POSITIONING, TURNING, MOVING,AND TRANSFERING PATIENTS

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POSITIONING, TURNING, MOVING,AND TRANSFERING
PATIENTS
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INTRODUCTION

• RESPONSIBILITY OF HEALTH CARE WORKER
• IF PROCEDURES DONE CORRECTLY, PROVIDE PATIENT
  WITH OPTIMUM COMFORT AND CARE
• ALSO HELP WORKER PREVENT INJURY TO SELF

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• CORRECT BODY MECHANICS ESSENTIAL FOR ANY OF THE
  PROCEDURES
• IF YOU ARE UNABLE TO MOVE OR TURN A PATIENT BY
  YOURSELF, ALWAYS GET HELP

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ALIGNMENT

• DEFINED AS POSITIONING BODY PARTS IN RELATION TO
  EACH OTHER TO MAINTAIN CORRECT BODY POSTURE
• DIRECT PATIENT CARE TOWARD MAINTAINING NORMAL
  BODY ALIGNMENT

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• CORRECT ALIGNMENT HELPS PATIENT FEEL MORE
  COMFORTABLE AND PREVENTS FATIQUE
• HELPS PREVENT DECUBITIS ULCERS

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DECUBITUS ULCERS

• ALSO CALLED PRESSURE SORES OR BEDSORES
• CAUSED BY PRESSURE ON AN AREA THAT INTERFERES
  WITH CIRCULATION

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• COMMON IN AREAS WHERE BONES ARE CLOSE TO SKIN,
  SUCH AS TAILBONE OR COCCYGEAL AREA, HIPS, KNEES,
  AND ELBOWS

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DEVELOPMENT OF DECUBITIS ULCERS

• FIRST SIGN IS PALE OR REDDENED AREA ON THE SKIN
• VESICLE OR BLISTER MAY FORM AT THE SITE
• AS CELLS DIE, SKIN BREAKS DOWN AND AN ULCER OR
  OPEN SORE DEVELOPS

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EASIER TO PREVENT DECUBITIS ULCERS THAN IT IS TO
TREAT THEM

• PROVIDE GOOD SKIN CARE
• CLEAN URINE AND FECES FROM SKIN PROMPTLY
• MASSAGE IN A CIRCULAR MOTION AROUND A REDDENED
  AREA

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• APPLY A LIGHT DUSTING OF POWDER TO AREAS WHERE
  SKIN TOUCHES SKIN TO AVOID FRICTION
• TURN PATIENT FREQUENTLY TO CHANGE POSITION
• POSITION TO AVOID PRESSURE ON IRRITATED AREAS

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• KEEP LINEN DRY AND FREE FROM WRINKLES
• OBSERVE SKIN CAREFULLY DURING BATHING AND TURNING
• REPORT PALE OR REDDENED AREAS IMMEDIATELY

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HELPS PREVENT CONTRACTURES

• TIGTHENING OR SHORTING OF A MUSCLE DUE TO LACK OF
  MOVEMENT OR USAGE OF A MUSCLE
• FOOT DROP IS A COMMON CONTRACTURE

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• PREVENT IN PART BY KEEPING FOOT AT RIGHT ANGLES
  TO THE LEG
• USE FOOTBOARDS AND HIGH-TOP TENNIS SHOES TO KEEP
  FOOT IN THIS POSITION

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• RANGE OF MOTION EXERCISES ALSO HELP PREVENT
  CONTRACTURES
• RANGE OF MOTION IS ABBREVIATED ROM

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MOVES AND TURNS

• PATIENTS WHO ARE CONFINED TO BED MUST BE TURNED
  FREQUENTLY
• POSITION SHOULD BE CHANGED AT LEAST EVERY TWO
  HOURS IF PERMITTED BY DOCTOR

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REASONS FOR TURNING FREQUENTLY

• PROVIDES EXERCISE FOR MUSCLES
• STIMULATES CIRCULATION
• HELPS PREVENT DECUBITIS ULCERS AND CONTRACTURES
• PROVIDES COMFORT TO THE PATIENT

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DANGLING

• DANGLING MEANS SITTING PATIENT WITH LEGS HANGING
  DOWN OVER THE SIDE OF THE BED
• PATIENT FREQUENTLY PLACED IN THIS POSITION PRIOR
  TO BEING TRANSFERRED FROM BED IF CONFINED FOR A
  PERIOD OF TIME

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PULSE IS CHECKED THREE TIMES DURING PROCEDURE

• TAKEN JUST BEFORE PATIENT MOVED TO SERVE AS
  RESTING OR CONTROL RATE
• TAKEN IMMEDIATELY AFTER POSITIONING PATIENT IN
  DANGLING POSITION
• TAKEN AFTER PATIENT HAS RETURNED TO LYING POSITION

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• BY NOTING CHANGES IN PULSE RATE YOU CAN DETERMINE
  HOW WELL PATIENT TOLERATES PROCEDURE

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OTHER OBSERVATIONS TO BE MADE

• CHECK RESPIRATORY RATE
• CHECK BALANCE AND NOTE VERTIGO OR DIZZINESS
• NOTE AMOUNT OF PERSIPRATION AND COLOR

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RETURN PATIENT IMMEDIATELY TO SUPINE IF

• EXCESSIVE INCREASE IN PULSE RATE OR WEAK PULSE
• SIGNS OF LABORED RESPIRATIONS
• COLOR BECOMES PALE OR INCREASED PERSPIRATION
  NOTED
• PATIENT GETS DIZZY OR WEAK

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TRANSFERS

• PATIENTS TRANSFERRED TO WHEELCHAIRS, CHAIRS, AND
  STRETCHERS
• CORRECT PROCEDURES MUST BE FOLLOWED TO PREVENT
  INJURY TO BOTH PATIENT AND WORKER

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IMPLEMENTATION

• PLACE BED IN LOW POSITION
• RAISE HEAD OF BED
• ASSIST PATIENT TO DANGLE

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• MANY DIFFERENT MODELS OF WHEELCHAIRS AND
  STRETCHERS AVAILABLE
• IF NO INSTRUCTIONS ARE AVAILABLE, ASK IMMEDIATE
  SUPERVISOR TO DEMONSTRATE CORRECT OPERATION

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MECHANICAL LIFTS

• FREQUENTLY USED TO TRANSER WEAK OR PARALYZED
  PATIENTS
• READ INSTRUCTIONS PROVIDED
• CHECK STRAPS, CLASPS, AND SLING FOR ANY DEFECTS
• USE SMOOTH EVEN MOVEMENTS WHILE OPERATING LIFT

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• REASSURE FRIGHTENED PATIENTS THAT LIFT IS SAFE
• MOVE UNNECESSARY FURNITURE OUT OF THE WAY DURING
  TRANSFERS
• PARTICULARLY INPORTANT IN HOME CARE SITUATIONS