MOD 1 - Patient Transfers

Indicators of Spinal Injury

• Pain in the neck or spine

• Paralysis/change in motor skills

• Paresthesia - abnormal sensation in the upper or lower extremities

• Point tenderness on palpation of the spine

who coordinates all movements

The caregiver at the head of the bed

clear directional instructions specify what

whose RT/LT it is (eg. patient’s r/l)

purpose of draw sheets

promote patient comfort and reduce friction on the patient's skin during movemen

ideally draw sheets are placed

above a patient’s shoulders and below the hips

when are pillows and sponges used

• when moving a patient from a supine to an oblique position

• to maintain the body’s position

Management of Tubes

1. tubes are secured to skin with tape

2. drainage bags are secured to the pt’s gown

3. drainage tubes ends should be kept sterile

4. DO NOT clamp tubing unless ordered

5. no kinks

6. draining bags are kept below drainage site

neutral c-spine alignment

patient's head and neck are in complete alignment with the thorax

how to confirm c-spine alignment

caregiver places their index finger on the sternal notch and ensures that the sternum is aligned with the point of the chin

Cradle Hold

• used when moving pt up/down, side to side, turning

minimum # of people to move a spinal cord injury pt

3

when can you perform a transfer with 2 caregivers

confirmed that the patient does NOT have C-spine or upper T-spine injury

Weight-shift / Pressure Relief

done to prevent the patient’s skin from break-down due to pressure points

Taut Pull

a technique to levitate the patient off the bed just enough to insert a cassette, pulling motion NOT lifting the draw sheets

Steps for doing weigh shift

1. caregiver on each side

2. communicate with patient

3. apply cradle hold

4. grasp the draw sheet (each hip corner, one shoulder corner)

5. Use proper body mechanics to allow an easy lift for roughly five seconds

6. Gently lower the patient down onto the bed

how many people for turning pts

• 3 if suspected or diagnosed cervical spine or upper thoracic injury

• 2 if no C-spine or upper T-spine injury are confirmed

pts should be turned every

2 hours

Steps for turning pts and returning to supine

check learning hub content

three specific conditions present in spinal injury pts

1. Autonomic Dysreflexia

2. Spasticity

3. Postural Hypotension

Autonomic Dysreflexia and symptoms

• condition where elevated blood pressure is caused by nerve stimulus below the level of spinal injury

• symptoms

  • severe headache

  • nasal congestion

  • decreased heart rate

Autonomic Dysreflexia Management

• immediately elevate the patient's head or sit the patient up

• Remove any loose or binding clothing which may be causing the stimulus

• if the BP doesn’t decrease notify the ward

Spasticity

• muscle spasms

• takes some time to develop

Spasticity management

• determine previous hx of spasticity

• determine common stimuli

• avoid F/E of muscle and joints

• have side rails up

Postural Hypotension and symptoms

• dramatic fall in blood pressure when a person moves to the upright position

• symptoms

  • weakness

  • dizziness

  • pallor

  • blurred vision

  • blackouts or fainting

Postural Hypotension management

• lowering the head of the bed

• instructing the patient to breathe deeply

• lowering the back of the patient's wheelchair, if possible or tip the chair back (if in a wheelchair) 

• then re-assessing the patient's blood pressure

Cervical Spine

Quadriplegia / Tetraplegia

• paralysis in all four limbs (legs,arms)

Level: C1,2,3 - mobility, resp

Mobility:

• limited head and neck movement

• complete paralysis of arms, body, legs

Respiratory System:

• Unable to breathe

• Ventilator required

• Unable to clear throat secretions

Level C4 - mob, resp

Mobility:

• Full head and neck movement only

• Some shoulder movement

• No arm, body or leg movement

Respiratory System:

• Able to breathe without a ventilator

• Assistance required to clear throat secretions

Level C5

Mobility:

• Full head and neck movement, good shoulder movement

• Elbow flexion only

• No body or leg movement

Respiratory System:

• Able to breathe without a ventilator

• Assistance required to clear throat secretions

Level C6

Mobility:

• Full head, neck & shoulder movement

• Wrist extension, elbow flexion

• No body or leg movement

Respiratory System:

• Able to breathe without a ventilator

• Assistance required to clear throat secretions

Level C7

Mobility:

• Full head, neck, shoulder movement

• Partial finger movement, both wrist/elbow flexion/extension

• No body or leg movement

Respiratory System:

• Able to breathe without a ventilator

• Assistance required to clear throat secretions

Thoracic Spine

Paraplegia

• leg/lower limb paralysis

Level T1-4

Mobility:

• Loss of sensation below nipples

• No lower body or leg movement

Respiratory System:

• Likely able to fully breathe and clear secretions normally

Level T5-9

Mobility:

• Full head, neck, shoulder and arm movement

• Some upper body strength depending on the level of injury

• No lower body or leg movement

Respiratory System:

• Able to fully breathe and clear secretions normally

Level T10-L1

Mobility:

• Full head, neck, shoulder and arm movement

• Upper body strength depending on the level of injury

• Partial lower body or leg movement

Respiratory System:

• Normal respiratory system