Physical Assessment for Mobility
- Make sure of no musculoskeletal or neurological injuries that affect movement.
- General ease of movement and gait, body alignment, joint structure, muscle mass, tone, strength, endurance that can be assessed walking to the room.
Assessment before moving patient
- Check medical records for conditions or orders that limit mobility
- Preform pain assessment. If there is pain administer medication 30 minutes before moving. If medication causes dizziness, move with caution.
- Assess patients ability to assist with moving and need for any equipment or assistance.
- While moving your patient assess for any skin signs of irritation, redness, edema, or blanching.
Back Injuries in Health Care Workers
- Uncoordinated lifts
- Manual lifting
- Transferring patients without assistive equipment
- Lifting when tired or recovering from injury
- Repetitive movements
- Standing for long periods of time
Proper Body Mechanics When Lifting
- Feet apart to create sturdy foundation
- Bend Knees instead of waist
- Keep neck, back, hips, and feet aligned when moving
- Avoid twisting/bending at the waist
- Raise bed to prevent back injury
- When moving patient who can assist, keep center of gravity high
Patient bedding positions
Fowler - Head of bed is 45-60 degrees.
(Helps with cardiac and respiratory functioning. Used for eating, conversation, urination, and defecation.)
Supine - Lying flat on back
Protective Side-Lying (Lateral Position) - Lying on side with pillows for support. Top leg flexed at 30 degrees and knee at 35 degrees. Calf of upper leg slightly behind body midline. Pillows to support back and top leg.
Patient Bedding Positions (cont)
Protective Sims Position - Variation of Lateral Position, but lower arm is behind the patient, and upper arm is flexed at both shoulder and elbow.
Protective Prone Position - Lies down on abdomen with head turned to side. This is not a good position for people with spinal problems. Pillow on head, abdomen and legs.
Protective Patient Techniques (Bedding)
- Special mattresses/adjustable beds help patients alleviate pressure. Pillows and rolls are used to keep patients in correct position. Patients position should be changed every 2 hours and massaging pressure points to restore blood flow.
Tools for bed positioning
Food Board - Prevents foot drop and used to keep foot in flexed position. Boots/High-top Sneakers can be used.
Trochanter Roll - Prevents external rotation of hips. Folded sheet with top edge by hips and lower edge 1/3 down thigh. Rolled up on each side so hips and thighs are in place.
Hand Roll - Wrist splints/hand rolls made of wash cloth can keep thumb in correct position.
Graduated Compression Stocking (TED Hose)
Require physician order for patients at risk of deep-vein thrombosis, pulmonary embolism, and to prevent phlebitis (clots and inflammation of leg)
- Increases velocity of blood in veins and improves venous valve function in legs, promoting blood flow back to the heart.
- Applied in the morning before patient gets out of bed in Supine position.
- If patient has been up/sitting patient should lie down with feet elevated for 15 minutes before applying.
- Also applied after surgery
How to apply TED
- Make sure size is correct
- Flip the hose inside out
- Start with toes and fit the heel
- Continue to roll up leg and make sure it is wrinkle free
Pneumatic Compression Devices (PCD)
- Fabric sleeves with air bladders that fit around leg and apply brief pressure. Intermittent compressions push blood from smaller vessels into deeper vessels and veins. Enhances blood flow.
- Can be used with anti-embolism stockings and anticoagulant therapy to prevent thrombosis formation.
How to apply Pneumatic Compression Devices (PCD)
How to apply Sequential Compression Devices (SCD)
SCD - Apply with Velcro and check arrows for proper application. Then attach to footboard and turn on.
Moving Patients
- Assess patient before moving
- Review medical record and nursing plan for contradictions in moving.
- Assess tubes/IV’s, incisions, or equipment that alter transfer.
- Assess patient weight and your strength to determine if more assistance is needed.
- Assess patient comfort level and provide medication if needed.
Assistive devices for moving patients in bed.
Siderails - Assist patient in pulling themselves up bed or rotating side to side.
Trapeze Bar - Assists patients in lifting themselves up or moving side to side
Lateral Assist Device - Friction reducing boards or board with rollers to push and pull patients to bed. Use legs instead of back to move patients to avoid injury.
Powered Full Body Sling Lift - Used when patient cannot bear weight. Moves patient in and out of bed/chair. If nurse must lift more than 35 pounds of patients weight, use assistive device. Sling is placed under body and lifts patient slowly.
Moving Patient from Bed to Chair
- Ensure bed and chair are both locked
- Place patient hands on your shoulder and not neck
- Grab patients waist
- Wide stance put leg closes to chair behind the other leg.
- Use legs to lift to avoid injuring back, stand same time patient stands, swivel, then squat down as patient sits.
Helping patient ambulate
- Assess patients continuing need for walking assistive devices and make sure they are properly used.
- Instruct family members in correct usage as well to reinforce teaching.
- Use non-skid socks or shoes and keep clear path.
- Use Gait Belt for patients at high risk of falls.
- Make sure patient is steady on feet when standing, patient should stand erect and look straight ahead.
- Nurse should follow close behind and towards the weaker side.
- If patient falls be prepared to grab shoulder and gait belt.
Gait Belt
- Used to help transfer patients
- Belt with handles to help patient stand and provide stabilization when pivoting.
- Do not use gait belts on patients with abdominal or thoracic incisions.
Walkers
Patient holds handgrips on upper bars, takes step, moves walker, takes another step.
Expected Outcomes
- Ambulates safely and free from falls
- Demonstrates proper use
- Demonstrates increased muscle strength, joint mobility, and independence
Canes
Hold cane on stronger side of body. Move cane up 6-10 inches, then move weak leg up with weight divided between leg and cane.
Single end cane with half circle handle - recommended for patients with minimal need for support and use stairs frequently.
Single end cane with straight handle - Patients with hand weakness, not recommended for patients with poor balance.
Canes with 3/4 prongs. - Recommended for patients with poor balance.
Crutches
- Size should be adjusted, should be 3-4 fingers below armpit.
4 point gait -Stability and Safety
3 point gait - Bears weight on stronger leg
2 point gait - Bears partial weight on both legs
Swing to and through gait - Provide mobility for patients with hip/leg paralysis.
How to sit with crutches
- Put both crutches onto weak side
- Shift weight to strong side
- Grab arm of chair on weak side
- Lower to chair
How to sit with walker
- Do not use walker to stabilize
- Grab arms of chair and lower or raise
Ascending/Descending Stairs with crutches
Ascending
- Begin with strong leg then follow with weak side and crutches.
Descending
- Begin with weak leg and crutches then follow up with strong leg.
How to handle falling patient
- Feet wide apart one in front of the other
- Move pelvis to nearest side of patient
- Grasp gait belt
- Pull patient back towards you
- Gently slide patient down to floor and protect patient head
- Stay with patient and call for help
-
1.1 The Nursing Process13
-
1.2 Infection Control and PPE13
-
1.3 Vital Signs34
-
2.1 Mobility29
-
2.2 Safety and Emergency22
-
2.3 Medication Administration Pt 215
-
2.4 Medication Administration (PART 3)24
-
2.5 Medication Administration (PART 4)24
-
3.1 Introduction to Nutrition23
-
3.2 Nutrition and the Patient17
-
4.1 Asepsis and Infection Control15
-
4.2 Fundamentals of Skin Integrity/Wound Care55
-
5.1 Respiratory Therapy and Oxygenation34
-
1.5 Medication Administration (Part 1)31
-
6.1 Urinary and Bowel Diversions: Ostomy Care21
-
6.2 Bowel Elimination60
-
6.3 Urinary Elimination48
