Transfers and Level of Assist Flashcards
Definition of Transfer
Safe movement of a person from one surface, location, or position to another
What is our primary responsibility?
To guard and protect the patient (CPI criteria # 1) and to avoid injury to yourself
7 Levels of Assistance
- Dependent of Total Assist
- Maximal Assist
- Moderate Assist
- Minimal Assist
- Modified Independent
- Contact Guarding
- Standby / Supervision Assist
Abbreviation for Dependent
D
Abbreviation for Maximal Assist
max (A)
*( ) denotes circle
Abbreviation for Moderate Assist
mod (A)
Abbreviation for Minimal Assist
min (A)
Abbreviation for Modified Independent
Mod (I)
Abbreviation for Contact Guarding
CGA
Abbreviation for Standby / Supervision Assist
SBA
Describe Dependent
These patients require total assistance form one or more persons to accomplish the activity safely
Describe max (A)
Patient performs less than 49% of activity. Assistance is required to complete activity
Describe mod (A)
Patient performs 50-74% of activity. Assistance is required to complete activity
Describe min (A)
Patient performs 75% or more of activity. Assistance is required to complete activity
Describe Mod (I)
The patient is able to perform task independently but must use some type of adaptive or assistive equipment or requires additional time
Describe CGA
A caregiver is positioned close to the patient with hands on the patient or gait belt and protection required during activity
Describe SBA
Verbal or tactile cues, directions, or instructions are required from a caregiver positioned close to patient, but they are not touching the patient while they are performing the activity
How would you document a pt who is able to walk independently for the most part but a caregiver still has a hand on the gait belt?
Patient ambulated with walker with CGA
What are verbal cues?
Verbal or tactile cues, directions, instructions or set-up required from caregiver but patient is able to perform activity without direct assist
Describe Independent
Patient can perform transfer without any type of verbal or manual assistance and they do not take an abnormal amount of time to perform task
When preparing for a transfer what are the 4 steps you should take?
1) Inform the pt
2) Demonstrate the transfer
3) Safety precautions
4) Use of proper equipment/assistance
Before you perform the transfer what are the 7 steps you should take?
1) Prepare the patient with proper footwear and any other necessary clothing
2) Plan the transfer across the shortest distance and move any obstacles
3) Prepare yourself
4) Prepare anyone assisting you
5) Review the medical chart
6) Interview the patient
7) Mentally prepare sequence of activities
such as position of equipment, operator of the equipment, position of patient’s body, and movements required
How do should you decide an appropriate transfer technique?
- Your evaluation, including patient experience and physical ability
- The medical record information available
Information from the patient - Goals of treatment
- Complicated transfers may require practice of component parts first
What should you do during the transfer?
1) Check the pt’s chart for precautions such as wt-bearing status, postsurgical restrictions, joint disease, or osteoporosis
2) Use brief, concise one-step commands/instructions
3) Encourage maximal mental and physical participation
4) Use proper body mechanics
5) Perform a safe and efficient transfer
What do you need to stabilize on the pt while performing the lift?
- Knees
- Pelvis
- Upper Thorax
6 Safety Concerns in Transfers
1) Ensure proper shoes are being worn
2) Gait belt
3) Be alert to the unexpected
4) Best position for caregiver: in front or slightly to the side?
5) Secure lap belt, bedrail, or other protective devices after transfer
6) Environment free of unnecessary equipment
What are the special precautions for THR?
Avoid a deduction (across midline), rotation in general, and be careful hip flexion does not go past Dr.’s precaution
**Using small shuffle steps to transfer –> this avoids rotation
What are the special precautions for Low Back Trauma or discomfort?
Avoid lumbar rotation, excessive side-bending, and use caution with flexion
What are the special precautions for spinal cord injury?
- Protect based upon type of surgery
- Sometimes have to be careful with pt’s due to osteoporosis
What are the special precautions for burns?
Absolutely avoid dragging (sliding) and be careful of new skin grafts
What are the special precautions for hemiplegia?
- Be very careful of the involved side
- Transfer towards strong side if possible
When positioning a patient what are the 6 things you should do?
1) Ensure patient is comfortable
2) Prevent development of soft tissue and joint contractures or pressure sores
3) Provide the patient access to the environment
4) Provide access and exposure to areas to be treated
5) Provide support and stability of patient’s trunk and extremities
6) Promote efficient function of the patient’s organ systems
When lying a patient in supine what should you avoid?
Excessive neck and upper back flexion and scapular abduction
When lying supine which position is ideal?
Hooklying (knees bent) supported ny a small pillow or bloster
In the supine position which contractures should you try to avoid?
Iliopsoas and hamstring muscles
With the patient in supine what helps to relieve pressure to the calcaneus?
A small bolster under the patient’s posterior ankles making sure the knees are not hyperextended
When lying a patient in prone position how should you position there head?
Turned to the side with their forehead resting on a small towel roll
When you have a pt in the prone position what will help to reduce lumbar lordosis?
a pillow positioned under their abdomen
When the pt is prone where should you position any towel rolls or bolsters and why?
Place a rolled towel under their anterior shoulders to adduct the scapulae.
Place a small bolster under the patient’s anterior ankles to relieve stretch on hamstring muscles and it also allows the pelvis and low back to relax
What do you need to be cautious of when placing a small bolster under a patient’s anterior ankles when they are lying in the prone position?
Contractures of the hamstring (due to knee flexion)
Describe patient alignment in the side-lying position
You need to maintain the alignment of the head, trunk, and pelvis. The patient’s lower extremities need to be flexed at the hip and knee.
Where should you place support in the prone position?
Support uppermost lower extremity on one or two pillows. And also put a pillow under the uppermost upper extremity for supposrt
3 things to remember when place a pt in the sitting position
- Chair should provide adequate support and stability for the trunk
- Lower extremities should be supported
- Distal and posterior thigh should be free of excessive pressure
What are the two greatest areas of pressure in the sitting position?
ischial tuberosities and posterior thigh
8 things caused by positioning for an extended period of time
- Excessive rotation or bending of the spine
- Bilateral or unilateral scapular abduction or a forward head position
- Compression of the thorax or chest
- Plantar flexion of the ankles and feet
- Hip or knee flexion
- Adduction and internal rotation of the glenohumeral joint
- Elbow, wrist, or finger flexion
- Hip adduction or internal/external rotation
Why is it important to avoid a patient lying in the same position for an extended period of time?
This is important to avoid muscle contractures, skin breakdown and pressure ulcers
5 Precautions for Patient Positioning
1) The patient must be lifted, not dragged, across the sheets
2) Avoid wrinkles in sheets, blankets
3) Protect bony prominences from excessive or prolonged pressure
4) Observe skin color before, during , and after treatment
5) Consider the patient’s cognitive status, age, physical condition, cardiovascular condition prior to positioning
4 Common Contracture Sites Related to the Supine Position
1) Hip and knee flexors
2) Ankle plantar flexors
3) Shoulder extensors, adductors, internal rotators
4) Hip external rotators
3 Common Contracture Sites Related to the Prone Position
1) Ankle plantarflexors
2) Shoulder extensors, adductors, internal/external rotators
3) Neck rotators, left or right
3 Common Contracture Sites Related to the Side-Lying Position
1) Hip and knee flexors
2) Hip adductors, internal rotators
3) Shoulder adductors and internal rotators
3 Common Contracture Sites Related to the Siting Position
1) Hip and knee flexors
2) Hip adductors, internal rotators
3) Shoulder adductors, extensors, internal rotators
5 Types of Transfers
1) Supine Sidelying
2) Sidelying Prone
3) Supine Sit
4) Sit Stand
5) Commode Transfer
