- A nurse is preparing to transfer a client who can bear weight on one leg. This is generally recognized as the correct and safe method for transferring a client in this condition. Study with Quizlet and memorize flashcards containing terms like A nurse is reviewing practice guidelines with a group of newly licensed nurses. What things should the nurse document for this client? Select all that apply. Perform a mental assessment and stabilize the client psychologically C. - The chair should be placed at a 45° angle to the bed on the client's strong side so that the client can safely and easily assist with the transfer. Which of the following actions by the nurse will be most safe for the client and the nurse? A. Two point alternating gait Weight-Bearing As Tolerated (WBAT): Weight can be applied to the operated leg as comfort allows, from a minimum of toe touch to full weight-bearing. this is a non-weight bearing gait. 6 weeks d. The nurse validated that the activity was completed and gave the UAP The nursing assistant is preparing to help the client make a lateral transfer from the bed to a stretcher. (1) Move the affected (non-weight bearing) leg and both crutches forward together. 1, 4, 2, 3 c. The client can bear partial weight and needs to be taught how to use the two-point gait while using crutches. On the other hand, clients that are unable to bear weight require mechanical lifts for transfer. Locate the nearest family members to get the client's history D. When transferring a client using a 1A, 2A, or sit-to-stand transfer method, first assist the resident to move to a seated position on the side of their bed. Two-point D. What additional information is most important to know before discharging the Orders that establish how much assistance is required for moving a client based on how much body weight they can independently bear and how much weight an assistant is required to support. 1 month c. 1, 2, 4, 3 d. Lifts should always involve mechanical lifting devices. After securing a safe environment, which of the following actions should the nurse take next? a. How should the nurse instruct the client to ambulate with her crutches?, The client's strength and type of disability are guides to the best possible crutch-walking gait or style of walking. What action would the nurse take to accommodate this weak extremity?, The nurse is preparing a client to move from the bed into a wheelchair. After securing a safe environment, which of the following actions should the nurse take next? a) Assist the client to pivot onto the strong leg b) Place the wheelchair at a 45-degree angle to the bed c) Apply the transfer belt around the client's waist A friction-reducing device can be used under clients to prevent skin shearing when moving clients in bed and when assisting with lateral transfers. A nurse is preparing to assist a client who can partially bear weight and is cooperative from the bed to a chair. After securing a safe environment, which of the following actions should the nurse take next? assess the client for orthostatic hypotension A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to assist a client who can partially bear weight and is cooperative with transfer from the bed to the chair. It provides a stable and slow gait pattern, making it appropriate for a client who can bear weight on only one leg. , The nurse is assessing an older adult client who sometimes loses her balance while walking Study with Quizlet and memorize flashcards containing terms like When the nurse cleanses the client's leg during a bed bath, it will allow for:, A nurse is washing a client's hair using a shampoo cap. Sep 13, 2023 · A nurse is preparing to transfer a client who is partially weight-bearing from the the bed to a chair. May 13, 2023 · A. , Just before a client is to be on a tilt table, the nurse applies After instruction, which action by a patient who can bear weight on both feet indicates an understanding of the proper use of crutches? a. After securing a safe environment, which of the following actions should the nurse take next? orthostatic HTN When preparing to transfer a client who can bear weight on one leg from the bed to a chair, the nurse must ensure the safety and stability of the client throughout the transfer process. Figure 1-9. Patient care transfer can also be defined as transferring patients within the . Which of the following statements by the client indicates an a nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. The most common patient transfers are from a bed to a stretcher and from a bed to a wheelchair. He asks a nurse if he can take a shower on his third postoperative day. A nurse is preparing to transfer a client from a bed to a chair A: instruct the client to flex their arm with the ha open B: Stroke the skin near the vein in an upward direction C: Apply a cool compares to the vein for 10 min D: Dangle the client arm over the edge of the be 3: A nurse is providing oral care for a client who unconscious which of the following actions sho the nurse take A: place the client C - the three point gait requires the client to bear all weight on one foot. A nurse is preparing to transfer a client from a bed to a chair. While going down the stairs with crutches the patient will move the crutches down onto the step followed by? A. Enlist help of another staff member. A two-person lift is performed, with one person on each side of the patient. The plan of care indicates that the client should perform an exercise in bed every two hours. It’s also for patients who need 25-75% assistance to be able to stand. Feb 7, 2024 · After securing a safe environment, the nurse's next action in preparing to transfer a client who can bear weight on one leg from the bed to a chair should be to ensure that the chair is properly positioned. Which of the following actions should the nurse take to maintain safety during the transfer? A) Enlist help from another staff member B) Adjust the bed to an appropriate height C) Use a powered standing assist Nov 29, 2023 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. Have patient grasp the arm of the wheelchair and lean forward slightly. After educating the client on how to adjust the Sep 2, 2023 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. Type of anesthesia used B. Which of the following action should the nurse take to maintain safety during the transfer. After securing a safe environment, which of the following actions should the nurse take next? 1) Assist the client to stand on the unaffected leg 2) Use a mechanical lift to transfer the client 3) Ask the client to hop on one leg to the chair 4 A client is preparing for discharge from the emergency department after sustaining an ankle sprain. b. A nurse accidentally administers the wrong medication to a client, which results in a severe allergic reaction and prolongs the client’s hospitalization. S1 and S2 auscultated, rate 76/min. The client needs crutches to ambulate. After a review of the physician's orders, the nurse notes an order stating, "Client may shower ten (10) days after surgery. Feb 21, 2024 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. Which of the following A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. On three, holding your knees tightly against the client’s knees, transfer the client’s weight over his or her feet. Position the bed at an appropriate height. Using a four-point crutch walk when not weight bearing on the Feb 18, 2022 · Weight-bearing as tolerated: The patient can support 50% to 100% of weight on the affected leg and can independently choose the weight supported by the extremity based on their tolerance and the circumstances. four-point alternating gait. a. Study with Quizlet and memorize flashcards containing terms like A nurse is giving change-of-shift report about a client they admitted earlier that day who has pneumonia. Feb 21, 2024 · A nurse preparing to transfer a client who can bear partial weight and has upper body strength should use a transfer belt to assist with the transfer from a chair to the bed. ) Aligning the nurse's knee with the client's knees just before the transfer. ) Placing the client's left leg in front of the right leg just prior to the transfer. Reach across the client’s back – grasp onto the transfer belt. In 48 hours 2. After securing a safe environment, which of the following actions should the nurse take next? 1) Assist the client in standing up 2) Call for additional assistance 3) Provide the client with a walker 4) Ask the client if they are ready to be The nurse would like to assist a client out of bed and into a chair. Need for specific equipment Study with Quizlet and memorize flashcards containing terms like The nurse is transferring a client from the bed into a wheelchair. moving the injured leg down onto the step. Three-point gait Swing through gait D. After securing a safe environment, which of the following actions should the nurse take next?, A nurse is caring for a client who requires a 24-hour urine collection. Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to transfer a client who has left-sided weakness from the bed to a chair. Rock the client up to a standing position. Keep his knees straight when moving the client. The patient is steadied This method is prescribed for patients who cannot bear weight on one leg. The client is allowed touch-down of the affected leg. After securing a safe environment, the next action the nurse should take is to ask the client if they are ready to be transferred. What motion would the nurse use when assisting the client to sit up on the side of The nurse replies that the client will be able to bear weight on the cast within, A nurse is giving the client with a left leg cast crutch walking instruction using the three-point gait. One-person assist with Apr 20, 2014 · The nurse is providing instructions to a client regarding ambulation after the application of a fiberglass cast to the lower leg. The client is using each Place a transfer belt on the client Position the bed at an appropriate height Assist the client to a seated position Determine if the client can bear weight 68. Adjust bed to appropriate height. Advance directives status C. Two-point gait involves simultaneous partial weight-bearing on both legs. , The nurse is Study with Quizlet and memorize flashcards containing terms like A patient is able to bear weight on one foot. Which of the following interventions should the nurse include that is within the RN scope of practice?, A nurse is preparing to transfer a client who can bear weight in one leg from the bed to the chair. You are free to move onto the stretcher without assistance, but I will supervise for your Assess and stabilize the client medically B. You must keep your back straight and you knees bent to maintain good body mechanics. While seemingly intuitive, successful patient transfers rely on understanding each patient's needs while adhering to evidence-based guidelines. A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. A nurse is preparing to transfer a client who is 72 hr postoperative to a long-term care facility. Respirations even and regular at 16/min. Have the client bear weight on her stronger leg. When should the nurse assure him that most people with amputations can fully bear weight? a. –e. Vital signs on day of admission D. Nov 26, 2023 · A nurse is preparing to transfer a client who can bear weight in one leg from the bed to the chair. May 12, 2023 · A nurse is preparing to transfer a client who is partially weight-bearing from the the bed to a chair. A friction-reducing device can be used under clients to prevent skin shearing when moving clients in bed and when assisting with lateral transfers. Assess the client for orthostatic hypotension. At client's beside for dressing change. Swing-through, A nurse is reinforcing teaching with the partner of a client who is immobile. Jul 31, 2024 · The nurse should instruct a partially weight-bearing client to transfer from the bed to a chair by utilizing their stronger leg to enhance stability. For a client who can bear weight on only one leg, this gait is not suitable. Full weight-bearing: The leg can support 100% of a person’s body weight, which permits walking. Which of the following actions should the nurse take first? a)determine if the client can bear weight b)place a transfer belt on the client c)position the bed at an appropriate height d)assist the client to a seated position Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client who is prescribed bedrest. Oct 17, 2022 · Patient care transfer is moving a patient from one flat surface to another. The client is uncooperative, has a leg cast, and can bear weight on the unaffected leg. nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. which of the following devices should the nurse use to transfer the pt? A. a nurse is preparing to transfer a client who can bear weight on lone leg from the bed to a chair. What is the nurse's best response? A. Weight Bearing Grades. The patient uses one leg, and crutches are essential. Which description below best describes this type of gait with crutches?, A client will be using crutches for mobility. After securing a safe environment, which of the following actions should the nurse take next? 1) Assist the client to stand on the unaffected leg 2) Use a mechanical lift to transfer the client 3) Ask the client to hop on one leg to the chair 4 Study with Quizlet and memorize flashcards containing terms like A nurse is assisting with transferring a client from the bed to a wheelchair. Pivot on the foot that is the farthest from the chair. Use a powered standing-assist lift. Ensure the patient can feel the wheelchair on the back of the legs prior to sitting down. the client can bear partial weight and has upper body strength. Medical diagnosis E. Study with Quizlet and memorize flashcards containing terms like 2. Ask the client to lean their upper body forward so their nose is over their toes: The client must be cooperative and predictable, able to bear weight on own legs, and have good trunk control. Who should use a Sara STEDY? A Sara STEDY is for patients who are able to bear weight in their legs, but it can be used for patients who are only able to bear weight in one leg. Determine if the client can bear weight. Four-point B. Which action indicates the best method to transfer this patient? a. The crutch-walking gait that the nurse teaches this patient is the: 1. Feb 11, 2024 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. After securing a safe environment, which of the Jan 26, 2023 · Devices that can be used to lift a patient who can't bear weight. three-point alternating gait. 3 months, 1. " In order to Study with Quizlet and memorize flashcards containing terms like A client is prescribed to use crutches for ambulation. Which of teh following actions should the nurse take first? a. A. With touch down weight-bearing, the toes of the foot can touch the floor to maintain balance only. After securing a safe environment, which of the following actions should the nurse take next? A) rock the client up to a standing position B) pivot on the foot that is the farthest from the chair C) assess the client for orthostatic hypotension D Nov 28, 2023 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. The nurse tells the client to advance the: and more. Residents who can transfer with one of these methods are able to bear some or most of their weight and should be able to move partially on their own. Transfer weight to crutches and unaffected leg. After securing a safe environment, which of the following actions should the nurse take next? Rock the client up to a standing position. Feb 26, 2024 · The correct transfer technique for a nurse preparing to move a client who can bear weight on one leg from the bed to a chair is a sit-pivot transfer. , mechanical lift Transfer = procedure used to assist a patient, who can bear weight at least through one leg or both arms to move from one surface to another. After securing a safe environment, which of the following actions should the nurse take next? 1) Assist the client in standing up 2) Ask the client if they are ready to be transferred 3) Move the chair closer to the bed 4) Call for additional Sep 22, 2023 · To transfer a client who can bear weight on one leg from a bed to a chair, a nurse needs to assess the client's strength, pain level, and comfortability, use safety equipment, and communicate effectively during the process. But, even if the client can bear weight, transfer belts cannot be used in individuals that are recovering from abdominal surgery or in individuals that have severe cardiac or respiratory diseases. Which of the following is the proper crutch gait for this client? A. 9. A nurse at an urgent care center cares for four clients with leg or foot injuries. The client informs the nurse that the client is able to move onto the stretcher without the nurse's help. Two-person standing pivot: The patient can assist with weight bearing, but may be inconsistent. Have the client bear weight on her stronger leg B. A nurse is teaching a client who can only bear weight on one leg how to ambulate using crutches. • The person is lifted and transferred with a mechanical lift—full-sling mechanical lift or stand-assist lift ( Fig. Move the crutches forward with the weight on the unaffected leg. D. Figure 8. - The nurse should grasp the gait belt around the client's waist. Where would the nurse be positioned when assisting the client to stand?, When assisting a client into a wheelchair, what action would the nurse take to ensure the client is properly positioned before sitting down in the wheelchair?, The nurse is caring for a Study with Quizlet and memorize flashcards containing terms like The nurse is caring for a client with postural hypotension. 14-2 ). After securing a safe environment, which of the following actions should the nurse take next? 1) Assist the client to stand on the unaffected leg 2) Use a mechanical lift to transfer the client 3) Ask the client to hop on one leg to the chair 4 A nurse is preparing to transfer a client from a bed to a chair. Safely lifting a patient who cannot bear any weight is no easy task, and requires the correct equipment, as well as knowledge of proper lift techniques for the caregiver's safety. A patient asks when he should expect to be up and walking after his below-the-knee amputation. Grasp arm of chair with free hand. ) Grasping the client under the axillae to assist them to their feet. After securing a safe environment, which of the following actions should the nurse take next? Weight shift to back leg by health care provider: 7. Sep 25, 2023 · A nurse is preparing to transfer a client who is partially weight-bearing from the the bed to a chair. Clients who are unable to bear weight require mechanical lifts for transfer. C. What is the nurse's best response?, What is a benefit of regular exercise over time?, A nurse is recommending aerobic May 1, 2023 · Most patients who can partially bear weight need crutches or some ambulatory device. What would the nurse include in the client's plan of care to prepare him for ambulation? Select all that apply. Which of the following crutch gait should the nurse take plan to instruct the client to use A. A nurse is aware that a patient who is having his leg amputated is also having a prosthesis Study with Quizlet and memorize flashcards containing terms like A client is preparing to mobilize for the first time following the surgical removal of a bunion on her left foot. Assist the client to a seated position. Study with Quizlet and memorize flashcards containing terms like A nurse is evaluating the crutch-walking technique of a client who is required to keep weight off their right leg. A lift involves moving a client who cannot bear weight on at least one leg. After securing a safe environment, which of the following actions should the nurse take next? Option 1: Check the client's blood pressure and heart rate while they are lying down. Full Weight-Bearing (FWB): The patient can put 100% of their weight on the operated leg, typically the goal at the end of the recovery period. Place both crutches in one hand. 3-point crutch walking gait. Dec 19, 2023 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. Vertigo Feb 1, 2024 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. Position the chair next to the bed at a 90-degree angle. The client is instructed to avoid weight bearing on the affected leg and is given crutches. After securing a safe environment, which of the following actions, should the nurse take next? Rock the client up to a standing position. Count to three aloud with the client. - The client's stronger right leg should be placed forward so that the client can bear weight on the strong leg when lifted. 4. 3. In approximately 8 hours 4. c. Position the chair next t the bed at a 90 degree angle. Transfer from bed to chair if client can partial bear weight Partial weight bearing, 1 nurse pivots client into chair using gait belt or powered standing-assist lift Transfer from bed to chair if client cannot bear weight This gait is not suitable for a client who can only bear weight on one leg. Once standing, have the patient take a few steps back until they can feel the wheelchair on the back of their legs. Which one of the following actions should the nurse take to maintain safety during the transfer, a nurse is administering an enteral feeding through a clients NG tube. Which of the following actions A nurse is preparing to transfer a client from a chair to the bed. After securing a safe environment, which of the following actions should the nurse take next? 1) Assist the client to stand on the unaffected leg 2) Use a mechanical lift to transfer the client 3) Ask the client to hop on one leg to the chair 4 The patient will move the non-injured leg forward onto the step and then will move the injured leg and crutches up. Negative pressure wound Nov 26, 2023 · When preparing to transfer a client who can bear weight on one leg from the bed to a chair, after securing a safe environment, the nurse should assist the client to stand on the unaffected leg. The patient is instructed to avoid pushing through pain. Moving the opposing crutch and leg together for a two-point crutch walk c. (3) Repeat this sequence for desired ambulation. 8. (2) Move the unaffected (weight bearing) leg forward. Which equipment or assistive device should the nurse use? When transferring a client using a 1A, 2A, or sit-to-stand transfer method, first assist the resident to move to a seated position on the side of their bed. Which of the following information should the nurse include in the transfer report? (SELECT ALL THAT APPLY. Transfer status orders include independent, contact-guard-assist (CGA), 1 assist (1A), 2 assist (2A), sit-to-stand lift, or full-body mechanical lift. Question: A nurse is preparing to transfer a client who is partially weight-bearing from the the bed to a chair. This technique allows the patient to use the strength in their good leg to assist with the transfer while the nurse helps guide and support them into the chair. moving the non-injured leg down onto the step. g. Adjusting the crutches so that they rest directly under the axilla b. , A nurse is working with a patient who is able only to assist the nurse in moving from the bed to the chair A nurse is preparing to transfer a client who is partially weight-bearing from the bed to a chair. Repeat the sequence. Jun 20, 2024 · The nurse is preparing to assist a client who can partially bear weight and is cooperative with transfer from bed to chair. two-point gait. after securing a safe environment, which of the following Study with Quizlet and memorize flashcards containing terms like A 22-year-old client with an external fixation device attached to his left thigh is unable to bear weight on his left leg. Arrange for a transfer to the nearest medical facility, A 42-year-old female client reports colicky abdominal pain that worsens after eating a high-fat meal. Which of the following actions should the nurse take? A. Place a transfer belt on the client. Gently rock with the client to gain some momentum, and prepare to move after the count of three. Which of the following actions by the nurse demonstrates the correct transfer technique?, A nurse is caring for a client who has been hospitalized and is performing active ROM exercises. Which nursing intervention is appropriate?, A bedridden client has become debilitated. , A nurse is caring for a client who has been hospitalized and is performing active range-of-motion exercises. Which of the following actions should the nurse Study with Quizlet and memorize flashcards containing terms like The nurse is helping a client with a weak left leg to a standing position for an assist into a wheelchair. Study with Quizlet and memorize flashcards containing terms like An uncooperative 70-year-old male with right-sided paralysis from a recent cerebrovascular accident (CVA) has to be transferred from the bed to a wheelchair. The plan of care indicates that the client should perform an exercise in bed every 2 hours. After reviewing the image above, which is the most appropriate reason for the nurse to observe this client 3. 3 weeks b. A nurse preparing to transfer a client who can bear weight on one leg should take several important steps to ensure safety and efficient transfer. Four-point alternating gait B. Completely lower self into chair. One-person standing pivot: The patient can bear weight on one or both legs and is cooperative and predictable. It’s best when used on hard floors, but it can be used on carpeted floors. B. Three-point gait: This gait is appropriate for a client who can only bear weight on one leg. The nurse has communicated how to get the client out and back into bed and told the UAP not to allow the client to bear weight on the left leg. After the client stands and pivots, what should the nurse instruct the client to do next?, The nurse is caring for a female client who has used the bedside commode. In 24 hours 3. 9 Nov 5, 2016 · The person can bear some weight, can sit up with help, and may be able to pivot to transfer. ) A. Which of the A) To promote the client's muscle tone and strength B) To improve the client's upper arm strength C) To normalize client's blood pressure prior to ambulating D) To help the client adjust to bearing weight on his or her feet, A nurse is caring for a client whose fractured ankle is in a cast. A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. The nurse witnessed the UAP correctly perform the task on previous occasions and knows the UAP is competent to perform the task. swing-through gait. Which of the following action should the nurse take as directed by the plan of care. the nurse should be concerned about the safety of the client if weight is being applied to the unaffected leg. Lift = procedure used to carry the entire weight of a patient –e. The nurse determines that the client understands the instructions if the client states that weight bearing on the casted leg can begin at which time period? 1. Which step should the nurse use?, The nurse is caring for a client who is on bed rest. d. Jan 18, 2024 · A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. After securing a safe environment, which of the following actions should the nurse take next? assess the client for orthostatic hypotension Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to assist a client who can partially bear weight and is cooperative with transfer from bed to chair. Click to highlight the findings that indicate an improvement in the clients condition. Have the patient move both crutches forward with their weight on the unaffected leg. Study with Quizlet and memorize flashcards containing terms like The nurse is assisting the client with transfer to a bedside commode. To deselect a finding click on it again. Place the patient in the tripod position and instruct him to do the following. A powered stand-assist device can be used with clients who can bear weight on at least one leg, can follow directions, and are cooperative. Non-weight bearing means the leg should not touch the floor or support any bodyweight. Three-point C. 13. There are multiple devices available that can help lift a patient without putting them, or their Question: 11. The patient is cooperative and predictable. To reduce the likelihood of falls or injuries, the chair should be inclined slightly, while the nurse should sustain a broad base of support by bending knees and placing feet shoulder-width apart. In a three-point gait, the client uses crutches and swings or hops the non-weight-bearing leg forward, landing on the good leg. 4, 2, 1, 3 and more. The patient also can sit with minimal support on the side of the bed. Which of the following pieces of information is the priority for the nurse to provide?, A nurse is caring for a client who has an NG tube and is receiving intermittent feedings through an open system. In which order will the nurse present the instructions starting with the first step? 1. After securing a safe environment, which of the following actions should the nurse take next? A. By instructing the client to bear weight on the stronger leg, the nurse can minimize the risk of falls or loss of balance during the transfer. Move the unaffected leg forward, shifting weight onto the crutches. the client should advance and bear weight on both crutches and then advance the unaffected (stronger) leg. 4, 1, 2, 3 b. Four-point gait involves alternating weight-bearing on each leg. Study with Quizlet and memorize flashcards containing terms like A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. After securing a safe environment, which of the following actions should the nurse take next? a) Place a gait belt around the client's waist b) Ask the client to stand up and pivot to the chair c) Call for assistance from another healthcare provider Study with Quizlet and memorize flashcards containing terms like A nurse is caring for a client in a medical-surgical unit. Which of the following actions should the nurse take?, A nurse is caring for a client who is prescribed bedrest. Study with Quizlet and memorize flashcards containing terms like The nursing assistant is preparing to help the client make a lateral transfer from the bed to a stretcher. Weight bearing refers to a person’s ability to stand on one or both legs. , sit-to-stand May 10, 2024 · A transfer is a dynamic effort in which the client aids in the transfer and is able to bear weight on at least one leg. Have the client bear weight on her stronger leg: This action is appropriate as it allows the client to utilize their stronger leg for support and stability during the transfer. After instruction, the client demonstrates proper crutch use in the hallway. 2. wozguk xcfik pgmcb slak xxrudbb jyaxx kbjdg nif szcbocwn zrdmevz