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Difficulty: HardBasic Care and Comfort

A practical nurse is assisting a client with right-sided hemiplegia who is sitting on the edge of the bed to transfer into a wheelchair. In what order should the nurse perform the following actions? Arrange the steps from first to last.

  1. 1Position the wheelchair at a 45-degree angle on the client's left side.
  2. 2Lock the wheels on both the hospital bed and the wheelchair.
  3. 3Apply a transfer belt securely around the client's waist.
  4. 4Brace the client's right knee and assist them to a standing position.
  5. 5Instruct the client to reach for the wheelchair armrest with their left hand.

Answer

The correct sequence prioritizes environmental safety and leading with the strong side: Position the wheelchair on the left side, lock the wheels, apply a transfer belt, brace the right knee during the stand, and instruct the client to reach with their left hand.
Safe transfer of a client with hemiplegia requires moving toward the strong side. The environment is secured first (chair positioned on the strong left side, brakes locked). Next, the client is secured with a gait belt. During the pivot, the nurse protects the weak side by bracing the right knee, allowing the client to use their strong left arm and leg to guide the transfer safely.

Step-by-Step Solution

1
Analyze the client's deficit and prepare the environment.
The nurse identifies the left side as the strong side, positions the wheelchair on the left at a 45-degree angle, and locks all wheels.
Transfers must always be directed toward the unaffected side to maximize client participation and safety. Securing the environment prevents equipment from shifting during weight transfer.
2
Secure the client for physical movement.
The nurse applies a transfer (gait) belt around the client's waist.
The belt provides a secure grip for the nurse to control the client's descent if they begin to fall, avoiding pulling on the client's arms or shoulders.
3
Provide support to the compromised extremity during the lift.
The nurse braces the client's right knee with their own knee/foot while assisting the client to stand.
Right-sided hemiplegia means the right leg lacks motor control and strength; bracing it prevents the knee from buckling under the client's weight.
4
Utilize the strong side to complete the pivot and transfer.
The client reaches for the wheelchair armrest with their functional left hand before sitting.
Reaching with the strong arm maintains spatial orientation and provides a final point of stability as the client lowers into the chair.

Key Concept

Safe mobility and transfer techniques for clients with hemiplegia
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Topics

Basic Care and Comfort

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