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Intro to Interventions > Chapter 8 - Transfer Activities > Flashcards

Chapter 8 - Transfer Activities Flashcards

1
Q

What does the word “bariatric” mean?

A

field of medicine that is concerned with weight loss or that deals with causes, prevention, and treatment of obesity

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2
Q

What does “hemiplegia” mean?

A

paralysis of one side of the body

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3
Q

What does “paralysis” mean?

A

loss of power or voluntary movement in a muscle through injury or disease of its nerve supply

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4
Q

What does “paresis” mean?

A

partial or incomplete paralysis

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5
Q

Different levels of assistance with transfers

A

min assist, mod assist, max assist, standby supervision (independent), dependent

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6
Q

Contact guarding

A

Caregiver is positioned close to patient with hands on patient and gait belt to protect patient during activity

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7
Q

Patient performance during min assist

A

pt performs 75% or more of activity, assistance required

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8
Q

Patient performance during mod assist

A

pt performs 50-74% of activity, assistance required

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9
Q

Patient performance during max assist

A

pt performs 25-49% of activity, assistance required

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10
Q

Preparation for Patient Transfer

A
  1. review medical record and interview pt/family for info to help plan activity: restrictions/precautions? Premorbid status? Cognitive status?
  2. Set goals for treatment
  3. Wash hands and wear gloves if appropriate
  4. Make sure pt wears correct footwear and is properly dressed
  5. Place gait belt on if transferring from one surface to another
  6. Consider whether mechanical or human assistance is needed
  7. explain transfer procedure and cue pt, make sure the pt understands and repeat steps if applicable
  8. Transfer pt across shortest possible distance toward stronger side and assist with weaker side (exceptions e.g. THA)
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11
Q

Performing the Transfer

A
  • lock wheels on wheelchair, bed, gurney
  • be aware of all objects (IV lines, leads, catheters) and make sure they are appropriate length for transfer
  • apply safety belt
  • remain close to patient and guard properly
  • Use proper body mechanics
  • Continually cue pt
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12
Q

Total hip replacement precautions

A

surgically replaced hip should not be adducted or rotated, flexed more than 90 deg, or extended beyond neutral flex/ext
Do not cross ankles, pull on affected extremity, or allow pt to lie on affected extremity
Maintain affected extremity in abduction in motion, may use pillow

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13
Q

Back surgery precautions

A

May wear brace, or have pt engage core muscles in movement
Avoid excessive rotation, flex/ext, side-bending
“logroll” technique

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14
Q

Hemiplegia precautions

A

pay attention to weak side and make sure it is supported, do not pull on affected extremity
Check often for blood pressure changes
Sensation may be reduced

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15
Q

Burns precautions

A

avoid shearing forces across surface of wound, graft, or area where graft was taken (sliding)
Have pt elevate body or extremities when moving area
Bandages, sensation, edema, pain, other restrictions

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16
Q

Documentation for Transfer

A
  • type of transfer
  • type of assistance
  • How much did I do? Did I need help? Were the instructions understood?
  • “Intangibles” and “Tangibles”
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17
Q

Intangibles of Transfer Documentation

A

amount of time (when abnormal)
level of safety
quality of movement
–make PT skilled, billable activity

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18
Q

Tangibles of transfer documentation

A

precautions
level of consistency
equipment/devices used

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19
Q

Requirements for all transfer movements

A
  • proper body mechanics for pt and PT
  • do not pull on extremities, head or neck
  • cue and teach, have patient assist when possible
  • get help if needed
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20
Q

side-to-side movement in supine dependent

A

one forearm under pt shoulders, other under upper back, pull/slide toward self
forearms under distal trunk, pull toward self
forearms under thighs and legs, pull toward self
can also place hands on sides or shoulders and trunk
Lower, keep COG close to patient’s COG and move in transverse plane

21
Q

upward and downward movement in supine dependent

A

These movements use two people. The patient should lie on the back with arms crossed over chest. Each person should stand on either side of the patient and should grab a hold of the draw sheet under the patient by the pelvis and by the shoulder. Without lifting, the sheet is slid up or down 6-10 inches as needed.

22
Q

Supine to Side-lying

A

Initially place pt close to far edge of bed/mat with bedrail or wall on other side
Cross upper ankle over other ankle

23
Q

side-to-side movement supine independent

A

Bend your knees so your feet are flat on the bed
Place your hands by your sides with your palms facing down
Move one of your hands further away from your body – the one on the side you will move towards
Lift your hips up towards the ceiling, this is called a “bridge”
Move your hips over and put them down where you want to go
Prop yourself up and move your shoulders over
Walk your feet to the side one by one

24
Q

upward and downward movement in supine independent

A

Patient should lie with feet on table and arms reaching over head onto bedrails. The patient should pull with the arms and push with the legs if moving upward. The patient should push with the arms and pull with the legs if moving downward. The patient should only move 6-10 inches at a time.

25
Q

upward and downward movement in supine assisted

A

Upward: Patient should lie with feet on table, and arms crossed over chest. The PT should stand at the patient’s chest level with feet staggered. The PT’s hands should be placed underneath the pelvis and underneath the head for support. The PT should ask the patient to lift pelvis slightly off the table and push with the legs as the patient is moved 6-10 inches up the table.
Downward: Patient should lie with feet on table and arms crossed over chest. The PT should place both hands on either side and underneath the patient’s pelvis. The PT should ask the patient to lift pelvis slightly off the table and pull with the legs as the patient is moved 6-10 inches down the table.

26
Q

supine to prone dependent

A
  1. ) The therapist will move the patient to the edge of the bed.
  2. ) The arm the patient is rolling over should be close to his or her side with the shoulder rolled out, elbow straight, palm up, hand placed under hip.
  3. ) The patient will be rolled toward the therapist into a side-lying position.
  4. ) The therapist will make sure there is enough room to continue the roll onto the stomach.
  5. ) The therapist will then position his or her thigh against the edge of the bed to protect the patient from rolling off.
  6. ) The therapist will gently ease the patient onto his or her stomach and adjust the body to a comfortable position.
27
Q

supine to prone independent

A
  1. ) Move towards one side of the bed.
  2. ) The arm that is being rolled over should be placed under the body or the shoulder can be placed up near the ear.
  3. ) Cross the left leg over the right.
  4. ) Roll into the side-lying position
  5. ) Gently ease yourself over using your left hand for support.
  6. ) Adjust as needed to find comfort
28
Q

prone to supine dependent

A
  1. ) The therapist will move the patient to one side of the bed.
  2. ) If rolling to the right, the patients left leg will be placed over the right.
  3. ) The right arm should be close to the side with the elbow straight, palm up, hand tucked under the hip.
  4. ) The therapist will stand on the far side of the table and roll the patient towards them into a side-lying position.
  5. ) The therapist will place his or her leg against the table to protect the patient and gently ease the patient onto his or her stomach by resisting the hips and shoulder.
29
Q

Supine to side-lying dependent

A
  1. Stand facing the patient so you can roll or turn them toward you to a side-lying position.
  2. When rolling the patient towards the right, place their left leg over their right leg. Place their left arm on their chest and their right arm lying straight across the table.
  3. Roll the patient towards you by pulling gently on their left upper back and their left hip in order to control the movement.
  4. When the patient is in a side-lying position slightly bend their hips and knees. Then place a pillow under their head, between the knees and ankles, and along the front and back of the trunk for support.
30
Q

Supine to side-lying independent

A
  1. Instruct the patient to move to the far side of the bed or mat.
  2. To roll to the right tell the patient to simultaneously reach across their chest with their left arm and lift their left leg diagonally over their right leg.
  3. Have the patient pull up their head and tighten their abdominal muscles to roll onto their side
  4. The patient can also use their left hand to grasp the end of the mattress, sheet, or bed rail to pull to a side-lying position.
  5. Alternatively a patient can push with their left arm and left leg before reaching across the body.
31
Q

Prone to supine independent

A
  1. ) Move yourself towards one side of the bed. Make sure you have enough room to complete the roll!
  2. ) The right arm should be placed under the body if attempting to roll toward the right.
  3. ) The left hand should be flat on the table near the shoulder.
  4. ) By pushing with the left hand move into the side-lying position.
  5. ) Check your surroundings to make sure you have enough room to continue the roll. If you do not have enough room to continue the roll, scoot yourself forward.
  6. ) Gently ease yourself onto your back and adjust as needed for comfort.
32
Q

2-person lift transfer: wheelchair to bed

A
  1. Position wheelchair parallel and in the middle of the bed.
  2. Lock wheels on bed and wheelchair.
  3. Remove armrest and footrest on bedside WC.
  4. Stronger person lift under armpits and give signal to begin. Second person
    should lift legs.
  5. Have patient fold their arms across chest.
  6. Have lead lifter go under armpits and above forearms while secondary lifts the
    legs.
  7. Have lead lifter signal when to lift and transfer patient to bed.
  8. Stay by patient while you make them comfortable.
33
Q

2-person lift transfer: bed to wheelchair

A
  1. Position wheelchair parallel and in the middle of the bed.
  2. Lock wheels on bed and wheelchair.
  3. Remove armrest and footrest on bedside WC.
  4. Have patient fold their arms across chest.
  5. Have lead lifter go under armpits and above forearms while secondary lifts the
    legs.
  6. Stronger person lift under armpits and give signal to begin. Second person
    should lift legs.
  7. Have lead lifter signal when to begin and perform the transfer.
  8. Replace the armrest and footrest.
34
Q

Supine to sitting dependent

A
  1. Move patient to one side of the bed so that you can roll them onto their opposite side.
  2. Cross the leg opposite of the direction that you are rolling over the other leg and cross the patients arms over their chest
  3. With one hand under their hips and the other under their shoulders, slowly roll the patient onto their side in one smooth movement
  4. Make sure they have a slight bend in their knees while in the side lying position
  5. From there, place one hand under their knees and the other under the bottom of the shoulder
  6. As you raise their upper body, rotate their legs over the side of the table
  7. To prevent injury, make sure you gently lower their lower extremities to the floor
  8. Never allow a patient to sit unattended or unsupported
35
Q

supine to sitting assisted

A

Follow same instructions as the dependent method, except for the following changes:
o Once in side lying position, instruct the patient to push off with one or both arms as you assist in the rotation to the side of the table
o When rotating, ask the patient to look into the direction of the movement
Only use as much assistance as the patient requires; encourage them to help as much as possible

36
Q

supine to sitting independent

A

The patient should move themselves to one side of the bed, but making sure they are not too close to the edge
The patient should roll to the side-lying position and make sure they have a slight bend in their knees and hips
The patient should use both of their hands at the mid-chest level to push up and lift the upper body off the bed
The lower body should turn simultaneously as the patient moves their upper body
Once in the sitting position, the patient should keep each hand at their side on the bed to stabilize themselves

37
Q

sitting to supine

A

For each of the three methods, the patient can go from sitting to supine by following the instructions in the reverse order.

38
Q

general transfer principles

A

Predetermine the patient’s mental status and weight bearing capabilities
Mentally prepare for the activity and transfer
Assess the patient’s pain status prior to and at the completion of the transfer
Instruct the patient slowly, clearly, and concisely, allow time for the patient to process and apply the information
Secure any needed equipment for the transfer, apply a gait belt
Be alert for any mishaps
Do not guard the patient by using clothing or grasping the arm, USE THE GAIT BELT
Position yourself to guard, direct and pro-tect and guide the patient
Ask the patient to do as much as possible, assist as necessary
At the conclusion, position the patient for comfort, stability, and safety

39
Q

Standing Dependent Pivot Transfer

A

With the patient elevated to a standing position, place your feet and knees on the outside of the patient’s feet and knees.
Pivot the patient so that his/her back is toward the surface to which they will be moved.
From this point, help the patient into a sitting or laying position and position them as needed to be comfortable and in a proper alignment.

40
Q

Proper body mechanics for transferring pt

A 
Lift with legs
Avoid bending and twisting
Widen base of support
Get close to the patient
Use a staggered stance
41
Q

Preparations for Transfer

A
  1. Prepare surroundings
    - No obstacles in path
    - Equipment is out and ready
  2. Make sure patient is wearing safe clothing and footwear
  3. Position wheelchair parallel to the table or at a slight angle
  4. Lock wheelchair drive wheels
  5. Swing away wheelchair front rigging
  6. Apply the gait belt around the patient’s hips
42
Q

standing transfer - assisted pivot

A
  1. STAND
    - Be in front of the patient, slightly to the side
    - Have patient initiate transfer (“nose over toes”)
    - Patient pushes down on wheelchair armrests
    - Patient stands with stronger leg behind weaker leg
    - Provide assistance with gait belt; stabilize weak leg by straddling weak leg
  2. REST
    - Give the patient some time to establish balance
    - Check to see if dizzy
  3. PIVOT
    - Patient takes small steps toward bed or table
  4. SIT
    - Patient contacts bed or table with back of thighs and arms before sitting down
43
Q

Placing drawsheet under pt in bed

A
  1. perform dependent side roll
  2. gather sheet halfway, tuck under hips and shoulders
  3. roll pt supine toward yourself
  4. roll pt side-lying toward yourself (switch sides or toward siderail of bed)
  5. unroll sheet and smooth out folds
  6. roll pt supine
44
Q

contralateral vs. ipsilateral

A

contralateral: on the other-or opposite-side
ipsilateral: homolateral; on the same side

45
Q

protective transfer to and from the floor for a person with low back dysfunction: movement from standing to the floor

A
  1. pt places one hand on firm object and moves to a single knee (half-kneeling) position, keeping trunk erect
  2. pt briefly kneels on both knees (high-kneeling), then moves to all fours
  3. pt moves hands forward until he/she is prone or gently side sits, if not painful–lowers onto one elbow to side-lying
  4. pt adjusts body as desired
46
Q

protective transfer to and from the floor for a person with low back dysfunction: movement from floor to standing

A
  1. pt in prone and pushes to hands and knees or logrolls to side-lying position
  2. if pt is on all fours, he/she moves to half-kneeling then to standing; firm object may be used for assistance
  3. if pt side-lying: pt can push to side-sitting position, then performs previous movements
47
Q

Transfer with transfer board

A
  • *try to work on two level surfaces–lower bed if applicable, etc.
    1. position wheelchair at 45 deg angle to bed, lock chair and remove armrest and front rigging on side moving to
    2. help pt lean away to place board under hip, with other side resting on chair or bed. PT position: slightly in front of and to the near side of the pt to guard and protect for transfer
    3. help pt move across board, guard and protect trunk if LEs need to be lower from bed; help pt shift weight away from the board, and remove the board. keep hands and fingers on top of board so they don’t get pinched.
    4. position pt for safety and comfort
48
Q

guarding for patient with one non-weight-bearing LE in standing transfer

A

guard non-weight-bearing LE, possibly by placing own foot on outside of affected leg, with knee across to the inside of the affected leg

Intro to Interventions (3 decks)

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