Transcript Assisting With Moving and Positioning Clients in Bed

Assisting With Moving
and Positioning Clients
in Bed
Assisting With Moving and
Positioning Clients in Bed
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A, Pressure points in lying
position.
B, Pressure points in sitting
position.
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Shearing forces against
sacrum cause tissue
damage.
The skill of moving and
positioning clients with
acute spinal cord trauma
requires critical thinking
and knowledge
application unique to a
nurse.
Assisting With Moving and
Positioning Clients in bed
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Moving client with one
nurse
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Moving client with aid of
trapeze.
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1. Ad|just position of IV pole, tubes, and catheters.
2. Provide client with hearing aid and glasses if used.
3. Lower the head of the bed to the lowest position. Place the
pillow near headboard.
5. Assist client to supine position with knees Hexed so that
soles of one or both feet are
flat on the bed.
6. If there is no trapeze, slide arm nearest the head of the bed
under client's shoulders, reaching under and supporting client's
opposite shoulder. Place other arm under
client's upper back (see illustration). Have lient push with feet
as you lift on the
count of three.
7.If there is a trapeze, assist client with grasping it. Slide one
arm under thighs and one arm under trunk (see illustration).
8. Have client lift with trapeze and/or push with feet on the
count of three. Repeat if needed to move up farther in the bed.
9. Ask client about level of comfort, and adjust as necessary
Positioning in semi-Fowler's and
Fowler's position.
For the semi-Fowler's position the
head of the bed is raised 45 to 60
degrees. The high-Fowler's position,
with the head of the bed raised 90
degrees, is recommended for eating.
With client in supine position, raise the
head of the bed to the appropriate
level (45 to 90 degrees) (see
illustrations).
Use pillows to support client's arms and
hands if upper body is immobilized.
Position a pillow under client's head if
desired, and raise the knee break of
the bed slightly. Avoid pressure under
the popliteal space (back of the knee).
Change the degree of elevation of the
head of bed 5 to 10 degrees
frequently. Identify potential pressure
points, including scapulae, elbows,
sacrum or coccyx, and heels
(implement pressure ulcer prevention.
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Side-lying position with pillow placement
Moving dependent client to 30-degree lateral (sidelying) position.
This move removes pressure from bony prominences of
entire back.
Lower the head of the bed as much as lient can tolerate,
keeping head of bed delow 30-degree angle. Lower side
rail.
Using a pull sheet, move client to the side of the bed opposite
to the one toward which
client will be turned. Raise side rail. Go to opposite side of
the bed, and lower side rail.
Prepare to turn client onto side. Flex client's knee that will not
be next to mat tress once turned. Assist client with raising
arm nearest you above head, adjusting pil low if needed.
Place one hand on client's hip and one hand on client's
shoulder and hip, and as sist client with rolling toward you
onto side.
Flex both client's knees after the turn, and support upper leg
from knee to toot using a pillow or folded blanket.
F.ase lower shoulder forward, and bring upper shoulder back
slightly. Check client's comfort.
Support upper arm with pillows so that arm is level with
shoulder.
Optional: Place pillow behind client's back and under so that it is
tucked smoothly against back (see illustration).
Make sure client's back is straight without evidence of twisting.
Adjust as needed for comfort.
Pressure points to check include the ear, shoulder, anterior iliac
spine, trochanter, lateral side of the knee, malleolus, and
foot
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Promoting Activity and Mobility
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Logrolling to maintain neck and spinal alignment following injury or surgery
(1) Determine number of staff required to logroll client.
Lower the head of the bed as much as client can tolerate.
Place a pillow between the legs. Use of a pull sheet placed between shoulders and knees can facilitate
turning.
Cross client's arms on chest.
Position two nurses on side of bed to which the client will be turned. Position third nurse on the other side
of bed (see
illustration).
Fanfold or roll the drawsheet or pullsheet.
Using the count of three, turn client as one unit with a continuous, smooth, and coordinated effort.
Support client with pillows along the length of the client. Gently lean client as a unit back towards the
pillows for support.
Assisting With Moving and
Positioning Clients in Bed
Step 5f(1)
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Sims' (semiprone) position.
(2) Pillow placement for supine position
Positioning dependent client in supine position
Place client on back with head of bed flat.
Place pillow under upper shoulders, neck, and head (see illustration).
To position trochanter roll at client's hips, place a folded bath blanket under
hips and roll ends under until toes point directly up (see illustration)
Place small support under ankles to mini mize pressure on heels. A footboard
or use of high top tennis shoes may be used to prevent footdrop. Shoes should
be removed at least 3 times a day for ROM exercises to prevent contractures.
Place small supports under forearms with hand-wrist splints or small rolls to
support fingers and thumb in a functional position.
Pressure areas to check include the back of the head, scapulae, elbows,
posterior iliac spine, sacrum or coccyx, ischium, Achilles tendons, and heels
Promoting Activity and Mobility
Steps 5h(3) and 5h(4) Prone
position with pillows in place
Step 5h(6).Prone position with pillows supporting lower legs
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Roll client to one side.
Roll client over arm positioned close to body,
with elbow straight and hand under hip. Position client on
abdomen in center of bed.
Turn client's head to one side, and support head with small
pillow (see illustration).
Place small pillow under client's abdomen below level of
diaphragm (see illustration).
Support arms in flexed position level at
shoulders.
Support lower legs with pillow to elevate
toes (see illustration).