Safe patient handling Flashcards
normal movement and alignment (normal is CPR B)
- Body Alignment or Posture
- Balance
- Coordinated Body Movement
- Postural Reflexes
Alignment of body parts permitting optimal musculoskeletal (MSK) balance (don’t stress, it’s ergonomics)
Postures that do not put undue stress on muscles and joints
while maintaining balance
• Apply ergonomics
Ergonomics - definition (ergo, I prevent injury)
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The practice of designing equipment and daily work tasks to prevent injuries.
Ergonomics - details (ergonomic posture takes habit, time, Sarah, and limits. Help!)
➢ Use proper body mechanics and maintain good posture
➢ Develop safe habits
➢ Take the extra time
➢ Use lift equipment - Sarah Steady
➢ Recognize your body’s limitation
➢ Ask for help
always ask and report (ask if you’re mobile)
mobility
always squat because
you’re using your strongest muscles and keeping your center of balance
Applying Ergonomics to Prevent Back Injuries (EBCCPL) (and what about the knees)
➢Practice erect posture
➢Use biggest muscle groups for strenuous tasks
➢Engage core muscle, e.g. abdominal muscles
➢Bring heavy objects close to body and use legs to lift instead of back
➢Push instead of pull heavy objects
➢Avoid locking knees when standing
Balance - Achieved when the body is in (balance ballet)
correct alignment
• Line of gravity must pass through the base of support
• Center of gravity is close to base of support
• Use a broad stance to lower the center of gravity
balance impacted by
disease, inner ear, pain meds, aging
Coordinated Movement (bones, joints and skeleton, oh my! )
Coordinated Movement
Using the skeletal muscles, bones, and joints in coordination
to produce a purposeful movement:
• Bones serves as the levers
• Joints serve as fulcrums for the levers
• Skeletal muscles are the force that produce movement
postural reflexes (maintains posture using msk and cns - easy)
Group of reflexes which :
a) Maintains body position and equilibrium
b) Integrates the MSK and central nervous system (CNS) to
coordinate movement and maintain balance
postural reflexes - labyrinthine sense
Labyrinthine sense: Sensory organ in the inner ear that provides sense of position, orientation, and movement
inner ear has crystal rocks and as they touch the cilia message sent to brain about our direction.
body mechanics - the evidence (35 and 1/3)
Occupational musculoskeletal disorders (MSD’s) are the leading and most costly work related health problems
• 1/3 of nurses have back problems !
• Education and proper use of body mechanics alone will not prevent occupational injuries
• Fitness does not eliminate risk of injury
• Health care facilities are focusing on no lift policies
• Assistive devices should always be used to lift a weight > 35 pounds
patient transfer involves what 2 things? (AP) how to plan a move…
assessment and planning
Assessment: safe patient transfer - know the patient (diagnose Wald’s limitations, weight bearing, and devices)
diagnosis, physical limitations, weight bearing restrictions, assistive devices
Planning: safe patient transfer (pre-med, choose equip, how many staff, clutter, instructions)
➢Pre-medicate for pain if necessary
➢Decide on equipment to use if any
➢Appropriate number of staff to assist with transfer (move a 400 lb person)
➢Clear area of clutter
➢Clear instructions to patient and other personnel
prn
as needed
Passive and active ROM
Active ROM – Movement of a joint by an individual without assistance
Passive ROM – Movement of a joint with the assistance of another person
Isotonic exercises (need a tonic after regular workout)
muscle shortening and active movement
• Ex: lifting a weight
• Benefits: increase muscle mass, tone, strength, CV health and bone mass, joint mobility, flexibility.
isometric exercise (my metric hands contract but don’t shorten)
muscle contraction without muscle shortening
• Ex: keeping arm extended or contraction of ab muscles while seated
• Benefits: increase muscle mass, tone, strength
ie pushing hands together - still using the muscle but nothing move
Isokinetic exercise (kinetic knee device)
muscle contraction with resistance
• Ex: use of Continuous Passive
Motion (CPM) device after knee surgery
even amount of resistance entire time
Flexion (flex the elbow)
Decreasing the angle of the joint (bending the elbow)
Hyperextension
Hyperextension Further extension or straightening of a joint (bending the head
backward)
Abduction
Movement of the bone away from the midline of the body
can’t do this with hip surgery
Adduction (adding to my body)
Movement of the bone toward the midline of the body
can’t do this with hip surgery
Pronation (put down pro nation)
Moving the bones of the forearm so the palm of the hand faces downward while held in the front of the body
Supination
Moving the bones of the forearm so the palm of the hand
faces upward while held in the front of the body
passive ROM (coma or restrained)
Purpose: To maintain joint mobility
• Performed on people who have no or very limited mobility• spinal injuries
• post stroke
• sedated or coma state
• Important to support the limb above and below the joint
• Use smooth, slow, and rhythmic methods
• Avoid forcing beyond existing ROM
complications of immobility - cardiovascular (just 2 things - ortho and DVT)
Cardiovascular System
○ Orthostatic hypotension
○ Venous stasis (DVT)
Complications of Immobility● Metabolic Process (Nitro wastes muscle and becomes anorexic)
Negative nitrogen balance Resulting from ↑metabolic demand from acute illness (catabolic protein breakdown)
■ Muscle wasting
■ Anorexia and decreased nutrition
complications of immobility Gastrointestinal System (you’re eating and not moving…)
Slow GI motility → constipation
○ Increased nutrition with low energy expenditure may lead to weight gain
○ Low appetite, alter protein metabolism, and poor digestion
complications of surgery - Urinary System (AND, what else)
Urinary stasis leads to risk of UTI and renal calculi (kidney stones, bitches)
complications of surgery - skin and social isolation
Pressure Injuries
● Psychosocial
○ Social isolation, poor coping, depression, sleep disturbance
Fowlers: High Fowler’s (what angle and when is it ideal)
● High fowler’s (HOB 90°)
○ Ideal for respiratory distress and when eating
Semi fowlers (semi TV and breath easy)
HOB 45°
○ Ideal for TV watching, respiratory comfort
Trendelenberg (Tu wants the trendel and what type of bp)
○ manages Hypotension
○ Avoid in patient with increased intracranial
pressure
Supine - when to use?
lying down face up
○ Risk for aspiration
○ Use when patient becomes hypotensive
Prone (prone to face downward) (think of covid respiratory post)
○ Avoid post abdominal surgery or drains on abdomen
○ Intervention for patients in severe respiratory distress
Sim’s position and Lateral position: (sim needs an enema)
○ Avoid post abdominal surgery or drains on abdomen
○ Position for administering enemas
Fowlers: repeat
● High fowler’s (HOB 90°)
○ Ideal for respiratory distress and when eating
Semi fowlers (HOB 45°)
○ Ideal for TV watching, respiratory comfort
Trendelenberg
○ Hypotension
○ Avoid in patient with increased intracranial
pressure
Physical restraints
• Physical devices designed to restrict a person’s movement
• Means of last resort to protect patient from harming self or others
• Always use the least restrictive form of restraint
Chemical Restraints: (chemical restaint HAS the best)
Drugs used to alter a
person’s behavior
• Ativan
• Haldol
• Seroquel
Federal Guidelines - restraints
• Employed ONLY after all other means of ensuring safety have been unsuccessful
• Discontinue as soon as no longer necessary
• Know facility policy and procedure
• PRN restraint orders are prohibited (Pro Re Nata=as needed)
• Must be documented and reordered according to policy
• Having all 4 side rails up are restraints (except under certain circumstances)
Alternatives to restraints (talk, relax, check, arm chairs, apron, companion)
Verbal interventions : reality orientation and reassurance
Relaxation techniques
Frequent monitoring
Bed /chair alarms
Camouflaging - Apron
Comfort measures
Companionship/safety attendants (Coaches)
Use of restraints must meet one
of the following objectives:
• Reduce the risk of falling
• Prevent interruption of therapy
• Prevent removal of life-supporting equipment
• Reduce the risk of injury to self/others
restraint negative outcomes (negative outcome, SAIDDD C)
● Depression
● Delirium
● Skin breakdown
● Contracture (muscle breakdown)
● Anxiety
● Incontinence
● Risk for sentinel event: Injury or Death
violent/behavior restraint - how often to monitor and when to notify MD?
• Violent aggressive behavior
• 1:1 observation, monitoring at all times
• RN to notify MD within 1 H of application
• MD to complete order within 1 H of
application
non-violent restraint - how quick to notify MD? (not that fast for non-violent)
• Document justification and safety q2h
• RN notifies MD ASAP or within 12 H for order
• MD to complete assessment and document within the next calendar day
• Renew q24h; assessed by treating MD
assessment of restraints
✔ Limbs for adequate circulation
• ✔ Skin integrity under restraint
documentation for restraints (reason, type, removal, alternatives, education, document, assessment of skin, etc)
• Justification
• Type of restraint
• Criteria for removal
• Skin care/assessment
• Alternatives attempted
• Patient/family education
• Documentation must match order
• Condition of extremities, including circulation, sensation, ROM
screen risk for fall (yellow)
• Risk for Fall sign outside door
• Yellow armband on patient
• Yellow socks on patient
• Bed in lowest position
• Call light within patient reach
• Tray table within reach
• Bed/chair alarm on
• Clutter free room
postural reflexes - proprioceptor or kinesthetic sense
When joints move, special nerve endings in the muscles, tendons, and fascia are stimulated providing information to the brain about the location of the body part
helps us understand our body position
postural reflexes - visual or optic reflexes
Provides spatial information to the brain (allows eyes to know if something is up or down, even if we move head)
visual reflex allows eyes to know if something is up or down no matter what direction our head is pointing
postural reflexes - Extensor or stretch reflexes (ex of one that skips the brain)
When an extensor muscle is stretched beyond its limit, signals contraction of the muscle (this skips the brain - knee jerk) - THIS ONE SKIPS the brain - ex is knee jerk
assessment - safe patient transfer - mobility
➢Assess patient’s ability to assist with planned mobility
assessment - safe patient transfer - readiness (DIP into readiness)
➢Assess patient readiness: fears of pain, injury, drowsiness
assessment - safe patient transfer - mobility
assess patient’s ability to assist with planned mobility
balance impacted by…
disease, injury, pain, medications, physical development, and life changes, inner ear.
complications of immobility - respiration (vent, secrete, collapse)
Decreased ventilatory effort (e.g. decreased respiratory depth and rate)
○ Increased respiratory secretions
○ Complications include atelectasis and pneumonia
complications of immobility - muscular (think muscles, joints, and bones)
○ Muscle atrophy
○ Decreased joint mobility and flexibility (contractures and foot drop)
○ Bone demineralization
○ Reduced activity endurance
considerations for high fowlers - not always good
○ exaggerated curvature of spine
and slumping which can impede expansion of
lungs
○ Shearing can cause skin break down
○ Risk for hypotension in critically ill patients
monitoring of restraints - offer….
• Offer fluids/food (as appropriate) and opportunity for toileting
• Allow and supervise patient to perform active ROM exercise (if safe to remove restraints); or provide passive ROM (if unsafe to remove
restraints)
• Reposition to prevent pressure injury
• Temporary removal for reasons above does not equal discontinuing order and does not need renewal
considerations for restraints
• Assess physical and psychological status and comfort
• Provide emotional support
• Consider alternatives to help patient meet behavior criteria for
discontinuing restraint
renewing restraints (and what NEVER to do)
• Renewed according to need: “violent vs non-violent”
• Renewed according to age of person being restrained
• Restraints may be applied in an emergency before an order
• Never written as PRN (“as needed”)
• Face To Face : violent restraints (ages and times)
• Face To Face :
• ≥ 18 yrs of age, q8h
• ≤ 17 yrs of age, q4h
renewal of violent restraints (ages and times)
• ≥ 18 years, q4h
• 9-17 years, q2h
• < 9 years, q1h
do bones benefit from isometric exercises?
nope
• Having all 4 side rails up are restraints unless the patient:
• Is being transported
• To keep equipment secure in bed
• Seizure precaution
• Requested by person to aid in mobility in/out of bed
(person must be able to lower rail independently)
• Temporary restraints for a medical procedure is…
not considered a “restraint”
lordosis
sway back
non-violent restraints - how often to document justification and safety?
every 2 hours
falls are what type of event?
a never event
documentation needs to follow whose standards?
the joint commission
Document which specific health care provider was notified of which
specific concerns at what specific time.
telephone orders have to be signed how quickly?
within 24 hrs.
