Chapter 16 Moving and Positioning Patients

Transcription

1 Chapter 16 Moving and Positioning Patients

2 Terminology Related to Movement Contractures Shortening and tightening of muscles due to disuse Dorsiflexion Bending of the foot in an upward direction Plantar flexion Bending of the foot in a downward direction

3 Terminology Related to Positioning Patients Log roll Patient is turned in the same way a log would be rolled (as one unit) Trochanter roll Tightly rolled sheet or blanket placed against the lateral side of the thigh to prevent outward motion of the hip and leg

4 Hazards of Immobility Blood clots Pneumonia Bone demineralization Kidney stones

5 Constipation Pressure ulcers Hazards of Immobility (cont.) Urinary retention Depression

6

7 Body Systems Affected by Immobility Musculoskeletal Cardiovascular Respiratory Gastrointestinal Urinary Integumentary Neurological Psychological effects

8 Preventing Musculoskeletal Complications Maintain proper body alignment Keep the head, trunk, and hips in a straight line Prevent the legs from rotating in the hip socket medially or laterally Maintain arms in correct alignment with the shoulders

9 Nursing Actions to Prevent Contractures and Osteoporosis Perform ROM exercises every 8 hours Support the weight of the extremity at the joints Apply any supportive or therapeutic devices for maintaining body alignment Assist with ambulation as soon as orders permit

10

11 Effects of Immobility on the Cardiovascular System Venous thromboembolism (VTE) Orthostatic hypotension Syncope

12 Nursing Measures to Prevent Cardiovascular Complications Encourage the movement of extremities Apply ordered devices to prevent pooling of blood in the legs Gradually move the patient from lying to sitting or to a standing position Change the patient s position frequently Remain with the patient the first few times getting out of bed and dangling

13 Nursing Measures to Prevent Respiratory Complications Turn the patient from side to side every 2 hours Elevate the head of the bed 45 degrees Encourage coughing and deep breathing Encourage use of the incentive spirometer

14 Nursing Measures to Prevent Gastrointestinal Complications Assist the patient with early ambulation Reposition the patient every 2 hours; encourage ROM exercises Place the patient in a sitting position on the bedpan Inquire about food likes and dislikes and plan balanced meals Encourage fiber and fluid intake Administer a laxative or stool softener PRN

15 Nursing Measures to Prevent Urinary Complications Encourage fluids to prevent concentrated urine Assist female patients to urinate in a sitting position Assess the patient s output

16 Nursing Measures to Prevent Integumentary Complications Provide adequate nutrition Reposition the patient every 2 hours Inspect bony prominences for redness every 2 hours and massage the area around the redness Use mild soaps for cleansing skin Provide an appropriate surface for the patient

17 Nursing Measures to Prevent Neurological Complications Determine the patient s level of consciousness by asking specific questions relating to person, place, and time Use a footboard to keep feet in a natural position Perform neurological checks Provide clues in the room to the correct date and time

18 Psychological Effects of Immobility Depression Anxiety Hostility Fear Isolation Restriction of self-image and independence Sensory deprivation Difficulty sleeping

19 Nursing Measures to Prevent Psychological Complications Minimize sensory deprivation Involve patient senses when with the patient Encourage the patient to remain awake during the day and do as much for the self as possible Allow the patient to express concerns Encourage visits from family and friends

20 Position of Function Places the extremities in alignment Maintains the potential for their use and movement Helps prevent undue pressure on the nerves Helps prevent discomfort, pain, and nerve damage Uses devices including pillows, hand rolls, arm boards, and foot boards

21 Common Patient Positions Supine: Lying on back, arms at side Dorsal recumbent: Lying on back, arms at sides, legs apart, knees bent, feet flat Trendelenburg: Lying on back, arms at side, feet higher than head (Shock position) Reverse Trendelenburg: Lying on back, arms at side, head higher than feet Lateral: Lying on back or right side, supported by pillows

22 Common Patient Positions (cont.) Left Sims: Left side semi-prone, right leg drawn up to chest, left arm along patient back Right Sims: Right side semi-prone, left leg drawn to chest, right arm along patient back Low, semi-, and high Fowler s: Semi-sitting with various degrees of head elevations Orthopneic: Sitting upright, leaning slightly forward, arms supported on overbed Prone: On stomach with head to side Lithotomy: On back, legs in stirrups

23 ANA Handle With Care Campaign Instituted in response to significant number of musculoskeletal disorders reported by nurses No lifting programs; instead, use lift equipment Sit-to-stand lifts, hydraulic lifts, battery-powered lifts

24 Devices Used to Move Patients Transfer belts Nylon friction reducing devices Slide boards Partial or full weight-bearing assist devices Overhead ceiling lift devices

25

26 Support Surfaces and Specialty Beds Mattress overlays Specialized mattresses Specialty beds Air-fluidized bed Low air-loss bed Combination air-fluidized and low air-loss bed Continuous lateral-rotation bed

27 Information in the Connection Features Clinical Connection Knowledge Anatomy and Physiology Patient Teaching Real World Supervision/Delegation Post Conference

28 Information in the Safety Features Why are the particular safety features so important that they are highlighted as safety issues? What could happen if those safety guidelines are not followed?

29 Information in the Skills Procedures Review the steps of each of the skills procedures. Make sure you understand why the steps are important. What could happen if each of the steps are not followed or are followed out of order?