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Mod D: Patient Safety and Positioning
Patient Safety p.236
Risk factors for ________________:
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Impaired _______________ due to injury, disease, or surgery
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_____________ affecting mental status, balance, coordination
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______________ due to change in environment or disease
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Impaired _____________ or _________________
Possible causes for ________________:
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Misjudged _________________
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_____________, dizzy
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Rapid change in _______________ – losing balance, getting light headed
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________________ on hallways
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Poor _______________________•
Not calling for help
Prevention is key! Study Preventing Patient Falls Figure 15.1 p. 237!!!!!
Restraints p. 237
________________ – medications affecting mood/behavior
____________________-: any technique or device that ___________ movement or ____________ access to body
Remember: The resident has the __________ to be ________ from physical and chemical restraints, so document
objectively what’s going on
Physical restraints are only used when ________ of pt or others is at risk and nothing else works, ex. If pt climbs
out of bed to go to bathroom – keep urinal in reach
Always have to try _______________ first, ex. Pt who gets out of WC gets a chair alarm and WC is placed by the
nurse’s station, so everyone can keep an eye on pt
If restraints are necessary, start with ____________________ first
Need a __________________________, often family/pt will sign consent, and follow protocol
P. 238 examples of physical restraints
Table 15.1: Complications of restraints!
P. 246: Guidelines for The Use of Restraints!! Especially: check _________, release ______________ for at
least _____________ mins etc
Applying Restraints in Bed p. 244
Ex: wrist, vest, poncho, jacket, belt restraints; Always follow manufacturers guidelines
Center pt’s hips in middle of bed (where it bends when HOB goes up)
Make sure straps are _________________, not at an angle
Wrap straps around ____________________ deck (movable part of bed frame that supports mattress)
Don’t wrap on stationary bed frame part (when you move HOB, it gets pulled), __________________, or
on outside of bed, so pt can’t untie it
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Use bedspring to tie on strap
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Use _____________ when pt is restrained in bed
See Figure 15-14
Enablers & Side rails p. 241
___________________: Device that _______________, assists pt to function at highest level possible; if used
purely to keep pt from getting up = restraint ex. Wheelchair lap tray Figure 15-9
________________ supports: devices that maintain body ____________ and alignment
_________________: can be ____________, can be ____________; 4 rails up=always restraint
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If pt has physical restraints on in bed – side rails must be up
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Injuries with side rails: ____________ = hip fractures, _____________ between mattress, rails see Figures
15-10A,p. 242
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____________ for side rails: for seizure disorders, blood thinning medications, pt who wants to climb
through side rails
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______________ to side rails: see all figures on p. 243
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Keep bed in ___________ possible position, wheels ______________
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Padded _______________ on floors, so no injuries when fall
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Meet needs = ______________ reasons for getting up: hunger, thirst, bathroom, pain
Pressure-sensitive bed and chair ________________: sound when pt gets out of bed or chair
Pressure-sensitive ______________: sound alarm when someone steps on them
Alternatives to Restraints p. 245
Try before using restraints – document what was tried, how it didn’t work
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Care for pt’s personal _______________________
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Know pt’s with fall risks – __________________ them more often
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Make sure pts walk and transfer ______________________
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Report any physical or mental _________________ that could lead to an accident STAT
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Maintain safe, quiet, calm __________________
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Comfortable chairs, supportive devices
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Use ___________________: wrist sensors (go off if pt tries to leave building), bed or chair ________
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Use __________ wisely, often just covering the IV site with long sleeves etc. keeps pt from pulling on it
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Preventing other Incidents p. 247
Accidental ____________: _________ all chemicals/cleaning solutions; Pt food belongs in pt ________, labeled
with _________ and ____________
_________________ injuries: heat or cold
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Follow _____________ accurately when administering warm/cold treatments
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Check ____________- temperature
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Check ____________ temperature
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Store flammables safely
__________________ injuries: lacerations (cuts/breaks in skin)
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Keep _______________- locked up: scissors, knives, razors, needles
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Dispose of them properly in a _______________
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Clean up broken glass immediately
Preventing other Incidents p. 248
________________:
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______________: accidental entry of food or object into trachea (windpipe)
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Pt having problems with swallowing (______________-): cut food small, feed ___________, fluids
between bites, place food in ________________ side (CVA), use __________________ if ordered
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Place pt ____________, good body ________________ before eating; sit up for ______ mins after eating
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If pt ______________ food, give oral care after meal
Procedures p. 249 - 252
Procedure: practices and processes used when following facility policies in patient care
Prioritizes and orders your responsibilities
Initial Procedure actions p. 249!!, Ending Procedure actions p.251!!
Body mechanics for the patient p. 253
Body _____________________: position in which body can properly function
Maintained by ___________, _______________, _________________- pt so it
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Helps the pt feel more comfortable
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Relieves _____________
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Helps body _______________ more efficiently
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Prevents complications like __________________ and ____________ (pressure ulcer)
Complications of incorrect positioning p. 253
_________________- (PUs): unrelieved ____________ on a __________________________ interferes with blood
flow leading to tissue breakdown (wounds)
_______________________:
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Occur when joint is in _________________ position for too long
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Can begin in as little as ____ days of immobility
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Pt loses ability of free movement after 15 days
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Muscles stiffen and shorten, preventing joint from moving fully
Painful, ________________, interfere with mobility
Supportive devices p. 254
Anything that helps maintain proper body __________________
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_____________, folded sheets, blankets
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_____________ devices, ex. Splints
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Special boots or shoes
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Bed _______________ to prevent blanket sitting on feet
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Footboards to prevent ___________________
Body Positions p. 254
____________ (abdomen)/ semiprone (variation
___________ (back)/ semisupine (variation)
____________ (side)/ Sims’ (variation)
______________ position/ high Fowler’s, semi-Fowler’s, orthopneic position
Regardless the position, it always involves:
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moving pt into proper ________________, may need to move pt up or to one side of the bed
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________________ pt on back, side, or abdomen
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Placing pt’s _______ and _________ in proper position, maintaining alignment with use of supportive
devices
Moving/ lifting pts p. 255
Responsibility of nursing assistant
Follow proper _______________ and safety rules for you and your pt
ALWAYS find out if you need help moving/lifting pt before beginning
Ask for help
Check _________________ for special positioning instructions
___________ sheet /draw sheet:
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Extends from above ____________ to below _____________
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Used to move heavy or helpless pt
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Procedures 14-17!! P. 255-258
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Read procedures:
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Turn pt toward you
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Turn pt away from you
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Moving pt to HOB
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Logrolling pt
Positioning pt p. 259
You have to know the positions!!
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__________________ Position p. 259
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HOB flat, head 2-3 inches from HOB
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Pillow extends 2 inches below pts shoulders, head in middle
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Trochanter roll: from above hip to above knee, for affected hip or weak hips (prevents external rotation)
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Pillows everywhere, feet at 90 Degree angles
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Semisupine Position = tilt position (not lateral)
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Relieves pressure from hip, sacrum, coccyx and buttocks
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45 Degree angle between pt back and bed
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Bottom shoulder slightly forward
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Legs and spine are straight
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___________________ Position p. 260
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Pillow under head extends to shoulders and 5-6 inches beyond face
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Small pillow under abdomen (reduces back pressure)
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Pillows under arms, lower legs
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Legs and spine are staight
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Semiprone Position (not lateral)
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Starts in prone, then pillow under shoulder and chest, under top leg
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Lower arm is behind body
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Legs and spine are straight
______________________ Lateral Position p. 262 XXXX Skill check off XXXXXX
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Start in supine, bring pt more to left side of bed, so he can turn right and have enough space
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Place pillow under head extending 5-6 inches beyond face and down to shoulders
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Position right (lower) arm, so shoulder, elbow are flexed, palm facing up
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Place left (upper) arm in comfortable position, support with billow; shoulder, elbow wrist at same height
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Pillow behind pts back to maintain position
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Pillow between legs from above knee to below ankles; hip, knee and ankle at same height
________________-- position p. 262 (variation of left lateral position)
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Left (lower arm) extended and behind back
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Right (upper arm) flexed and forward, supported with pillow
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Left leg extended
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Right leg flexed
________________- Position (to feed pts, for watching TV etc)
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Start in supine, middle of bed, hip where bed bends
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HOB at ___ Degrees = _______-Fowler’s, HOB ___________ Degrees = ________, HOB ____ Degrees
= ______ Fowler’s
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Pillow extends 4-5 inches below shoulders
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Flex elbows, support with pillows to prevent pulling on shoulders
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Pillow under legs from above knee to ankles to prevent pressure on heels
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Footboard/folded pillow to prevent foot drop
___________________ Position
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Variation of high Fowler’s when pt has __________________________
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Sit pt up as ___________________ as possible
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Lean pt __________________, using overbed table in front of pt as support for extended arms
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Pillow behind back for support
_________________ Position
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In chair or WC
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Back and buttocks up against chair back
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Stabilize feet on floor or footrests
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Feet, knees, thighs at 90 degree angles (90-90-90 position)
Skill 3: positioning patient in lateral position
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