Nurse is going to place a hemiplegic patient in a prone position. Which is the first action?

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

The primary principle in moving a hemiplegic patient is to ensure safety by leveraging their existing strength.
Initiating the turn from the unaffected (strong) side allows the patient to participate in the movement, using their functional arm and leg.
This action provides better control and stability during the turn, reducing the risk of injury to the paralyzed (affected) side.
It follows the safe patient handling principle of encouraging patient participation to the best of their ability.

Option A: Positioning the head is a final step in the procedure, performed after the patient is already prone to ensure a clear airway.
Option B: While bending the knees is part of the log-rolling technique used for turning, it is a mechanical step within the process, not the first strategic action.
Option D: This action is vague and does not represent the primary step. Correctly positioning the arms to prevent injury is crucial, but it is a preparatory step, not the initiation of the turn itself.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient Positioning and Mobility to guide bedside assessment, documentation, and the next nursing action.
Proper positioning techniques are fundamental to nursing care to prevent complications such as pressure injuries, joint contractures, and respiratory issues.
Incorrect handling of a hemiplegic patient can lead to shoulder subluxation, pain, and other musculoskeletal injuries for both the patient and the nurse.
What if? If the patient also had an unstable spinal injury, the procedure would change significantly. A log-rolling technique with at least three staff members would be mandatory to keep the spine in strict alignment. The turn would be a coordinated effort with one person dedicated to stabilizing the head and neck.

How to Approach the Question

First, identify the key elements of the question: the patient's condition (hemiplegic), the desired outcome (prone position), and the specific question (first action).
This is a priority-setting question that requires knowledge of procedural steps.
Recall the core nursing principles for mobility: patient safety, preventing injury, and using the patient's own abilities.
For a hemiplegic patient, this means protecting the weak side and utilizing the strong side.
Evaluate each option based on this principle. Ask yourself, 'Which action establishes the safest and most effective plan for the entire maneuver?'
Eliminate options that are steps performed later in the process (like positioning the head) or are components rather than the initiating action.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 4 pp. 164-166, 156-158

Practise the full NORCET 2 -2021 (Shift-2)

Attempt every question from this paper in a timed mock, then review the full solution for each one.