Moving And positioning Clients

Base of Support (BOS)

* A person feet provide the base of support The wider the base of support the more stable the person is *The feet should be spread sidewise when lifting toi give a side to side stability. *One foot is placed slighting in the front of the other ,for back to front stability Weight is distributed evenly between both feet

Supporting the client in a sitting postiom in bed

* FOWLER POSITION - Head is raised about 30 -45 degrees in a high fowlers the head of the bed is raised nearly vertical this position can also be refereed to as orthopedic position *THE OTHOPNEIC POSITION used for cardiac and respiratory condition clients to make breathing easier this position makes breathing easier Achieved by placing the over bed table across the bed in front of a chair with one or 2 pillows on top of the table PRONE POSITION- Lying on the stomach THE SEMI_PRONE ( lateral ) POSITION- MORE comfortable than the prone position

Center of gravity

* Is the pelvic area * When lifting an object bend at the knees and hips and keep the back straight. By doing so the center if gravity remains over the feet, giving extra stability. It is easier to maintain balance

Postioning for examiations and tereatments

* It is important to know how to assist the client and place necessary drapes * Commonly used positions are supine ( dorsal recubent) lying on the back ) *Prone ( on the abdomen) *Sims - Semi Prone on the side usually ;left side with the knees flexed *Fowler's ( on the back with the head elevated * Knee chest or genupectoral ( on the knees with the chest resting in the bed * Dorsal lithotomy ( on the back with feet on stirrups *Lateral ( On the side ) *The supine postion can be modified by bending the knees and placing the feet flat at the bed * Trendenlenberg *( head down with the head lower than the feet-----> used to treat shock by promoting cereberal blood floe and for some portions of postural drainage * Reverse Trendelenberg ------> Postion used to enhance tube feeding and as an emergency to help stop bleeding in a head injury Two less commonly used psotions are the Modified Standing postions and Lumbar Puncture position

MOVING AND POSITION CLIENTS

* Position changes restore function, relive pressure stimulate reservations and circulation, provide diversion and enhance self esteem * Its important to explain to the client the reason for position change and how it will be done , This gives the knowledgeable client to maintain the position also the clients cooperation can assist the nurse and give the client excersize * in some cases turning is only encourage to give back rubs or to asses. or change any wound dressings or bed linens In some cases clients are encourage only to remain in supine position in this case the client is instructed to do isometric exercises if able to physically put up Special beds are also operated to relive pressure and provide back support

Passive Range of Motion (PROM)

* When a client is unable to move the nurse performs exersize In active range of Motion - the client is able to do it independently * Do not force joint movement * If client complains of pain stop stat

Body alignment with the client on the back (supine)

* When a client prefers this position. use pillows to support the head , neck , arms and hands and a foot board to support the feet * This position allows digestive system and respiratory organs to function without restriction, * If the clients trunk is much flatter than the upper part of the body one pillow is needed to support the head and neck * A knee roll is placed under the knees and a pad is placed under the ankles to prevent pressure on the heels When the immobile patient is to lie on the back for some time TRONCHANTER ROLLS are placed on each side of the legs to keep legs and feet from rotating oUtward causing later deformities TRONCHANTER ROLLS ARE MADE BY ROLLING A BATH BLANKET OR BY USING A ALRDY PREPARED ONE

Following measures that are carried out before draping the client for examinations?

* a signed release is obtained if necessary *The client is asked to empty the bladder unless contraindicated------> this allows the person to feel more comfortable * A urine specimen is collected as ordered *The client is encouraged to defecate before most examinations example rectal examination * The client is provided with an examination gown or bath towel to cover the chest and perineal areas * A bad blanket is provided for warmth or privacy for the person *The procedure is fully explained *The body is draped properly exposing only the parts that are necessary *Appropriate lighting is provided * Necessary equipment and supplies are prepared * The nurse remains during the procedure * The nurse and provider wash and sanitize there hands before and after the procedure *Gloves are Worn ass-long with other pee equipment * The nurse observes and documentss * After the exam the nurse assist with disposing equipment

Positioning the client

* encourage clients to move in bed , get out of or walk *Immobility can contribute to a number of disorders example pressure wounds blood clots constipation muscle weakness and atrophy pneumonia joint deformities urinary disorders depression * To prevent injuries to yourself or your clients it is important to practice good body mechanics and use medical devices when necessary to lift a person

Turning the client a side lying position

* proper alignment is always important when turning the patient * Pillows can be used for more comfort

Assiting the mobile and partially mobile client

* you must follow this principles when assisting the clients out of bed

Turning and moving patients ( preventing deformities)

*Any client that can not move hands should be supported in an open position, to prevent contractures * Usually a hand roll is placed in the clients both hands to support the wrist keep the fingers bent slightly and keep the thumb out in a grasping position * Hand rolls can be made by rolling a washcloth or small towel or by using an already made hand roll * By using the hand roll the client will be able to use his/her hand functionally later on * WHEN THE CLIENT IS ON BED - the knees are supported in a comfortable position A slanting foot board is comfortable and prevents footdrop FOOTDROP- is a contracture deformity in which the foot remains in a plantarflexed position * Basically those deformity prevents the fit from ever touching the ground The mattress may slip to the foot of the bed when the head of the bed is raised , Maintain proper body alignment becomes difficlut. -----> to avoid this place a pillow or roll a blanket btw the edge of the matress and the foot of the bed.

Canes and Walkers

A cane is a slender man he'll stick or device meant to provide support while walking three basic types of cains supports the client and assist on walking it provides additional support when one side of a persons body is weak or if the client has pain in one hip or knee The cane is held on the clients strong side and adjusted to the appropriate height this is the side contralateral to the week or painful side A walker is a four lug tubular device with handgrips it provides 30 support for clients who are unable or too unstable to walk with a cane it's made up of light we are human the client groups the device raises it from the floor moves it away from the body a few inches sets it securely on the floor and walks towards it a moderate amount of upper body strength is necessary for a client to use the walker some walkers have rubber tipped feet others have wheels in front or back or both some walkers alsoHave a seat so the client converse is is he or she becomes tired or weal a basket to facilitate in carrying items

Continous Passive Motion (CPM)

A mechanical device that is used to provide contious motion to a specfic joint usually the knee or hip * Uusually use after joint replacement or arthrocropic joint repair * Autmatically moves the clients leg promoting joint mobility and speeding recovery * The nurse must explain the action and purpose of the machine to reduce anxiety. Discomfort may occur THE ELECTRIC CPM has a padded rack 4 the extremity and the physical therapist or healthcare provider sets the parameters and movements per min Be sure that the call light is within the clients reach and tell them to call when experiencing pain * It is often helpful to give a PRN ( as needed MED before 15mins treatment

THE LOGROLL TURN

A method to turning the client that keeps the body in a straight alignment * This relived pressure areas over the bony parts and generally adds to the clients comforts * Used for patients with spinal cord injuries or who has had a back surgery * 2 to 3 people are required to turn the position in this method *Needs providers order and with special in service education

Evaluating Fall Risk

Although the formal Fall-Risk Assessment is done by an RN, the LPN/LVN plays a vital role in observ- ing and reporting observations. Clients at risk for falling are often identified by special slippers (yellow), a yellow name band, and a special sign attached to the door of the room (see Guidelines for fall prevention are given to clients on admission. These guidelines include: calling for assistance, realizing that some medications and physical disorders cause dizziness, getting up slowly, and wearing proper footwear when up. Clients are reminded to use their glasses and hearing aids, never to try to climb over siderails, and to use handrails when needed.

JOINT MOBILITY AND RANGE OF MOTION

ROM range of motion- limited opening closing motion share responsibility for managing client ROM Helps prevent abnormalities * Nursing and and physical occupational therapy SHARE SAME RESPONSIBILITY WHEN MANAGING ROM

Helping the Mobile Client out of Bed

Clients who are weak from long periods of bedrest or who are unsteady because of illness require assistance from bed. Take care to ensure that the client has a secure sense of bal- ance before helping him or her out of bed. In Practice: Nurs- ing Procedure 48-6 discusses the steps in helping the mobile client out of bed.

Conditioning and Strengthening Exercises

Conditioning and Strengthening Exercises Conditioning and strengthening exercises prepare the cli- ent's body for action. The client pulls up on the trapeze, footstool while sitting, to regain the feeling of standing. men in. Encourage the client to press the feet down on a correct posture: head up, chest out, back straight, and abdo- performs these actions, he or she is encouraged to practice practices standing next to the side of the bed. As the client performs isometric exercises, dangles, sits in a chair, and

Assisting the Mobile and Partially Mobile Client

Follow these basic principles when assisting clients out of bed: • Check the provider's order, to determine the client's allowed activities. • Assist the client to put on bathrobe and slippers. Provide a bedpan, if necessary. Offer a blanket, to avoid chilling. • Remind the client to tell you if he or she is becoming tired, faint, or weak.ovord eloj lotnos For bst • Offer PRN pain medication approximately 30 minutes before the client gets up. (This increases client comfort and may enable the client to be up longer.)i gan • Make sure the nurse call signal is within reach, if you leave the client while he or she is sitting up. (A client pro- tective device may be necessary, to prevent the client from falling out of a chair.) Tbotiei to bolimil od Start with short periods out of bed and increase as the client is able. elonox Help the client dangle on the edge of the bed before getting

The Client in Danger of Falling

If a client feels faint, try to assist the person to sit. If it is not pos- sible to assist the client into a chair or bed, carefully guide him or her to the floor (Fig. If the client is sitting, lower the head as close to the lap as possible. If the client is on the floor, assist him or her to lie down. If help is not readily available,

Actions During a Client Fall

If a client you are assisting to ambulate starts to fall and grabs your neck for support, lower your head to escape the client's grip on your neck. Gently lower the client to the floor, to avoid injury. Your neck will not support the weight of a falling client. Injury to the client and/or to your neck is very likely to occur.

Line of gravity

Imaginary vertical line thru the top of the head, the center of gravity and the base of support

Active Range of motion

Indivdual self directed exerisize Izometric exercise ( Muscle setting) tightening and releasing certain muscle groups ISOMETRIC ARE HELPFUL TO STRENGTH ABDOMINAL GLUTEAL AND QUADRCEPS MUSCLES THOSE NECESSARY FOR ABBULATION ARE NOT HElpful in preventing contractions Thiese exerzise are useful in preparing a client for a cructh walker or wheel chair muscle tone in a casted limb or teaching bowel or bladder training. *the routine that acheives the best results is the sets of 5 reptitions lasting 5 second with a 2 min rest period

body alignment

Proper alignment is necessary to maintain balance * When the body is aligned correctly the muscles work together for the safest and most efficient movement without muscle strain * stretching the body ass tall as possible helps produce proper alignment via correct posture

Dangling

This helps the client who has been in bed to prepare to sit in a chair and eventually, to walk. Be careful: Allow the person to sit in the bed for a few minutes before assisting him or her out of bed. (It may be neces- sary to raise the head of the bed.) The client may experience light-headedness or weakness, due to a temporary fall in blood pressure (orthostatic or postural hypotension). It is important to understand the client's limitations. He or she may only be strong enough to dangle and then lie down again. In Practice: Nursing Procedure 48-5 discusses the steps for dangling.

Helping the client to walk

Use a transfer belt the first time the client gets out of bed and each time after that, if needed. Remember: the goal is to keep the client safe and injury-free. Help steady the person while he or she sits on the side of the bed. Return to the supine position (lying down) as soon as possible. If the client is in a chair, have him or her bend over at the waist and lower the head. • If walking with a client who feels faint, help him or her to lean against a wall and over. If this does not help, and you are alone, ease him or her to the floor (see Fig. 48-9).

Use of the Transfer Belt

Use of the Transfer Belt The nurse can provide support to the weak or unsteady person by using a transfer belt (also called a gait belt). This belt is a sturdy webbed belt with a buckle, easily secured around the client's waist. Explain to the client that the belt provides safety and protection for both client and nurse.

Key Concept

When the client gets up to walk, it is important that he or she wear sturdy shoes or slippers, with nonslippery soles. They should fit well and have low, broad heels. The client should not wear slipper socks unless abso- lutely necessary, and never without gripper soles. (These factors help prevent falls. Slipper socks provide no arch support; extended use may cause serious damage to the feet, arches, and hips. The client may also step on something sharp and be injured.) Good arch support is important. (This helps prevent conditions such as sciaticapain along the sciatic nerve in the thigh and leg and plantar fasciitis, an inflammation of the fascia in the foot.)

Crutches

crutches are walking aids and made of wood or metal in the form of a chef they reach from the ground to the clients XL or forearm people with a permanent or long-term disability often preferred to scratch the person can drop the ham bar and grasp a hand roll or do you work without losing the crutch although the last string scratch is more convenient than traditional crutches it provides less stability the platform crutch is used in a similar manner another type of coach is called a rocker crutch this crutch Has the two bars extending straight down to the floor connected by a rounded end or rocker the rocker and contains a rubber pad to prevent slipping this crutch gives more support because it stays in contact with the floor while the client rocks on the crutch and swings the way through

Helping a Client Move From Bed to Chair

some clients have difficulty moving from bed to chair back again because of weakness or paralysis the nurse can assist the mobile client with the client requires lifting and mechanical lift should be used

USING MOBILITY DEVICES

stand up alone, a client reminder device or protective device may be needed, to prevent him or her from falling. An order is required for the use of most protective devices (discussed may Be sure to lock the wheels of the wheelchair for each transfer. Sometimes, the client will be moved in a wheelchair to another area for examinations or tests. In Practice: Nursing Procedure 48-7 describes skills in pushing a wheelchair. (Many of these skills are also used when pushing a wheeled stretcher [a litter or gurney], used for moving people who cannot sit or walk.)

Body Mechanics

use of the safest and efficient methods of moving and lifting *Applying mechanical principles * Principles underlying correct body mechanics involves major factors, including center of gravity, base of support, and line of gravity

Clutch adjustment

• Place the bottom of each crutch about 6 in (15 cm) from the outside of the client's feet. The top of the crutch should be two to three finger widths below the client's axil- lae when his or her elbows are flexed approximately 30 degrees (Fig. 48-13B). Adjust the hand bar so that the client can extend the arm almost completely when leaning on the palms. Even if crutches are the correct total length, the position of the hand bar may need to be adjusted. crutches are short- ened by more than 1 in, the position of the hand bar will most likely also need to be changed. Crutches that fit properly and are used correctly are com- fortable and do not create pressure under the arms. Rubber pads may be on the tops of the crutches to protect clothing. In many cases, the rubber pads are removed, to discourage clients from leaning on the tops of the crutches. The crutch tip is madeOf sturdy rubber that fits snugly a large vacuum tip is a necessityBecause it provides a firm base of support and prevents sliding ice grips are also available for slippery conditions