A female client who’s paralyzed on the left side has been receiving physical therapy and attending teaching sessions about safety. Which behavior indicates that the client accurately understands safety measures related to paralysis?
A. The client leaves the side rails down.
B. The client uses a mirror to inspect the skin.
C. The client repositions only after being reminded to do so.
D. The client hangs the left arm over the side of the wheelchair.
Correct Answer: B. The client uses a mirror to inspect the skin.
Using a mirror enables the client to inspect all areas of the skin for signs of breakdown without the help of staff or family members. Inspect skin daily. Observe for pressure areas, and provide meticulous skincare. Teach the patient to inspect skin surfaces and to use a mirror to look at hard-to-see-areas. Altered circulation, loss of sensation, and paralysis potentiate pressure sore formation. This is a lifelong consideration.
Option A: The client should keep the side rails up to help with repositioning and to prevent falls. Perform and assist with full ROM exercises on all extremities and joints, using slow, smooth movements. Hyperextend hips periodically. Enhances circulation, restores and maintains muscle tone and joint mobility, and prevents disuse contractures and muscle atrophy.
Option C: The paralyzed client should take responsibility for repositioning or for reminding the staff to assist with it if needed. Reposition periodically even when sitting in a chair. Teach the patient how to use weight-shifting techniques. Reduces pressure areas, promotes peripheral circulation.
Option D: A client with left-side paralysis may not realize that the left arm is hanging over the side of the wheelchair. However, the nurse should call this to the client’s attention because the arm can get caught in the wheel spokes or develop impaired circulation from being in a dependent position for too long.
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