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  2. A. PURPOSE  To maintain proper body alignment  To maintain skin integrity and prevent deformities of the musculoskeletal system  To provide comfort and relaxation  To maintain optimal position for ventilation and lung expansion.
  3. To prevent joint deformities. To relieve pressure and prevent bed sore. To stimulate blood circulation. To give treatments such as range of motion exercises.
  4. B. ASSESSMENT Before positioning a client, assess the following, Client’s:  body size  ability to follow instructions  activity tolerance  Level of comfort
  5. • The space in which the transfer is maneuvered • Number of assistants needed • The skill and strength of the nurses
  6. C. PLANNING • Plan movement before doing it. • Always lock wheels on bed, stretcher, or wheelchair. • Allow patient to assist during move. • Use mechanical aids (e.g., transfer belts, mechanical lifts, slide boards, body mobilizers) or additional personnel to move heavy patients.
  7. SUPPORT DEVICES PILLOWS Used for support or elevation of a body part (e.g. arm). Specially designed dense pillows can be used to elevate the upper body. MATTRESSES Should be periodically rotated and evenly supported BED BOARDS Are usually made of wood and are placed under the mattress to provide support CHAIR BEDS Can be placed into the position of a chair for clients who cannot move from the bed but require a sitting position FOOT BOOT Usually have a firm exterior and padding of foam to protect the skin. They provide support to the feet in a natural position and keep the weight of covers off the toes. Clients who are able to sit may benefit from high-top shoes to maintain foot alignment. FOOT BOARD A flat panel often made of plastic or wood. It keeps the feet in dorsiflexion to prevent plantar flexion.
  8. • When possible, slide, push, or pull patient rather than lift or carry. • Tighten abdominal and gluteal muscles before lifting or moving patient. • Use smooth, rhythmic, coordinated motions. • If another person is assisting, plan your movements before beginning.
  10. Preparation 1. Plan what to do and how to do it 2. Obtain essential equipment before starting (transfer belt, wheelchair) and check that it is functioning correctly
  11. Performance 1. Introduce yourself and verify the client’s identity. 2. Explain the procedure to client to get cooperation. 3. Perform hand hygiene and observe other appropriate infection control procedures. 4. Provide for client privacy. 5. Lower head of bed as flat as patient can tolerate. Raise level of bed to comfortable working height. 6. Remove all pillows from under patient. Leave one at head of bed.
  12. MOVING A PATIENT UP IN BED: (One Nurse) 1. Instruct patient to bend legs and put feet flat on bed. 2. Place your feet in broad stance with one foot in front of the other. Flex your knees and use your thighs. 3. Place one arm under patient’s shoulders and one arm under thighs. Keep head up and back straight. Ask patient to fold the arms across chest, if able. Have patient lift head and place chin on chest.
  13. MOVING A PATIENT UP IN BED: (One Nurse) 4. Rock back and forth on front and back legs to count of three. On third count, have patient push with feet as you lift and assist the patient up in bed. 5. Elevate head of bed and place pillows under head. Raise side rails and lower bed to lowest level.
  14. 1. One nurse stands on each side of bed with legs positioned for wide base of support and one foot slightly in front of the other. 2. Each nurse rolls up and grasps edges of turn sheet close to patient’s shoulders and buttocks. 3. Flex knees and hips. Tighten abdominal and gluteal muscles and keep back straight. MOVING A PATIENT UP IN BED: (Two Nurses)
  15. MOVING A PATIENT UP IN BED: (Two Nurses) 4. Rock back and forth on front and back legs to count of three. On third count, both nurses shift weight to front leg as they simultaneously lift patient toward head of bed. 5. Elevate head of bed and place pillows under patient’s head. Adjust other positioning pillows as necessary. Put up side rails and lower bed to lowest level.
  16. POSITIONING PATIENT IN SIDE – LYING POSITION 1. Elevate and lock side rail on side patient will face when turned. 2. Using draw sheet, move patient to the edge of the bed, opposite the side on which he or she will be turned. 3. Place arm that patient will turn toward away from his or her body. Fold another arm across chest. 4. Flex patient’s knee that will not be next to mattress after turn. Have patient reach toward side rail with opposite arm.
  17. POSITIONING PATIENT IN SIDE – LYING POSITION 5. Assume a broad stance with knees slightly flexed. 6. Using draw sheet, gently pull patient over on side. 7. Align patient properly, then place pillows behind back and under head. 8. Pull shoulder blade forward and out from under patient. Support patient’s upper arm with pillow. 9. Place pillow lengthwise between patient’s legs from thighs to foot. 10. Cover patient with top linen and blanket. Elevate head of the bed.
  18. LOGROLLING 1.Obtain assistance. Assess the need for a cervical collar or thoracic braces or jackets to stabilize the spine. 2.Nurses stand with feet apart, one foot slightly ahead of the other. Flex knees and hips. 3.Use one pillow to support patient’s head during and after turn. Instruct patient to fold arms over chest and keep body stiff. Roll draw sheet toward patient. 4.Place pillows between patient’s legs. 5. Reach across patient and support head, thorax, trunk, and legs. On count of three, roll patient in one coordinated movement to lateral position.
  19. After care Hand hygiene Document relevant information
  20. E. EVALUATION • Conduct appropriate follow up • Report significant deviations from a normal to the primary care provider. • Observe client’s joints and face for signs of exertion, pain or fatigue.