Week 10 - Mobility and Transfers Flashcards
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Safety First
- Always use gate belt
- Always be conscious of your body mechanics
- Grab hold of the gate belt securely with both hands, ensure tight with no slippage.
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Don’t have to do all the work for the patient, trying to teach them to be as independent as possible.
How do we promote independence?
Have the client safely do as much as possible while giving excellent verbal and/or physical cues and guarding - promotes independence.
How do you prepare yourself for assisting with mobility activities?
Nurse is your friend. Do a chart review and check with nurse on patients level of activity, their most recent pain, medication schedule, and how the patient is doing physiologically and emotionally prior to stepping in the room.
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Interview Patient
Test and Measures
-Strength (how patient is able to help and assist)
-Mental Status (alert and oriented, able to fall one step and two step commands, follow sequence of instructions for motor activity)
-Range and Mobility (to actively participate)
-Any other contraindications
Preparing the environments
consider the equipment that may be need
- sliding board
- hydrolic or numatic lift
- do you need the patient to assist with the rail of their bed
- what kind of tubes, catheters could interfere with transfer
Preparing Wheelchair
Lock heel chair
Remove Arm Rest
Remove Swing Away Leg Rest
T/F: It is okay to ask the patient if they understand?
False too simple, explain details of the activity and how the patient can participate
- We are going to..
- I will help you…
- I would like you to…
- I will say “1,2,3 turn”
How do you prepare the patient?
- Explain details of activity and how the patient can participate.
- Demonstrate as appropriate.
- Have patient describe and practice components of transfer.
- Ensure patient is properly dressed or draped with proper shoes or slippers
- Check for tubes lines, and monitors etc.
Types of Assistance (4)
V.C.’s (verbal cueing or manual)
Balance Control (holding onto gate belt)
Lifting (their body weight)
Supporting (patient)
What is an independent assistance?
No longer needed. Predictor for discharge.
What is a SBA/Close Guard assistance?
Stand by Assist or close guard, not willing to turn back on patient, still not confident they won’t need you assistance.
What is Contact Guard assistance?
Actually have hand on patient
What is a Min A?
Patient is able to do 75% of the transfer or mobility activity by themselves.
What is a Mod A?
Patient is able to do 50-75% of the transfer or mobility activity by themselves.
What is a Max A?
Patient is able to do 25-50% of the transfer or mobility activity by themselves.
What is a Total Assist/Dependent?
Patient is able to do 0% of the transfer or mobility activity by themselves. You are doing a max lift or total assist?
How is a Max Assist recorded?
1,2,3 depending on how many people assist with transfer.
What is the Goal for the activity?
Achieve maximum level of patient independence in safe way.
When should you use a Hoyer lift?
If you are unsure you can perform a lift in a safe matter. Be careful of spreading germs on sling.
Proper body mechancis
Bend at hip and not back. Keep both feet on the floor. Don't twist and rotate body. Have gait belt secure to doesn't slip. Remove wheelchair parts.
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Patient should be wearing shoes or leather slippers.
Do not leave patient unattended.
Assess for any changes in patient status from previous visit that may impact care.
Total Hip Arthroplasty Precautions
Avoid: Hip adduction, crossing midline Hip Rotation (IR>ER) >60/90 deg hip flexion (varies based on surgery Lying on Hip Pulling on LE
Promote THA?
Do keep hip abducted during movement or in side lying
Do use a recliner for sitting (greater than 90 deg flexion)
THA precautions are similar to (2)
THA same for dislocation or hip fracture
LBP/Lumbar Trauma, Post-Operative Spine Surgery Precautions
Avoid: Lumbar Rotation Trunk Lateral Flexion Trunk Flexion Excessive Trunk Flexion
Promote
Do logroll (pelvis and shoulder move as one unit) Do keep knees flexed for comfort in supine and sidelying Adhere to post-operative guidlines
Spinal Cord Injury Precautions
Avoid:
With fixation devices:
-Rotation
-Distraction (don’t pull on LE’s)
Spinal Cord Injury Promote
Promote:
Awareness of fixator device
Awareness of osteoporosis (especially LEs and Vertebrae)
Use protective positioning/restraints with side-lying, sitting without back support
Watch out for orthostatic hypotension and autonomic hyperreflexia
Do log roll
