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4 values of proper body mechanics for transfer
conserve energy
reduce stress and strain to muscles, joints, ligaments and soft tissue
promote effective, efficient, and safe movements
promote and maintain proper body control and balance
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best transfer:
right hemiplegia. full wt bearing on his left leg with weight bearing as tolerated on his right
stand pivot
bilateral LE amputation below the knee secondary to diabetes, limited overall mobility due to limited strength in her trunk and upper extremities
sliding board
traumatic brain injury from a MVA, coma and minimally responsive to tactile and auditory input
2 person lift
BLE amputation below the knee, 1 month post injury
lateral transfer
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length of cane
greater trochanter, wrist crease, or ulnar styloid process to the heel with the hip and knee straight
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full wt bearing on left lower extremity, partial weight bearing on right lower extremity
- ambulation device:
- axillary crutch
- quad cane
- walker
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full wt bearing on right LE, non-weight bearing on left
- ambulation:
- walker
- rapid ambulation
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guidelines for positioning and draping
1.introduce yourself to the patient-give your name and status. confirm the patient's name and current, relevant information about himself(i.e. diagnosis,complaints, previous treatment and response, physician)
2.inform him/her of the planned treatment. apply the principles of informed consent and obtain consent for treatment
3.specifically describe how he/she isto be positioned. provide assistance if required.
-if the person is wearing street clothes indicate the specific articles of clothing he/she is to remove or request permission to remove them if assistance is required
-provide temporary clothing or linen to protect his/her modesty and provide warmth
-have sufficient linen,pillows and equipment needed for the treatment available in the treatment area
-provide safe and secure storage for patient's valuable items
4.specifically describe how you desire the pt. to use the linen items, gown, robe or exercise clothing to cover (drape) himself/herself. provide privacy while the pt. disrobes (provided the pt. is safe)
5.instruct him/her to inform you when he/she is positioned and draped. ask if he/she is clothed or draped before entering the treatment area
6.at the conclusion of the treatment
-instruct him/her to remove drape items and temporary clothing and to redress in to street clothes. provide assistance as needed. provide privacy while dressing.
-provide linen so the patient can remove perspiration, massage lotion, gels, water or other substances
return valuables
dispose of linens in proper container
prepare treatment area for next treatment
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positioning-supine
1.small pillow or roll under the patient's head. avoid excessive neck and upper back flexion or scapular abduction.
2.small pillow or rolled towels in popliteal spaces (under knees) to relieve lumbar lordosis and promote comfort
3.small rolled towel or small bolster can be placed at the patient's posterior ankles to relieve pressure to the calcaneus (Heel). avoid knee hyperextension
4.upper extremities may be elevated on pillows or positioned in whatever way the patient desires for comfort. Extremities should be totally supported on the mat or table
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positioning-prone
1.place small pillow or towel roll under the patient's head or have the patient turn his/her head to the left or right. some patients are comfortable with a small towel roll under their forehead (special headrest)
2.a pillow placed under the patient's lower abdomen will reduce his/her lumbar lordosis.
3.a rolled towel should be placed under each anterior shoulder to adduct the scaplula and reduce the stress to the interscapular muscles
4.use pillow, towel roll or small bolster under the patient's anterior ankles to relieve stress on his/her hamstring muscles. it will also allow the pelvis and lower back to relax
5.upper extremities may be positioned for comfort
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positioning-sidelying
1.position patient in ceter of bed, table w/ head, trunk, and pelvis aligned.
2.LE should be flexed at the knees and hips
3.the uppermost LE should be supported on one or two pillows and positioned slightly forward of the lowermost extremity. The lowermost extremity provides stability to the patient's pelvis and lower trunk
4. one or two pillows should be used to support the patient's head
5.a folded pillow placed at the patient's chest is used to support the uppermost UE and prevent him/her from rolling onto his/her abdomen
6.it may be necessary to place folded pillows along the posterior trunk to prevent the patient from rolling onto his back.
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rationale for proper draping
1.provide modesty for patient
2. maintain appropriate body temperature
3.provide access and exposure to areas to be treated while protecting other areas
4.protect the patient's skin or clothing from being soiled or damaged
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3 point pattern
used with walker
referred tpo as "step-to" or step through pattern (rather than swing-to or swing-through pattern
used when a patient is able to bear weight on one LE but is non-weight bearing(NWB) on the opposite LE
requires good strength in UE's and energy expenditure is quite high because of the need to use the UE to lift, support and propel the body
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3-1 point
modified 3-point pattern
requires the use of bilateral ambulation aids or a walker
pattern used when the patient is permitted FWB on one LE but PWB on the other LE
the walker is advanced simultaneously with PWB LE
then the FWB LE is advanced while the patient distributes his/her body weight onto the aid, partially bearing weight on the protected LE
- more stable pattern than the 3-point pattern and
- requires less strength and energy expenditure that the 3-point pattern
slower pattern
allows the effected extremity to be exercised while maintaining some weight bearing on it
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modified 2-point pattern
require the use of one ambulation aid
used with the patient who has only one functional UP or who uses only one ambulation aid
the aid is held in the UE opposite to the LE that requires protection to widen the BOS and aSSIST IN SHIFTING THE PATIENT'S cog AWAY FROM THE PROTECTED le
REFERRED TO AS THE "HEMI" GAIT OR HEMI pattern
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situations when hand washing should be done
before and after patient contact
before and after contact with wounds, dressings, speciments, bed linen, and protective clothing
after contact with secretions or excretions and when hands are soiled or considered contaminated
before and after toileting
after sneezing, coughing, or nose blowing
after removing gloves
before and after eating
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standard precautions
barriers
- gloves
- protective clothing
- eye protection
- face shield
- mask
- mouthpiece, intubation device, resuscitation bag during CPR
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