chapter 11 protection and movement

Importance of Proper Bed Height and Body Mechanics

• Emphasis on raising the patient's bed to appropriate height before performing any procedures.

  • Avoid bending over during tasks like starting IVs.

  • Protects healthcare workers from back injury.

Patient Assessment Prior to Mobility

• Critical factors to determine:

  • Weight Bearing Status: Can the patient bear weight on limbs?

  • Physical Attributes: Patient's weight, height, strength, and cooperation ability.

  • Assess for conditions affecting mobility such as:

  • Spinal Cord Injury: May lead to immobility.

  • Dementia/Alzheimer's: Affects cognition and participation.

  • Parkinson's Disease: May influence movement and balance.

Safe Patient Handling Techniques

• Importance of not using personal weight to lift patients.

• Need to be cautious if a patient falls; if they begin to fall, gently lower them to the ground.

• Patient-centered care approach:

  • Respect patient choice and autonomy in mobility decisions.

  • Educate patients on the importance of mobility but acknowledge refusals.

Effective Communication with Patients

• Use lay language in patient education.

  • Avoid medical jargon to ensure patient understanding.

  • Example: Use "legs" instead of "lower extremities" for clarity.

Realistic Care Plans

• Care plans must consider individual patient circumstances:

  • Example: A patient who hasn't walked for three years may not be able to walk by discharge.

  • Include family caregivers in learning about transfer and mobility techniques.

Evidence-Based Practice in Safe Patient Handling

• Safe handling programs lead to improved attitudes and practices in patient handling.

• Components of a comprehensive patient handling and mobility program:

  • Proper Equipment

  • Patient Mobility Practices

  • Patient Assessment Protocols

  • Patient Handoff Procedures

Common Mobility Aids and Equipment

• Gait belts, walkers, canes, and lift equipment (e.g., ceiling lifts).

• Importance of proper equipment maintenance and reporting malfunctions.

Monitoring Patient Activity Tolerance

• While mobilizing patients, monitor:

  • Vital Signs: Oxygen levels, respiratory rate, skin color.

  • Pain Levels: Inquire about patient pain during movement assessments.

Safety Precautions for Transfers

• Stand on the patient’s weak side during transfers for support.

• Ensure surrounding area is clear of obstacles before transfer procedures.

• Communicate health status clearly with team members.

Wheelchair Safety Guidelines

• Raise side rails opposite to where staff is standing during transfers.

• Ensure patients are educated on wheelchair use and maintenance:

  • Watch for pressure injuries from prolonged wheelchair use.

• Utilize friction-reducing devices (e.g., slide sheets, waffle mattresses) to facilitate safer transfers.

Anticipating Transfer Problems

• Always assume patients needing assistance may be a heavy dead weight.

• Use left and right height adjustments properly and enlist assistance when needed.

• Delegation of transfer tasks is possible but must ensure all personnel are educated on patient handling techniques.

Unexpected Outcomes During Mobility Interventions

• Patients may be unable to comprehend or follow transfer directions. Constant reassessment and simplification of instructions may be needed.

• Allow resting periods for patients who are fatigued or in pain.

• Potential adverse reactions from pain medications include dizziness and respiratory depression.

  • Choose appropriate pain management while considering adverse effects.

Use of Alternative Transfer Devices

• Implement slide boards or hydraulic lifts for patients unable to stand during transfers.

• Train patients on proper use of assistive devices for transfers.

Patient Hygiene Care Considerations

• Encourage participation in personal hygiene as part of rehabilitation while in the hospital.

  • Increase frequency of Range of Motion (ROM) exercises for immobilized areas.

Significance of Pressure Injury Prevention

• Regular assessments for erythema and skin breakdown are essential.

• Increase frequency of repositioning for at-risk patients and apply appropriate friction reduction devices.

Importance of Delegation in Patient Care

• Understand that delegation is feasible based on patient assessment and designated responsibilities.

  • Include training for personnel on use of safe patient handling devices according to individual patient's needs.

Monitoring for Joint Contractures

• Recognize that immobile patients are at risk for developing joint contractures due to prolonged immobility.

• Utilize scheduled repositioning and ROM exercises to combat potential contractures.

Conclusion

• Always be prepared for unexpected patient responses during mobility interventions.

• Ensure that patients receive comprehensive evaluations and appropriate support throughout their care journey.