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NUR350 Midterm > SPHM and Mobility > Flashcards

SPHM and Mobility Flashcards

1
Q

Nurse and Patient Safety SPHM

A

Nurse
- MSK injuries

Patient

  • Falls
  • Pressure ulcers
  • De-conditioning
  • Functional decline
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2
Q

Risk factors for nurses getting hurt

A
  • Previous history of back pain
  • Lack of personal physical conditioning
  • Stress
  • Not taking the time to obtain help
  • Slippery or wet surfaces
  • Uneven floor surfaces
  • Physical obstructions
  • Small spaces
  • Uneven work spaces
  • Staffing levels
  • Patient assignment
  • Availability of equipment
  • Reaching and lifting loads far from the body
  • Heavy loads
  • Twisting while lifting
  • Changes during lifting
  • Frequent lifting
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3
Q

Body Mechanics

A
  • The coordinated efforts of the musculoskeletal and nervous system to maintain balance, posture and BODY ALIGNMENT during lifting, bending, moving, and performing ADLs
  • Not sufficient to protect the nurse from the heavy weight, awkward positions, and repetition involved in manual handling
  • Safe manual handling techniques must be used in combination with equipment and technology for safe patient handling and movement
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4
Q

Ergonmics

A
  • “Fitting the job to the worker”
  • Concerned with designing and arranging workplace settings in such a way that people interact more effectively with the objects they encounter in that environment
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5
Q

Lifting Risks

A
  • Always use specialist equipment to prevent manual handling injuries
  • Patients can be awkwardly shaped, hard to hold, patient can be unpredictable
  • Nurses get hurt when they don’t ask for help when it is needed
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6
Q

Principles of Safe Client Handling

A

1) Ask for help
- One who is loading the heaviest part is the one coordinating
2) Use patient transfer devices to assist
3) Encourage the patient to assist
4) Position yourself in close proximity to the patient
- Minimize the amount of reaching you’re doing
5) Tighten core muscles and keep back, neck, pelvis and feet aligned
6) Avoid twisting
- Keep the work in front of you, when not possible keep toes in the direction you are going
7) Bend at the knees and keep your feet wide apart
8) Use your arms and legs; NOT your back

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7
Q

SPH Programs

A
  • Patient assessments and algorithms
  • Proper equipment (SPH aids)
  • Resource nurses (sometimes) or lift team
  • Staff training
  • Minimal or no-lift policies
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8
Q

SPH Aids

A

They bear most of the load and reduce friction on the skin

  • Mechanical lifts; Hoyer lift, ceiling lift
  • Transfer board
  • Transfer belt/Gait belt
  • Stand-assist device
  • Trapeze bar
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9
Q

Mechanical Lift

A

Hoyer Lift

  • Portable lift that bears the client’s load
  • Manually or battery operated
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10
Q

Transfer Board

A
  • Used to help move patients between a bed and a stretcher or two beds
  • Works to reduce friction
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11
Q

Transfer Belt/Gait Belt

A
  • Anytime we’re walking a patient
  • Also used for transfer where the patient can bear some weight
  • Always want to put on over clothing
  • Buckle doesn’t go on patient’s spine
  • Reasonably snug
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12
Q

Stand-assist Device

A
  • Electronic device that helps the client from sitting to standing
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13
Q

Trapeze bar

A
  • Used to help the patient reposition themselves and the help them get up out of bed
  • Seen on orthopedic units
  • Also used to do therapy activities
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14
Q

Key Considerations for Transfer Techniques

A

1) You
- Do you have any injuries or issues that will interfere with your ability to transfer the client safely?
2) Your client
- What is their physiological capacity to assist?
- What is their cognitive status?
- What is their height/weight?
- Do they have dressings, tubes, etc?
- Do they have a history of falls?
3) The environment
- Is there enough space?
- Are there any barriers preventing safety?
- Do you have the correct equipment
4) Your team
- Do you have enough help?
- Do team members understand their roles?

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15
Q

How to put safety first when transferring patient

A
  • Gather appropriate equipment
  • Ensure that you have the assistance required
  • Perform hand hygiene
  • Ensure that bed breaks are ON
  • Explain procedure to patient
  • Ensure patient is wearing non-slip footwear of standing
  • Allow patient to DANGLE at side of bed prior to standing or transferring (for around 1min)
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16
Q

Types of Bed to Chair Transfers

A

One or two person assist

  • Patient comes to a full upright stand and either pivots or takes small steps to reposition self in front of new surface
  • If patient hasn’t been up out of bed yet, make sure you take a baseline BP before attempting to get up
  • First thing you want to do is assess the situation for potentially unsafe conditions
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17
Q

Side Effects of Mobility

A
  • Decreased metabolism
  • Weight loss, muscle wasting
  • GI disturbances
  • Atelectasis (collapse of alveoli)
  • Pneumonia
  • Orthostatic hypotension; drop of more than 20mmHg in systolic or 10mmHg diastolic within 3mins of standing
  • Increased cardiac workload
  • Thrombus/emboli
  • Disuse atrophy
  • Contractures; i.e. foot drop
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18
Q

Active ROM

A

Is able to move all joints through ROM independently

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19
Q

Passive ROM

A

Nurse moves joints through ROM

  • Begin exercises as soon as possible
  • Assess patient’s ability to participate
  • Movements should be slow and smooth
  • Support limb above and below joint
  • Each movement should be repeated five times during the session
20
Q

Ambulating Clients

A
  • Early ambulation important; decreases length of stay
  • Assess the patient (e.g. vital signs, strength, coordination, balance and pain)
  • Assess the environment for safety
  • Proper footwear
  • Allow patient to sit at side of bed for 1-2mins
  • Support patient at the waist (patient’s centre of gravity is midline)
  • Use assistive devices if necessary
21
Q

Ambulation Equipment - Walker

A
  • Top should be aligned with wrist crease and elbows should be resting at 45 degree angle
22
Q

Ambulation Equipment - Cane

A
  • Less stability than a walker
  • Traditional cane; want the level to be at the patient’s greater trochanter, on patient’s stronger side
  • Quad cane; similar to tradition but has 4 feet on it
23
Q

Ambulation Equipment - Crutches

A
  • Axillary crutches vs forearm crutches
  • 2-3 finger lengths below the axilla, patient’s elbows flexed at 20-25 degrees
  • Forearm crutch is 20-25 degrees flexion in elbows, cuff is 2.5cm below the elbow crease
24
Q

What is a pressure injury/ulcer

A
  • Localized damage to the skin and/or underlying tissue as a result of prolonged ischemia (decreased blood flow)
  • Compounded by other forces such as friction and shear that occur with movement
25
Q

Bony Prominences (Pressure Points on the Body)

A

Greatest risk of forming pressure injury sites include:

  • Elbows
  • Hips
  • Shoulder blades
  • Ankle bones
  • Sacrum
  • Knees
  • Heels
26
Q

Friction

A
  • Force that occurs in a direction opposing movement

- Affects top layer of skin (shallow)

27
Q

Shear

A
  • Force exerted against the skin while the skin remains stationary
  • Tissue damage (necrosis) is deep
28
Q

Prevention of pressure ulcers/injuries

A
  • Maintain good body alignment
  • Change the patient’s position while in bed (q2Hr)
  • Use positioning devices to protect bony prominences
  • Joints should be slightly flexed
  • Position extremities to avoid skin-to-skin contact
  • Keep bed clean, dry, and wrinkle free
29
Q

What can improper positioning in bed lead to?

A
  • Improper position can lead to contracture
  • A permanent shortening of the muscles and eventually the ligaments and tendons
  • Braden scale; predicts pressure ulcer risks
30
Q

Devices for Positioning

A
  • Pillows
  • Wedges (abduction) Pillow
  • Foot Boot; keeps foot flexed at proper angle, prevents foot drop and helps keep the weight of the sheets off the toes
  • Trochanter Roll; can be made by rolling blanket and putting under patient
  • Sandbags
  • Hand Rolls; maintain adduction (towards midline) and meant to prevent hand contractures, mostly for patients who are paralyzed of unconscious
  • Hand-wrist Splints
  • Trapeze Bar
31
Q

Fowler’s Position

A
  • Head of bed is usually 45-60 degrees
  • Semi-Fowler is between 30-45 degrees
  • High Fowler is 60+ degrees
  • Good for meal time, difficultly breathing, socializing, trachea tube
32
Q

Supine Position

A
  • Lay flat on back; note there are special supports to put in place to support limbs
  • Used for transfers, sleeping, CPR, lumbar puncture
33
Q

Prone Position

A
  • Face down on the bed, head turned to one side or the other
  • Used for acute respiratory distress syndrome or potentially burn victims, used in NICU for vital sign regulation and digestion
34
Q

Side-lying Position

A
  • Lateral position

- Used for C-sections, hygiene measures, surgery measures

35
Q

Sim’s Position

A
  • Similar to side-lying but weight is on shoulder and collar bone
  • Mouth care for the unconscious client; promotes drainage out of the mouths; administering edemas and rectal temperatures
36
Q

30 Degree Side Lying Position

A
  • Using this for patients who are at risk for pressure ulcers and injuries
  • Least amount of pressure on the greater trochanter
  • Often head is raised as well to about 30 degrees
37
Q

Support Surface

A
  • Specialized device for pressure redistribution designed for management of tissue loads, microclimate and other therapeutic functions
38
Q

Types of Support Surfaces

A

1) Low-air loss
- Pressure redistribution; provides air flow to manage heat and humidity from the skin
- Prevention of skin breakdown
2) Non-powered
- Pressure redistribution; air moves with body position
- Prevention of skin breakdown
3) Air-fluidized
- Pressure redistribution via fluid substances
- Prevention of skin breakdown and for patients with excessive moisture

39
Q

Body alignment/posture

A
  • The positioning of the joints, tendons, ligaments, and muscles while standing, sitting, and lying.
  • Being in correct body alignment means that the individual’s centre of gravity is stable.
  • Correct body alignment reduces strain on musculoskeletal structures, minimizes the risk of injuries and falls, aids in maintaining adequate muscle tone, and contributes to balance.
40
Q

Bed rest

A

Bed rest is an intervention that restricts patients to bed for therapeutic reasons. The general objectives of best rest are as follows:
• To reduce physical activity and the oxygen needs of the body
• The reduce pain, including postoperative pain, and the need for large doses of analgesics
• To promote safety for patients recovering from the effects of anaesthetics or who are sedated
• To allow patients who are ill or debilitated to rest
• To allow patients who are exhausted the opportunity for uninterrupted rest

41
Q

Impaired physical mobility

A
  • Impaired physical mobility is defined as a state in which the individual experiences or is at risk of experiencing limitations of physical movement.
  • Alterations in the level of physical mobility can result from prescribed restriction of movement in the form of bed rest, physical restriction of movement because of external devices (i.e. a cast of skeletal traction), voluntary restriction of movement, or impairment of motor or skeletal function.
42
Q

Hazards of immobility

A

Metabolic changes;

  • metabolism becomes slower, causing GI disturbances;
  • weight loss, decreased muscle mass and weakness
  • change in calcium resorption, hyperglycemia

Respiratory changes;

  • atelectasis (collapse of alveoli)
  • hypostatic pneumonia (inflammation of lungs from stasis or pooling of secretion)

CV changes;

  • Orthostatic hypotension
  • Increased cardiac workload
  • Thrombus formation

MSK changes;

  • disuse atrophy
  • impaired calcium metabolism
  • joint abnormalities

Urinary changes;

  • Urinary stasis, increased UTI risk
  • dehydration, kidney stone risk

Integumentary changes;
- Pressure ulcers

43
Q

Tissue Ischemia

A
  • Reduction in blood flow
  • Can occur if the pressure applied over a capillary exceeds the normal capillary pressure and the vessel is occluded for a prolonged period of time
  • Can result in tissue death is the patient has decreased sensation and thus does not have the cue of discomfort to prompt shifting (off-loading) pressure
44
Q

Blanching

A

Occurs when the normal red tones of light-skinner patients are absent. Does not occur in patients with darkly pigmented skin

45
Q

Shearing force

A
  • Shear is the force exerted parallel to the skin and results from both gravity pushing down on the body and resistance (friction) between the patient and a surface
  • When a shear is present, the skin and subcutaneous layers adhere to the surface of the bed, while layers of muscle and the bones side in the direction of body movement
  • The underlying tissue capillaries are stretched and angulated by the shear force; as a result, necrosis occurs deep within the tissue layers, causing undermining of the dermis.
46
Q

Friction

A
  • Is the force of two surfaces moving across one another, such as the mechanical force exerted when skin or dragged across a coarse surface such as bed linens
  • Unlike shear injuries, friction injuries affect the epidermis, or top layer of the skin
  • The denuded skin appears red and painful and is sometimes referred to as a “sheet burn”
  • A friction injury occurs in a patient who is dragged over the bed surface instead of being lifted slightly during position changes

NUR350 Midterm (11 decks)

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