Transfers and Level of Assist

Question 1

Definition of Transfer

Answer 1

Safe movement of a person from one surface, location, or position to another

Question 2

What is our primary responsibility?

Answer 2

To guard and protect the patient (CPI criteria # 1) and to avoid injury to yourself

Question 3

7 Levels of Assistance

Answer 3

• Dependent of Total Assist
• Maximal Assist
• Moderate Assist
• Minimal Assist
• Modified Independent
• Contact Guarding
• Standby / Supervision Assist

Question 4

Abbreviation for Dependent

Answer 4

D

Question 5

Abbreviation for Maximal Assist

Answer 5

max (A)

*( ) denotes circle

Question 6

Abbreviation for Moderate Assist

Answer 6

mod (A)

Question 7

Abbreviation for Minimal Assist

Answer 7

min (A)

Question 8

Abbreviation for Modified Independent

Answer 8

Mod (I)

Question 9

Abbreviation for Contact Guarding

Answer 9

CGA

Question 10

Abbreviation for Standby / Supervision Assist

Answer 10

SBA

Question 11

Describe Dependent

Answer 11

These patients require total assistance form one or more persons to accomplish the activity safely

Question 12

Describe max (A)

Answer 12

Patient performs less than 49% of activity. Assistance is required to complete activity

Question 13

Describe mod (A)

Answer 13

Patient performs 50-74% of activity. Assistance is required to complete activity

Question 14

Describe min (A)

Answer 14

Patient performs 75% or more of activity. Assistance is required to complete activity

Question 15

Describe Mod (I)

Answer 15

The patient is able to perform task independently but must use some type of adaptive or assistive equipment or requires additional time

Question 16

Describe CGA

Answer 16

A caregiver is positioned close to the patient with hands on the patient or gait belt and protection required during activity

Question 17

Describe SBA

Answer 17

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

Question 18

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?

Answer 18

Patient ambulated with walker with CGA

Question 19

What are verbal cues?

Answer 19

Verbal or tactile cues, directions, instructions or set-up required from caregiver but patient is able to perform activity without direct assist

Question 20

Describe Independent

Answer 20

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

Question 21

When preparing for a transfer what are the 4 steps you should take?

Answer 21

1) Inform the pt
2) Demonstrate the transfer
3) Safety precautions
4) Use of proper equipment/assistance

Question 22

Before you perform the transfer what are the 7 steps you should take?

Answer 22

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

Question 23

How do should you decide an appropriate transfer technique?

Answer 23

• 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

Question 24

What should you do during the transfer?

Answer 24

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

Question 25

What do you need to stabilize on the pt while performing the lift?

Answer 25

- Knees - Pelvis - Upper Thorax

Question 26

6 Safety Concerns in Transfers

Answer 26

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

Question 27

What are the special precautions for THR?

Answer 27

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

Question 28

What are the special precautions for Low Back Trauma or discomfort?

Answer 28

Avoid lumbar rotation, excessive side-bending, and use caution with flexion

Question 29

What are the special precautions for spinal cord injury?

Answer 29

- Protect based upon type of surgery | - Sometimes have to be careful with pt’s due to osteoporosis

Question 30

What are the special precautions for burns?

Answer 30

Absolutely avoid dragging (sliding) and be careful of new skin grafts

Question 31

What are the special precautions for hemiplegia?

Answer 31

- Be very careful of the involved side | - Transfer towards strong side if possible

Question 32

When positioning a patient what are the 6 things you should do?

Answer 32

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

Question 33

When lying a patient in supine what should you avoid?

Answer 33

Excessive neck and upper back flexion and scapular abduction

Question 34

When lying supine which position is ideal?

Answer 34

Hooklying (knees bent) supported ny a small pillow or bloster

Question 35

In the supine position which contractures should you try to avoid?

Answer 35

Iliopsoas and hamstring muscles

Question 36

With the patient in supine what helps to relieve pressure to the calcaneus?

Answer 36

A small bolster under the patient's posterior ankles making sure the knees are not hyperextended

Question 37

When lying a patient in prone position how should you position there head?

Answer 37

Turned to the side with their forehead resting on a small towel roll

Question 38

When you have a pt in the prone position what will help to reduce lumbar lordosis?

Answer 38

a pillow positioned under their abdomen

Question 39

When the pt is prone where should you position any towel rolls or bolsters and why?

Answer 39

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

Question 40

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?

Answer 40

Contractures of the hamstring (due to knee flexion)

Question 41

Describe patient alignment in the side-lying position

Answer 41

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.

Question 42

Where should you place support in the prone position?

Answer 42

Support uppermost lower extremity on one or two pillows. And also put a pillow under the uppermost upper extremity for supposrt

Question 43

3 things to remember when place a pt in the sitting position

Answer 43

- 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

Question 44

What are the two greatest areas of pressure in the sitting position?

Answer 44

ischial tuberosities and posterior thigh

Question 45

8 things caused by positioning for an extended period of time

Answer 45

- 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

Question 46

Why is it important to avoid a patient lying in the same position for an extended period of time?

Answer 46

This is important to avoid muscle contractures, skin breakdown and pressure ulcers

Question 47

5 Precautions for Patient Positioning

Answer 47

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

Question 48

4 Common Contracture Sites Related to the Supine Position

Answer 48

1) Hip and knee flexors 2) Ankle plantar flexors 3) Shoulder extensors, adductors, internal rotators 4) Hip external rotators

Question 49

3 Common Contracture Sites Related to the Prone Position

Answer 49

1) Ankle plantarflexors 2) Shoulder extensors, adductors, internal/external rotators 3) Neck rotators, left or right

Question 50

3 Common Contracture Sites Related to the Side-Lying Position

Answer 50

1) Hip and knee flexors 2) Hip adductors, internal rotators 3) Shoulder adductors and internal rotators

Question 51

3 Common Contracture Sites Related to the Siting Position

Answer 51

1) Hip and knee flexors 2) Hip adductors, internal rotators 3) Shoulder adductors, extensors, internal rotators

Question 52

5 Types of Transfers

Answer 52

1) Supine Sidelying 2) Sidelying Prone 3) Supine Sit 4) Sit Stand 5) Commode Transfer