CH15Positioning, Lifting, and Transferring Clients Flashcards
Overview of Client Positioning and Nursing Responsibilities
Purpose of Position Changes:
Repositioning patients and residents prevents complications caused by remaining in one spot for an extended duration.
Specific positioning may be required to facilitate medical procedures or support surgical and clinical recovery.
Role of the Certified Nursing Assistant (CNA):
Clients frequently require physical assistance to alter their body position.
CNAs are directly responsible for ensuring clients change positions safely and correctly.
Systemic Complications of Immobility
Primary Targeted Complications and Mitigations:
Integumentary System (Pressure Ulcers): Skin degradation caused by prolonged pressure; requires routine patient turning.
Musculoskeletal System (Contractures): Bone and muscle deformities caused by immobility; mitigated through Range of Motion (ROM) exercises and regular repositioning.
Respiratory System (Pneumonia): Lung infection secondary to immobility; mitigated through active ambulation.
Cardiovascular System (Blood Clots): Formation of thrombi due to circulatory stasis; mitigated through active ambulation.
Comprehensive Effects of Immobility Across Body Systems:
Cardiovascular System:
Formation of blood clots.
Overall reduced blood flow.
Digestive System:
Decreased appetite.
Constipation.
Incontinence.
Integumentary System:
Decreased localized and systemic blood flow.
Formation of pressure ulcers.
Musculoskeletal System:
Development of brittle bones.
Formation of joint and muscle contractures.
Generalized muscle weakness.
Nervous System:
Lack of sensory and environmental stimulation.
Escalated feelings of anxiety.
Escalated feelings of isolation.
Respiratory System:
Development of pneumonia.
Decreased respiratory effort.
Decreased oxygenation of the blood.
Urinary System:
Reduced kidney function.
Urinary incontinence.
Increased incidence of urinary tract infections (UTIs).
Body Alignment and Supportive Devices
Principles of Body Alignment:
Proper body alignment maintains the natural straight posture of the body.
Effective alignment reduces physical pain, prevents musculoskeletal injury, and relieves general discomfort.
Observation standard: Caregivers must continuously assess whether the client visually appears comfortable and correctly aligned.
Types and Functions of Supportive Devices:
Function: Used to maintain proper body alignment while offering comfort and mechanical support.
Approved Devices:
Pillows.
Rolled sheets and towels.
Rolled blankets.
Basic Body Positions
Mandatory Verification Protocol:
Always confirm the intended position with the nurse or review the client's care plan prior to executing any movement.
Core Positions:
Supine (Dorsal Recumbent) Position: Client lies flat on their back.
Fowler's Position: Client is in a semi-sitting or upright sitting position in bed.
Lateral Position: Client lies on one side of the body.
Prone Position: Client lies flat on their abdomen.
Sims' Position: Client lies on their side with the upper leg flexed and drawn up toward the chest.
Sitting Position: Client is seated upright in a chair or at the edge of the bed.
Guidelines and Procedures for Repositioning
Core Repositioning Rules:
Maintain continuous alertness for signs and symptoms indicating complications of immobility.
Always lift or roll the client during repositioning; never drag the client across bed sheets, as dragging creates severe friction and shearing forces that damage the skin.
Always request assistance from additional staff whenever necessary to move a client safely.
Review and adhere strictly to specific institutional dos and don'ts outlined in Guidelines Box 15-1.
Standard Repositioning Procedures:
Moving a person to the side of the bed.
Helping a person move up in bed.
Raising a person's head and shoulders.
Turning a person onto his or her side.
Logrolling a person (maintaining spine-straight alignment).
Client Transfer Planning and Assistive Devices
Transfer Planning Strategy:
Plan the entire movement strategy prior to physically moving the client.
Avoid initiating transfers without a finalized plan.
Transfer Belts (Gait Belts):
Used to assist weak or unsteady clients during transfers, standing, and walking.
Application rule: Place the belt securely around the client's waist over top of their clothing.
Transfer-Assist Devices:
Primary Goal: Prevent work-related musculoskeletal injuries among care staff.
Device Types:
Lift Sheets: Used to pull or reposition clients in bed.
Side Rails: Utilized directly by the client to assist in pulling themselves up or turning.
Powered Lifts: Mechanical apparatuses used to hoist full body weight.
Sliding Boards: Facilitate smooth lateral transfer between adjacent surfaces (e.g., bed to wheelchair).
Wheelchair and Stretcher Safety Protocols
Wheelchair Safety Inspection Checklist:
Inspect for any broken or missing components prior to seating the client.
Ensure all wheels roll smoothly.
Verify that safety straps are functional and secure.
Test brakes to confirm they lock firmly.
Verify that footrests fold up completely and swivel smoothly to the side out of the transfer pathway.
Stretcher Transfer Protocols:
Always utilize an appropriate transfer device such as a lift sheet or a transfer board (sliding board).
Stretcher transfers require assistance from additional care staff.
Mechanical Lifts
Indications:
Utilized for lifting and moving clients who are completely unable to assist with their own physical transfer.
Safety Verifications:
Verify the client's total weight prior to transfer.
Cross-reference the client's weight against the maximum weight capacity rating of the mechanical lift.
Assisting with Client Ambulation
The Dangling Protocol:
Definition: Seating the client on the edge of the bed with their legs hanging down prior to standing.
Clinical Purpose:
Serves as a vital initial step in fall prevention when transitioning out of bed.
Allows necessary time for the cardiovascular system and heart rate to adapt to spatial position changes.
Allows the CNA to observe the client for acute signs of dizziness, lightheadedness, or fainting.
Ambulation Assistive Devices:
Safety and Fitting Rule: Devices must be custom-fitted to the individual resident and never shared between residents due to infection control and physical safety risks.
Specific Devices and Positioning:
Walkers: Provide multi-point support in front of the client.
Canes: Must always be held on the client's strong side. The CNA must stand on the client's weak side to offer support.
Crutches: Provide underarm/arm leverage for non-weight-bearing or partial-weight-bearing ambulation.
The content focuses on client care in nursing, particularly relating to positioning and preventing complications from immobility, which can be likened to strategy in motorsports like F1 and NASCAR.
In F1, drivers must constantly adjust their positions in the cockpit for optimal performance, much like nurses must reposition patients to prevent pressure ulcers and other complications. Just as a driver changes tires to adapt to track conditions, CNAs assist clients in changing positions to avoid system complications from remaining immobile too long.
In NASCAR, drivers have a crew that anticipates their needs for pit stops, paralleling how nursing staff must plan repositioning to enhance patient comfort and health outcomes. Both fields require teamwork: in NASCAR, the pit crew works together for a successful stop, while in nursing, staff collaborate to ensure safe patient handling and correct positioning.
So, in summary: client care is like a well-managed pit stop, where quick, effective action is essential to keep everyone healthy, akin to how a racing team maintains its car to ensure peak performance throughout a race.