A patient is admitted to the ward on bed rest. The on-duty nursing officer instructs the patient to move up with the help of a trapeze bar because it prevents?

1. A

   Shearing

2. B

   Pressure

3. C

   Ischemia

4. D

   Friction

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

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• Shearing.
• A trapeze bar allows the patient to lift their torso and hips off the bed surface when moving.
• This lifting motion prevents the skeleton and deeper tissues from sliding while the skin remains fixed to the sheets, which is the definition of shear force.
• Shear damages blood vessels and soft tissue deep under the skin, leading to severe pressure injuries.
• By eliminating the sliding motion, the trapeze bar directly counteracts the mechanism of shear.

Why Other Options Were Wrong

• Option B: Pressure is the force exerted by body weight on a surface. While a trapeze helps in repositioning which relieves pressure, its primary mechanical benefit during the act of moving is preventing shear and friction, not the constant force of pressure itself.
• Option C: Ischemia, or lack of blood flow to tissues, is the result of sustained pressure or shearing forces. It is a consequence, not the primary force that the trapeze bar prevents. By preventing shear, the trapeze indirectly prevents ischemia.
• Option D: Friction is the rubbing of one surface against another (e.g., skin against sheets). While using a trapeze does reduce friction, shearing is a more significant and damaging force that occurs in deeper tissue layers. The primary benefit of lifting versus dragging is the prevention of shear.

Related Visual

• Visual 1: Diagram - A side-by-side illustration showing the difference between friction (surface rubbing) and shear (internal tissue layers sliding against each other). This helps clarify why shear is a deeper, more damaging force.
• Visual 2: Infographic - A graphic demonstrating proper use of a trapeze bar, highlighting the 'lift and move' technique to prevent sliding, and listing the key benefits like preventing shear, increasing independence, and strengthening upper body.

Clinical Relevance

• Nursing practice connection: Use the key finding related to Pressure Injury Prevention and Assistive Devices to guide bedside assessment, documentation, and the next nursing action.
• Nurses must educate patients on the correct use of a trapeze bar to maximize its benefits and ensure safety. This includes assessing if the patient has sufficient upper body strength.
• Preventing pressure injuries is a key nursing responsibility. Understanding the difference between pressure, shear, and friction is crucial for implementing the correct preventative interventions.
• What if the patient lacks upper body strength to use a trapeze? In this case, the nurse should use a friction-reducing slide sheet or a mechanical lift with at least one other staff member to lift the patient clear of the bed surface during repositioning, again emphasizing the principle of 'lift, don't drag' to prevent shear.

How to Approach the Question

• First, identify the core concept: prevention of complications from immobility.
• Analyze the function of the device mentioned: a trapeze bar allows a patient to lift their body.
• Consider the action of 'moving up' in bed. This can be done by sliding or lifting.
• Differentiate between the options: Friction (surface rubbing), Shear (internal sliding), Pressure (compression), and Ischemia (result of pressure/shear).
• Connect the action of lifting (enabled by the trapeze) to the force it prevents. Lifting eliminates sliding, which is the primary cause of shearing forces.
• Conclude that while friction is also reduced, preventing the more damaging shear force is the most significant benefit.

Concept Tested & Keywords

• Concept Tested: Pressure Injury Prevention and Assistive Devices
• Stem keywords: bed rest, trapeze bar, move up, prevents
• Lead-in keywords: prevents
• Clinical cues: Patient is on bed rest, increasing risk for immobility complications.
• Clinical cues: Use of a trapeze bar indicates a focus on patient-assisted movement.

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