ADLs #1 - Midterm Flashcards

Question

Discuss the effects of infrequent turning and positioning on circulation.

Answer 1

- causes pressure points which do not receive enough blood flow so the tissues in that area don’t get adequate oxygen (can lead to skin breakdown or bedsores) - movement of muscles helps to move blood through the arteries and veins and prevents blood clots, not moving increases the danger of blood clots

Answer 2

- poor posture and decreased movement causes the lungs to not expand enough to allow for proper aeration - secretions can accumulate in the lungs resulting in pneumonia

Answer 3

-proper positioning promotes bowel and bladder function

Answer 4

- if body joint left in same position too long, the muscles in that area start to stiffen and shorten - joint may become locked into a fixed position permanently (contracture)

Answer 5

- check the kardex, care plan or nurse to determine activity routine and mobility status - determine how many attendants will be needed to assist - always survey the environment around where the move will take place and ensure the work area is free of obstacles

Answer 6

* semi-to-upright sitting position - always check with the care plan, care map or patient’s nurse for any specifics or changes to the patient’s positioning needs - Low-Fowler’s position: raise the head of the bed 15-30 degrees - Semi-Fowler’s position: raise the head of the bed 30-45 degrees - High-Fowler’s position: raise the head of the bed 45-90 degrees, used when patient are eating meals in their bed (90 degrees) and 60 degrees is usually the most comfortable sitting position - keep the spine straight - a good position for someone who is having trouble breathing (High-Fowler’s position) - raise client’s knees slightly using knee gatch control or small pillow - use backrest, foam wedge pillow or sofa pillows to support client - place small pillow behind head and neck, under arms and hands, under lower back and ankles - measure angle of the head of the bed with angle indicator

Answer 7

* back-lying position used for sleeping and resting - use a small pillow or towel along the outside of the legs for a patient who is partially or totally paralyzed to keep legs from turning outward - ensure patient’s head is not being pushed forward by too large a pillow under their head that it makes it too hard to breathe - make sure bed is flat - place the person’s arms along the person’s sides, palms facing down - place a small pillow under the arms and hands, under the knees, lower back, thighs and ankles as directed by supervisor

Answer 8

* front-lying position on the abdomen with the head turned to one side - be sure the back is properly aligned - use only for a short amount of time - more comfortable without a pillow under the head - patient can be moved toward the foot of the bed so the toes are hanging over the end of the mattress - a small pad placed under a female patient just below the breasts to decrease pressure - a small pad can be placed under a male patient just below the genital area to relieve pressure - ensure elderly patients can turn their head enough to be comfortable in this position - a good position for a patient who has had an above-knee amputation to prevent contracture of the upper leg - not recommended for patients with cervical or lumbar spinal problems - patients who have heart or breathing problems may feel like they are suffocating in this position

Answer 9

* side-lying position - be sure the head is in line with the spine - upper and lower leg should form a right-angle at the knees - hip, knee and ankle should be at the same height off the mattress - check often to make sure the client isn’t experiencing pain, numbness, or discomfort - bend the upper leg at the knee, position the upper leg in front of the lower leg - place a small pillow under the head and neck, upper leg and thigh, upper hand and arm, and against the client’s back

Answer 10

* left-side-lying position in which the right leg is sharply flexed - combination of lying on the abdomen and side-lying - used for administering enemas or used for resting - not comfortable for older adults, but if you must place lots of pillows - check with supervisor first - make sure the bed is flat - position the client on the left side - bend the upper right leg and position it such that it does not lie on the lower left leg - bend the upper right arm and position the hand palm down near the head - place the lower left arm behind the client palm facing up - place a small pillow under the head and neck, upper arm and hand and under the upper leg

Answer 11

- to help a resident move in and out of bed - to help a resident move in and out of a wheelchair, commode or tub chair * patient must be able to bear their own weight on at least one lower limb, attain and maintain an upright position during the transfer, and can turn through the pivot movement

Answer 12

- chair is sturdy and comfortable - provides adequate support to the patient’s head and spine - feet should rest flat on the floor or footrest - if can’t keep their bodes in an upright sitting position, may require postural supports which can restrict movement and should be used with caution

Answer 13

1) stabilize the chair against a wall 2) position the patient with knees bent and feet flat on the floor, heels in line with front edge of the chair, cross the patient’s arms in front across his lap 3) stand in front of the patient with your knees resting against his legs, place one foot sideways in front of his feet to prevent them from slipping forward 4) place the palms of your hands over his shoulders and ease the patient forward to an upright position, be sure to use your thigh and stomach muscles

Answer 14

* repositioning using a transfer belt 1) position wheelchair in front of a grab rail or side rail of the bed, ensure brakes of both bed and wheelchair are on 2) if patient is independent they may stand under cuing if not use a transfer belt 3) apply transfer belt, ensure that it is tight and secure 4) health care aide is positioned on the weak side of the patient 5) instruct patient to lean forward, nose over toes and push off on arms of the chair on a decided count 6) have patient hold onto the grab rail or side rail of the bed 7) instruct them to sit 8) ensure that the patient is properly positioned and comfortable

Answer 15

- use proper body mechanics for yourself - keep the bed clean and dry - be sure that all extremities can move freely - avoid placing one body part, particularly one wth bony prominences, directly on top of another body part - check the patient’s skin every time they are turned, pay particular attention to bony prominences - for patients who are heavy or who cannot move independently, have two or more health care workers move or turn the patient - be sure the patient’s body alignment is straight, not curved or twisted - always ask the patient if they are comfortable

Answer 16

- at least every two hours throughout the day as well as during the night (should correspond to when the patient is awake) - prepare a 24-hour turning schedule to be placed on the patient’s nursing care plan or at the bedside

Answer 17

1) pillows: cushion and support body parts in good alignment and relief pressure, too many can cause the opposite effect 2) folded towels: used like pillows for positioning 3) foot board: a padded board placed upright at the foot of the bed when patient is lying supine with their feet placed flat against the board (helps to prevent foot drop) 4) bed cradles: device placed under the top covers to keep them off the patient’s legs and feet to relive pressure and prevent toes from being pushed down out of alignment 5) hand rolls: placed in the palm of the hand to prevent the hand and fingers from contracting in the bent position, must be removed regularly to exercise fingers and wrist 6) splints: used to provide support and keep a body part in proper alignment, usually made of plastic or metal padded with foam 7) hip abduction wedges: abduction is moving a body part away from the midline of the body 8) trapeze: used for exercises to strengthen arm muscles; is suspended from an overbed frame and the client grasps the bar with both hands to lift the trunk off the bed 9) trochanter roll: prevent the hips and legs from turning outward; made by folding sheets and rolling them up; the loose end is placed under the client from hip to knee and the roll is tucked alongside the body

Answer 18

Ex) Parkinson’s disease, multiple sclerosis - effect control and movement of muscles, stiffness in or flaccidity of muscles, shaking and tremors, increasingly difficult to walk, extremely frustrating and emotionally upsetting for patients - patients require patience and understanding by family and staff, frequent rest periods and careful assistance with ambulation and positioning

Answer 19

- joints are swollen and very painful, restricts and slows movement - due to being unable to move themselves, correct positioning of paralyzed limbs is necessary to prevent joint contractures and pressure sores

Answer 20

- caused by the bursting or blockage of a blood vessel in the brain, patients frequently paralyzed on one side and may be confused and unable to speak or see well - patients are unable to move themselves, correct positioning o paralyzed limbs is necessary to prevent joint contractures and pressure sores

Answer 21

- common in the elderly due to falling more easily and their bones are brittle, fixed by pinning or hip replacement - after surgery, special positioning is necessary to prevent hip dislocation: avoid adduction (moving a body part toward the midline of the body) and flexion of the hip, place several pillows between the legs when positioning or turning the person can help prevent adduction, the hip should be flexed no more than 90 degrees, patients must use raised toilet seats and not to bend at the waist or sit in low chairs or wheelchairs, positioning protocols are often posted at patient’s bedside

Answer 22

Bedrest: Patient must remain in bed and may or may not be allowed to perform self-care activities Bedrest with bathroom privileges: Patient must remain in bed but is allowed to be up to the bathroom as necessary

Answer 23

1) assess and plan each activity beforehand, size up the load before moving, get help if you need it 2) prepare the patient by explaining to them what is going to be done and encourage the patient to participate as much as possible 3) survey the environment around the work area and ensure it is free of any obstacles 4) ask the patient how much they are able to assist (some days can be better than others or you may need one person one day and two the next) 5) maintain good posture to reduce stress on the back and therefore reduce the risk of injury 6) wear appropriate footwear

Answer 24

1) always use correct body mechanics 2) always explain rational to the patient with each move 3) when boosting and or turning a patient in bed, be sure the bed is raised to a good working height to prevent strain on back and when moving a patient make sure the bed is at its lowest position 4) when moving a patient in bed, lower the side rail closest to you and lower the head of the bed (place pillow at head of bed) 5) support the patient’s neck 6) remove all pillows and fan fold blankets to the side of the bed 7) give the most support to the heaviest parts of the patient’s body 8) move and hold the patient close to your body for the most support 9) move the patient with a smooth and steady motion, avoid sudden jerks 10) use a lift sheet/slider/turning sheet to help reduce friction or shearing of patient’s skin 11) if getting a patient out of bed, have all needed items ready and close at hand

Answer 25

-requires no assistance, patient moves independently

Answer 26

- requires assistance with equipment, environment and or footwear, set-up or verbal reminders - cooperates and follows directions - walks with or without equipment unassisted - may need verbal cuing or coaching

Answer 27

- may need minor physical assistance - may need to use walking aid such as a can or have to use transport accessory equipment like oxygen tank - may need verbal cuing or coaching

Answer 28

-when using a transfer/gait belt, patient must be fully weight bearing once standing and require only slight physical exertion from the health care aide when rising to stand or lowering to sit

Answer 29

- when the patient is partially dependent on some physical support for trunk or legs is required during transfer or ambulation - moderate assistance often incorporates the use of equipment (sit to stand devices) with a minimum of 1-2 health care aides

Answer 30

- the patient may be dependent for turning, repositioning, standing, walking and or transferring - the patient may have difficulty with key factors in providing assistance such as inability to follow directions, inability to bear weight, demonstrating uncooperative behaviour, unpredictable behaviour, or inability to provide the needed level of strength required to safely perform the task

Answer 31

*when patients lie in bed with the head of the bed elevated and tend to slide down toward the foot of the bed=discomfort or poor body alignment 1) prepare the patient and encourage him to A) use his arms to pull on the head or push on side of the bed B) bend his knees and push on heels of his feet C) use the overhead bar or trapeze to move up or turn over 2) check to make sure wheels of bed are locked 3) raise the bed to a good working height, lower siderails 4) lower the head of the bed 5) remove pillows, position one pillow against the headboard to protect the patient’s head 6) have the patient turn away from you, using the far siderail for assistance 7) fold the slider in half and place from above the shoulder to below the buttocks 8) raise the siderail and have the patient turn to the opposite direction 9) walk around to the other side, drop the siderail and pull the slider into place 10) ask the patient to turn into the supine position 11) direct them to lift and tuck in their head, cross their arms and bend their knees 12) assist the patient by either A) hold the patient’s ankles and have them push off with their heels to the head of the bed B) tell the patient to use the side rail and move themselves to the head of the bed 13) once in proper position, remove the slider 14) return the patient to a comfortable position, keeping in mind good body alignment, lower bed, raise head of the bed as desired

Answer 32

* slider reduces friction during transfers and repositioning 1) make sure the patient is clean and dry 2) adjust the bed height to near hip level of the shorter caregiver 3) have two HCAs present, one on each side of the client’s bed 4) place a folded flannel sheet over the slider or use a slider on a slider 5) place the flannel sheet and slider under the patient by turning the patient from side to side 6) position the slider so the top end is beyond the shoulders and the bottom end below the hips 7) if the person is able to assist, have him bend both knees and place feet firmly on the bed 8) roll the slider until it is tight against the person’s hip and shoulder 9) hold the flannel sheet with palms up (coffee cup grip) 10) the leader holds the flannel sheet near the patient’s other shoulder and hip 11) the assistant hands hold the flannel sheet near the patient’s other shoulder and hip 12) use a full hand grasp (coffee cup grip), assume a wide stance with feet pointing towards the bed, bend at the hips and knees 13) on the count of 1,2,3, slowly slide the patient up in bed 14) shift weight from back foot to front foot 15) remove the slider and flannel sheet or slider by turning the patient from side to side 16) return the patient to a comfortable position, keeping in mind good body alignment, lower bed, raise head of the bed as desired NOTE: The force required to move a patient using a slider is much less due to reduced friction. DO NOT pull hard and DO NOT lift

Answer 33

* to move the person who is unconscious, paralyzed or unresponsive 1) prepare the patient (even if the patient is unresponsive it remains important to advise the patient of what you are about to do to them) 2) be sure the wheels on the bed are locked 3) raise the bed to a good working height, lower the siderails as necessary 4) lower the head of the bed 5) remove the pillows 6) place the slider under the patient by turning the patient from side to side 7) cross the patient’s arms across his chest 8) the HCA and their helper stand on opposite sides of the bed between the shoulders and hips of the patient 9) the HCA pushing the patient puts their hands on the shoulders and hips of the patient and the one pulling rolls up the slider tight to the shoulder and hip 10) on the count of 3, slowly slide the patient to the side of the bed 11) the HCA pulling the patient rocks back on their legs and the HCA pushing rocks forward on their legs 12) keep your arms and shoulders close to your body to ensure a sliding rather than lifting action 13) remove the slider once the patient is comfortably positioned 14) lower bed, raise head of bed as desired

Answer 34

1) ensure that there are no contradictions to turning the patient on the particular side chosen (recent hip fracture or surgery) 2) designate one care provider as the leader 3) raise the bed to a good working height, lower the siderails 4) lower the head of the bed 5) stand on the side opposite to where you will turn the patient, be sure the far siderail is up 6) lower the siderail near you 7) move the patient to the side of the bed 8) cross the patient’s arms over his chest, cross the patient’s near leg over his far leg or bend the knee of the leg opposite to the turn 9) moving the patient away from you *log rolling: A) stand with a wide base of support, flex your knees B) place one hand on the person’s shoulders and the other on the client’s buttock that is near you C) roll the client in one step gently toward the other side of the bed making sure that client’s neck and spine are not being twisted, shift your weight from your rear leg to your front leg D) if stated in the client’s care plan, some clients can be log-rolled more easily by bending the knee opposite to the side they are going to turn onto, ensure spine and neck do not get twisted 10) moving the patient toward you *log rolling A) lower the bed rail if it is up B) stand with a wide base of support, flex your knees C) place one hand on the client’s far shoulder and the other on the far hip D) roll the client toward you gently in one step making sure that the neck and spine do not get twisted E) if stated in the care plan, some clients can be log rolled more easily by bending the knee opposite to the side they are going to turn onto, ensure client’s neck and spine do not get twisted 11) ***post procedure A) provide for safety and comfort B) place the call bell within reach C) return the bed to its lowest position, raise or lower the bed rails according to the care plan D) remove privacy measures E) perform hand hygiene F) report and record your actions and observations, according to employer policy **** remember to adjust the shoulder and arm, the patient should never be positioned lying on their arm

Answer 35

* referred to as “dangling the legs,” used in preparation for getting someone to stand before going for a walk or getting into a chair * older patients may get dizzy when first sitting up, so allow to sit for 1-5 minutes. Before attempting to move them out of the bed 1) check to ensure the patient can assume the sitting position 2) ensure the bed is in the low position so the patient’s feet can touch th floor 3) brakes of the bed are on 4) position the patient into the side-lying position facing you 5) raise the head of the bed 6) stand near the patient’s hips, position your body so it is facing the foot of the bed 7) lower the bed rails if it is up 8) turn so that you face the client, stand with a broad base of support 9) slide one arm under the client’s neck and shoulders, grasp the far shoulder, place your other arm over the client’s thighs near the knees, grasp under the thighs 10) pivot back toward the head of the bed while pulling the client’s feet, and lower the client’s legs over the edge of the bed 11) once the client is balanced in a sitting crouch, place the palm of your hands behind their hips and help them get a safe distance from the edge of the bed 12) never pull on the patient’s arms or neck 13) if the patient is going to stay in this position, make sure that his feet are supported by a footstool if the bed is too high for his feet to reach the ground * NOTE: This method, though widely used, is a back breaker for the caregiver * Alternate way used for patients EXCEPT the unconscious or someone with a fractured arm: 1) raise the head of the bed to semi-Fowler’s position 2) cross the patient’s arms over their chest, placing their hand in front of their body 3) place their legs close to the edge of the bed 4) when you and the patient are both ready, tell the patient to push with the hand in front and they may also use the elbow of the other arm, assist at the shoulder if necessary 5) the legs will usually swing off the bed as the patient sits up 6) if this does not happen, use both hands to slide the legs off the bed as you move your weight from the front leg to the back leg * apply reverse procedure when patient is returning to bed

Answer 36

* used to help prevent falls when transferring unsteady patients * has loops or handles that are held by the health care aide to control movement of the patient during the transfer * should not be used on patients with recent abdominal surgery, abdominal pain, ostomies, abdominal feeding tube, lower rib fractures or hiatus hernias * not used for lifting purposes 1) inspect the belt prior to application 2) explain the procedure to the client 3) perform hand hygiene 4) provide for safety 5) assist the client to the sitting position 6) apply the belt around the client’s waist over clothing, do NOT over bare skin 7) tighten the belt so that it is snug, you should be able to slide your fingers under the belt 8) make sure that the women’s breasts are not caught under the belt 9) place the buckle off centre in the front or in the back for the client’s comfort, the buckle should not be over the spine 10) grasp the transfer belt from underneath when using it to transfer a client

Answer 37

1) assist the patient to a sitting position, ensure the patient’s feet are flat on the floor 2) apply the belt around the patient’s waist, over top of their clothing (do not apply over bare skin), you should be able to place two fingers between the patient’s body and the belt 3) standing on the weak side of the patient with you your feet and body facing the patient, bend your knees 4) grasp transfer belt with one hand behind the patient and other hand is on the patient’s shoulder for cuing, make sure your entire hand isn’t inside the handle of the belt 5) place your other hand in front of the patient’s shoulder to guide their movement 6) have the patient lean forward with their nose over their toes and push off of the bed on count 7) stand with the patient, straightening your knees and keeping your back straight 8) ask the patient if they are okay before moving towards the chair 9) demonstrate walking patient until seat is felt against back of legs 10) patient reaches armrest to sit 11) lower the client into the chair as you bend your hips and knees keep your back straight with your lumbar area curved, the client assists by leaning forward and bending the elbows and knees 12) make sure the client’s buttocks are at the back of the seat, position in good alignment 13) position the client’s feet so that they are flat on the ground 14) cover the client’s lap and legs with a bath blanket 15) remove transfer belt

Answer 38

* due to stroke causing paralysis, always position his unaffected side closest to the direction in which the patient is going during a transfer (helps the patient to support himself and pivot on his strong side) * one person transfer (patient must be able to at least partially weight-bear reliably in order to complete this maneuver 1) position the chair back even with the headboard, place the chair next to the bed so that the patient’s unaffected side is closest to the chair 2) if transferring to a wheelchair, ensure the wheels are locked, fold up or remove footrests so the patient does not trip on them, clear the area of unnecessary obstacles 3) help the patient to a sitting position on the side of the bed, put on his robe and non-slip footwear 4) help the patient to a standing position beside the bed slowly and carefully pivot on your feet and assist the patient to pivot so that he can grasp the far arm of the chair, the back of his legs should be touching the edge of the chair 5) continue to turn the patient until he is able to grasp the other armrest as well 6) lower the client into the chair as you bend your hips and knees keep your back straight with your lumbar area curved, the client assists by leaning forward and bending the elbows and knees 7) make sure the client’s buttocks are at the back of the seat, position in good alignment 8) position the client’s feet so that they are flat on the ground 9) cover the client’s lap and legs with a bath blanket 10) remove transfer belt * when returning a patient to bed, the steps are reversed ensuring the client’s unaffected side is closest to the bed and direction of the transfer * under no circumstances should you manually lift a patient from the bed to a chair or wheelchair

Answer 39

* transferring patients from a bed to a chair and back 1) position the bed and chair at the same level 2) position the chair at an angle facing the bed and the patient 3) sit patient up on the side of the bed with feet touching the floor 4) ensure patient is wearing pants which makes it easy to slide, or powder the board covered with a towel for the patient to sit on and be pulled along the board 5) lay one edge of the board alongside the patient and the edge of the chair to for a a bridge (ensure it is secure) 6) have the patient slide onto and along the board, using the feet and arms for stability

Answer 40

1) place the wheelchair at a right angle to the toilet, with the patient’s unaffected side toward the toilet, raise or remove footrests 2) assist patient to a standing position ensuring that the patient is wearing non-slip footwear 3) have the patient pivot on his unaffected foot toward the unaffected side (NOTE: the use of grab bars if available will help) 4) assist patient to lower himself onto the toilet * reverse the procedure to help the patient back to the wheelchair

Answer 41

1) prior to starting, place a rubber mat on the floor next to the tub and a rubber mat or stickers in the tub to prevent slipping 2) place the wheelchair parallel to the tub with the patient’s unaffected side closer to the tub 3) assist patient to a standing position 4) have the patient pivot on his unaffected foot toward the unaffected side 5) assist the patient to lower himself to a sitting position on the side of the tub 6) using his unaffected hand and leg, have the patient slide himself onto the tub chair or bench placed across the tub, assist as necessary 7) once the patient’s unaffected leg is in the tub, he should use his unaffected hand to lift his affected leg into the tub * patient should leave the tub by moving toward his affected side, then lifting the affected leg out, next swinging the unaffected leg out, assist him to a standing position and return him to a chair

Answer 42

C) Fowler’s position

Answer 43

B) a wide base of support

Answer 44

D) should be placed on a flat surface

Answer 45

A) friction

Answer 46

A) from head to toe

Answer 47

* assist to safely transfer patients who are not consistent or reliable in their weight bearing * Sara, Medi Lift or Golvo used to transfer from bed to chair, wheelchair to tub * policies at all WRHA health care facilities require that two staff members assist with the use if a mechanical lift * before using a mechanical lift: 1) identify the client according to employer policy 2) ask someone to help you 3) explain the procedure to the client 4) collect all items required (mechanical lift, armchair or wheelchair, footwear, bath blanket or cushion 5) perform hand hygiene 6) provide for privacy 7) check the sling to ensure that it is in good condition 8) slings are not to be left under the patient/resident while in the bed 9) slings are not to be left under the patient/resident when sitting Steps 1) check to ensure the type of sling matches the mechanical device you are using 2) ensure that you have the correct size of sling, slings are often colour coded based on size 3) centre the sling under the patient, for correct support the patient should be sitting with his knees slightly higher than his hips when raised to a sitting position 4) place the chair at the head of the bed 5) lock the bed wheel and lower the bed to its lowest position 6) raise the lift so that it can be positioned over the client 7) position the lift over the client 8) lock the lift wheels in position 9) attach the sling to the swivel bar 10) assist the client to the sitting position, raise the head of the bed or use pillows for support 11) cross the client’s arms over the chest, let the client hold onto the straps and not to the swivel bar 12) raise the lift high enough that the client and the sling are free of the bed 13) ask your helper to support the client’s legs as you move the lift and client away from the bed 14) position the lift so the client’s back is toward the chair 15) lower the client into the chair 16) lower the swivel bar to unhook the sling, remove the sling from under the client unless instructed otherwise 17) position the client’s feet on the wheelchair footrest 18) cover the client’s lap and legs with a blanket Applying Mechanical Lift Sling while Patient is in the chair (wheelchair, commode, tub chair) 1) in the majority of cases, slings should not be left under the client therefore reapplying the sling for return transfer is necessary 2) lock the brakes on the chair 3) remove any lap trays, seat belts or other obstructions 4) one care provider should stand behind the chair, the other in front of the patient 5) front care provider helps the patient to move forward in the chair, ensures that the patient is safe from falling forward 6) place the sling behind the patient, between the chair and the patient’s back, the bottom edge of the sling is positioned at the base of the patient’s spine 7) ensure the middle of the sling is aligned with the client’s spine 8) have the patient lean back and bring the tailpieces of the sling under the patient’s thighs by lifting the patient’s legs one at a time *mechanical lifts should be clean, comfortable and safe, send to laundry when necessary, wiped clean on a regular basis with disinfectant solution

Answer 48

* ambulation is the action of walking * always be sure of patient’s ability to ambulate before you attempt to assist him 1) determine the client’s activity status and mobility capabilities 2) make sure the patient is wearing sturdy shoes with non-slip soles 3) apply a transfer belt to the patient 4) assist the patient to a standing position 5) stand to the side and slightly behind the patient (stand on his affected side if applicable), hold onto the transfer belt at the side and back 6) encourage patient to stand straight with head up and looking forward 7) help the client walk, walk to the side and slightly behind the client, provide support with the gait belt or have one arm around the back to support the client 8) encourage the client to walk normally, the heel should strike the floor first, discourage shuffling, sliding or walking on tiptoes 9) walk the required distance if the client can tolerate the activity, do not rush the client 10) return patient to bed or chair

Answer 49

*a client may start to fall when standing or walking *trying to prevent a fall could cause greater harm to either yourself or the client 1) Stand with your feet apart, keep your back straight 2) Bring the client close to your body as quickly as possible, use the gait belt if the client is wearing one. If not, wrap your arms around the client’s waist. You can also hold the client under the arms. 3) Move your leg so the client’s buttocks rest on it. Move your leg near the client. 4) Lower the client to the floor. Let the person slide down your leg to the floor. Bend at your hips and knees as you lower the client. 5) After the fall... A) If you are in a facility, call for a nurse. Stay with the client, and do not move. B) If you are in a home care setting, check for obvious signs of injury. If there are obvious signs of injury, do not move the client, call 911 and then call your supervisor. Keep the client warm and calm until help arrives 6) ***Report and record the following, according to employer policy: how the fall occurred, how far the client walked, how activity was tolerated before the fall, any complaints before the fall, and the amount of assistance needed by the client while walking 7) complete an incident report and the actions you took *any patient found on the floor must be assessed by nursing and or other qualified professional before the client is moved Important to remember: - do not rush to get the person up immediately - do not move the fallen patient until they are examined - get help - plan the safest way to move based on an assessment and a team decision - transfer patient up with at least 2 assisting explaining to the patient what you are doing along the way and how they can help - continue to assess the patient’s ability to move - if patient becomes dizzy or is in pain, stop the transfer until the patient is able to continue - survey the environment and move any obstacles in the way

Answer 50

1) manual transfer-depending on alertness, ability to follow directions, flexibility and strength 2) mechanical lift-if the patient is known to have mobility concerns, or if assessment at the scene determines the person is unable to assist with transferring off the floor 3) lifting board

Answer 51

- used by patients who need extra stability and support while walking due to difficulty maintaining balance or because of a weakness on only one side of their body - good control of the body, strength in the arms and a good hand grasp are necessary in order to patient to use one

Answer 52

- intended to be carried on the side opposite to the affected leg (on the strong side) - should be adjusted to the height of the individual - in standing position, the cane tip should be about 15-25cm to the side of the foot and about the same distance in front of the foot - the grip or handle should be level with the patient’s wrist

Answer 53

1) The cane is moved forward 15 to 25 cm. 2) The weak leg (opposite the cane) is moved forward even with the cane. 3) The strong leg is brought forward and ahead of the cane and the weak leg

Answer 54

- a waist-high, lightweight metal frame with four widely-placed legs - recommended for patients who have general weakness of both legs, partial weight-bearing on one leg or a mild balance problem - must have strength in both arms in order to pick up and move the walker

Answer 55

- standard, bent-handle canes have a single tip, available in woods and aluminum - others could have three or four tips for added support

Answer 56

- standard walker: a rigid four-legged frame with non-slip safety tips, the patient lifts and advances the walker and then steps forward, using arms for support, all four legs are placed on the floor at once and the patient walks into the open space - wheeled walker: a standard frame but the front two legs have wheels, this walker is meant to be pushed or slid along and is especially useful on carpet and for patients who don’t have the strength to lift a standard walker

Answer 57

Standard walker: 1) picked up and moved about 15 to 20 cm in front of the client 2) client moves the weak leg and foot and then the strong leg and foot up to the walker Wheeled walker: 1) the walker is moved about 15 to 20 cm in front of the person 2) both feet are moved up to the walker *rubber tips on the back legs prevent the walker from moving while the client is walking or standing *slight tendency to lean backward when picking up the walker, patient should be instructed to keep his weight forward and use his arms to lift the walker to prevent from falling backward *to sit down, the patient should back up against the chair and using the arms of the chair (not the walker) for support, lower his body into the chair

Answer 58

- used to decrease weight borne by one or both feet and legs - used by a patient after amputation, fracture, operation, or injury of a leg - instructions for their use should indicate whether they are to be full, partial or non-weight bearing - nurse of physiotherapist is responsible to teach the patient safe crutch walking methods

Answer 59

- axillary crutches: fit just under the patient’s armpit (about two fingerbreadths below) and are usually made of wood or aluminum, they are cumbersome to handle and require considerable balance and two strong arms, they must be fitted to the patient using them, the handgrips should be adjusted so that the patient’s elbows are bent at about a 30 degree angle, the patient’s weight is borne by the hands and arms, NOT the axilla (this can cause permanent nerve damage) - elbow (or forearm) crutches: fit the forearms by means of metal cuffs and are usually made of aluminum, usually preferred because it allows patients to release their hands without dropping the crutch, it also eliminates pressure on the ribs and axilla that may be experienced with improper use of axillary crutches

Answer 60

1) when using crutches, the patient should stand as straight as possible and look straight ahead, not at the floor 2) maintain a wide base of support by placing crutches to the side, never in front of the feet 3) crutches must fit properly: fit under armpits and elbow should be at a 30 degree angle, weight borne by hands and arms 4) crutch tips must be attached, replace worn or torn tips, keep dry 5) after use, check the patient’s skin for signs of pressure caused by contact with the crutches, pay special attention to the axilla, elbows and palms of the hands 6) keep crutches within reach of the client when not in use 7) practice safety measures to prevent falls 8) make sure the client wears well-fitted, flat, non-skid street shoes 9) ensure the client’s clothing fits well

Answer 61

- help to support a weak part of the body or hold a part of the body in position - may be made of metal, leather or plastic - most common ones fit over the ankle, knee or back - skin and bony points under the brace should be kept clean and dry to prevent skin breakdown - report redness or signs of skin breakdown and any complaints

Answer 62

- comfortable and lightweight, can move freely in small spaces and fold up for storage or automobile travel - can be ordered with accessories and modifications to suit individual patient needs - can be custom made for special requirements of height, width, depth of seat and special measurements of back and footrests - used simply for transport from one place to another for the patient who experiences shortness of breath on exertion=part-time use - if patient has paraplegia or other physical or neurological condition which affects mobility=full-time use

Answer 63

- standard wheelchair: may be wheeled by the individual themselves or by an assistant - motorized wheelchairs: battery powered and operated by the user, required by persons who have lower body and/or upper body impairments (quadriplegics) following a motor vehicle accident or individuals with Amyotrophic Lateral Sclerosis (ALS)

Answer 64

- brakes: essential not only for security, but also to stabilize the wheels when getting in and out of the wheelchair - hand rim: a rim on the wheel which can be used to propel the chair (protects the hand from direct contact with the wheel) - detachable, swinging footrest: makes getting in and out of the wheelchair easier and safer, patient’s feet must be positioned on foot rests

Answer 65

- heel loop: prevents foot from slipping - toe loop: maintains alignment of an affected foot - buttoned backrest: removable to facilitate patient transfer - upholstered armrests: full length arms, desk or cut-away arms designed for housework, sitting at tables and desks - skirt guards: keep clothing away from wheels - foam seat cushions: “egg crate” cushions - removable seat - cane holder: for individuals who use canes - wheelchair tray - hand rim with knobs

Answer 66

- lock brakes during transfers and when chair is in position - release brake when chair is in motion - fasten safety belt if needed (check facility policy) - back wheelchair down ramps or curbs to prevent patient from falling out - help patient transfer to and from wheelchair - position patient in good sitting alignment - reposition or exercise patient to release pressure areas - encourage patient to propel chair independently - position patient where they can be easily observed and participate in activities - position wheelchair so that chair and patient do not obstruct traffic flow - keep chair, cushions and other accessories clean - inspect chair before and after use for loose or improperly working parts, report problems immediately

Answer 67

1) lock brakes 2) sit in the wheelchair with both feet on the footrests 3) maintain proper body alignment 4) release brake 5) to move forward: grasp hand rims, push both wheels forward at the same time * remember that long, even pushes are less tiring than short pushes 6) to move left: hold the left wheel in position and push forward on the right wheel 7) to move backwards left: push backward on the right wheel 8) to move right: hold the right wheel in position ad push on the left wheel 9) to move backwards right: reverse the left wheel

Answer 68

The performance of physical exertion for improvement of health or correction of physical deformity.

Answer 69

- improves muscle tone and posture - controls weight - reduces tension - promotes relaxation - reduce the risk of cardiovascular (heart and blood vessel) disease - improve cardiopulmonary (heart and lung) functioning

Answer 70

- joints become stiffened - contractures can develop - muscles shrink and lose strength - bones lose minerals - blood circulation is slowed

Answer 71

- Highest degree of motion of which a joint is capable - maintained by normal everyday activities (dressing, bathing, sitting, walking, washing dishes) - if individual is confined to the bed or is paralyzed, the individual will not be getting the exercise they need, so will need assistance to keep joints flexible by range of motion (ROM) exercises

Answer 72

Active ROM exercises: done by the client independently Passive ROM exercises: have the staff move the joints of the client through the range of motion, client does not participate in joint movement Active-assistive ROM exercises: client participates as much as possible and the support worker assists in exercising the client with those he is unable to perform

Answer 73

Moving a body part away from the midline of the body Joint capable of making this movement? Hip joint

Answer 74

Moving a body part toward the midline of the body Joint capable of making this movement? Leg

Answer 75

Straightening of a body part Joint capable of making this movement? Neck

Answer 76

Bending a body part Joint capable of making this movement? Fingers

Answer 77

Excessive straightening of a body part Joint capable of making this movement? Lower back

Answer 78

Bending the toes and foot up at the ankle

Answer 79

Turning the joint Joint capable of making this movement? Ankles

Answer 80

Turning downward Joint capable of making this movement? Neck

Answer 81

Turning upward Joint capable of making this movement?Neck

Answer 82

Circular movement (shoulder)

Answer 83

- check with the nurse for specific instructions or limitations - provide privacy, comfort and warmth for the patient - do each exercise 3-5 times unless otherwise instructed - follow a logical sequence (start at the head and work down) - if the patient can move parts of the body, encourage him to do as much as possible - stop the exercise if the patient complains of pain or discomfort, report this to the nurse - do not exercise a swollen, reddened joint - provide support to the limb being exercised - expose only the body part being exercised - move the joint slowly, smoothly and gently - do not force a joint beyond its present range of motion or to the point of pain - perform range of motion exercises to the neck only if allowed by the employer - the role of the health care aide in ROM exercises will be depend on the patient’s level of ability and the physician’s orders

Answer 84

* only if allowed by your employer and if supervisor instructs you to do so 1) place your hands over the client’s ears to support the head, support the jaws with your fingers 2) flexion: bring the head forward so that the chin touches the chest 3) extension: straighten the head 4) hyperextension: bring the head backward until the chin points up 5) rotation: turn the head from side to side 6) lateral flexion: move the head to the right and to the left 7) repeat 2-6 five times or number of times stated on the care plan

Answer 85

1) grasp the wrist with one hand, grasp the elbow with your other hand 2) flexion: raise the arm straight in front and over the head 3) extension: bring the arm down to the side 4) hyperextension: move the arm behind the body 5) abduction: move the straight arm away from the side of the body 6) adduction: move the straight arm to the side of the body 7) internal rotation: bend the arm at the elbow, place it at the same level as the shoulder, move the forearm down toward the body 8) external rotation: move the forearm toward the head 9) repeat 2-8 five times or the number of times stated on the care plan

Answer 86

1) grasp the client’s wrist with one hand and the elbow with your other hand 2) flexion: bend the arm so the hand touches the same-side shoulder 3) extension: straighten the arm 4) repeat 2-3 five times or the number of times stated on the care plan

Answer 87

1) pronation: turn the hand so that the palm is down 2) supination: turn the hand so that the palm I up 3) repeat 1-2 five times or the number of times stated on the care plan

Answer 88

1) hold the wrist with both hands 2) flexion: bend the hand down 3) extension: straighten the hand 4) hyperextension: bend the hand back 5) radial flexion: turn the hand toward the thumb 6) ulnar flexion: turn the hand toward the little finger 7) repeat 2-6 five times or the number of times stated on the care plan

Answer 89

1) hold the client’s hand with one hand and hold the thumb with your other hand 2) abduction: move the thumb out from the inner part of the index finger 3) adduction: move the thumb back next to the index finger 4) opposition: touch each fingertip with the thumb 5) flexion: bend the thumb into the hand 6) extension: move the thumb out to the side of the fingers 7) repeat 2-6 five times or the number of times stated on the care plan

Answer 90

1) abduction: spread the fingers and thumbs apart 2) adduction: bring the fingers and thumbs together 3) extension: straighten the fingers so that the fingers, hand ad arm are straight 4) flexion: make a fist 5) repeat 1-4 five times or as stated on the care plan

Answer 91

1) support the leg, place one hand under the knee, place your other hand under the ankle 2) flexion: raise the leg 3) extension: straighten the leg 4) abduction: move the leg away from the body 5) adduction: move the leg toward the other leg 6) internal rotation: turn the leg inward 7) external rotation: turn the leg outward 8) repeat 2-7 five times or the number of times stated on the care plan

Answer 92

1) support the knee, place one hand under the knee, place your other hand under the ankle 2) flexion: bend the leg 3) extension: straighten the leg 4) repeat 2-3 five times or the number of times stated on the care plan

Answer 93

1) support the foot and ankle, place one hand under the foot, place your other hand under the ankle 2) dorsiflexion: pull the foot forward, push down on the heel at the same time 3) plantar flexion: turn the foot down or point the toes 4) repeat 2-3 five times or the number stated on the care plan

Answer 94

1) continue to support the foot and ankle 2) pronation: turn the outside of the foot up and the inside down 3) supination: turn the inside of the foot up and the outside down 3) repeat 2-3 five times or the number stated on the care plan

Answer 95

1) flexion: curl the toes 2) extension: straighten the toes 3) abduction: spread the toes apart 4) adduction: pull the toes together 5) repeat 1-4 five times or as stated on the care plan