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Patients who need assistance indressing & undressing:

1. Patient who are in cast or a brace.

2. Patient who is very young.3. Patient who is too weakened a condition to help

him or herself.

4. Patient who have contracture of an extremity.

5. Patient with poor eyesight.


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1. Removing clothing of trauma patients, esp coming from

ER, in conventional manner may cause injury or pain.

2. Clothing must not be cut without the patients consent

except in extreme emergencies. (If patient is unable

give consent, a family member should do in writing for

protection).

3. Clothing must be cut off into a seam if at all possible.

4. If the patient is very young and is accompanied by afamiliar adult, he or she will be more relaxed &

cooperative if the adult helps him to dress and undress.


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Patient with disability of lower extremity

1. Place a long gown on the patient.2. Instruct patient to loosen belt buckles, buttons, or

hooks around the waist.

3. Slip the trousers over the hips. (if the patient cannot

do this, reach under the gown and pull the trousers

down over the hips)

4. Have the patient sit down.

5. Squat in front of the patient and gently pull the

clothing over the legs and feet to remove it.

6. If the patient is not able to help, call for anassistance.


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Steps to re-dress the patient:

1. Slide the clothing (pants or skirt) over the feet or legs

as far as the hips while the patient is sitting and stillwearing an examining gown.

2. Have the patient stand and pull the clothing over the

hips if he or she cannot tolerate it.

3. If the patient is not able to pull the clothing over the

hips alone, have an assistant raise the patient offthe chair so that you can slip the clothing over hips

and waist.

4. Remove the patients arm from the sleeves of the

gown.5. Have the patient hold the gown over his or her chest.

6. Carefully pull the shirt over the head, or put it on one

sleeve at a time.

7. When the outside items of clothing are on the

patient, remove th gown from under the clothes.


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The Disabled Patient on Gurney or

Radiographic table:

1. Explain what is to be done and ask the patient to help

if he or she is able. (if the patient is paralyzed or

unconscious, summon help before beginning the

procedure)2. Cover the patient with a draw sheet and have an

examining gown ready.

3. Remove the clothing from the less affected side first

and then remove the clothing from the more affected

side and place the clean gown on that side. (makesure to keep the patient covered with the draw sheet)

4. Place the clean gown on the unaffected side and tie

the gown at the back, if practical.


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Radiographic table:

1. Roll the garment up above the waist.

2. Remove the garment above the waist

3. Remove the patients arms from the clothing, first

from the unaffected side and then from the affectedside.

4. Neatly, gently lift the clothing over the patients head

(one person alone should not attempt to undress a

disabled patient for the risk of causing further injury

or discomfort).


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Radiographic table:

1. Loosen buckles and buttons.

2. Have the patient raise his buttocks as the trousers

are slipped over his hips.

3. If the patient is unable to help, have an assistantstand at the opposite side of the table.

4. After the trousers have been loosened, have the

assistant pull the patient toward him or her, and then

slide the trousers off one side of the hip.

5. Draw the patient towards the opposite side and have

the assistant slide the trousers off the other hip.

6. Slip the trousers below the knees and off.

7. Fold the clothing and place it in a paper bag on which

the patients name has been printed.

Removing trousers


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Bedpan

Urinal


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ImmobilizersAny manual method or physical or mechanicaldevice, material or equipment attached or

adjacent to the persons body that the person

cannot remove easily that restricts freedom of

movement or normal access to ones body.

Omnibus Reconciliation Act, 1989

Must be ordered by the physician in charge ofthe patients care and applied in compliance

with institution policy.


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Reasons for application of Immobilizers

1.T

o control movement of an extremity when anintravenous infusion or diagnostic catheter is in

place.

2. To remind the patient who is sedated and having

difficulty remembering to remain in particular

position.3. To prevent a patient who is unconscious, delirious,

cognitively impaired, or confused from falling from a

radiographic table or a gurney

4. To prevent patient from removing a tube or dressing

that may be life sustaining.

5. To prevent patient from injuring him or herself by

impact with diagnostic imaging equipment.


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Rules for application of Immobilizers

1. The patient must be allowed as much mobility as is

safely possible.2. The areas of the body where immobilizers are

applied must be padded to prevent injury to the skin

beneath the device.

3. Normal anatomic position must be maintained.

4. Knots that will not become tighter with movement

must be used.

5. The immobilizer must be easy to remove quickly, if

this is necessary.

6. Neither circulation nor respiration must be impairedby the immobilizer.

7. If leg immobilizers are necessary, wrist immobilizers

must also be applied.


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Assess patient

1. Deviation from correct body alignment.2. Immobility or limitation in range of joint

motion.

3. The ability to walk.

4. Patient general condition.5. Range of motion & weight-bearing ability.

6. The patients strength and endurance.

7. The patients ability to maintain balance.

8. The patient ability to understand what isexpected during the transfer.

9. The patients acceptance of the move.

10.The patient medication history.


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Rules to observe during transfer

1. Give only the assistance that the patient

needs for comfort and safety.

2. Always transfer a patient across the shortest

distance.

3. Lock all wheels on bed, gurneys, and

wheelchairs before the move begins.

4. Generally, it is better to move a patient towardhis or her stronger side while assisting on the

patients weaker side.

5. The patient should wear shoes for standing

transfers, not slippery socks.6. Inform the patient of the plan for moving and

encourage him or her to help.

7. Give the patient short, simple commands and

help the patient to accomplish the move.


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BODY MECHANICS

The principle of proper body alignment, movement, and balance.

Concepts of Body Mechanics

1. Base of support

- the portion of the body in contact with the

floor or other horizontal surfaces.

2. Center of gravity

- the point around which body weight is balanced.

3. Line of gravity

- an imaginary vertical line passing through the

center of gravity.


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Principles for Safe Transfers

Let the patient do as much of the transfer as possible.

Check the chart for precautions, such as weight-bearing status andjoint disease, before executing the transfer to minimize patient

discomfort and harm.

Use a wide base of support for your stability.

Hold the patients center of gravity close to your own center of

gravity for a better mechanical advantage.

Hold the patient with a transfer belt around the patients waist to

minimize stress on the patients shoulder girdle.

Lift the patient with your legs. Avoid back bending.

Avoid trunk twisting during transfer.

Never lift more than you can. Ask assistance when needed.

Watch the patient for signs of orthostatic hypotension and take

precautions to minimize its effects.


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Rules of Body Mechanics

1.Provide a broad base of support.2.Work at a comfortable height.

3.When lifting, bend your knees and keep

your back straight.4.Keep your load well balanced and close

to your body.

5.Pull heavy object or patient.

6.Always protect the spine.7.Make certain that the floor area is clear

of all objects


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Wheelchair Transfers

4 Types:

1. Standby AssistTransfer

2. Assisted Standing PivotTransfer

3. Two Person Lift

4. Hydraulic LiftTechniques


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1. Footrest 10. Push Axle

2. Legrest 11. Rear Wheels

3. Front Rigging 12. Handrims

4. Frame 13. Brakes

5. Seat 14. Tipping Lever

6. Metal Skirt 15. Crossbars7. Armrest 16. Caster Wheels

8. Backrest 17. Anti-Tip Casters (Not Pictured)

9. Push Handles


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Standby AssistTransfer

1. Move the wheelchair footrest out of the way.

2. Be sure that the wheelchair is locked.

3. Sit on the edge of the wheelchair seat.

4. Push down on the arms of the chair to assist in rising.

5. Stand up slowly.6. Reach out and hold onto the table with the hand

closest to the table.

7. Turn slowly until table from behind can be felt.

8. Hold unto the table with both hands.9. Sit down.


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Assisted Standing PivotTransfer1. Move the wheelchair footrest out of the way.

2. Be sure the wheelchair is locked.3. Have the patient sit on the edge of the wheelchair seat.

Provide assistance as needed.

4. Have the patient push down on the arms of the

wheelchair to assist in rising.5. Bend at the knees, keeping your back straight and

grasp the transfer belt with both hands. The patients

feet and knees must be blocked to provide stability

especially for paraplegic and hemiplegic patients who

are partially paralyzed and may not be able to move orfeel sensation in the lower extremity. This is

accomplished by placing one foot outside the patients

foot while the knee is placed at the medial surface of

the patients knee.


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6. As the patient rises to a standing position, rise also by

straightening your knees.

7. When the patient is standing, ask, Are you feeling allright? If the patient reports any feeling of dizziness

or exhibits any of the other signs of orthostatic

hypotension, let him or her stand for a moment until

recovered.

8. When the patient is ready, both of you pivot towardsthe table until the patient can feel the table against the

back of the thighs.

9. Ask the patient to support himself or herself on the

table with both hands and to sit down.

10. Help the patient to sit by gradually lowering him or

her on the table. Be sure that your back remains

straight and that the lowering occurs from the knees.


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Two-Person Lift The stronger person should lift the patients torso while

the other person lifts the patients feet.

The person lifting the patients torso is usually in charge ofthe transfer and directs the other persons action.

Prepare the transfer by verbally planning out the

procedure.

Before the patient is moved, lock the wheels of the

wheelchair, remove the armrest, and swing away or

remove the leg rest.

Ask patient to cross his or her arms over the chest.

Stand behind the patient, reach under the patients axillae,

and grasp the patients crossed forearms. The other person should squat in front of the patient and

cradle the patients thighs in one hand and the calves in

the other hand.

At the command, patient is lifted to clear the wheelchair

and is moved as a unitto the desired place.


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A Hoyer lift is a hydraulic lift for movingimmobile people, such as physically disabled

patients.

Hoyer lifts can be battery-powered or manually powered

with various sizes, load weights and other features.

Aide caregivers in transfer of patient from bed to

wheelchair and back again.

Hydraulic Lift


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Step 1

It is important that before using a Hoyer lift that the person

being lifted is informed exactly what it is that you will bedoing. For first timers, you may have to reassure them that

this adaptive equipment is indeed safe.

Step 2Secure the chair that the person will be transferred to.

(example: lock the wheels of the wheelchair, allowing

clearance for the forks of the lift.)


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Step 3

Place the sling under the person while he/she is lying in the

bed, assisting the client to turn from side to side.

Hoyer lift sling


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Step 4

Ensure the sling (square/straight) equal on both side of the

person. (proper placement of the sling as such: the top of thesling should be just below the neck at the top of the

shoulders, the bottom of the sling should be about 1-3 inches

above the knee).

Step 5

Position the lift over the bed and person to be transferred.

Step 6

Widen the base of support of the lift and lock the wheel of the

lift.

Step 7Attach if necessary the arm hook over the person's chest

area


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Step 8

Attach the chains to the top of the sling then the arm hook of

the lift then the bottom of the sling. (Attach the chain

beginning with the chain farthest away from you). The shortpart of the chain always goes at the top.

Close the control valve (H)

and raise the boom (D) using

the pump handle (G). Spreadthe legs (A) of the lift open

with the shifter handle (B).

Roll the lift so the legs are

under the bed and the boomand swivel bar (E) are above

the patient.


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Step 9

Instruct the person to keep their hands and arms inside the

sling at all times.

Step 10Using the hydraulic pump, pump the lift up until the person's

body clears the surface of the bed. (Check for proper

placement of sling, the person should be in the sitting

position over the surface you are transferring from; IF NOT

lower the person back down onto the surface and readjustthe sling and or the chains).


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Step 11

Unlock the wheels of the lift and slowly maneuver the lift until

the person is over the chair

Step 12Lock the wheels of the lift and gradually and slowly lower the

person into the chair.

Step 13

After the person is securely in the chair, remove the chains

from the top of the sling then the arm hook of the lift then thebottom of the sling.

Step 14

Then remove the arm hook from the lift. Then unlock the

wheels of the lift and pull the lift away from the person.

Step 15

Narrow the base of support, and place the chains and arm

hook in the appropriate storage.


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GurneyA hospital gurney is a kind of narrow

bed on a wheeled frame which may be

adjustable in height.

For ambulances, a collapsible gurney

is a type of stretcher on a variable-

height wheeled frame. It is usually

covered with a disposable sheet to aid

in preventing infections.

Its key value is to facilitate moving the

patient and sheet onto a fixed bed ortable on arrival at the emergency room.

Both types may have straps to secure

the patient.

Gurneys in hospitals come in two

types:

1.Non-power assisted: Totally manually

powered.

2.Power assisted: Uses a small motor to

help amplify the push energy. Usually

used in bariatrics departments with

heavy patients.


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Methods of Moving Patients

By Gurney ( Cart or Stretcher )

SheetTransfer

1. Obtain a heavy draw sheet or use a full bed sheet and fold it in

half.

2. If assistance is needed, have one person on each side of the

bed or table.

3. Turn the patient on his or her side toward the distal side of the

bed or table.

4. Place the sheet on the bed or the table with the fold against the

patients back.

5. Roll the top half of the sheet as close to the patients back as

possible.

6. Inform the patient that he or she will be turned onto the side

toward you and will be moving over the rolled sheet.

7. Have your assistant straighten the sheet on the distal side.

8. Return patient to a supine position.


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Sliding sheet

- reduces friction whenyou have to position bed-

ridden person,for

example in order to turn

a patient for treatment orreposition a patient on

the bed.


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9. If the patient is adult, three or four people should participate in

the maneuver.

If three persons:

One person stands at the patients head to guide &

support it during the move.

Another at the side of the surface to which the patient

will be moved.

Third person at the side of the surface on which the

patient is lying.

If four persons:

Two may stand at each side

10. In unison (usually on the count of three),the team transfers the

patient to the other surface.

Note:

If the radiographic table is stationary, extra padding should be

placed over the metal parts of the tables edge to protect the patient

from being bruised while being moved.


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Sliding Board Transfer

A glossy, plasticized board approximately 1.7 meters

(5 ft 10 in) in length and about 75 cm (2 feet 6

inches) wide.

Purpose:

Facilitates moving patients

from one surface to another, usually

from the gurney to an examining

table.

Sliding Board


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1. Obtain the sliding board, and spray it with anti-static spray, if

necessary.

2. Enlist the assistance of one other person if the patient is of

average size and weight; if the patient is large, three people may

be necessary to move the patient safely.

3. Move the patient to the edge of the gurney, one person should hold

the sheet that the patient is lying on over the top of the patient to

keep the patient from possibly rolling off the gurney.

4. Move the gurney up against the radiographic table; lock the wheels

of the gurney.5. Assist the patient to turn onto his side away from the table, and

place the sliding board under the sheet upon which the patient was

lying.

6. Create a bridge with the board between the edge of the

radiographic table, and the edge of the gurney.

Steps: (Sliding Board Transfer)


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7. Place the sheet over the board, and allow the patient to roll back

onto the board.

8. With one person at the side of the radiographic table and the other

at the side of the gurney, slide the patient onto the radiographic

table.9. Assist the patient to roll toward the distal side of the radiographic

table, keeping the patient secure by holding onto the sheet on

which he was lying. The person standing on the side of the gurney

should remove the sliding board from under the patient.

10. Remove the gurney and perform the radiographic procedure.11. When the procedure is completed, the patient can be transferred

back to the gurney by repeating the steps.

12. Once the patient is back on the gurney, place a pillow under the

patients head, if this is permitted, and put the side rails of the

gurney up. Place a soft immobilizer over the patient. The patient

may then be transferred.

13. When the move is complete, discard the soiled linen that was

used on the radiographic table, and clean the sliding board and

the table with the disinfectant spray.

14. Wash hand and place clean linen on the table.


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Assisting the Patient to Dress and UndressSteps:

1. If the patient is very young and is accompanied by a familiaradult, he or she will be more relaxed and cooperative if the

adult helps him to dress and undress. Explain to the adult how

the child should be dressed for the procedure, arrange the

meeting place, and leave them alone.

2. If you must assist a patient who has a disability of the lowerextremities, the clothing should be removed from the top part

of the body first.

3. Place a long examining gown on the patient. Instruct him to

loosen belt buckles, buttons or hooks around the waist and

slip his trousers over his hips. If he cannot do this for himself,reach under the gown and pull the trousers down over the

hips.

4. Have the patient sit down. You may have to squat in front of

the patient and gently pull the clothing over the legs and feet

to remove it.


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If the dress will be pulled over the womans head1. Place a draw sheet over the patient and then help her to

remove her slip and brassiere.

2. Help her to put on an examining gown then remove the draw

sheet.Re-dressing a patient with a paralyzed leg, a leg injury a

cast, or a brace1. Slide the clothing (pants or skirt) over the feet or legs as far

as the hips while the patient is sitting and still wearing an

examining gown.2. Have the patient stand, and pull the clothing over the hips if

he or she can tolerate it.

3. If the patient is not able to pull the clothing over the hips

alone, have an assistant raise the patient off the chair so that

you may slip the clothing over the hips and waist.4. Remove the patients arms from the sleeves of the

gown. Have the patient hold the gown over his or her

chest, and carefully pull the shirt over the head, or put

it on one sleeve at a time.

5. When the outside items of clothing are on the patient,remove the own from under the clothes.


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6. To remove trousers, loosen buckles and buttons and have the

patient raise his buttocks as you slip the trousers over his

hips. If the patient is unable to help, have an assistant stand at

the opposite side of the table. After the trousers have been

loosened, have the assistant pull the patient toward him or

her, then slide the trousers off one side of the hip. Next, draw

the patient toward you and have the assistant slide the

trousers off the other hip.

7. Slip the trousers below the knees and off.

8. Fold the clothing and place it in a paper bag on t=which thepatients name has been printed. If the patient is

accompanied by a relative or a friend, ask the person to keep

the patients clothing. If the patient is alone, you will be

responsible for caring for the clothing.

Take Note!When changing a disabled patients gown, allow

enough material to work with by removing theunaffected side first or by placing the gown on the

affected side first.


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The patient with an Intravenous Infusion

1. If the patients gown must be changed, slip the clothing off theunaffected side first.

2. Carefully slide the sleeve of the unaffected side over the I.V.

tubing and catheter, then over the container of fluid. (For this

step, the container must be removed from the stand)

3. When replacing the soiled gown with a clean one, first place

the sleeve on the affected side over the container of fluid,

then over the tubing and onto the arm with the venous

catheter in place. Re-hang the bottle of fluid and complete the

change.

4. When moving the arm of a patient who has an I.V. catheter in

place, support the arm firmly so that the catheter does notbecome dislodged. Remember to keep the bottle of fluid

above the infusion site to prevent blood from flowing into the

tubing.

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