Two types of restraints :

1. Physical restraint
2. Chemical restraint

As a NA  you will be more concern with the use of physical restraints.

Examples of physical restraint  :

• Wrist/arm
• Vest
• Jackets
• Hand Mitts
• Geriatric and cardiac chairs
• Wheelchair safety belts, bars and tables
• Bed rails (if they meet the definition of a restrain

Enablers

Devices used as enablers that maintain body position and alignment are commonly called postural supports.

around the frame deck (the moveable part of the frame that supports the mattress), once or twice.

• wrap the strap around the lower frame, or the restraint will tighten and inhibit respiration when the head of the bed is elevate.
• tie the end of the strap to the outside of the frame, this enables the patient to reach down and untie it.
• fasten/tie the straps to  the side rails or loop or wrap the straps around the side rails.

1. Care for patients' personal need promptly
2. Know which pts are at risk for falling
3. Observe pts who walk and transfer independently
4. Report immediately any physical or mental chang that could increase the risk of an incident (disorientation, complain, problem with balance and coordination)
5. Maintain a safe, quite, calm environment
6. Provide comfortable chairs

• Check for irritation or poor circulation
• change the patient's position
• exercise-ambulate the patient or do passive range-of-motion exercise
• Take the patient to the bathroom
• Change incontinent patients and cleanse their skin
• Provide fluid or nourishment
• Attend to any other needs

1. Wash your hands
2. Assemble supplies and equipment and bring to patient's room
3. Knock on the door and identify yourself
4. Identify the patient according to facility policy
5. Ask visitor to leave to room
6. Explain what you are going to do
7. Provide privacy by closing the door, privacy curtain and window curtain
8. Wash your hands 
9. Position the patient for the procedure
10. Cover the patient with a bath blanket 
11. Raise the bed to a comfortable working height
12. Apply PPE
13. Lower the side rail on the side where you will be working

1. Remove gloves
2. Reposition the pts
3. Replace the bed covers, than remove any drapes used
4. Elevate the side rails, before leaving the bedside
5. Remove other PPE
6. Wash your hands
7. Return the bed to the lowest horizontal position
8. Open the privacy and window curtains
9. Position the call signal and needed personal items within reach
10. Wash your hands 
11. Remove procedural trash and contaminated linen when you leave the room
12. Inform visitors that they may return to the room
13. Document the procedure, your observation and the patient's response

 To protect the resident and NA from injury 

• Use turning or lifting sheets/draw sheet
• Get help

moving, turning and positioning the patient.

In a manner that :

• Helps the patient feel more comfortable
• Relieves strain
• Helps the body function more efficiently
• Prevent complications like contractures and pressure ulcers

Shortening of the muscles

A serious complication of immobility, making movement and activity painful and difficult. 

Occurs when a joint is allowed to remain in the same position for too long.

Not reversable-cut ligament

preventable by exercise

Atrophy

Reversable with exercise

pressure ulcers,

the constructures cause bony prominences to suffer reduced blood flow, increasing the risk for development of pressure ulcers.

Supportive device

1. Prone (on the abdomen)
2. Supine or horizontal recumber position 
3. Lateral
4. Fowler's position (45º to 60º) and Orthopneic position

Body positions on the abdomen

• Prone
• Semiprone;  help breathing easier than prone position

• Supine
• Semisupine

• Right Lateral
• Left lateral (Sim's position)

Fowler's 45º to 60º

• Low Fowler's 20º - 30º
• Semi Fowler's 30º
• High Fowler's 90º

• The back and buttocks should be up against the chair back
• Stabilizing the patient's feet on the floor or wheelchair footrests

90-90-90 position

• Feet should be at a 90º angle to the lower legs
• Lower legs should be at a 90º to the thighs
• The thighs should be at a 90º angle to the torso

Orthoses, also called splints

the correct use of these devices prevents constracture formation 

• chair is padded
• remind him/her to shift weight every 15 minutes
• reposition the patient in the chair at least every 2 hours

Semisupine position

Should not be confused with lateral position, patient in this position is not lying directly on the side.

 lying on the abdomen may make breathing more difficult for some patients.

Check the patient every 15 minutes

NA help to gain and maintain proper alignment by remember to :