Transfers and Body Mechanics

Question 1

Why do we need to transfer a patient

Answer 1

Permit them to function in new environment
Allow access to equipment
Allow for ADLs
Inc level of independence

Question 2

Guidelines

Answer 2

Pt and PT safety must not be compromised
Pt must be informed
Therapist at pt head is in charge
Plan ahead
Adjust bed to convenient height
Lock wheels
Use gait belt
Transfer toward strong side
Recheck equipment
Perform transfer
Assure pt safety in new position
Reasses entire transfer

Question 3

What is meant by body mechanics

Answer 3

How you move
The use of one’s body to produce motion that is safe, energy conserving anatomically and physiologically efficient and maintains the bodys balance and control

Question 4

Body mechanics and lifting -

Answer 4

Reach level by bending hips and knees - NOT back
Lift with legs using quads and glutes
Keep load close
Maintain good base of support
DO NOT lift and twist - move feet instead

Question 5

Types of lifts

Answer 5

Deep squat
Power lift
Straight leg lift
Golfers lift
Half kneel lift
Traditional lift
Stoop lift

Question 6

Deep Squat

Answer 6

Hips below the knees

Not used that often

Question 7

Power lift

Answer 7

Not common unless fucntional for pt
Load is higher and hips are above the knees
Extending knees and hips and lifting load at same time

Question 8

Straight leg lift

Answer 8

lighter loads

Question 9

Golfers lift

Answer 9

To get down to pick up a small object
One leg straight and back leg kicks out a little
keep back stright

Question 10

Half kneel lift

Answer 10

Keeping load close the entire time
Lighter loads
No knee problems

Question 11

Traditional lift

Answer 11

Hips are parallel with knees

Start to lift a little and then extend knees and hips to lift the rest of load

Question 12

Stoop lift

Answer 12

Bend down with back straight and then go ahead and extend legs while keeping arms straight
Picking something up at side

Question 13

Equipment considerations

Answer 13

1. Proper bed height

2. Wheelchair (armrests, foot rests, locks/brakes, position)

Question 14

Proper bed height - bed to chair.. the chair should be

Answer 14

an inch or two below the bed height

Always want to transfer to a lower surface

Question 15

Position of chair transfering to

Answer 15

You want it at a 45 degree angle to the bed and almost touching the bed

Question 16

Components of proper posture and body mechanics - Standing

Answer 16

Weight is equally distributed btw the feet, look at spine and make sure it is straight
If pt is standing for a long time it is ok to have them place one foot on a stool or something but they need to keep hips neutral

Question 17

Components of proper posture and body mechanics - Sitting

Answer 17

Hips at 90
Knees at 90
Elbows should be at 90
Wrists can be in slight extension
Monitor needs to be 10 degrees below eye level

Question 18

Components of proper posture and body mechanics - lying down

Answer 18

Pillows - just enough to take up space behind neck
Should have pillows under their knees (if side, btw knees with knees flexed a bit and pillow to fill space btw shoulder and head and spine in neutral)

Question 19

Safe patient handling and movement

Answer 19

OSHA recommends manual lifting of patients and residents be minimized in all cases and eliminated when feasible - ZERO lift policy
If patient isn’t helping you, you need to get a manual lift

Question 20

Types of transfers

Answer 20

Dependent
Assisted
Independent

Question 21

Dependent Transfer

Answer 21

Minimal to no assistance from patient
Recumbent Draw Sheet (slide)
Recumbent Three person lift/carry
Dependent stand-pivot
Hydraulic Lift (Hoyer Lift)

Question 22

Assisted Transfer

Answer 22

Requires patient participation
Two person lift
Stand-pivot
Slide board
Sitting assisted lateral lift transfer

Question 23

Independent

Answer 23

Stand-pivot
Sliding board
Sitting lateral/push up

Question 24

Draw sheet slide

Answer 24

dependent 
Can you chuck pads or draw sheet
Need at least two people
shoulder and mid thigh
Someone count to pull tight
Someone count to slide up/down
Pt should cross arms
If patient can lift their head, have them do it - if not then need to have sheet higher up to protect head

Question 25

Slide boards

Answer 25

dependent Put it under sheet and have it over the two beds Do not ever leave the board under the patient

Question 26

Recumbent three person carry

Answer 26

Dependent Person at head is the counter Everyone have hands under the patient and if patient can lift head, have them - if not person needs to be at head Strongest or tallest usually at head

Question 27

dependent stand pivot transfer - from chair to bed

Answer 27

Have them scoot forward in chair - or you get them more forward If they can push from chair - let them, if not you need to stand them up (gait belt) Make sure both legs touching ground if can, pivot and then sit - take off belt and lay down

Question 28

Hoyer lift

Answer 28

Dependent Used only when patient can literally do nothing Now some people use it to help lift people so that they can do more activity

Question 29

Two person lift (from chair to bed)

Answer 29

Assisted Chair is parallel to the bed - need chair without arm rests Pt puts arms across chest person in back can put hands on gait belt or around the patient Count to three, take step and move over the chair

Question 30

Assisted Stand - chair to bed

Answer 30

Same as other but less dependent on therapist helping

Question 31

Slide Board

Answer 31

Assisted Used for highly functioning neuro, maybe with poor balance Place board from chair to bed and they slide Going from high to low

Question 32

Sitting Lateral Lift Transfer - chair to bed

Answer 32

For more independent, WB on both legs Lift buns up a little, move over and sit down Best with chair w/o arm rests

Question 33

You just received an order for transfers and gait training on a patient in acute care hospital, what do you do?

Answer 33

Make sure they have an order in the chart | Think about their disease process, if you need assistive devices, how independent are they, make sure they are oriented

Question 34

What do we need to look at with chart review

Answer 34

``` Diagnosis WB status Vitals O2 sat HgB (NOT below 8) White count Pain level and if taking meds - work with them 30 min to an hour after having taken pain med ```

Question 35

Walking into the room - what do you need to be aware of

Answer 35

You need to have your gait belt and any assistive devices | Look to see where everything is - IV poles, bed, chair, catheter, foot wear, take in an extra gown too just in case

Question 36

Treatment

Answer 36

Bed mobility | Transfers

Question 37

Tx - Bed mobility

Answer 37

Have them show you how they move Moving up in bed Moving side to side - have them cross one arm over and other above head, one leg crossed over other, remove glasses, turn head to side going to

Question 38

Tx - transfers

Answer 38

Supine to sit | Sit to stand - feet flat on ground

Question 39

Upone completion of transfer what do you do

Answer 39

Reasses | Did it go well, do you need o simplify, assistive device

Question 40

Documentation of functional activity

Answer 40

``` assistance level how many people what positions how did they respond to cues how many times did they transfer assistive device or no Nursing was notified that patient is now safely in the chair with call light in hand or whatever Document that you used a gait belt too ```

Question 41

Special Considerations

Answer 41

``` Paraplegic/quadriplegic Hemiplegics Burns THR Non WB transfers Amputees ```

Question 42

Paraplegic/Quadriplegic

Answer 42

Need o be focused on skin because they wont tell you if something hurts Will be more dependent Educate family or care givers Make sure no wrinkles in sheet

Question 43

Hemiplegics

Answer 43

Challenged on how many cues can be used and understood Transfer to strong side to begin with Will need to log roll

Question 44

Burns

Answer 44

Be aware with transfers because dont want to shear skin

Question 45

THR

Answer 45

ELbows and then hands to get up, may or may not need to have shoulder back

Question 46

Nonweightbearing transfers

Answer 46

Transfer to non involved side because they are Non WB on other side Make sure they have good footwear Always put involved leg into rest first

Question 47

Amputees

Answer 47

Pillows are crucial Always want a flat pillow - putting them into any flexion at knee could cancel them from getting a prosthesis because of contractures