Monthly Archives: February 2012

Green Jello – Little Pig, Little Pig

A little Green Jello for Tuesday:

For all my friends at the hospital looking for Jello. . .

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Safe Lifting – Sooooo Important!

As a CNA, it’s important to know safe lifting techniques.  Let’s face it, being off work on disability sucks rocks – but more importantly, you only get one spine, and it’s awfully nice to have the use of it for more than just one shift.

CNAs working in LTC experience lots of time pressure, particularly at peak bed-to-chair or chair-to-bed transfer times.  I swear everyone wants to go to bed approximately 2.5 minutes after finishing a meal!  Plus, there’s a significant conflict between following facility lifting rules (2 staff when using a mechanical lift – super easy to coordinate when you have 7 or more residents per CNA, right?) and the realistic time pressures of getting your section done before it’s time to chase call lights the remainder of your shift and/or until it’s time to get people up/down for the next meal.  CNAs working in acute care have a different set of problems stemming from rusty/nonexistent Hoyer skills.  It is not the purpose of this post to solve the above issues, but rather to give one CNA’s mental tool kit for safe lifting.

Before performing a mechanical lift of a patient/resident, assess the following factors:

  1. available equipment – includes lift and sling(s)
  2. resident/patient factors – includes weight (because you need to check that against the weight capacity of the lift AND the sling), body proportions, and mental/emotional status
  3. physical environment factors in all 4 directions – huh?  (I’ll explain more below.)

Available Equipment:

Know your lifting options – what Hoyer-style lifts are available to you?  Is there a sit-to-stand lift option?  What is the maximum weight capacity of each lift?  Is the lift one that is always available on your unit/wing, or does it tend to disappear just when you need it?  What other residents/patients are likely to need a particular lift (helps when you need to figure out where the heck it went/bribe a coworker that is hogging it. . .)

Which sling(s) belong to which lift – the slings used with a sit-to-stand are not compatible with Hoyer-style lifts, for example.  There are mesh slings to use when showering/bathing a resident/patient, and solid slings for regular transfers.  Which sling goes with which lift?  Familiarize yourself with your options before you need to know them.

Resident/Patient Factors:

Obviously, the resident/patient’s weight is important.  Weight capacity varies by lift, so make sure of a good match before someone gets hurt. 

Does your resident/patient become anxious easily?  If so, explain the process of the lift to him/her before starting, and step-by-step as you perform the lift.  (This is more important in acute care when you are more likely to deal with a patient that has never participated in a mechanical lift, and might be justifiably anxious about the process.)

Does the resident/patient have a factor that might necessitate a third (or maybe fourth) helper?  For example, if you are using a chair-style sling, and the resident has extremely heavy legs, is post knee-replacement, or has some other factor that necessitates lifting the lower extremities carefully, to avoid patient/staff injury?  Try to think strategically before starting the lift – it’s harder to figure out these factors mid-lift (personal experience).

Physical Environment Factors in All 4 Directions:

Know your over/under- no, not talking placing bets, here, but rather planning your next move (and the moves after that).

Yes, thinking strategically before starting the lift is quite important.  Assess the underside of the bed – what cables/cords need to be moved or lifted before attempting to slide the lift frame under (or out from under)?  How will the lift frame interact with the bed (include the geometry of the patient load in this assessment)?  Will lowered bed rails affect your ability to get the lift under the bed?

How much room do you have to maneuver/roll the lift adjacent to the bed?  What obstacles are in your path?  Do you need to move items before starting the lift? 

How will the top of the lift interact with items beside and over the top of the patient’s bed?  Is there a trapeze bar frame that will bump a wall-mounted light fixture when you raise or lower the bed?  What other obstacles can you find?

Conclusion:

This post is not intended to replace your facility-provided training sessions for lift usage.  Rather, it is designed to help you think strategically about factors that affect lifts.

Happy and safe lifting!

Wednesday, I’m in Love…

OMG OMG OMG! I can’t wait ’till it arrives! A Pentel 8-color automatic pencil! My textbooks and note cards will never know what hit’em! A review will be forthcoming…

Pentel 8-Color Automatic Pencil

Update: it’s here! And just as marvelous as anticipated! Here’s a picture of this gadget:

20120218-154700.jpg

A Sedation Alphabet

A is for Ativan and anxious

B is for benzodiazepine and barbiturate

C is for central line

D is for dopamine receptors

E is for Equanil

F is for frontal lobe

G is for glutethimide

H is for Haldol and Halcion

I is for intravenous and IJ line

J is for JCHAO

K is for Klonopin

L is for lorezepam

M is for mitts and morphine

N is for neuroleptic

O is for obtunded

P is for Propofol and Precedex and Prozac and paradoxical reaction

Q is for quiet

R is for restraints and Restoril

S is for sitter/safety companion and sedative and Security

T is for tardive dyskinesia and tricyclic antidepressant

U is for understanding

V is for Valium and Versed

W is for waking

X is for Xanax

Y is for y-site compatibility

Z is for zzzzzzzzzzzz…

1:1 Patient Sitting Survival Tips

CNAs often are called upon to serve as patient sitters, particularly in the acute care setting. Sitters are an alternative to increased sedation and/or restraints for combative patients. Facility policy may dictate the use of a sitter (“safety companion”) if a patient has expressed suicidal ideation.

When dealing with an agitated, combative patient, using a soft voice, dimming lights, and providing a calm, restful setting can go a long way toward minimizing the amount of action going on. If a patient is fidgeting in the bed, but not actively trying to pull out their central line (that would be a BAD THING), peripheral IV, or fourth (ouch) Foley that day, heck, let’em fidget! If the patient is given some opportunity to get rid of excess energy through some, ah, bed mobility, chances are good they might be able to settle down and even get some rest.

Cloth tape may be your BFF for keeping leads, IVs and sat probes on/in your patient. You can use a square of cloth tape over tele leads to make them more likely to stay on, and if you have the pulse ox probe on a toe, use cloth tape to secure its cable to the top of the patient’s foot.

Distraction is another valid approach to use with the agitated patient. Try telling stories, singing or employing other entertaining methods to help the patient get his/her mind off being in the hospital.

What kinds of survival supplies will help you have a more enjoyable shift as a sitter (assuming you’re not spending an entire shift doing everything you can just to keep the patient in bed, that is)?

Here’s a list:

-book to read (can be a textbook)

-smartphone with Netflix – many programs are close-captioned so you can watch without waking your patient, or you can play Words with Friends (scrabble game), Facebpook, text, etc.

-snacks, bottled water

-cards/stationery so you can catch up on correspondence

-portable reading light (so you don’t wake your patient)

-cell phone charger

Happy sitting!