Chapter 8 exam 3 Flashcards
Work related pain in PTA
65 % experince it mostly from handeling patients and movement involved in therapeutic activities.
SPHM
Safe Patient Handling and Mobility - “no lift” policies
Why is SPHM rare
equipment and time constraints. Not knowing how to use equipment. or not operable in patient care space.
Nusrsing staff sometimes believe
injury is part of the job.
SPHM activites
Grouped into lifting transfers, lateral transfers or repositioning transfers.
SPHM decision making
Factors include:
Person
Task
Environment
Total Body Lift
ceiling lifts
Floor lifts ->Hoyer lifts
Sling lifts
Hoyer lifts
u or v shaped bases either manually or battery operated.
Hybrid total body lift
freestanding but with an overhead A-frame to lift from above.
sling lift
supine or seated to floor and back
the most versitile total body lifts can do this but not all.
sling lift
Choosing a sling
size:
area of the body the sling will support
where the seat edge of the sling fits ont he body
location of the leg straps
the psostion of the overhead sling bar.
sling lift
pediatric sling weight limit
100lbs
sling lift
bariatric sling weight limit
1000lbs
sling lift
adult size sling weight limit
between 250 and 450
sling lift
For patients who weigh less than 300 or 400 pounds the upper and lower straps of the sling are connected
to a single cross bar
sling lift
For patients over 300 to 400 pounts the upper and lower straps of the sling are connected
to seperate lift components.
Key non-intuitive steps for Bed to chair and chair to bed lifts
widen the base before hooking up straps to frame
only lift as far as you need to clear surfaces.
Set all breaks.
Have a second person to position pt.
For positioning on a bed - have drawsheet under them bofore setting them down.
When moving to a temporary surface the sling is left in place.
sit to stand lift
for patients that require moderate to maximum assistance for mobility
are able to flex and achieve a sitting position
maintiain sitting balance
do not have LE weight bearing restrictions
do not have severe back problems or other conditions
Sit to stand as therapeutic exercise
No adverse effects of sphm equipment use on patients rehabiolitation outcomes have been found. (PT at Madona Rehab in Lincoln said it taught stroke patients the wrong thing (to push back against strap rather than stand upright), but that was 9 years ago and studies show she was wrong.)
Increase therapy options.
Lateral transfer Devices
Air assisted devices
Slippery sheets
Ridgid and semirigid full body transfer boards.
Safety of drawsheets
hand and spine forces exceed safety limits when clinicians use a drawsheet for all but the lightest-weight adult patients.
transfer board/slippery sheet/air-assisted device
Number of clinicians for transfer
> 100 lbs- two people with transfer board
200 to 100 lbs. two people with air assisted device or slippery sheet
<200 lbs. min of 3 people. with air-assisted device, slipper sheet, or transfer board.
transfer board/slippery sheet/air-assisted device
Number of motions
If there are safe stopping points, clinicians can reposition and safety is enhanced.
Fear- some patients perfer one move. Others appreciate several smaller moves.
transfer board/slippery sheet/air-assisted device
min clinician trunk flexion
For narrow to narrow surface, - golfer’s lift if it can be done safely.
Head and foot of bed with unobstructed lateral path
For wider surfaces it may need to be done in multiple steps.
seperate the surfaces for better body mechanics once the pt is safely supported by the new surface.
transfer board/slippery sheet/air-assisted device
Head control
often have hand grips or supportive devices near the head.
May need another clinician to support head for transfer. - that technician would coordinate the tranfer
transfer board/slippery sheet/air-assisted device
HALO
an aditional clinician may be necessary to support the weight of the halo.
air assisted device.
the air assisted device matress is placed under the patient
perforations in the lower chamber create a cushioned film of air that supports the patient and lowers friction for lateral transfes.
reduce injury to clinicians
also help patients with integumentary problems.
Slippery sheets
low friction coating such as silicone elastomer.
reduce mechanical load involved in a lateral transfer, but still exceed recommeded limits with average to above average weight.
Rigid or semi rigid transfer boards
slide boards or patient shifters.
friction reducing to some degree.
support full length of body (shorter transfer boards are used for seated transfers.)
Can be easier to use when there is a slight difference in height between the transfer surfaces.
Drawsheets
creates a sling out of sheets or blankets.
Number or clinicians: 3-5
small virtical lift necessary to reduce friction
Head to feet or accross surfaces
when head to feet can’t be used, and transfering lateraly accross two surfaces, cliinician saftety is a problem becase of trunk flexion. \
stabalize trunk.
flex at hips
support thighs against the transfer surface to stabalize lower body.
Lateral transfer
If wheels don’t lock on one of the surfaces
Need an extra person to secure the surface.
Lateral transfer
Tallest clinician
usually placed near the pt’s head.
Lateral transfer
Complications
- Fear the patient is experiencing
- pain caused by transfer
- Movement precautions
- External fixation devices
- skin conditions interacting with shearing forces
- Can the patient help - AMAP/ANAP
Repositioning sheets
friction reducing sheets with handles that can be left under patient after repositioning.
bed repositioning with sheets/chuck/ air assisted device, transfer board
Rule 1 of repositioning
Have HOB flat.
2 is height of bed (top of clinician pelvis.)
bed repositioning with sheets/chuck/ air assisted device, transfer board
Clinician safety when repositioning
Semi-lunge stance minimizes trunk rotation.
Some Air assisted devices
are designed to be left under patient. - ideal for bariatric pts.
