Module 4: Body Mechanics, Patient Transfer, Skin Care Flashcards
CARE OF PATIENT’S BELONGINGS
* Patients should be given ——— for clothing.
* ————– such as necklace, rings, and watches are not to be worn for many diagnostic procedures and must be removed before the procedure can begin.
* ———— on patient’s belongings.
- hangers
- metal items
- Do not place value
Body Mechanics
Rules of body mechanics are based on the ?
laws of gravity
Body Mechanics
the force that pulls objects toward the center of the earth.
Gravity
Body Mechanics
When a person is standing, the center of gravity is
center of pelvis
Body Mechanics
the body is in alignment with all the parts in balance.
good posture
Body Mechanics
Good posture permits the musculoskeletal system to work at ———————— on joints, tendons, ligaments, and muscles.
maximal efficiency with minimal amount of strain
Rules for correct upright posture are as follows:
- Hold chest up and slightly forward with the waist extended.
- Hold head erect with the chin held in.
- Stand with the feet parallel and at right angles to the lower legs. The feet should be 4 to 8 inches apart.
- Keep the knees slightly bent.
- Keep the buttocks in and the abdomen up and in.
Lifting and Moving Heavy Objects
- Keep the heaviest part of the object close to the body. (Ask assistance if this is not possible.)
- The forces of friction opposes the movement.
- Reducing the surface area to be moved. (Asking the patient to use their own strength, if not, place the patient’s arms across the chest)
- The surface must be dry and smooth.
- Pulling rather than pushing, as this reduces friction when moving a heavy object or person.
- Keep the body’s line of balance closest to the center of the load
Rules for picking up or lifting heavy objects are
When picking up an object from the floor, bend the ———————– . Do not bend at the waist.
knees and lower the body
Rules for picking up or lifting heavy objects are:
the strongest arm muscles and are effective when pulling
biceps
When assisting a patient to move, balance the weight over ———–
both feet
Rules for picking up or lifting heavy objects are:
Always protect the ——
spine
Rules for picking up or lifting heavy objects are:
Make certain the floor area is ———
clear of all objects
MOVING AND TRANSFERRING PATIENTS
MOVING AND TRANSFERRING PATIENTS
- Establish the correct identity of the patient.
- Request pertinent information concerning the patient’s ability to comply with the physical demands of the procedure while at the nurses’ station.
- Request information concerning the patient’s ability to ambulate and any restrictions or precautions to be taken concerning the patient’s mobility.
- Move the patient to the imaging department according to the necessary restrictions after greeting an identifying him or her and providing and explanation of what is to occur
When the procedure is completed, return the patient to the hospital room using the following procedure:
- Stop at the appropriate nurses’ station, return the chart, and inform the unit personnel that the patient is being
returned to the room. Request help if it is needed at this time. - Return the patient to the room, help the patient get into the bed, and make them comfortable and safe. Place
the patient’s bed in the position that is closest to the floor with the side rails raised and the call button within
the reach in case the patient needs assistance.
Assessing the patient’s mobility
- Deviations from correct body alignment.
- Immobility or limitations in range of joint motion.
- The ability to walk.
- Respiratory, cardiovascular, metabolic, and musculoskeletal problems.
- The patient’s general condition.
- Range of motion and weight-bearing ability.
- The patient’s strength and endurance.
- The patient’s ability to maintain balance.
- The patient’s ability to understand what is expected during the transfer.
- The patient’s acceptance of the move.
- The patient’s medication history
The following rules should be observed during a move
- Give only the assistance that the patient needs for comfort and safety.
- Always transfer a patient across the shortest distance.
- Lock all the wheels on beds, gurney, and wheelchairs before the move begins.
- Move the patient toward his or her stronger side while assisting on the patient’s weaker side. The patient should wear shoes for standing transfers, not slippery socks.
- Inform the patient of the plan for moving and encourage them to help.
- Give the patient short, simple commands and help the patient to accomplish the move.
METHODS OF MOVING THE PATIENTS
three ways of transferring patients
by gurney, by wheelchair, and by ambulation.
If the patient is unconscious or unable to cooperate in the move, the patient’s spine, head, and the extremities must be well supported. Convenient and safe ways to do this are by using a sliding board or a sheet to slide the patient from one surface to another.
By Gurney
Sheet transfer
- To place a sheet under a patient, use a heavy draw sheet or a full bed sheet that is folded in half.
- Have one person stand on each side of the table or bed at the patient’s side.
- Turn the patient onto his or her side toward the distal side of the bed or table.
- Place the sheet on the table or bed with the fold against the patient’s back.
- Roll the top half of the sheet as close to the patient’s back as possible.
- Inform the patient that he or she will be turned onto the side toward the opposite side and will be mobbing
over the rolled sheet. - Then turn the patient across the sheet roll and have assistant straighten the sheet on the distal side.
- Return the patient to a supine position, and the transfer may begin.
also called a smooth mover and a “smoothie”
Sliding Board Transfer
a glossy, plasticized board approximately 5 feet
10 inches in length and about 2 feet 6 inches wide.
Sliding Board
Sliding Board Transfer
Obtain the sliding board and spray it with antistatic spray if necessary.
2. Obtain the assistance of one other person if the patient is of average size and weight.
3. Move the patient to the edge of the gurney.
4. Move the gurney up against the radiographic table and lock the wheel of the gurney.
5. Assist the patient to turn onto his or her side.
6. Create a bridge with the board between the edge of the radiographic table and the edge of the gurney.
7. Place the sheet over the board, and allow the patient to roll back onto the board.
8. With one person at the side of the radiographic table and the other at the side of the gurney, slide the
patient over the board and onto the radiographic table.
9. Assist the patient to roll toward the distal side of the radiographic table, keeping the patient secure by
holding onto the sheet on which he or she was lying.
10. Remove the gurney and perform the radiographic procedure.
11. When the procedure is completed, the patient can be transferred back to the gurney by repeating the steps
above.
12. Once the patient is back on the gurney, place a pillow under the patient’s head (if this is permitted), and put
the side rails of the gurney up.
13. Do after, care.
Wheelchair transfer
- If the patient can assist, instruct him or her to push up with the upper arm when
told to do so. - On the count of three, move or help the patient to a sitting position at the edge of
the table. - If the patient needs minimal assistance to get off the table, stand at the patient’s
side and take the patient’s arm to help. - If the radiographic table is high, never allow a patient to step down without
providing a secure stepping stool. Always stay at the patient’s side to
assist. - The wheelchair must be close enough so that the patient can be seated
in the chair with one pivot. Have the foot supports of the chair up and
the wheels locked. - The footrests on the wheelchair should then be put down and the
wheels unlocked. A safety belt should be put across an unsteady patient.
————— must be ordered by the physician in charge of the patient’s care and applied in compliance with institutional policy.
Use of immobilizers
states that immobilizers should be used only after less restrictive measures have been
attempted and have proved ineffective in protecting the patient.
The Joint Commission
Use of ————— to avoid the use of immobilizers if at all possible.
critical thinking skills
defined as any manual method or physical or mechanical device, material, or equipment
attached or adjacent to the person’s body that the person cannot remove easily that restricts freedom of movement or normal access to one’s body.
Immobilizers
Reasons for application of immobilizers in the care of an adult patient include the following:
- To control movement of an extremity when an intravenous infusion or diagnostic catheter is in place.
- To remind a patient who is sedated and having difficulty remembering to remain in a particular position.
- To prevent a patient who is unconscious, delirious, cognitively impaired, or confused from falling from a
radiographic table or gurney; from removing a tube or dressing that may be life sustaining; or from injuring him
or herself by impact with diagnostic imaging equipment.
Rules for application of immobilizers:
1.The patient must be allowed as ————— safely possible
2.The areas of the body where immobilizers are applied ————– to prevent injury to the skin beneath the device
3.———– must be maintained
4.——– that will become tighter with movement must be used
5.The immobilizer must be ———- quickly, if this is necessary
6.—————- must be impaired by the immobilizer
7.If leg immobilizers are necessary, ———— must also be applied to prevent the patient from either unfastening the device or, in an attempt to leave the radiographic table or gurney, accidentally hanging him or herself
- much mobility as is
- must be padded
- Normal anatomic position
- Knots
- easy to remove
- Neither circulation nor respiration
- wrist immobilizers
various types of immobilizers
- Limb holders or four-point restrains
- Ankle and wrist immobilizers
- Immobilizing vest for keeping a patient in a wheelchair
- Waist immobilizer, which keep the patient safe on an examining table or in a bed, but allows the patient to change position.
patient is flat on the back.
Supine or dorsal recumbent position
patient is on the right or left side with both ankles flexed.
Lateral recumbent position
patient lies face down.
Prone position
patient semi-sits with head raised at an angle of 45 to 90 degrees off the table, used for patient’s in respiratory distress.
High Fowler position
patient’s head is raised at an angle of 15 to 30 degrees off the table.
Semi-Fowler position
patient lies on either left of right side with the forward arm flexed and the posterior arm
extended behind the body, used for diagnostic imaging of the lower bowel as an aid in inserting the enema tip.
Sims position
patient’s head is lower than the rest of the body, for promotion of venous return in patients with inadequate peripheral perfusion caused by disease.
Trendelenburg position
ASSISTING THE PATIENT TO DRESS AND UNDRESS
* For patients from outside the hospital, they may need assistance if there is ———-, —————–, or is in —————- to help him or herself.
* If a trauma patient is brought to the diagnostic imaging department from the emergency unit, removing the clothing in the ————– may cause further injury or pain.
o It may be necessary to ———— that interfere with acceptable radiographs.
o ———– from the patient or a family member should do so in writing for protection.
- a cast or a brace, is very young, weakended condition
- conventional manner
- cut away garments
- Secure consent
Undressing and Dressing: The Disabled Patient
THE DISABLED PATIENT
1. Cover the patient with a draw sheet and have an examining gown ready.
2. Remove the clothing from the less affected side first and then remove the clothing from the more affected side and place the clean gown on that side.
3. Next place the clean gown on the unaffected side and tie the gown at the back, if practical.
4. If the patient is wearing an article of clothing that must be pulled over the head, roll the garment up above the waist. Next, remove the patient’s arms from the clothing, first from the unaffected side and then from the affected side.
5. Neatly, gently lift the clothing over the patient’s head.
6. To remove the trousers, loosen the buckles and buttons and have the patient raise his buttocks as the trousers are slipped over his hips.
7. Slip the trousers below the knees and off.
8. Fold the clothing and place it in a paper bag.
Undressing and Dressing: The Patient with an Intravenous Infusion
- If the patient’s gown must be changed, slip the clothing off the unaffected side first.
- Carefully slide the sleeve of the unaffected side over the IV tubing and catheter, then over the container of fluid.
- When replacing the soiled gown with a clean one, first place the sleeve on the affected side over the container
of fluid, then over the tubing and onto the arm with the venous catheter in place. - When moving the arm of a patient who has an IV catheter in place, support the arm firmly so that the catheter
does not become dislodged. Remember to keep the bottle of fluid above the infusion site to prevent blood from
flowing into the tubing.
Skin Care
can occur in a brief period of time (1 to 2 hours and result in a decubitus ulcer that may take
weeks or months to heal.
Skin Breakdown
Skin Care
Mechanical factors that may predispose the skin to breakdown
- Immobility
- Pressure
- Shearing force
Skin Care
Early signs that indicate imminent skin breakdown are blanching and a feeling of coldness over pressure areas
Ischemia
Skin care
followed by heat and redness in the area as the blood rushes to the traumatized spot in an attempt to provide nourishment to skin
Hyperemia
Skin Care
If, at the time of reactive hyperemia, the pressure on the threatened area is not relieved, the tissue begins to ———–, and———- soon become visible.
necrose, and small ulceration
Patients who are most prone to skin breakdown
malnourished, the elderly, and the chronically ill.
PREVENTING DECUBITUS ULCERS
The areas most susceptible to decubitus ulcers are the —————
scapulae, the sacrum, the trochanters, the knees, and the heel of the feet.
Patients should be allowed to change position occasionally to keep pressure off the ——, ——, and ——-
hips, knees, and heels.
Place —— or ———– under the patient or by turing him or her to a different position whenever possible.
pillows or soft blanket
How often does the patient need to change position in a usual hospital situation?
Every 2 hours
How often does the patient need to change position if lying on a hard surface
30 mins
If a patient is perspiring profusely or is incontinent or urine or feces, make certain that he or she is ———— and ——, take precautions make certain that he or she is ——- and —–, take precautions when moving the patient to prevent skin abrasions.
kept clean and dry
Cast Care and Traction
may produce pressure on the patient’s skin under the cast, and this, in turn, may lead to the formation of a decubitus ulcer at the site of
compression.
Compression of a cast
Cast Care and Traction
A cast that becomes too tight may cause
circulatory impairment or nerve
compression.
Signs of impaired circulation or nerve compression
- Pain
- Coldness
- Numbness
- Burning or tingling or fingers or toes
- Swelling
- Skin color changes (to a pale or bluish color)
- Inability to move fingers or toes
- Decrease in or absence of pulses
Radiographic images of patients who are in traction
require the use of the portable unit
must never be removed or pulled on
The traction device
ASSISTING THE PATIENT WITH A BEDPAN OR URINAL
- If possible, the patient to reach the lavatory near the examining room; this is the most desirable way to handle
the situation. However, do not allow the patient to go to the toilet without assistance. - If the can help him or herself in the lavatory, close the door and tell the patient that assistance is just outside the
door waiting if help is needed. - After the patient has finished using the lavatory, help him or her to wash hands is unable to do so.
- Accompany the patient back to the examination are and cover the patient to make him or her comfortable.
- Return to the lavatory and make certain that it is clean.
- The radiographer must wash his or her hands
If the patient is unable to clean the perineal area, the radiographer will have to do this
- Wear disposable gloves.
- Take several thickness of tissue and fold them into a pad. Wipe the patient’s perineum from front to back and
drop the tissue into the pan. * Cover the pan to take it to the bathroom and empty it. - Remove the gloves and wash hands correctly
made of plastic and is shaped so it can be used by a patient who is supine, lying on the right or left side, or in Fowler position
The male urinal
Procedure for patient in using male urinal
- If the patient is able to help himself, simply hand him an aseptic urinal and allow him to use it, providing privacy
whenever possible. - When he has finished, put on clean, disposable gloves, remove the urinal, empty it, and rinse it with cold water.
- Offer the patient a washcloth with which to cleanse his hands.
- Remove the clean glove and wash hands.
If a patient is unable to assist himself using the urinal, the radiographer must position the urinal for him.
- Put on clean, disposable gloves; raise the cover sheet sufficiently to permit adequate visibility, but do not expose
the patient unduly. - Spread the patient’s legs and put the urinal between them.
- Put the penis into the urinal far enough so that is does not slip out, and hold the urinal in place.
- Remove the urinal, empty it, discard it, remove gloves, and wash the hands.