Bed Mobility Flashcards
Bed Mobility
the adjustment of the position in bed
Positions in bed (mobility)
- supine to and from sidelying
- prone to and from sidelying
- supine to and from sitting
- all movements within the bed
principles for bed mobility
- reduce friction
- reduce gravity
- increased planning for COM movement
- transfers principles: predetermine, preplan, instructions, perform, conclusion
transfers (Tfs)
the movement from one surface to another (from bed to wheelchair)
what is the goal from transfers?
patient to achieve max level of independence that can be performed safely
principles for transfers
- patient’s physical capabilities
- patient’s mental capabilities
- weight bearing status (WB)
define FWB
full weight bearing - no restrictions
define WBAT
weight bearing as tolerated - pain level, as pain allows
define PWB
partial weight bearing - percent or pounds, surgeon’s orders
define TTWB
toe touch weight bearing - very light, egg shells under toes
define NWB
non weight bearing
equipment for transfers (Tfs)
- footwear - shoes or grippy socks (safe, put on in bed on towel
- clothing - maintain modesty
- gait belt
- transfers (Tfs) surface
preplan for transfers (Tfs)
- mentally
- instruct - unpack equipment, talk through & demonstrate transfer steps
- practice individual components prior to the completion of the entire transfers (Tfs) - have patient repeat steps back
- plan for problems - wheelchair as close to bed as possible, fear of falling, repeat steps
instructions for transfers (Tfs)
- slow - slow words, not fast talking
- concise and appropriate for patient (pt) - how you speak (to them)
guarding for transfers (Tfs)
- do not use clothing or the patient’s (pt’s) arm - use gait belt
- use the gait belt which is positioned at the pt’s COM - transfer sling, sheet, towel under their buttocks
performance for transfers (Tfs)
- PTA should notbe doing more work than the patient is with the exercises
1. the patient must be leading
2. therapist assisting only
3. proper body mechanics
4. DO NOT EVER LEAVE PATIENT SITTING ON EOB (EDGE OF BED) UNATTENDED (always have a hand on the patient)
conclusion for transfers (Tfs)
- provide call light within pt’s reach
- position in the appropriate position
- a. skin breakdown risk
- b. contracture risk: short muscles, tendons (could be painful to move)
- c. comfort
define different types of standing and sitting transfers
- dependent: patient relies on me to do work (spinal cord, paralyzed)
- assisted: patient & PTA both partial work
- independent: patient all by themselves
what type of pt would you NOT use standing lifts (sit to stand lift) with?
- non weight bearing
- amputee
- spinal cord injury
- stroke
- total hip replacement
what type of pt would you use standing lifts (sit to stand lift) with?
assisted - total knee replacement if at 90 degrees
what type of pt would you NOT want to use cradle lifts (hoyer lift) with?
- hip precautions: flexion past 90 degrees, adduction (legs crossing), internal rotation
- back precautions: acute spinal cord injury, excessive flexion, rotation, lateral
what type of pt would you use cradle lifts (hoyer lift) with?
- 100% dependent
- spinal cord: if not acute
define transfer (Tfs) aids slide board
most often used so that the patient can be as independent as possible
- diagnosis: amputee and spinal cord injury
define transfer (Tfs) aids beasy board
disk allows decrease friction and require pt more assistance than slide board
define transfer (Tfs) aids pivot disc
decrease friction and requires more assistance than SPT
define transfer (Tfs) aids slide sheets
made from very slippery synthetic fabric designed to assist in sliding across a seat or Tfs board
- decrease friction with bed mobility
define transfer (Tfs) aids trapeze bar
patient can use to become as independent as possible
- do not compensate until everything has been restored
- possible Rotator Cuff tear
- doctors and nurses like this 2 degrees not helping pt as much
– nurses are not having to be called to the room all the time to help reposition patient
– doctor’s think patient is becoming more independent
define transfer (Tfs) aids swivel seat
used for independence so you can sit and swivel
- decrease friction
- used primarily in vehicles (sit & spin)
define transfer (Tfs) aids leg lifter
primarily seen with TKR and THR
- can be short or long term
– total hip or knee replacement
define transfer (Tfs) aids transfer sling
used around patient’s buttock
- if you don’t have a Tfs sling you can use a soaker pad or sheet
why should the pt’s medical records be reviewed before bed mobility/transfers?
- diagnosis
- past Tfs history - does the patient get anxious
- limitation and abilities - one LE weak or precaution WB status or in P! (pain)
- goals for treatment - independent with slide board vs Independent SPT (student PT)
- assess for precautions to monitor
what are hip precautions for Total Hip Replacement (pending on surgical approach)
- why?
- no hip flexion greater than 90 degrees
- no hip internal rotation
- no hip adduction
– could possibly dislocate hip
what are back precautions for spinal cord injury, surgery, general trauma
- why?
- avoid excessive lumbar
– flexion
– rotation
– side bending
— protect surgery fix
what are burns precautions
- why?
- avoid creating a shear force across the surface of the graft or burn site
– could tear open wound sites
what are wounds precautions
- why?
- avoid creating a shear force across the surface of the graft or burn site
– compromise healing
what are hemiplegia (stroke CVA) precautions
- why?
- avoid pulling on the weakened extremity (half of body)
– dislocate shoulder, suplex
what are precautions after shoulder surgery
- why?
- avoid pulling on the shoulder or allowing weight bearing to be place through it
– tear/injury through internal sutcher(s)
what is a sternotomy?
- cut through the sternum and spread rib(s) apart
what are precautions after a sternotomy?
- why?
- no pushing, pulling, or lifting with arms
– sternum could re-break open
how do you transfer (tfs) a patient that just had a sternotomy?
- raise bed
- hold heart pillow
- push up with legs
- stretch out legs and knees
what are precautions for weight bearing status?
- broken/fractured bone
- upper and lower extremities
what should the PT include when introducing themselves to the patient?
- introduce themselves and briefly explain what you are going to do/work on
what should be included when the PT is gathering necessary equipment for the patient?
- non-skid socks - shoes are better
- gait belt
- assistive device (goes on strong side of bed)
how should the PT prepare the room for the patient?
- position the chair
- assistive device
how should the PT prepare the patient?
- reassess for precautions - rugs, weight bearing
- feet - do NOT use slippery foot-wear, bare feet, or socks (no slip)
- attire - drape or dress the patient appropriately for modesty and warmth
- apply gait belt
- obtain consent for treatment from the patient
what are the steps for applying the gait belt to a patient?
a. fasten securely over clothing
b. fasten around low waist (ilium) so the patient can be brought to my COM
what are contraindications for applying the gait belt low?
if any of these are present on the patient where should you fasten the gait belt?
- presence of PEG tube (G/feeding tube)
- abdominal drains
- abdominal incision
- abdominal aortic aneurysm - refer patient to primary doctor
- colostomy
- avoid entrapping breast tissue
- avoid impairing the pts ability to breath
- documentation
– around chest and under axilla - apply above breast tissue for women
what should you do if the patient declines to use the gait belt?
- you must explain risks and benefits or if you are unable to to use gait belt due to multiple contraindications, you must document all of this in the Objective portion of your daily note
how should the PT instruct the steps for stand pivot transfer (SPT) to the patient?
- briefly explain the transfers (Tfs) to the pt
- demonstrate the transfers (Tfs)
- patient explains the transfers (Tfs) back to PT
what techniques should the PT use during bed mobility with the patient?
- remain in close proximity to effectively guard the pt keeping both COMs close to each other
- provide effective stabilization using key points of control
- use proper body mechanics by exhale on exertion
what are the 3 key points of control when doing transfers?
- shoulders
- hips
- kneesde
define levels of assistance
- measured by the amount of assistance the patient is providing, NOT how much the therapist is assisting
define cueing
- be sure to document how much cueing is required and for what
what are the 2 types of cueing a PT will use on a patient?
- tactile/manual - physical, touching patient
- verbal - only using words
how many times should cues be provided throughout the activity/exercise?
1 - 3 times
