A nurse is preparing to transfer a client from the bed to a wheelchair. The client has a history of severe orthostatic hypotension and right-sided hemiparesis following a cerebrovascular accident. Arrange the following steps in the correct chronological order to ensure a safe and hemodynamically stable transfer.
- 1Position the wheelchair at a 45-degree angle to the bed on the client's left side and lock both wheels.
- 2Elevate the head of the bed to a high-Fowler's position to allow the client's cardiovascular system to adjust.
- 3Assist the client to a sitting position with their legs dangling over the edge of the bed.
- 4Assess the client for dizziness and apply a transfer belt securely around their waist.
- 5Instruct the client to bear weight on their left leg and pivot smoothly into the wheelchair.
Cevap
The correct sequence prioritizes environmental preparation, followed by gradual physiological adaptation to upright posture, and concludes with a mechanically safe pivot transfer.
This sequence synthesizes two critical nursing priorities: proactive environmental safety and hemodynamic adaptation. By placing the wheelchair on the strong (left) side first, the nurse ensures the client is never left unsupported while symptomatic. Gradual elevation and dangling prevent orthostatic syncope. Finally, using a gait belt and pivoting on the strong leg ensures maximum biomechanical stability.
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Anahtar Kavram
Principles of safe mobility and transfer for clients with hemiparesis and orthostatic hypotension.
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