Physical Exam - Lifting & Moving Pt Positions

physical exam includes

• vital signs

• Ht

• Wt

• bld work

• X-rays

• EKGs

techniques used for physical

• auscultation

• palpation

• observation

Why physicals?

• determine and assess info about your Pt

  • presence, extent, source of pathologies

ascultation

listening to sounds from within body with stethoscope

palpation

using hands to feel parts of the body you can not see

commonly used equipment for physical exams

• gloves

• stethoscope

• sphygmomanometer

• percussion hammer

• tuning fork

• penlight

• tongue depressor

• otoscope

key to moving Pt

• good posture

• gravity

center of gravity

point at which mass of Wt is centered

10 commandments of body mechanics (first 5)

1. inform Pt

2. size up load (call for help if more than you can handle)

3. check your footing (feet should be apart to give broad base of support)

4. move close

5. squat (don’t use back muscles)

10 commandments of body mechanics (second 5)

6. lift (use your thigh muscles)

7. smooth and synchronized

8. turn (shift position of your feet)

9. don’t lift

10. teach

lifting and moving

• always use good alignment

• avoid bending, twisting, being off center, using back muscles

• use leg & thigh muscles, upper arms

always use safety precautions

• re-strain Pt if needed be

• reverse gurney/wheelchair on downgrades

• lock gurney/wheelchair when moving Pt on or off and be aware of Pt LOC (lvl of consciousness)

Bed to wheelchair

1. adjust bed to lowest position of wheelchair seat

2. wheelchair next to bed and lock wheels

3. review procedure with Pt

4. Pt place arms around shoulders and around back

5. count of three

Bed to gurney

1. adjust height of gurney to same height as bed

2. with/without Draw sheet or Slider board

   1. Draw sheet: ½ under Pt body

   2. Slider board: completely under Pt

3. lock wheels

4. once on gurney, rise and secure side rails

Pt positions

• supine

• prone

• Sim’s

• Fowlers

• Trendelenburg

• Lithotomy

• knee chest

supine

• face up, “flat on back”

• provide with support pillow\keep knees slightly flexed

• provides comfort

• takes Wt off pelvis

prone

• face down, head to side

• therapeutic to prevent bed pressure

Sim’s

• Pt halfway b/w lateral and prone positions

• body slightly rolled forward, pressure on chest

• right extremity flexed at hip and knee

Fowler’s

• sitting up

• head of bed elevated

• Pt hips may/may not be flexed

• increase comfort, ventilation, relaxation

What kinds of patients use Fowler’s position?

relaxation after thoracic surgery or got Pt with cardiovascular problems

High/full Fowler’s

HOB 90 degrees

Semi-Fowler’s

HOB elevated 45 degrees

Trendelenberg

• Pt supine position with head in downward angle

• raising foot of the bed

What kinds of patients use Trendelenberg position?

hypotensive patients

Lithotomy

• on exam table that has stirrups with hips right to lower edge of table

• primarily for vaginal/digital rectal exams

Knee chest

• Pt on knees and chest

• difficult for elderly Pt

• for procto-sigmoidoscopic exams