Patient Positions and Transfers

Question 1

What is body alignment?

Answer 1

• positioning of the joints, tendons, ligaments, and muscles while standing, sitting and lying
• correct alignment reduces strain on the musculoskeletal structures, minimizes the risk of injuries and falls, aids in maintaining adequate muscle tone, and contributes to balance
• balance is enhanced with a wide base of support correct body posture and good centre of gravity

Question 2

What can body alignment be compromised by?

Answer 2

Disease, injury, pain, physical development, life changes, medication, prolonged immobility

Question 3

Conditions with potential for damage to the musculoskeletal system

Answer 3

Impaired mobility, decreased sensation, impaired circulation, lack of voluntary muscle control

Question 4

Lying position

Answer 4

• Supine
• Head is midline
• Shoulder and hips are straight and parallel
• Thighs are relaxed and legs are slightly externally rotated
• The ankles are slightly plantar flexed
• The arms lie at the sides with elbows and fingers slightly flexed

Question 5

Recumbent position

Answer 5

• side
• head and neck aligned without excessive flexion or extension
• only one pillow and no other supportive aids
• vertebrae is aligned
• extremities straight

Question 6

Sitting position

Answer 6

• head erect and midline
• vertebral column straight alignment
• body weight evenly distributed on buttocks and thighs
• thighs parallel and horizontal
• feet flat on floor
• arms resting (chair arms, in lap, or on table)
• 1-2 inches maintained in popliteal space
• patients with muscle weakness, muscle paralysis, or nerve damage alterations have diminished sensation in affected areas and may be unable to perceive pressure or decreased
• proper sitting reduces risk of musculoskeletal system damage

Question 7

Standing position

Answer 7

• head erect and midline
• body parts symmetrical
• spine straight with normal curvatures (cervical concave, thoracic convex, lumbar concave)
• abdomen comfortably tucked
• knees, hips, and ankles straight
• feet flat on the floor pointed directly forward and slightly apart
• arms hanging comfortably at sides

Question 8

Range of Motion

Answer 8

Used to assess the degrees of damage or injury to a joint

Question 9

What does testing ROM assess?

Answer 9

Joint stiffness, swelling, apin, limitation of movement, unequal movement

Question 10

What are the joint movements?

Answer 10

Flexion and extension
Hyperextension
Dorsiflexion and plantar flexion
Abduction and adduction
Eversion and inversion
Pronation and supination
Internal and external rotation
Circumduction

Question 11

What is immobility?

Answer 11

Inability to move about freely

Question 12

What is bed rest?

Answer 12

Intervention that restricts patients to remain in bed for therapeutic reasons
- prescribed by nurses
- usually indicated to:
reduce physical activity and oxygen demands, reduce pain, promotes safety for patients recovering post anaesthetics, allow ill, debilitated or exhausted patients to rest
- e.g. during pregnancy, post brain surgery, post heart attack

Question 13

What are systemic effects of immobility?

Answer 13

Metabolic Changes
- decreases metabolic rate, appetite and intake
- increased calcium respiration and bone loss
- decreased peristalsis in GI system
Respiratory Changes
- atelectasis
- hypostatic pneumonia
Cardiovascular Changes
- orthostatic hypotension
- increased cardiac workload
- thrombus formation
Musculoskeletal Changes
- loss of endurance
- decreased strength
- loss of muscle mass
- decreased stability and balance
- joint contractures (e.g. foot drop, frozen shoulder)
Urinary Elimination Changes
- urinary stasis, increased UTI risk
- decreased urine output
Integumentary Changes
- pressure ulcers
- ischemia

Question 14

What are psychosocial effects of immobility?

Answer 14

Decreased social interaction
Social isolation
Sensory deprivation
Loss of independence
Role changes
Depression
Behavioural changes (e.g. hostility, anxiety, fear)
Sleep-wake alteration
Affect coping patterns (e.g. withdrawal, passive)

Question 15

Prevention of immobility hazards

Answer 15

Positioning:

• supports: pillows, foot boots, trochanter rolls, hand rolls, sand bags, splints
• trapeze bar
• bed positioning: Fowler’s, supine, prone, side-lying, Sims’
• joints should be slightly flexed or mobility is decreased
• important to assess bony prominences

Question 16

How to assist patients with positioning and transfers

Answer 16

• requires proper body mechanics by the nurse to prevent injury
• use patient’s strength
• lift, rather than push or pull
• bend your legs, not your back
• avoid twisting - pivot
• keep object close
• use a widened stance with one foot slightly in front of the other
• coordinate with others, use momentum

Question 17

Supported Fowler’s

Answer 17

• head of bed 45-60 degrees
• knees slightly elevated without pressure
• support head, thighs, ankles, arms, lower back
• common problems: excessive neck flexion, knee hyperextension, pressure on back of knees, external rotation of hips, pressure on heels and sacrum, unsupported feet

Question 18

Supine

Answer 18

• elbows slightly flexed
• foot support to prevent foot drop
• trochanter and hand rolls
• problem areas: excessive neck flexion, elbows extended, hips externally rotated, unsupported feet, pressure points on occiput, vertebrae coccyx, elbows, and heels

Question 19

Prone

Answer 19

• thin pillow prevents neck extension

- ensure foot dorsiflexion

Question 20

Side Lying

Answer 20

• body weight on hip and shoulder
• 30 degrees side lying recommended for patients at risk of pressure ulcers
• support upper shoulder and hip to prevent internal rotation adduction
• pillow behind back

Question 21

Sim’s Position

Answer 21

• weight on anterior ilium, humerus, clavicle
• support upper shoulder and hip
• pillow on plantar surface of foot

Question 22

General Transfer Guidelines

Answer 22

• raise opposite side rail
• elevate bed to comfortable working height
• obtain assistance from other nurses
• explain procedure to patient and what they need to do
• assess body alignment and pressure areas after transfer
• use mechanical lift if necessary

Question 23

Assessment Prior to Patient Transfer

Answer 23

• LOC (comprehension, communication, cooperation)
• Muscle strength in legs and upper arms
• Pain
• Vital signs and orthostatic hypotension
• Sensory status: hearing, vision, sensation
• Rand of motion
• Level of aggression
• Mobility and balance
• Environment, equipment, personnel

Question 24

Requirements when moving patient up in bed

Answer 24

• 1 nurse child, 2 for adult
• remove all pillows
• ask client to fold arms on chest
• nurses face head of bed
• place hands under shoulder and thigh
• feet apart, one foot slightly behind the other
• patient flexed knee and neck
• count of 3: patient pushes back with heels, nurses rock and shift weight from back to front of leg

Question 25

Moving patients up in bed with a drawsheet

Answer 25

• drawsheet extends from shoulder to thighs
• hold sheet palms up
• feet apart, knees flexed
• count of 3… lift forward

Question 26

Assisting patients to sit up

Answer 26

• face bed at 45 degrees
• place hand under shoulders and one on bed
• raise patient by shifting weight from front to back leg
• push against bed surface

Question 27

Moving patient to sit up

Answer 27

• turn patient on side
• elevate head of bed to 30
• face foot of bed at 45
• foot closer to head in front
• one arm under shoulder and other over thighs
• shift weight to rear leg, elevate patient’s body

Question 28

Transfer from bed to chair

Answer 28

• patient must be able to help
• use transfer belt
• support patient’s weaker leg
• flex hip and knees
• rock patient back and forth, then lift and pivot towards chair
• patient must touch back of chair with knees and reach for armrest
• assess alignment and position once seated