Chapter 10

Question 1

Alignment

Answer 1

based on the word line; a body is in alignment when a straight line could be drawn through the center of his body and his center of gravity.

Question 2

Base of support

Answer 2

the foundation that supports an object.

Question 3

Center of gravity

Answer 3

the point in the body where the most weight is concentrated.

Question 4

Fulcrum and lever

Answer 4

a means of moving an object by resting it on a base of support; a seesaw is an example of a fulcrum and lever.

Question 5

Guidelines for using proper body mechanics:

Answer 5

*Assess the load.

*Think ahead, plan, and communicate the move.

*Check base of support. Have a firm footing.

*Face what you are lifting.

*Keep back straight.

*Begin in squatting position. Lift with legs.

*Tighten stomach muscles when beginning.

*Keep object close to the body.

*Push rather than lift.

Question 6

Positioning

Answer 6

the act of helping people into positions that promote comfort and health.

Question 7

Supine

Answer 7

body position in which a person lies flat on his back.

Question 8

Lateral

Answer 8

body position in which a person is lying on either side.

Question 9

Prone

Answer 9

body position in which a person is lying on his stomach, or front side of the body.

Question 10

Fowler’s

Answer 10

a semi-sitting body position, in which a person’s head and shoulders are elevated 45 to 60 degrees.

*High fowler’s = 60 – 90 degrees, used when eating

*Semi-fowler’s = 30 – 45 degrees

Question 11

Sims’

Answer 11

body position in which a person is lying on his left side with the upper knee flexed and raised toward the chest.

Question 12

draw sheet

Answer 12

an extra sheet placed on top of the bottom sheet; used for moving residents. (also known as a lifter device)

Question 13

Shearing

Answer 13

rubbing or friction that results from the skin moving one way and the bone underneath it remaining fixed or moving in the opposite direction.

Question 14

Logrolling

Answer 14

moving a person as a unit, without disturbing the alignment of the body.

Question 15

Dangle

Answer 15

to sit up with the legs hanging over the side of the bed in order to regain balance and stabilize blood pressure.

Question 16

Facts about the five basic body positions:

Answer 16

1. Supine Position:

*Resident lying flat on back

*Pillows under head and shoulders

*Pillow under calves so heels are elevated; pillows or other support can also be used to properly position arms, hands, and feet

2.Lateral Position:

*Resident lying on either side

*Pillows support head, arm, and leg on upper side, back and head. Upper knee on pillow.

3. Prone Position

*Resident lying on stomach

*Small pillow under head and to keep feet off bed

*Seldom seen in long term care

4. Fowler’s Position:

*Semi-sitting, head and shoulders elevated

*Pillows at flexed knees, at flexed feet, and under head

5. Sims’ Position:

*Variation on lateral side position, left side-lying position

*Lower arm behind the back, upper knee flexed

*Pillows under head, arms, flexed knee, and bottom foot

Question 17

Steps for moving a resident up in bed:

Answer 17

1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for the resident’s privacy with curtain, screen, or door.
5. Adjust bed to a safe level, usually waist high. Lock bed wheels.
6. Lower the head of bed to make it flat. Move the pillow to the head of the bed.

7.If the bed has side rails, raise the rail on the far side of the bed.

8. Stand by the bed with your feet shoulder-width apart. Face the resident.
9. Place one arm under the resident’s shoulder blades. Place the other arm under the resident’s thighs. Use proper body mechanics.
10. Ask the resident to bend her knees, place her feet firmly on the mattress, and push with her feet and hands on the count of three.
11. On three, shift your body weight to help move the resident while she pushes with her feet. As always, allow the resident to do all she can for herself.
12. Make the resident comfortable. Put the pillow back under resident’s head and arrange the blankets for her.
13. Return bed to lowest position and return side rails to ordered position. Remove privacy measures.
14. Place call light within resident’s reach.
15. Wash your hands.
16. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 18

When you have help from another person, you can modify the procedure as follows:

Answer 18

1. Follow steps 1 through 6 above.
2. Stand on the opposite side of the bed from your helper. Each of you should be turned slightly toward the head of the bed. For each of you, the foot that is closest to the head of the bed should be pointed in that direction. Stand with your feet about shoulder-width apart. Bend your knees. Keep your back straight.
3. Roll the draw sheet up to the resident’s side. Have your helper do the same on her side of the bed. Grasp the sheet with your palms up, and have your helper do the same.
4. Shift your weight to your back foot (the foot closer to the foot of the bed), and have your helper do the same. On the count of three, you and your helper both shift your weight to the forward foot. Slide the draw sheet and resident toward the head of the bed.
5. Make resident comfortable. Put pillow back under resident’s head and arrange the blankets for her. Unroll the draw sheet and leave it in place for the next repositioning.
6. Return bed to lowest position. Remove privacy measures.
7. Place call light within resident’s reach.
8. Wash your hands.
9. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 19

Moving a resident to the side of the bed:

Answer 19

Equipment: draw sheet

1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for the resident’s privacy with curtain, screen, or door.
5. Adjust bed to a safe level, usually waist high. Lock bed wheels.
6. Lower the head of the bed.
7. Stand on the same side of the bed to which you are moving the resident. Stand with feet shoulder-width apart, and bend your knees.
8. Gently slide your hands under the resident’s head and shoulders and move them toward you.
9. Gently slide your hands under her midsection and move it toward you.
10. Gently slide your hands under the hips and legs and move them toward you.
11. Make the resident comfortable.
12. Return bed to lowest position. Remove privacy measures.
13. Place call light within resident’s reach.
14. Wash your hands.
15. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 20

Positioning a resident on the left side:

Answer 20

1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for the resident’s privacy with curtain, screen, or door.
5. Adjust bed to a safe level, usually waist high. Lock bed wheels.
6. Lower the head of the bed.
7. Move the resident toward the right side of the bed, using the previous procedure.
8. If the bed has side rails, raise the side rail on the left side of the bed.
9. Cross the resident’s right arm over his chest. Move the left arm out of the way. Cross the right leg over the left leg.
10. Stand with feet shoulder-width apart. Bend your knees.
11. Place one hand on the resident’s right shoulder. Place the other hand on the resident’s right hip.
12. While supporting the body, gently roll the resident onto his left side as one unit, toward the raised side rail. (You may need to roll the resident toward you without using a raised side rail. In this scenario, you would use your body to block the resident to prevent him from rolling out of bed. Follow facility policy.)
13. Position the resident properly and comfortably. Proper positioning includes the following:

*Head supported by a pillow (resident’s face should not be obstructed by the pillow)

*Shoulder adjusted so the resident is not lying on his arm or hand

*Top arm supported by pillow

*Back supported by supportive device

*Top knee flexed

*Supportive device between legs with top knee flexed; knee and ankle supported

*Pillow under bottom foot so that toes and ankle are not touching the bed

15. Return bed to lowest position. Return side rails to ordered position. Remove privacy measures.
16. Place call light within resident’s reach.
17. Wash your hands.
18. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 21

Logrolling a resident:

Answer 21

Equipment: draw sheet, coworker

1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for the resident’s privacy with curtain, screen, or door.
5. Adjust bed to a safe level, usually waist high. Lock bed wheels.
6. Lower the head of the bed.
7. Both people stand on the same side of the bed. One person stands at the resident’s head and shoulders. The other stands near the resident’s midsection.
8. Place a pillow under the resident’s head to support the neck during the move
9. Place the resident’s arm across his chest. Place a pillow between the knees.
10. Stand with your feet shoulder-width apart. Bend your knees.
11. Grasp the draw sheet on the far side.
12. On the count of three, gently roll the resident toward you. Turn the resident as a unit. Use your bodies to block the resident to prevent him from rolling out of bed.
13. Make resident comfortable. Arrange pillows and covers for comfort.
14. Return bed to lowest position. Remove privacy measures.
15. Place call light within resident’s reach.
16. Wash your hands.
17. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 22

Assisting a resident to sit up on side of bed: dangling

Answer 22

1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for the resident’s privacy with curtain, screen, or door.
5. Adjust bed to lowest position. Lock bed wheels.
6. Raise the head of bed to a sitting position. Fanfold (fold into pleats) the top covers to the foot of the bed. Ask the resident to turn onto his side, facing you. Assist as needed (see earlier procedure).
7. Tell the resident to across his chest with his top arm and place his hand on the reach edge of the bed near his opposite shoulder. Ask him to push down on that hand to raise his shoulders up while swinging his legs over the side of the bed.
8. Always allow the resident to do all he can for himself. However, if the resident needs assistance, follow these steps:

• Stand with your legs shoulder-width apart. Bend your knees. Keep your back straight.

9. Place one arm under the resident’s shoulder blades. Place the other arm under the resident’s thighs.
10. Have resident dangle as long as ordered. The care plan may direct you to allow the resident to dangle for several minutes and then assist him to lie down again, or it may direct you to allow the resident to dangle in preparation for walking or a transfer. Follow the care plan. Do not leave the resident alone. If the resident is dizzy for more than a minute, have him lie down again. Count his pulse and respiration rates and report to the nurse .
11. Remove slippers or shoes.
12. Gently assist the resident back into bed. Place one arm around the resident’s shoulders and the other arm under his knees. Slowly swing the resident’s legs onto the bed.
13. Make resident comfortable.
14. Leave bed in its lowest position. Remove privacy measures.
15. Place call light within resident’s reach.
16. Wash your hands.
17. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 23

Ergonomics

Answer 23

the science of designing equipment, areas, and work tasks to make them safer and to suit the worker’s abilities.

Question 24

transfer/gait belt

Answer 24

a belt made of canvas or other heavy material that is used to help people who are weak, unsteady, or uncoordinated to transfer.

Question 25

slide board

Answer 25

a wooden board that helps transfer people who are unable to bear weight on their legs; also called transfer board.

Question 26

1. When assisting residents NAs must know... 2. NAs should never refer to a “bad side” or a “bad” leg or arm – they should always use the terms..

Answer 26

1. which side is stronger and which is weaker and move the stronger side first. 2. affected or involved.

Question 27

Applying a transfer belt:

Answer 27

Equipment: transfer belt, nonskid footwear 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Adjust bed to lowest position. Lock bed wheels. 6. Assist the resident to a sitting position with feet flat on the floor. 7. Put nonskid footwear on the resident and securely fasten. 8. Place the belt over the resident’s clothing and around the waist. Do not put it over bare skin. 9. Tighten the buckle until it is snug. Leave enough room to insert flat fingers/hand comfortably under the belt. 10. Check to make sure that skin or skin folds (for example, breasts) are not caught under the belt. 11. position the buckle slightly off-center in the front or back for comfort.

Question 28

Guidelines for wheelchairs:

Answer 28

* Know how to use brake, armrests, and footrests. * Always lock before transfer; unlock after. * Open by tilting chair to raise wheels on opposite side and pressing down on one/both seat rails. Close by lifting center of seat. * Remove armrests by releasing lock. * Remove footrests by pulling back on lever and swinging out toward side of chair. * Lift or lower footrest by squeezing lever and pulling up or pushing down. * Resident must use side of body that can bear weight and lift side that cannot. * Resident must be wearing nonskid footwear before transferring. * Keep resident safe and comfortable during transfers. * Assist resident as needed by having chair close and wheels locked. Use transfer belt and check alignment in chair. * To move resident to back of chair, stand behind resident and ask resident to grasp armrests while feet are flat on floor. On count of three, ask resident to push himself back. Gently assist as needed. * Reposition resident at least every hour. This promotes comfort and muscle tone, reduces pressure, increases circulation, and exercises joints.

Question 29

Transferring a resident from bed to wheelchair:

Answer 29

Equipment: wheelchair, transfer belt, nonskid footwear, and robe or folded blanket 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. Check the area to be certain it is uncluttered and safe. 5. Place the wheelchair at the head of the bed, facing the foot of the bed. The arm of the wheelchair should be almost touching the bed. The wheelchair should be placed on resident’s stronger, or unaffected, side. 6. Remove both wheelchair footrests close to the bed. 7. Lock wheelchair wheels. 8. Raise the head of the bed. Adjust bed to lowest position. Lock bed wheels. 9. Assist the resident to sitting position with feet flat on the floor. Let resident sit for a few minutes to adjust to the change in position. 10. Put nonskid footwear on the resident and fasten securely. 11. Stand in front of the resident with your feet about shoulder-width apart. Bend your knees. Keep your back straight. 12. Place the transfer belt around the resident’s waist over clothing (not on bare skin). Tighten the buckle until it is snug. Grasp belt securely on both sides, with hands in an upward position. 13. Provide instructions to allow resident to help with transfer. Instructions may include: “When you start to stand, push with your hands against the bed.” “Once standing, if you’re able, you can take small steps in the direction of the chair.” “Once standing, reach for the chair with your stronger hand.” 14. With your legs, brace (support) resident’s lower legs to prevent slipping. This can be done by placing one or both of your knees in front of the resident’s knees. 15. Count to three to alert resident. If possible, have the resident rock while counting to three. On three, with hands still grasping the transfer belt on both sides and moving upward, slowly help resident to stand. 16. Tell the resident to take small steps in the direction of the chair while turning his back toward the chair. If more help is needed, help the resident pivot (turn) to stand in front of wheelchair with back of resident’s legs against the wheelchair. Always allow the resident to do all he can for himself. 17. Ask the resident to put hands on wheelchair armrests if able. When the chair is touching the back of the resident’s legs, help the resident lower himself into the chair. 18. Reposition resident so that his hips touch the back of the wheelchair seat. 19. Attach footrests and place the resident’s feet on the footrests. Check that the resident is in proper alignment. Gently remove the transfer belt. Make resident comfortable. Place a robe or folded blanket over the resident’s lap as appropriate. 20. Remove privacy measures. 21. Place call light within resident’s reach. 22. Wash your hands. 23. Report any changes in resident to the nurse. Document procedure using facility guidelines. *When transferring back to bed from a wheelchair, the height of the bed should be equal to or slightly lower than the chair. Help the resident pivot to the bed. When the resident feels the bed with the back of his legs, help him sit down slowly.*

Question 30

Guidelines for using stretchers:

Answer 30

*Lock wheels before transferring. *Keep safety belts fastened while in stretcher. *Raise safety rails. *Keep resident covered with a sheet. *Keep wheels locked except when moving stretcher. *Get help. *Move slowly and carefully. *Push stretcher from head end. *Go through doorways by opening door, entering first, and pulling stretcher through. *Do not hit walls or doorways. *Be cautious while going down sloping areas. *Stay with resident at all times.

Question 31

Transferring a resident from bed to stretcher:

Answer 31

Equipment: stretcher, blanket, draw sheet 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Lower the head of bed so that it is flat. Lock bed wheels. 6. Fold linens to the foot of the bed. Cover the resident with a blanket. 7. Move the resident to the side of the bed. Have your coworkers help you do this. Refer to the procedure Moving a resident to the side of the bed earlier in this chapter. 8. Place the stretcher solidly against the bed, and lock stretcher wheels. Bed height should be equal to or slightly above the height of the stretcher. Move the stretcher’s safety belts out of the way. 9. Two workers should be on one side of the bed opposite the stretcher. Two more workers should be on the other side of the stretcher. 10. Each worker should roll up the sides of the draw sheet and prepare to move the resident. Protect the resident’s arms and legs during the transfer. 11. On the count of three, the workers lift and move the resident to the stretcher. All should move at once. Make sure the resident is centered on the stretcher. 12. Raise the head of the stretcher or place a pillow under the resident’s head. Make sure resident is still covered with the blanket. 13. Secure the safety straps across the resident. Raise side rails on the stretcher. 14. Unlock the stretcher’s wheels. Move resident to the proper place, staying with him until another staff member takes over. 15. Wash your hands. 16. Report any changes in resident to the nurse. Document procedure using facility guidelines. 17. To return the resident to bed, the bed height should be equal to or slightly below the stretcher.

Question 32

Guidelines for mechanical lifts:

Answer 32

* Safer for two people to transfer with these lifts. * Keep chair or wheelchair close to bed to only move resident a short distance. * Make sure valves are working. * Use the correct sling for the lift. * Check sling and straps for tears or fraying. Do not use mechanical lift if there are tears or holes. *Open legs of stand to widest position before helping resident into lift. *Pump up lift only to the point where the resident’s body clears the bed or chair. *Know how to operate emergency release on electric/battery-powered lifts.

Question 33

Transferring a resident using a mechanical lift:

Answer 33

Equipment: wheelchair or chair, coworker, mechanical or hydraulic lift The following is a basic procedure for transferring using a mechanical lift. Ask someone to help you before starting. 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Lock bed wheels. 6. Position wheelchair next to bed. Lock brakes. 7. Help the resident turn to one side of the bed. Position the sling under the resident, with the edge next to the resident’s back. Fanfold if necessary. Adjust the bottom of the sling so that it is even with the resident’s knees. Help the resident roll back to the middle of the bed, and then spread out the fan folded edge of the sling. 8. Roll the mechanical lift to bedside. Make sure the base is opened to its widest point. Push the base of the lift under the bed. 9. Position the overhead bar directly over the resident. 10. With the resident lying on his back, attach one set of straps to each side of the sling. Attach one set of straps to the overhead bar. Have a co-worker support the resident’s head, shoulders, and knees while being lifted. The resident’s arms should be folded across his chest. If the device has S hooks, they should face away from resident. Make sure all straps are connected properly and are smooth and straight. 11. (This needs 2 people) Following manufacturer’s instructions, raise the resident two inches above the bed. Pause a moment for the resident to gain balance. 12. A lifting partner can help support and guide the resident’s body while you roll the lift so that the resident is positioned over the chair or wheelchair. 13. Slowly lower the resident into the chair or wheelchair. Push down gently on the resident’s knees to help the resident into a sitting, rather than reclining, position. 14. Undo the straps from the overhead bar to the sling. Remove sling or leave in place for transfer back to bed. 15. Be sure the resident is seated comfortably and correctly in the chair or wheelchair. Remove privacy measures. 16. Place call light within resident’s reach. 17. Wash your hands. 18. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 34

Guidelines for stand-up lifts:

Answer 34

*Used when resident can bear some weight on his legs but has poor leg strength and/or balance *Resident must be able to stand and have some arm strength. *Manual and battery-powered lifts are different types. *Brakes must be locked before using. *Resident in sitting position, with feet on foot plate and knees against knee pads *Resident grasps support bar and pulls himself up. *Lower sides of seat into position, adjust straps, and resident lowers himself into seat while holding bars.

Question 35

transferring a resident onto and off of a toilet:

Answer 35

Equipment: 2 pairs of gloves, toilet paper or disposable wipes, wheelchair 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. Make sure the resident is wearing nonskid shoes. 4. Provide for the resident’s privacy with curtain, screen, or door. 5. Position the wheelchair at a right angle to the toilet to face the hand bar/wall rail. Place wheelchair on the resident’s stronger side. 6. Remove wheelchair footrests. Lock wheels. 7. Put on gloves. 8. Apply a transfer belt around the resident’s waist over clothing (not on bare skin). Grasp belt securely on both sides, with hands in an upward position. 9. Ask the resident to push against the armrests of the wheelchair and stand, reaching for and grasping the hand bar with her stronger arm. Move wheelchair out of the way. 10. Ask the resident to pivot her foot and back up so that she can feel the front of the toilet with the back of her legs. 11. Help resident to pull down pants and underwear. You may need to keep one hand on the transfer belt while helping to remove clothing. 12. Help resident slowly sit down onto the toilet. Ask resident to pull on the emergency cord if she needs help. Remove and discard gloves. Wash your hands. Leave the bathroom and close the door. 13. When called, return and wash your hands. Don clean gloves. Assist with perineal care as necessary (see Chapter 13). Ask the resident to stand and reach for the hand bar. 14. Use disposable wipes to clean the resident. Make sure she is clean and dry before pulling up clothing. Remove and discard gloves. 15. Help resident to the sink to wash her hands. 16. Wash your hands. 17. Help the resident back into the wheelchair. Be sure the resident is seated comfortably and correctly in the wheelchair. Remove the transfer belt. Replace footrests. 18. Help the resident to leave the bathroom. Make sure resident is comfortable. Remove privacy measures. 19. Place call light within resident’s reach. 20. wash your hands again. 21. Report any changes in resident to the nurse. Document procedure using facility guidelines.

Question 36

transferring a resident into a vehicle:

Answer 36

Equipment: wheelchair 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Place wheelchair close to the vehicle at a 45-degree angle. Open the door on the resident’s stronger side if possible. 5. Lock wheelchair wheels. 6. Ask the resident to push against the armrests of the wheelchair and stand, grasp the vehicle, and pivot his foot so the side of the seat touches the back of his legs. 7. The resident should then sit in the seat and lift one leg, and then the other, into the vehicle. Assist as needed. 8. Carefully position the resident comfortably in the vehicle. Help fasten seat belt. 9. Safely shut the door. 10. Return the wheelchair to the appropriate place for cleaning. 11. Wash your hands. 12. Document procedure using facility guidelines.

Question 37

Ambulation

Answer 37

walking.

Question 38

Ambulatory

Answer 38

capable of walking.

Question 39

Assisting a resident to ambulate:

Answer 39

Equipment: gait belt, nonskid shoes for resident 1. Identify yourself by name. Identify the resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door. 5. Adjust bed to its lowest position so that the feet are flat on the floor. Lock bed wheels. 6. Before ambulating, put nonskid footwear on the resident and fasten securely. 7. Stand in front of and face the resident. Stand with your feet about shoulder-width apart. Bend your knees. Keep your back straight. 8. Place gait belt around the resident’s waist over clothing (not on bare skin). Grasp belt securely on both 9. Always allow resident to do whatever he is able to do for himself. If the resident is unable to stand without help, brace (support) the resident’s lower extremities. This can be done by placing one of your knees against the resident’s knee, or it can also be done by placing both of your knees against both of the resident’s knees. Bend your knees. Keep your back straight. 10. Hold the resident close to your center of gravity. Provide instructions to allow the resident to help with standing. Tell the resident to lean forward, push down on the bed with his hands, and stand on the count of three. When you count, begin to rock. On three, with hands still grasping the gait belt on both sides and moving upward, rock your weight onto your back foot and slowly help the resident to stand. 11. Walk slightly behind and to one side of the resident for the full ordered distance, while holding on to the gait belt. If the resident has a weaker side, stand on the weaker side. Use the hand that is not holding the belt to offer support on the weak side. Ask the resident to look forward, not down at the floor, during ambulation. 12. Observe the resident’s strength while you walk together. Provide a chair if the resident becomes dizzy or tired. 13. After ambulation, remove gait belt. Help resident to the bed or chair and check that the resident is in proper alignment. Make resident comfortable. 14. Leave bed in lowest position. Remove privacy measures. 15. Place call light within resident’s reach. 16. Wash your hands. 17. Report any changes in resident to nurse. Document procedure using facility guidelines.

Question 40

When an NA assists a visually-impaired resident with ambulation, the resident should...

Answer 40

walk beside and slightly behind him. The NA should warn the resident when approaching corners or steps.

Question 41

When a resident starts to fall, the NA should respond in this way:

Answer 41

*Widen stance. *Bring resident’s body close. *Bend knees and support resident. *Lower resident to floor. *Do not try to stop the fall. *Call for help. *Do not attempt to get resident up.

Question 42

C cane

Answer 42

a straight cane with a curved handle at the top.

Question 43

Functional grip cane

Answer 43

cane that has a straight grip handle.

Question 44

Quad cane

Answer 44

cane that has four rubber-tipped feet and a rectangular base.

Question 45

Walker

Answer 45

a type of walking aid with four rubber-tipped feet and/or wheels that provides stability when a person is unsteady or lacks balance.

Question 46

Guidelines for cane or walker use:

Answer 46

*Make sure cane or walker is in good condition. *Make sure resident is wearing securely fastened nonskid footwear. *Resident should place cane on stronger side. *Resident should place both hands on the walker, and walker should be placed no more than six inches in front of resident. *Stay near resident on weaker side. *Do not hang purses or clothing on walker. *Report to nurse if cane or walker seems to be the wrong height.

Question 47

Assisting with ambulation for a resident using a cane, Walker, or crutches.

Answer 47

Equipment: gait belt, non-skid shoes, cane, walker, or crutches 1. Identify yourself by name. Identify resident by name. 2. Wash your hands. 3. Explain procedure to resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible. 4. Provide for resident’s privacy with curtain, screen, or door. 5. Adjust bed to lowest position so that the feet are flat on the floor. Lock bed wheels. 6. Before ambulating, put nonskid footwear on the resident and fasten securely. 7. Stand in front of and face the resident. Stand with your feet about shoulder-width apart. Bend your knees. Keep your back straight. 8. Place gait belt around resident’s waist over clothing (not on bare skin). Grasp belt securely on both sides, with hands in an upward position. 9. If the resident is unable to stand without help, brace (support) the resident’s lower extremities. This can be done by placing one of your knees against the resident’s knee or by placing both of your knees against both of the resident’s knees. Bend your knees. Keep your back straight. Help the resident to stand as described in the previous procedure. 10. Help as needed with ambulation. -Cane: Resident places cane about six inches, or a comfortable distance, in front of his stronger leg. He brings his weaker leg even with the cane. He then brings his stronger leg forward slightly ahead of the cane. Repeat. -Walker: Resident picks up or rolls the walker and places it about six inches, or a comfortable distance, in front of him. All four feet or wheels of the walker should be on the ground before the resident steps forward to the walker. The walker should not be moved again until the resident has moved both feet forward and is steady. The resident should never put his feet ahead of the walker. 11. Crutches: Resident should be fitted for crutches and taught to use them correctly by a physical therapist or a nurse. The resident may use the crutches several different ways, depending on his weakness. No matter how they are used, the resident’s weight should be on his hands and arms. Weight should not be on the underarm area. 12. Walk slightly behind and to one side of the resident for the full distance, while holding on to the gait belt. If the resident has a weaker side, stand on the weaker side. 13. Watch for obstacles in the resident’s path. Ask the resident to look forward, not down at the floor, during ambulation. 14. Encourage the resident to rest if he is tired. When a person is tired, it increases the chance of a fall. Let the resident set the pace. Discuss how far he plans to go based on the care plan. 15. After ambulation, remove the gait belt. Help the resident to the bed or chair and check that the resident is in proper alignment. Make resident comfortable. 16. Leave bed in its lowest position. Remove privacy measures. 17. Place call light within resident’s reach. 18. Wash your hands. 19. Report any changes in resident to nurse. Document procedure using facility guidelines.