Transcript Chain of Survival and EMSC

Chapter 18
Lifting, Moving, and Positioning
Patients
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 18
Lesson 18.1
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
1)
Describe the anatomy and function of the
musculoskeletal system
2)
Explain the importance of proper body mechanics,
alignment, and position change for both patient
and nurse
3)
Discuss the principles of body movement and
positioning, giving an appropriate example for
each principle
4)
Identify ways to maintain the patient’s correct
body alignment in bed or in a chair
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Musculoskeletal System
Overview

Bones


Joint


Four types
• Short, long, flat, and irregular
A union of two or more bones; moves freely
Bursa

A small fluid-filled sac that provides a cushion at
friction points in the joints
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Musculoskeletal System
Overview (cont’d)

Skeletal muscle


Tendon


Fibrous tissue that connects muscle to bone
Ligament


Striated muscles surrounded by a connective
tissue sheath
Connects bone to cartilage
Cartilage

Fibrous connective tissue; acts as a cushion
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 5
Functions of Bones



Provide a scaffolding to support the body
Give shape to the body and support the
internal organs and skin
Provide places for ligaments and tendons to
attach to facilitate movement

Joints allow movement and flexibility of the
skeleton
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 6
Functions of Muscles





Can stretch; can be stimulated to contract
electrically or to extend elastically
Provide movement
Stabilize joints
Produce heat
Maintain posture
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 7
Changes Occurring with Aging





Bone mass loss may lead to osteoporosis
(more severe in women)
Loss of bone density predisposes the elderly
to fractures
Muscle cells are lost and replaced by fat cells
Elasticity of muscle fibers is decreased,
limiting flexibility
Joint motion may decrease, limiting motion
and mobility
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 8
Principles of Body Movement
for Nurses


One of the most common injuries in health
care workers is lower back strain
Get help whenever possible; ask patient to
help if able



Two nurses moving a patient divides the work
It is better to wait for help than to risk injury
Use your leg muscles; bend and flex your
knees

Bend at the knees, not at the waist
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 9
Principles of Body Movement for
Nurses (cont’d)





Use the greatest number of muscles possible
Use thigh, arm, or leg muscles rather than back
muscles, and use a wide base of support
Keep feet approximately shoulder-width apart
Pull and pivot, using smooth, coordinated
movements; avoid jerking or sudden pulling
movements
Encourage patient to assist when transferring
and moving if possible
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 10
Figure 18-3: Use leg muscles to
prevent back strain
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 11
Moving and Lifting Patients



Keep elbows close and work close to your
body; work at same level or height as the
object to be moved; keep the load near your
center of gravity
Pulling actions require less effort than pushing
or lifting; face the direction of the movement
Use arms as levers when pulling patient
toward you; lock elbows and rock back on your
heels, using weight of your body to move the
patient
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 12
Body Movement and Alignment
for Patients

Two basic principles



Maintain correct anatomic position
Change position frequently
Hazards of improper alignment

Interference with circulation, which may lead to
pressure ulcers
 Muscle cramps and possible contractures
 Fluid collection in the lungs
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 13
Figure 18-2: Correct standing
body alignment
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 14
Figure 18-5: Correct sitting body
alignment
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 15
Pressure Ulcers




Also known as decubitus ulcers, or bedsores
Occur when pressure on the skin causes an
area of local tissue necrosis
Occur most often between a bony
prominence and an external surface
May be caused by shearing as force is
applied downward and forward on tissue
beneath the skin (as when a patient slides
down in a chair)
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 16
Nursing Diagnoses for Problems
of Body Movement

Commonly used nursing diagnoses




Risk for injury
Impaired physical mobility
Risk for impaired skin integrity
Impaired walking
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 17
Planning


Decide how to change the patient’s position
and whether you can delegate this task to
assistive personnel
The home setting must also be considered
when planning care for the patient
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 18
Goals and Expected Outcomes





Patient will experience no musculoskeletal injury
Former level of mobility will be reattained within 6
months
Skin integrity will remain intact while patient is on
bed rest
Patient will not experience injury while
ambulating
Patient should have full range-of-motion exercise
actively or passively performed several times a
day
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 19
Question 1
When moving a patient, it is important to use proper
body mechanics. Which of the following is not a
proper body mechanic?
1)
2)
3)
4)
Using your leg muscles
Keeping your feet together to provide stability for
movement
Using smooth, coordinated movements instead of
jerking or sudden movements
Keeping loads as well as your elbows close to the
body
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 20
Question 2
Leann is teaching her patient’s husband how to lift his
wife safely. Which of the following is true regarding
lifting the elderly?
1)
2)
3)
4)
As the body ages, there is no change in posture.
There is usually an increase in muscle mass as
we age.
Whatever items that could be lifted in your youth
should be lifted in later years.
Joint motion may decrease, limiting mobility.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 21
Chapter 18
Lesson 18.2
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
5)
Describe the proper method for transferring
a patient between wheelchair and bed
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 23
Learning Objectives
Clinical Practice
1)
Correctly position a patient in the following
positions: supine, prone, Fowler’s, and Sims’
2)
Assist patients to sit up in bed
3)
Demonstrate complete passive range-of-motion
(ROM) exercises for a patient
4)
Correctly transfer a patient from a wheelchair to a
bed
5)
Transfer a patient from a bed to a stretcher
6)
Demonstrate the correct techniques to ambulate a
patient and to break a fall while ambulating
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 24
Positioning

Accomplishes four objectives




Positioning provides comfort
Positioning relieves pressure on bony
prominences and other parts, decreasing the
patient’s risk of developing bedsores
Positioning prevents contractures, deformities,
and respiratory problems
Positioning improves circulation
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 25
Common Positions and
Variations: Supine


Patient lying on her back
Fowler’s position


Semi-Fowler’s position


Supine with the HOB elevated 60 to 90 degrees
Supine with the HOB elevated 30 to 60 degrees
Low Fowler’s position

Supine with the HOB elevated 15 to 30 degrees
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 26
Fowler’s Positions
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 27
Common Positions and
Variations: Supine

Dorsal recumbent position


Supine with knees flexed and feet flat on the bed;
used for many procedures and examinations
Dorsal lithotomy position

Feet in stirrups and legs spread farther apart;
used in pelvic exams
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 28
Figure 18-6: Dorsal Recumbent
Position
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Figure 18-7: Lithotomy Position
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 30
Common Positions and Variations:
Side-Lying Lateral

Patient lying on her side


Oblique side-lying position



Alleviates pressure on bony prominences of the
back
Removes pressure from shoulder and hip
Easier for patients
Sims’ position

A variation of side-lying used for rectal
examinations or insertions of tubes or
suppositories
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 31
Figure: Side-Lying Positions
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 32
Figure: Sims’ Position
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 33
Common Positions and
Variations: Prone




Patient lying face-down
Often used for patients with spinal cord injury
Not generally well-tolerated
Knee-chest position


Face down, with chest, knees, and elbows resting
on the bed
Used for rectal examinations
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 34
Figure: Prone Position
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 35
Figure 18-8: Knee-Chest Position
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 36
Common Positioning Devices

Pillows


Boots or splints


Maintain dorsiflexion
Footboards, high-top sneakers


Used to support the body or extremities
Maintain dorsiflexion
Trochanter rolls

Prevent external rotation of the leg
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 37
Common Positioning Devices (cont’d)

Sandbags


Hand rolls


Used to immobilize an extremity, provide support,
and maintain body alignment
Help prevent contractures and prevent dorsiflexion
of the wrist
Trapeze bars, side rails, bed boards

Enhance patient mobility, provide patient safety,
and support patient’s back
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 38
Moving the Patient in Bed

Using a lift sheet




Requires at least two people standing on opposite
sides of the bed
Both face the bed and use the sheet to move the
patient up in the bed
Moving the patient is performed as a coordinated
effort
Patient is lifted and moved, not dragged
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 39
Figure 18-9A: Trapeze Bar
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 40
Figure 18-9B: Trochanter Roll
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 41
Logrolling





Turning the patient as a single unit
Body alignment maintained at all times
Used to change bed linen, can be performed
with or without a lift sheet
Requires two people if patient cannot turn
herself
Leave a pillow under the patient’s head
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 42
Figure 18-10: Logrolling a Patient
Using a Lift Sheet
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 43
Figure 18-11: Logrolling a Patient
Without a Lift Sheet
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 44
Lifting and Transferring





Patients may transfer independently or require
different levels of assistance
Always dangle a patient at bedside before transferring
to a wheelchair, and observe for dizziness or nausea
Remember to lock the wheels on wheelchairs or
gurneys before attempting to transfer a patient
Stretchers used for transporting a patient who is
unable to sit in a wheelchair
Either lift equipment or two nurses should transfer a
patient to a wheelchair if patient unsteady, weak, or
heavy
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 45
Lifting and Transferring (cont’d)






Determine how much help you will need to
move or transfer the patient
Get help whenever possible
Make sure wheels on beds, wheelchairs, and
gurneys are locked
Use a transfer device when possible
Dangle the patient before ambulating
Use a gait belt when ambulating patients
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 46
Transfer Devices





Pull or lift sheets
Mechanical lifts
Roller boards
Slide boards
Transfer or gait belts
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 47
Question 3
Dr. Tingle called the unit and asked the nurse to put his
patient in Fowler’s position. Which of the following
correctly describes Fowler’s position?
1)
2)
3)
4)
Place the patient on her back and elevate the head
of the bed 30 to 60 degrees.
Place the patient on her back and elevate the head
of the bed 60 to 90 degrees.
Place the patient on her back and place the feet in
stirrups.
Place the patient in a side-lying position.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 48
Question 4
Dr. Tingle is now requesting you place his patient in
the prone position. Which position best describes
the prone position?
1)
2)
3)
4)
Place the patient on her back.
Place the patient on her back with knees bent.
Place the patient on her abdomen.
Place the patient on her abdomen with knees
tucked in and elbows at a 90-degree angle on
the bed.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 49
Question 5
Which of the following is not a position device?
1)
2)
3)
4)
Pillows
Boots
Footboards
Blankets
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Slide 50