A patient with hemiplegia may "negl

A patient with hemiplegia may "neglect" one side of the body (inattention to or unawareness of one side of body or environment), which distorts perceptions of the visual field.

A patient with head trauma or stroke may have perceptual cognitive deficits that create safety risks.

If the patient has difficulty in comprehension, simplify instructions by providing one step at a time and maintaining consistency.

Take the following precautions when transferring a patient with a recent total hip replacement:

Do not bend operative hip more than 90 degreesDo not rotate operative leg excessively (inward or outward)Do not cross the legsPerform hand hygiene before patient contact.Verify the correct patient using two identifiers.Assess the patient's physiological capacity totransfer.Muscle strength (legs and upper arms)Joint mobility and contracture formationParalysis or paresis (spastic or flaccid)Bone continuity (trauma, amputation)Assess presence of weakness, dizziness, or postural hypotension.Assess the patient's level of endurance.Assess level of fatigue during activity.Assess vital signs.Assess the patient's proprioceptive function (awareness of posture and changes in equilibrium).Ability to maintain balance while sitting in bed or on side of bedTendency to sway to or position self to one sideAssess the patient's sensory status, including adequacy of central and peripheral vision, adequacy of hearing, and presence of peripheral sensation loss.Assess the patient's level of comfort.PainMuscle spasmAssess the patient's cognitive status.Ability to follow verbal instructionsShort-term memoryRecognition of physical deficits and limitations to movementAssess the patient's level of motivation, such as eagerness versus unwillingness to be mobile.Assess the patient for specific risks of falling when transferred: neuromuscular deficits, motor weakness, calcium loss from long bones, cognitive and visual dysfunction, and altered balance.Determine need for special transfer equipment necessary for home setting. Assess home environment for hazards and family's ability to assist.Assess previous mode of transfer (if applicable).Determine the number of people needed to assist with transfer. Do not start procedure until all required caregivers are available.Perform hand hygiene.If the patient has partial weight-bearing with upper-body strength, use bariatric transfer aid with an appropriate number of caregivers (Figure 2). To reduce the risk of musculoskeletal injury, use a mechanical lift device totransfer the patient from bed to chair.If the patient has normal weight-bearing and upper-body strength, assist him or her to a sitting position on the side of the bed (Figure 3), (Figure 4), (Figure 5), and (Figure 6). If the patient is in a hospital bed, use electric controls to raise the patient to a sitting position in bed.Position chair at 45-degree angle to bed, and lock bed brakes. (If using wheelchair, position chair at 45-degree angle to bed, lock brakes, remove footrests, and lock bed brakes.) If the patient demonstrates weakness or paralysis of one side of the body, place the chair on the patient's strong side.Allow the patient to sit on side of the bed (dangling legs) for a few minutes before transferring to chair.Ask if the patient feels dizzy.Do not leave the patient unattended sitting on bed with legs dangling.Apply transfer belt (Figure 7), or use transferboard. Place the board across the bed to the chair so the patient can slide across the board.Assist the patient into stable nonskid shoes or slip-resistant slippers. Place the patient's weight-bearing, or strong, leg forward, with weak foot back. Always have the patient wear shoes or slip-resistant slippers during transfer; bare feet increase risk for falls.Spread own feet apart.Flex hips and knees, aligning knees with patient's knees (Figure 8Grasp transfer belt along the patient's sides.Never lift the patient by or under arms.Rock the patient up to standing position on count of three while straightening hips and legs and keeping knees slightly flexed (Figure 9). Rock the patient in a back and forth motion, keeping own body weight moving in the same direction as the patient's; this ensures that the patient and nurse are moving in the same direction simultaneously. Unless contraindicated, the patient may be instructed to use hands to push up.Maintain the stability of the patient's weak or paralyzed leg with own knee.Pivot on foot farther from chair.Instruct the patient to use armrests on the chair for support and ease into chair (Figure 10Flex hips and knees while lowering the patient into chair (Figure 11Assess the patient for proper alignment in sitting position. Provide support for paralyzed extremities. A lap board or sling helps support a flaccid arm. Stabilize the patient's leg with bath blanket or pillow. Remain in front until the patient regains balance, and continue to provide physical support to the weak or cognitively impaired patient.Ensure proper alignment for sitting position with the head erect and vertebrae in straight alignment. Ensure that body weight is evenly distributed on buttocks with thighs parallel and in horizontal plane. Place both feet supported on floor with ankles comfortably flexed. Maintain small space between edge of seat and popliteal space on posterior surface of knee.Praise the patient's progress, effort, and performance.Assess, treat, and reassess pain.Perform hand hygiene.Document the procedure in the patient's record.