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NURA 303 Fundamentals of Nursing Care Body Activity Case Studies

Corry Trocheck NURA 303

Objective: The objective of this assignment is to demonstrate understanding of essential nursing concepts and skills related to safe and effective care of clients with mobility problems. Understanding of concepts related to proper body mechanics, patient transferring, and fall prevention will also be elicited.

Case Study A: You are a nurse on a medical–surgical unit in a hospital caring for a 68-year-old brick mason who returned to the unit after surgery to repair both knees 2 days ago. The surgery went smoothly and you are responsible for his postoperative care. 1. What activity assessments would be needed to determine the best method to transfer this patient from bed to chair?

First, I would assess the patient’s vitals to make sure that the patient was not at risk for orthostatic hypotension (Taylor, Lynn, & Bartlett, 2019). I could then use the activity algorithm to help me through the process of transferring the patient from bed to chair (Occupational Safety and Health Administration [OSHA], 2009). Through this, I would first assess the patient’s weight-bearing capability to ensure that I was implementing the right transfer method and aid if necessary. For example, if the patient could not bear weight, but was cooperative, I could use a seated transfer aid. I would also assess the patients upper body strength. I could also complete

NURA 303 Fundamentals of Nursing Care Body Activity Case Studies

a fall-risk assessment, such as the Hendrich II Fall Risk Model or the Morse Fall Scale to determine whether the patient was able to ambulate with assistance safely (Taylor et al., 2019).

2. What must you consider regarding tubes, IV lines, incisions, and medical equipment when positioning and transferring this patient?

I would need to make sure that any tubes or IV lines were out of the way for ambulation and that they would not be pulled out in the process. The patient’s lines would need to be close/on the patient’s body and able to move with the patient the entire time (Taylor et al., 2019).

3. Outline the rationale for encouraging your patient to use a stand-assist aid.

Having the patient use the stand-assist aid is best if the patient is physically able to because it encourages the patient’s independence which in turn increases their self-esteem and mobility levels (Taylor et al., 2019). Patient autonomy is one of the goals we should always be working on in our nursing practice.

4. Why would you stand in front of the patient before allowing him to stand?

You should stand in front of the patient before allowing him to stand in case he or she becomes light-headed and faints, or loses balance; as a preventative for risk of falling or injury (Taylor et al., 2019).

NURA 303 Fundamentals of Nursing Care Body Activity Case Studies

5. Which instructions are vital to ensure a patient's safe transfer from bed to sitting in a chair?

I believe the most important instructions from the guidelines for transferring a patient from bed to chair are listed below (Taylor et al., 2019, p. 1189-1191). Ensuring you plan the appropriate approach in transferring the client. Making sure the bed brakes are locked and placing the chair next to the bed. Standing in front of the patient to preserve their safety before ambulation. Communicating to the client exactly what steps you will take to stand up (such as rocking back and forth 3 times and standing on the 3rd rock forward).

Case Study B: As an orthopedic nurse, a significant proportion of your nursing care consists of assisting patients in ambulating, transferring, and practicing physical therapy treatments to restore their mobility. 1. What steps would you take to prevent personal injury to yourself when assisting patients to stand?

There are many things nurses can do to safeguard against personal injury when it comes to assisting patients to stand. One habit that we should employ in our daily life is to maintain proper alignment of the spine, making sure we are not slouching. Along with this, is keeping a tight core (Taylor et al., 2019, p. 1151).

NURA 303 Fundamentals of Nursing Care Body Activity Case Studies

Specific precautions I will take with assisting a patient, include using the NIOSH lifting equation, assessing the client to ensure they can follow direction, making sure I clearly tell the patient what the plan is and allow the patient to help me as much as they can, moving in a smooth and slow fashion, and using a lifting-assist device or asking for help from a co-worker(s) if needed (Waters, 2007). Making sure I am close to the patient and use my legs instead of my back to lift any weight, and confirming the bed brakes are locked are also important in preventing injury as well (Taylor et al., 2019). 2. How do these steps prevent or reduce injury?

These steps reduce the possible musculoskeletal disorders that have been reported as one of the leading problems in the occupational health industry (Waters, 2007). The consequences of these disorders include high expenses associated with treatment, chronic pain, missing days at work and sometimes even leaving nursing as a profession (Occupational Safety and Health Administration [OSHA], 2009). These injuries are preventable through taking steps like listed above by reducing the high levels of biomechanical stress nurses incur when lifting inappropriate weight or not using proper lifting techniques/help (Waters, 2007). 3. Describe techniques that, along with using a gait belt, help you prevent a patient from slipping when attempting to sit them in a chair.

Putting non-skid socks on the patient, making sure the bed is locked and putting the chair against a solid structure that will ensure the chair doesn’t move are some things a nurse can do to make sure the patient remains safe (Taylor et al., 2019). Also, having a stable stance, placing a foot outside the patients foot, bracing the front of your knee on the patients weak side, and

NURA 303 Fundamentals of Nursing Care Body Activity Case Studies

making sure the patient has their balance before having them sit are some techniques one can use to prevent the patient from slipping (Taylor et al., 2019). 4. If your patient has hemiparesis (one-sided weakness), where would you stand to assist the patient in ambulation?

You would stand in front of the patient (using your knee to brace against their weak side) to help ambulate and then move to the stronger side to assist with ambulation (Taylor et al., 2019). 5. Outline the correct steps for initial use of a cane.

As described in Fundamentals of Nursing, the proper technique for the use of a cane are outlined below (Taylor et al., 2019). Make sure that the cane is the correct height for the patient (the top of the cane should be in line with the crease of the patient’s wrist when standing). If the patient is sitting, have the patient use the arms of the chair to stand up and then take hold of the cane on their unaffected side. The cane will be slightly out front and to the side of their body. The patient will begin moving by placing their affected side foot forward in line with the cane. This will mean they shift their weight on their unaffected leg. Using the cane for support along with the affected side, the patient will move the unaffected leg forward, past the cane, to complete the step. Continue forward in that fashion.

NURA 303 Fundamentals of Nursing Care Body Activity Case Studies

References Occupational Safety and Health Administration. (2009). Guidelines for nursing homes: Ergonomics for the prevention of musculoskeletal disorders (Publication 3182). Retrieved from

https://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html

Taylor, C., Lynn, P., & Bartlett, J.L. (2019). Fundamentals of nursing: the art and science of person-centered nursing care. Philadelphia, PA: Wolters Kluwer

Waters, T. (2007). For CE credit: when is it safe to manually lift a patient? The American Journal of Nursing, 107(8), 53-59. Retrieved from http://www.jstor.org/stable/29746479...