NSE 111 - Transfer and Ambulation

NURSING FOUNDATIONS - NSE 111
Mobility & Immobility

Transfer and Ambulation

LEARNING OBJECTIVES WEEK 4 - FOCUSED REVIEW

By the end of Week 4, students will be able to:

  1. Review proper body mechanics

    • Principles of Body Mechanics: Six Checkpoints When Transferring a Patient

      1. For the top half of the body:

        • Ears aligned with shoulders

        • Shoulders in line with hips

        • Maintain alignment to avoid injury

      2. For the lower half of the body:

        • Tighten abdominal muscles

        • Push buttocks back to maintain stability

        • Keep body weight balanced over the heels

        • Move trunk forward by bending at the hips, not at the waist

      3. Elbows should be tucked into the sides to maintain proper body mechanics.

      4. Use a palms-up grip for transferring to ensure stability.

      5. Work within a comfortable range: tuck elbows into the sides, moving hands from shoulders to hips.

      6. Weight transfer: stand with a stable base of support, transferring weight side to side and front to back.

        • Reference: (Box 36-2, Potter & Perry, 2019, pg 836).

    • Safe Patient Handling: Essential Steps

      • Perform a functional assessment to determine the patient’s mobility, strength, and assistance capabilities during transfers.

      • Stand on the patient’s weak side when assisting.

      • Ensure equipment is arranged to not impede the transfer process.

      • Raise the side rail of the bed opposite where the nurse is standing.

      • Confirm that the equipment is functioning properly before use.

      • Ensure the patient is in correct body alignment following the transfer.

  2. Describe the benefits of activity and exercise and illustrate how the concepts of mobility and immobility relate.

    • Definition of Exercise

      • Exercise is defined as any type of physical activity performed with the intent to condition the body, improve health, and maintain fitness levels.

      • Exercise may also serve as a therapeutic intervention, such as rehabilitative exercise following an ankle fracture.

    • Importance of Active Lifestyle

      • An active lifestyle is vital for promoting and maintaining overall health.

      • Engaging in regular physical activity and a mobile lifestyle boosts the efficacy of all body systems, including:

        • Cardiopulmonary function: leads to increased endurance.

        • Musculoskeletal fitness: enhances strength, flexibility, and bone integrity.

        • Psychological well-being: improves mood and reduces feelings of anxiety and depression.

      • Conversely, immobility leads to the absence of these benefits and can cause various physiological and psychological changes.

  3. Differentiate between activity tolerance, deconditioning, and functional decline.

    • Activity Tolerance

      • Refers to the type and amount of exercise or activity a person is able to perform.

      • It is influenced by physiological, emotional, and developmental factors specific to each patient.

    • Deconditioning

      • Defined as the reduced or loss of functional use of systems, particularly the musculoskeletal system, due to lack of use.

      • Examples of deconditioning include:

        • Joint contractures

        • Muscle atrophy

    • Functional Decline

      • Refers to the decrease in physical and/or cognitive functioning.

      • It typically occurs when a person cannot engage in activities of daily living (ADLs).

  4. Recognize physiological and psychological changes associated with immobility.

    • Physiological Changes Associated with Immobility

      • Cardiovascular Changes

        • Orthostatic hypotension: a drop in blood pressure upon standing.

        • Thrombus formation: the formation of blood clots due to stagnant circulation.

      • Musculoskeletal Changes

        • Muscle weakness

        • Muscle atrophy: loss of muscle mass.

        • Calcium reabsorption changes, leading to potential permanent loss of range of motion (ROM).

        • Joint contractures may develop.

      • Urinary Elimination Changes

        • Decreased fluid intake can result in renal calculi (kidney stones) and urinary tract infections (UTIs).

      • Gastrointestinal Changes

        • Reduced movement of the gastrointestinal tract may lead to constipation.

      • Integumentary Changes

        • Decreased circulation to the tissues can result in pressure injuries and prolonged ischemia.

    • Psychological Effects Associated with Immobility

      • Depression

      • Behavioral changes

      • Sleep-wake alterations

      • Changes in coping mechanisms

  5. Differentiate between friction and shearing

    • This differentiation is referred to Week 3 slides/readings and is not detailed in the current notes.

  6. Understand how to use the Morse Falls Scale to enhance client safety.

    • Morse Fall Scale

      • Utilized to identify patients at risk of falling.

      • It assesses specific risk factors including:

        • History of falls

        • Secondary diagnosis

        • Use of ambulatory aids

        • Patient on IV therapy or heparin lock

        • Gait and transferring abilities

        • Mental status

      • A high score (45+45+ points) indicates a high risk for falls.

    • Falls Risk - Nursing Interventions

      • Implement appropriate orientation strategies.

      • Utilize clear communication with the patient.

      • Assist patients with sensory aids (e.g., glasses, hearing aids).

      • Conduct comfort rounds to monitor: toilet needs, hydration, and position changes.

      • Educate family members on the importance of the call bell being within reach; ensure patients understand how to use it.

      • Remind patients to call for assistance when necessary.

      • Assess if the patient is using assistive devices correctly.

      • Provide non-slip footwear for safety.

      • Ensure that barriers and clutter are cleared from patient pathways.