Test 1 BPC 2-5 + 8(bed mobility)

Bed Mobility:

The ability to move upward, downward, or from side to side and the ability to roll, turn over, and move to a sitting position from a recumbent position.

BM Transfers:

Can prevent some effects of immobility.

Most Common Movements in BM:

Turning from supine to side lying and returning, supine to prone and returning, moving in bed-upward, downward, side to side, rolling, bridging, moving from lying to sitting EOB.

BM-Assited:

PTA assist the patient by instructing the pt in each component of the independent transfer until the pt becomes independent.

Moving pt up in bed:

Can go up or down, watch head if unable to control.

Side to Side Movement:

Move pelvis, move UE and trunk, etc.

Supine to Sitting Methods:

Logrolling and Long-sit

Long Rolling Transfer MUST:

Always used with a pt with a spinal fracture, recent back/spinal surgery.

Back Precautions:

BLT (NO bending, lifting, and twisting).

Posterior Hip Precautions:

No bending past 90 degrees flexion, No hip ADDUCTION past neutral, NO hip internal rotation past neutral.

Anterior Hip Precautions:

NO active hip extension past neutral, NO active hip Abduction, NO hip External Rotation past neutral.

Stand by Assist:

Supervision

Contact Assist:

Touching

Minimal Assist:

25% help

Moderate Assist:

25% - 49%

Maximal Assist:

50% - 74% help

Total Assist:

75% or more to help 2 people.

What does HAI stand for?

Healthcare Associated Infections (Nosocomial Infections)

HAI's occur in how many people?

They occur in 1 out of 31 patients.

Medical Asepsis:

Designed to confine pathogens to a specific area, object, or person to prevent the spread of disease to others.

Precaution of Medical Asepsis:

Such as minimizing contact with soiled items and room surfaces, use of PPE, removal of PPE to prevent cross-contamination.

Surgical Asepsis:

Designed to prevent ALL microorganisms from entering a surgical wound or contaminating a sterile field to prevent the risk of infection to the patient.

Precautions of Surgical Asepsis:

All PPE must be sterile: gloves, mask, face shield, shoe coverings, hair coverings, goggles, and gown.

Need for Standard Precautions?

Helps prevent the spread of disease that may or may not be known to be present.

Hand washing involves what and how long to use it?

Water and soap, 40 seconds.

Hand-rubbing involves what and how long.

Alcohol based germ-x and 15-30 seconds (or until dry).

HW for Medical Asepsis?

Visibly dirty, soiled, or contaminated and when exposed to C-DIFF.

When to perform HH?

After coughing/sneezing

Before/After using gloves, mask, etc.

Before/After iso. room

Soiled Hands

When in doubt

PPE: Gloves

Use when touching bodily fluids, secretions, execretions, touching mucus membranes and nonintact skin.

PPE: Gowns

Use during procedures and pt care that involves contact of clothing, skin with blood/fluids, etc.

PPE: Mask & Goggles

When patient is coughing/sneezing, splashes of blood. Used to protect the face, eyes, mouth, etc.

Transmission-Based Precautions (Isolation):

To protect the caregiver from patients who are known or suspected to be infected with highly transmissible pathogens.

Types of Precautions for TBP:

Contact precautions

Droplet precautions

Airborne precautions

Contact:

Microorganisms transferred from one to another with directly or indirectly contact through patient or their environment. (MRSA, VRE, Lice, etc.)

C-diff:

Associated with the use of antibiotics or CA treatment.

Droplet:

Transmission of reparatory droplets from respiratory tract to the mucosa of the recipient. (Transmitted through the air by sneezing, coughing, etc.)

Airborne:

Small, infectious particles that can recipient can inhale, remain in air longer than droplet. (N95 mask needed)

Protective Isolation:

Used to prevent spread of disease to at risk patients.

Blue bag includes?

Infected Linen (blankets, sheets, towels, etc.)

Red bag includes?

Infectious Trash (Contaminated dressings, needles, bandages, anything thrown away and not reused.)

Removal of PPE

Gloves: 1

Goggles/face shield: 2

Gown: 3 (turn inside out)

Mask or N95: 4

Hand Hygiene: 5

Purpose of Body Mechanics?

Save energy, prevent back strain, safety for yourself and patient's.

What is the result of poor body mechanics?

Bad Habits

Correct Posture?

Position w/ minimum stress on each joint.

Faulty Posture?

Increased stress on joints.

Faulty Alignment Factors:

Congenital Anomalies

Development Problems

Trauma

Disease

Deep Segmental Muscles: Transversus Abdominis and Longus Multifidus

Deep, closer to axis of motion, attach to each vertebral segment.

Global Muscles:

Superficial, farther from axis of motion, cross multiple segments, produce motion, compressive loading with strong contractions.

Valsalva Maneuver:

Increased intrathoracic pressure, decreased cardiac output, increased bp. (stroke or possible death).

VGL (Vertical Gravity Line):

Head slightly forward, through shoulder, midway through trunk, slightly posterior to hip joint, slightly anterior to knee joint, slightly anterior to lateral malleolus.

Kyphosis:

Excessive posterior curvature of the spine (round back, humpback/gibbus, flat back, dowager's hump).

Lordosis:

Anterior curvature of the spine.

Faulty Alignment is caused by what?

Excessive Kyphosis/Lordosis

Causes of Faulty Alignment:

Postural Deformity and Compensatory Mechanisms (Lax muscles, hip flexion contracture, fashion, congenital problems).

Swayback Deformity:

VGL posterior to midline of ear results in a forward head (Pelvis is anterior to VGL & Trunk posterior to VGL).

Body Mechanics:

Utilization of correct muscles to complete a task safely and efficiently, w/o undue strain on any muscle or joint.

Reasons for keeping normal curve in body mech.?

Protect discs, disc pressure, anterior ligament of spine (strong), posterior longitudinal ligament (weak), fiver layers of muscle in back will protect unless muscles are weak.

Principle of Body Mech.

Size up, get help, avoid twisting, talk to the person.

Increase Stability?

Increase base support, tighten deep segmental muscles, lower COG, maintain VGL with BOS, increase pt BOS.

Deep Squat:

Feet straddle the object, maintain trunk in vertical position, lumbar spine in lordosis with anterior pelvic tilt.

Power Lift:

From higher surfaces, don't squat as far, as lifting from stool, arms straight.

Straight Leg Lift:

Knees slightly bent, lumbar spine in lordosis, lifting out of trunk of car for example.

One Leg Stance:

Maintain lumbar lordosis, trunk vertical or horizontal, for light objects.

Half Kneeling Lift:

Foot flat, hip/knee flexed to 90 degrees, good if shott, weak arms, good lower body strength and balance, lunge lift.

Traditional Lift:

Feet anteroposterior on each side of object, deep squat, hold close to body, arms flexed.

Stoop Lift:

Objects below waste, lifting on one side, use one extremity, other for extremity for balance.

Why do we spend time on positioning?

Prevent skin breakdown, prevent joint contractures, decrease edema.

Who is increased risk of skin breakdown?

Immobile pt's, decreased sensation, confused or heavily medicated, minimal soft tissue protection over body prominences.

When do we change positions?

Every 2 hours

Pressure Points:

Time in Positions:

Reposition every 2 hours and inspect skin and observe for color change.

Sitting:

A patient must be moved every 15 mins to relief pressure on buttocks and sacrum.

Positioning Suspine:

Pillow under head, small pillow or towel for cervical support, support under popliteal space (decrease lordosis), ankle support to relieve pressure on calcaneus, support under elbows to relief pressure.

Side Lying:

Pt center of the bed (head, trunk, and pelvis aligned), LE's flexed at hip and knee with a pillow between legs, top LE slightly forward of bottom LE, pillow at chest/back to prevent rolling, pillow under top arm to keep chest open.

Prone:

Pillow under head, pillow under lower abdomen to decrease lumbar lordosis, rolled towel under anterior shoulder to adduct scapula, towel under ankles to relieve stress on hamstrings, also allows pelvis and lumbar to relax.

Semi-fowler:

Head lifted 30 degrees, pillow under popliteal space, used for breathing, eating, and visiting.

Sitting:

Feet- footstool- WC footrest, hip/knees- 90-degree flexion, ankles- neutral, and elbows at 90 degrees.

Amputations (Transfemoral):

Avoid prolonged hip flexion, hip abduction, and external rotation. NO pillow and limit time to sitting to 40 mins an hour.

Amputations (Transtibial):

Same as transfemoral but add avoid prolonged knee flexion.

Orthopedic:

Avoid positioning on surgical side and avoid prolonged knee flexion after knee surgery.

Neurological:

Hemiplegia: UE placed in shoulder abduction and external rotation, elbow extension, wrist and finger ext LE. avoid prolonged hip and knee flexion and hip external rotation, ankle plantarflexion.

Burns:

Contractures likely because of scarring, avoid most positions of comfort such as prolonged flexion or adduction.

Restraints:

a device that stops or slows something's motion (needs a physicians order every 24 hours).

Restraints Examples:

Wrist or ankle straps

Cloth body garment

Elevated bed rails

Drugs

Restraint on Adult:

4 hours to get order.

Restraint on Children (9-17):

Have 2 hours to get order.

Restraint on Children (1-9):

Have 1 hours to get order.

Not considered Restraints:

Straps for surgery

Arm board to protect IV site

Protective helmet

Orthopedic appliances

Therapeutic holding or comforting of children