Experience shows it is usually preferable to measure Surgical cases before surgery. This is true for many reasons.
Extreme care must be taken in measuring a client who is in bed. It is not as easy to adjust the Control Supports with the client in a reclining position as in a standing position and, in this position, the flesh of most clients is distributed differently.
When the client is measured before the operation, measurements for both the body support and breast supports can be taken. These supports can be designed while the patient is convalescing and delivered soon after.
When the client is measured after the operation, it is usually advisable to measure only for the body support, postponing the measuring for the breast supports until the body support is delivered and the client can be measured standing. Breast Supports cannot be satisfactorily measured with patient reclining.
It should be remembered, too, that much time may elapse after an operation before the client is strong enough to be measured. This could cause considerable delay in the delivering of badly- needed supports.
Co-operation of Doctor. A tactful explanation of these points to the doctors you serve will help you to obtain their co-operation in arranging to have their patients measured before surgery, when- ever possible.
Client's Own Spencer. If it is not possible to take new measure- ments before the operation, and the patient has been wearing Spencer Supports, you may use your record of the most recent order as a guide in ordering the new supports. These measurements should be used only as a last resort, and then only as a guide. Use only those measurements which cannot be taken.
When Patient Is in a Cast. If the patient is in a cast which cannot be removed, measurements may be taken over the cast. In doing so, please give the thickness of the cast under Additional Instructions. If the thickness of the cast varies in different parts, specify the thickness affecting the Waist, Hip and Top Edge Measurements. The doctor can give you this information.
Do not make any deductions from the measurements to compensate for the thickness of the cast. The technician will do this, according to the information you give.
Note. It is important to give complete and accurate information A one-inch-thick cast will change the circumference measurements approximately 6 inches.
Practice Technique. The technique of measuring a client who is lying down differs from that of measuring one who is standing. It is important that you practice on members of your family until you can follow instructions with a minimum of annoyance to the bed patient.
Extreme Deformities. There are deformed patients it is almost impossible to measure accurately in bed. The degree of deformity, the flexibility of joints and the general condition of the individual will determine what can be done.
Professional Ethics. To avoid any possible violation of professional ethics, it is always advisable to arrange for the attendance and assistance of a nurse or other qualified person. This can be done through the supervising nurse or the doctor, when there is no private nurse attending the patient.
Moving Patient. Where complete new bed measurements are required, the following methods, which have been worked out to avoid unnecessary moving of the patient, may be used. However, following certain operations, or because of other conditions, some of the methods suggested may not be practicable and others must be used to avoid moving the patient.
Preparation for Bed Measurements. Have everything you will need arranged conveniently. This includes four tape measures (three with buckles, one without), Control Support, safety pins, order forms and pencil.
Description of Figures. Because the patient should be moved as little as possible, the description of figure should be taken while you are preparing to place the Control Support on the patient. You can take all of the figure description, with the exception of the back-up and back-down, while the patient is lying on back. Try to visualize the figure as it would be if client were standing.
When No Control is Necessary. For thin patients or patients with firm flesh, measurements may be taken, when necessary, over the uncontrolled figure. When this is done, care should be taken that the tape measures are pulled smoothly, but not so tightly that they cut into the flesh.
In taking bed measurements, the Control Support is most often used to control the patient's figure. However, when the patient is being measured for a belt, a Sample or Emergency Belt may be used in place of the Control Support. If the patient is wearing a hospital binder, measurements may be taken directly over the binder, provided it fits snugly.
Test Waist Measurement. Take a test Waist Measurement to determine which front panel, if any, is to be used.
Patient Turns on Side. (In most cases it will be practicable for the patient to turn on her side. The following instructions are based on this assumption).
Standing to the patient's right, ask her to flex her knees slightly and turn on her right side facing you. Patient can probably do this alone or with the help of the nurse.
This is your opportunity to complete the description of figure by writing the description of back-up and back-down.
Adjust Back Lacer. The back lacing space cannot be readjusted after the Control Support is on the patient's figure. It is advisable, before putting it on, to hold the centre of the lacing space over the patient's spine, and then draw the side of the support up over the figure to determine if the hip seam will be straight up and down (see Fig. 235). If not, the lacer should be adjusted before you proceed.
After the lacer is properly spaced, the lacer loops should be tied and tucked inside the eyelet section. This will prevent interference from the loops when tape measures are placed around the patient.
Fold Side of Control Support. Starting from the extreme righthand side of the Control Support, fold the sections together until you reach the centre-back.
Place the support on the bed with the sections you have folded next to the patient's back. The inner side of the left-hand sections (which are not folded) should be placed so they may be drawn up over the body in the next step of the adjustment (see Fig. 236).
Locate Waistline. Locate patient's waistline between top of hipbones and lower ribs, and move Control Support until waistline knot is slightly below patient's waistline at back. Then bring the left side (the side not folded) of Control Support into correct place on left side of patient's body, being sure that centre-back of Control Support is properly located and that the lower edge of support is well down below patient's buttocks.
Patient Turns on Back. Hold the left side of Control Support in position while the patient turns on back. As patient turns, she will roll over that part of the support which has been folded.
Fasten Elastic Tape. You will now be able to locate correctly the right- hand side of support on body. Do this, then fasten and adjust elastic tape (see Fig. 237).
Adjust Support. Fasten front panel and adjust Control Support as you would Fig. 237 if patient were standing.
Tape Measure. Slip three tape measures (with buckles) under the patient's body at the waist. Then bring them into the approximate position for the Waist, Top Edge and Hip Measurements. Fasten tape measure buckles about 1 inch to the right of centre-front.
Waist Tape. Adjust the waist tape at the client's waistline.
Safety Pins. Use safety pins to prevent any possibility of injury to the patient.
Other Outlining. Outline for the Hip Measurement at the usual point, 7 inches below the waist, placing tapes through pins at side front and side hip. Then, outline for the top edge, placing tapes through pins at centre-front, under-bust and under-arm. If you are measuring for a corset, outline for the Length Cloth at Front (see Fig. 238).
Client on Back. While patient is on her back, you will be able to take these measurements :
|Length Cloth at Front||Height at Front|
|Waist to Pubic Bone||Length Front Bones.|
Length Front Bones. To take the Length Front Bones Measurement, loosen the thigh sections and have patient raise her right knee. Then take the Length Front Bones Measurement just as though the patient were seated (see Fig. 239).
Have patient turn on right side again. Check to see that all tape measures are correctly located and pin them in place at back (see Fig. 240).
Outline Length to Crease. To locate crease, have client straighten her left leg and move it back until crease where buttock joins the leg shows clearly. Place a pin to mark this point, in line with the centre of the leg (see Fig. 241).
Outline Length Cloth at Back. The pin indicating the Length Cloth at Back is placed about 1½ inches below crease.
Outline Length Cloth at Hip. The pin marking the Length Cloth at Hip is located slightly below the fullest part of the figure at that point.
The remaining measurements should be taken, including :
|Size Hip||Top Edge|
|Length to Crease||Height at Back|
|Length Cloth at Back||Height at Under-arm|
|Length Cloth at Hip||Length Back Bones|
|Length Hip Hose Supporters|
Length to Crease. Be sure to take the Length to Crease Measurement in line with the centre of the leg (see Fig. 242).
Length Back Bones. Pin the tape measure with end at the waistline. Before taking the Length Back Bones Measurement, have client draw up her legs as though in a seated position.
Then press a book covered with a towel firmly against the bottom of the buttocks.
This hard, flat surface takes the place of the chair seat to which you would measure if client were seated. The measurement can then be taken with the left hand while the book is held firmly in position with the right (see Fig. 243).
Tape Measures. Unfasten the tape measures so that they can be rolled back with the support.
Unfasten Support. With client still on her right side, unfasten the left side of the support. Fold the sections of this side of the support as far back as possible, just as you folded the right-hand sections before putting the support on the figure.
Remove Support. Have the client turn over on her back. Remove the support and the tape measures.