time!
Jan 21, 2011
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