Ch. 18 moving, handling, and positioning the surgical patient

When transporting a hearing patient:?

1. allow patient to keep hearing aids long as possible 2. use hang gestures to communicate 3. speak slowly & articulate your words 4. face patient during communication 5. allow patient to keep glasses 6. provide verbal orientation before moving 7. explain environment to patient & remain in contact. 8. provide increased assistance during moves.

equipment needed for an obese patient include:

- patient gurney - operating table - extra weight bearing wheel chairs - patient beds - slide sheets - extra large blood pressure cuff - extra large pneumatic tourniquet

objectives of positioning

- protect patients airway at all ties - allow access to monitoring sites on body - provide venous access for administration of medications - provide adequate exposure to operative site - maintain & promote homeostasis

Causes of patient moving & handing injuries:

- staff not trained adequately -specialized equipment not available - staff feel rushed -poor communication - staff are fatigued -protocols & guidelines not in place -staff are distracted - staff at unfamiliar with devices -equipment in poor condition

standing position to wheelchair:

1. Take on small step at a time rotate your body so patients back body is lined up with wheel chair. 2. slowly lower patient into wheelchair 3.place patients feet in foot rest & cover them with blanket and safety strap 4. make sure you have patient chart & records 5. proceed to your destination.

log roll & assisted lateral transfer

1. align bed & gurney side by side 2. lower the outside rails on both & raise to hip height 3. two people positioned at side of bed & one at patients head. & one positioned at feet 4. before moving patient free up all tubes, cables, & catheters 5. team should place hands at should, hip, & feet roll patient in lying position. 6. transfer device pulled gently to gurney while patient head & feet are in alignment 7. secure safety strap, and ensure no kinks in tubing.

physiological alteration

can occur with any rapid change of position . are managed by the anesthesiologist risk are minimized by slow, step by step positioning & repositioning.

Before entering patient room or cubicle?

collect all required documents including charts, test results & forms.

Care for obese patient can be complicated by complications like?

diabetes, heart disease, airway obstruction & airway exchange problems. & at high risk for deep vein thrombosis. All are fitted with sequential compression device.

musculoskeletal injuries included:

dislocation, tears, & compression injuries

jackknife (kraske) position

Is a modification of the prone position. safety is the same as described under prone.

three phase pedal operation

Most gurneys have neutral brake & steer phases built into pedal. Neutral- wheels turn freely brake- wheels are locked steer- all wheels are in forward position & will not turn.

If the patient has no ID band what do you do?

Must report this to the charge nurse or manager. Patient must have ID band to leave the unit.

fowler position

patient in recumbent in a sitting or modified sitting position for exposure to head, posterior neck, and cranium, anterior chest area, face and shoulders.

gardner or Mayfield headrests

penetrate the skull with sterile pins and hold the head in precise position .

neuropathy

permanent or temporary nerve injury that results in numbness or loss of unction of a body part

sacral pad

placed under sacrum to relieve pressure, especially in lithotomy position & for emaciated patients.

safety strap

places 2 to 3 inches above the patient's knee on top of blanket or sheet. Secured with 3 finger space between patient & strap.

Trendelenburg position

position in which a prone or supine patient is tilted with head down.

reverse trendelenburg

position in which the operating table is tilted downward feet first toward the floor

A nonambulatory patient may

require up to six people for transfer. (guided by one person)

eye injury

resulting in blindness occurs most commonly in prone position can also occur when patient is being turned or when eye is unprotected. To prevent injury eyelids are taped in closed position during general anesthesia.

side rails

safety mechanism on gurney. must be raised at all times when patient is on this.

vac pac ("bean bag")

sealed pouch filled with small plastic beads. Patient is first positioned and the pouch is molded loosely around the portion of body requiring support. suction is then applied to draw air from pouch creating a semi-rigid mold to support position.

glide sheet

smooth nylon fabric, used to in same manner as a transfer board, eliminating friction between patient & transfer surface.

surgical positioning

specific postures or positions the patient is placed in to provide adequate exposure to the operative site.

spinal table

spinal or allen able a simple foam thorax pad elevates the upper body at least six people required - patients arms maintained at greater than 90 degrees - head positioned on head rest to avoid pressure patients eyes, ears, or face -upper body suspended on padded brace with access to anterior thorax - care taken to ensure male genitalia are well within open portion of brace - lower body rest on operating table, padded to elevate toes to prevent them from resting on table.

Head tongs and horseshoe headrest support

the head for surgery of the cranium.

compression injury

tissue injury caused by continuous pressure over an area.

what is critical during patient movement and handling?

to not exceed the patients limit of a joint.

roller board

transfer device constructed of serial metal rollers that are encased in a heavy plastic fabric. Covered with a clean sheet. Then laterally pulls patients over the rollers without friction.

Safe positioning requires:

knowledge of anatomy physiology and individuals specific medical condition.

prone head pad

larger device, cradles the head and frames the face in prone position. hollow space provides access to airway and prevents injury to eyes, ears, facial nerves, & blood vessels.

roller board

lateral transfer device composed of serial rollers covered in heavy plastic fabric.

prone

lies recumbent with front of body in contact with OR table, arms positioned no greater than 90 degrees. provides exposure to perianal region, buttocks, posterior spine, & lower legs.

oxygen tank cradle

located at bottom of gurney. May not be placed alongside patient on mattress it can cause injury or roll off the gurney.

ischemia

loss of blood supply to a body part either by compression or as a result of a blockage in blood vessels. prolonged causes tissue death from lack of oxygen to the tissue.

decubitus (pressure) ulcer

loss of skin and deep tissue related to continuous pressure over an area of the body. Can cause tissue death.

wedges

made of foam, used to tilt the patient from the side or for isolated areas of the body that require elevation.

patient transport

methods and equipment used to move the patient within the health care facility.

gel arm cradle

more thickly padded arm rest that extends the full length of the arm.

abduction

movement of joint or body part away from the body

range of motion (ROM)

normal anatomical movement of an extremity

nerve injury

occur with continuous pressure on the nerve or its blood supply resulting in bruising or necrosis.

ear injury

occurs when patient's downside ear is not protected from folding or compression. injuries are prevented with a face rest or doughnut which prevents ear from bearing weight of patients head.

Four wheel break mechanism

operated by a foot pedal. Must be engaged any time gurney is at rest.

Moving patient from bed to gurney

1. arrange furniture for adequate space 2. lower bed rail & gurney rail near each other 3. align gurney with bed and lock wheels 4. Identify & free up all tubing, drainage collecting units must remain lower than the patients body at all times. IV line should be high than patients body. Move IV to gurney before moving patient. 5.guide patient slowly across bed 6. raise side rails & secure safety strap 7. proceed to operating room 8. fully conscious patient moved to OR table with 2 people assist 9. patient moved to table & safety strap secured & arm boards put in place

death from bumpers have occurred in three ways:

1. child becomes wedged against crib bumper & the mattress and suffocates 2. child becomes wedged against the crib bumper and is strangled by ties that attach to crib frame 3. child climbs over the rail & falls to the floor or becomes entrapped by crib bars during fall and fractures a limb.

guideline for transporting patient in wheelchair

1. cover patient with blanket 2. Avoid pilling charts and stuff in patients lap 3. travel facing forward except when entering elevator or ramp 4. Use patient elevators not public elevators 5. When elevator arrives lock the doors and pull patient in the unlock doors. and lock wheel chair 6. remind patient keep hand & arms within arm rest boundaries. 7. lock wheels at all times when at rest 8. going down a ramp turn wheelchair so back travels first.

Assisting a falling patient:

1. do not try and support the patients weight, ease patient to the floor while protecting their head. 2. spread your feet to create a wide base of support. Bend knees & use thigh muscles. 3. follow patients movement with your own body to prevent patient fro dropping 4. call out for assistance while remaining with patient.

validate patients identity

1. examine identity band 2. ask patient to state name & date of birth 3. ask patient state allergies 4. ask patient to state procedure being done 5. patient doesn't speak English (interpreter) 6. Remember patients have anxiety 7. Check chart, ID band, & hospital ID number

wheelchair to bed:

1. place table or bed at its lowest height. 2. reverse steps used to transfer patient to wheelchair. 3. If patient can put weight on hands, ask them to push down. & assist patient by placing arms under patients arms & securing hand on shoulder blade 4. place bracing foot back & rotate slightly 5. rotate until patient back aligned with bed to sit 6. keep spine & patients back in alignment 7. one person support patients back & head, another assist in bringing legs to bed. third person should stand at opposite side to prevent patient from falling. 8. ease patient to lying position. Place blanket over & secure side rails or safety strap.

assisting an ambulatory patient:

1. position yourself slightly behind patient shoulder while helping person walk. 2. give patient time to maneuver, do not rush, point out and orient patient with where they are going.

Sitting to standing position:

1. stand in front of patient, place hand around patients torso and under the arms. 2. slightly bend your forward leg while placing other foot in bracing position 3. slowly rock back and raise patient to standing position.

lithotomy

2 people required for rising legs - sacral pad, upper body gel pad used to protect the spine prevent venous stasis - arms on padded arm boards -leg holders require gel padding, if stirrups used the feet should be padded to prevent nerve damage - safety strap -anesthesia provider states when safe to raise legs - when using stirrups do not place the stirrup sling directly over Achilles tendon. -release the feet from stirrups.

When a patient is at high risk for falling?

Ask for help when transferring patient to wheelchair.

cribs should be equipped with?

a Plexiglas cover during transportation.

communication & team work count

a call is made to department or ward where the patient is ahead of time in order to coordinate the move.

embolism

a clot of blood, air, organic material, or foreign body that moves freely in the vascular system. Antiembolism stockings or SCD are used.

What can be frightening to a patient with sensory deficit if performed too quickly?

a lateral transfer may be frightening

traction injury

a nerve injury caused by stretching or compression of the nerve

the horse shoe rest is:

a padded, U shaped attachment that supports the forehead.

stretcher

a patient conveyance usually associated with emergency situations. capable of being carried by health care workers

transfer board

a thin plastic board that is place under the patient to perform lateral transfer.

patients in police custody

accompanied by one or two officers at all times . Patient fitted with hard restraint devices (hand or leg cuffs)

kraske position

also called jackknife, patient lies prone with middle section of the table flexed at slight angle

lateral decubitus

also known as sims position

dependent areas of the body

areas of the body under gravitational force. to prevent ischemia or necrosis it must be adequately be padded.

orthopedic table

at least four people required: - maintain spine & head in neutral position - center post of table removed before patient is moved well padded to protect genitalia - pressure points on sacrum, heels & unaffected lower leg must be padded - traction on affected leg adjusted - arms may be folded over the chest or extended on padded boards - open nature of this position can increase the patients risk for hypothermia. (forced air warming blanket)

where is the IV hanger positioned?

at the foot, to prevent patient head injury. Can be raised and lowered in height.

headrest

attached to operating table and stabilizes the head and neck during craniotomy or when in patient is in fowlers position.

lateral decubitus

exposed the flank and lateral thorax, with lateral position the down non operative site is down. - depending on BMI 4 to 6 people required -patient anesthetized in supine position - must be moved as one unit, head neck, spine, pelvis & legs all must be moved together. spine is maintained in alignment to prevent a torsion injury - head rests on a horseshoe pad or other cut away device to protect ear, eye, facial nerves & vessels - patients body is supported using vac pac (bean bag) - downside leg is flexed slightly at knee, upper leg remains extended & rest on pillow - padding placed under each foot to prevent nerve & vessel damage. - safety strap over hip and each arm. top arm pronated palm down, top side arm supinated palm down. -gel pad just below caudal to axillary area

prone position

four to six people required - position is complex & can compromise physiological mechanism - synesthesia is done in supine position on gurney and then positioned to prone -safety strap above knees - two gel chest rolls placed at clavicle and extended to iliac crest -when positioning female patient breast are positions within hollow formed lateral rolls -male patient, genitalia must be positioned on the midline - patient head is placed face down on a hollow center foam rest for protection

hyperextension

greater than normal extension

hyperflexion

greater than normal flexion

Children are transported to operating room by?

gurney, crib or bassinet.

Assisting patient from bed to wheelchair:

is performed with the patient's participation.

supine (dorsal recumbent)

two or four people required: -doughnut pad, -arms are extended on padded arm board, -arms are tucked at patient's sides arms faced inward (pronated) Tuck sheet between the arm and mattress pad & not between the mattress and the table. -Patient safety strap 2 inches above knee -additional padding for sacrum, pillow under knees - if pregnant use a wedge pad to prevent uterine compression on vena cava

Trendelenburg

two to four people required: - use all safety precautions for supine position - prevent underside of mayo tray contact patient - shoulder braces should not be used may injure brachial plexus - anticipate possible onset of hypertension

Revere Trendelenburg

two to four people required: - use safety precaution -padded footboard required to prevent patient from sliding toward the foot. -patients lower legs are supported with a pillow prevents the heels from resting on OR table

modified fowler

two to three people required: - first placed in supine position - arms secured on arm rest - lower legs cushioned on pillows and padded footboard should be attached. -safety strap - for reconstruction breast or shoulder surgery head rest must be padded to support the occiput.

mechanical hoist

used for lateral transfer, commonly used on patient wards, for the care of bariatric patients & requires detailed skills training.

sequential compression device (SCD)

used in positions that involve downward flexion of the lower body and in other cases where venous pooling is a potential problem.

log roll maneuver

used in supine lateral transfer, requires friction reducing transfer device. Patient is rolled from supine to a side lying position while keeping patient spine in a neutral position.

stirrups

used to elevate and abduct the legs for access to the perineal area in lithotomy position.

prone position

used to elevate the thorax and hip region for access to the spine.

arm board

used to extend the arms away from the body at an angle less than 90 degrees. provides access to arm for monitoring and intravenous access.

arm pads

used to protect the radial nerve and vessels when arm is extended on arm board.

abduction pad

used to separate the legs following hip fracture and postoperatively to maintain abduction and prevent dislocation.

head doughnuts

used to stabilize patients head for administration of anesthesia. Open space prevents pressure on the occipital bone.

hand grips

used to steer & maneuver the gurney.

air assisted transfer device

utilizes forced air to lift a baffled mattress off the surface of transfer surface. Bottom of mattress has multiple perforations that act as air jets. Air forced downward mattress & lifts the mattress allowing mattress and patient to be moved equally.

The decision of which lateral device is to be used depends on patients?

weight, physical condition, & level of consciousness. Fully consciousness patient can move with guidance & protection from staff.

shearing

when tissue plane such as the skin is pulled in one direction while opposing planes are pulled in the opposite direction.

adjustable upper body & full body Trendelenburg tilt

whole body is tilted head down or Reverse position for emergency situations.

weigh of falling person can cause?

you to lose your own balance and can result in a twisting injury or fracture.