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Question

Difficulty: HardBasic Care and Comfort

A nurse is preparing to transfer a client who has left-sided hemiparesis from the bed to a wheelchair. In which order should the nurse perform the following actions? (Arrange the steps from first to last.)

  1. 1Position the wheelchair on the client's right side and ensure the brakes are locked.
  2. 2Assist the client to a sitting position on the edge of the bed and apply a transfer belt.
  3. 3Stand facing the client, grasp the transfer belt, and brace the client's left knee.
  4. 4Assist the client to stand and instruct them to pivot on the right foot.
  5. 5Instruct the client to reach back and grasp the wheelchair armrest with the right hand.

Answer

The correct sequence begins with positioning the wheelchair on the strong (right) side, followed by assisting the client to sit and applying a gait belt. The nurse then braces the weak (left) knee, helps the client stand and pivot on the strong (right) foot, and finally has the client grasp the armrest with the strong (right) hand before sitting.
When transferring a client with unilateral weakness (hemiparesis), the nurse must optimize the client's remaining strength and ensure safety. The sequence begins with environmental setup: placing the wheelchair on the unaffected (right) side so the client can lead the transfer with their strong side. Locking the brakes is mandatory. Next, the client is assisted to sit (to stabilize hemodynamics) and a gait belt is applied for safety. The nurse then stands directly in front, grasping the belt and crucially bracing the weak (left) knee to prevent it from collapsing. The client is assisted to stand and pivot on their strong (right) leg. Finally, the client uses their strong (right) arm to reach back for the armrest, ensuring a safe, controlled descent into the chair.

Step-by-Step Solution

1
Position the wheelchair on the client's right side and ensure the brakes are locked.
The environment is prepared for a safe transfer toward the client's strong side.
Placing the chair on the unaffected side allows the client to pivot safely on their strong leg without crossing the weak leg.
2
Assist the client to a sitting position on the edge of the bed and apply a transfer belt.
The client is physiologically stabilized and the nurse has a secure method to support them.
Dangling prevents orthostatic hypotension, and the transfer belt ensures the nurse can safely guide the client's center of gravity.
3
Stand facing the client, grasp the transfer belt, and brace the client's left knee.
The nurse provides critical physical support to the hemiparetic extremity.
Bracing the weak left knee with the nurse's knee prevents it from buckling during weight-bearing.
4
Assist the client to stand and instruct them to pivot on the right foot.
The client moves safely from the bed toward the wheelchair.
The strong right leg must bear the majority of the weight to ensure a safe, balanced pivot maneuver.
5
Instruct the client to reach back and grasp the wheelchair armrest with the right hand.
The client is safely and securely seated in the wheelchair.
Reaching with the unaffected arm provides stability, widens the base of support, and guides the client's descent into the seat.

Key Concept

Safe client transfer and positioning for a client with hemiparesis
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Topics

Basic Care and Comfort

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