What is the purpose of therapeutic positioning?
- Stabilization and Healing
- Psychological stimulation
- Comfort
- Prevent of minimize edema formation
- Prevent or minimize skeletal deformities
- Promote proprioceptive and kinesthetic awareness
- Aid in decreasing effects of prolonged bedrest
- Prevent or minimize adaptive shortening
- Prevent skin breakdown
how does adaptive shortening occur when therapeutic positioning doesn’t occur?
adptive shortening = contracture = immobilization of a joint due to fixed muscle shortening
adaptive shortening an occur anywhere
what factors lead to adaptive shortening?
pain, inflammation, muscle weakness, immobilization, changes in tissue/body structure, spasm , paralysis
+++
Which muscles are overall likely to be shorter?
sagittal plane: flexion
frontal: adduction
transverse: LE - lateral rotators, UE: medial rotators
What is a pressure injury?
localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear.
What are the most common sites for pressure ulcers when sitting?
heels and ischial tuberosity
What are the most common sites for pressure ulcers when laying down on your back?
heels, sacrum, elbows, scapula
What are the most common sites for pressure ulcers when laying down on your stomach?
eaer, acromian process, knees
What are the most common sites for pressure ulcers when laying on your side?
malleolus, knees, greater trochanter, ear
What are the two primary causes of skin breakdown?
prolonged pressure and shearing stress/force
What is the relationship between time and pressure for skin breakdown?
inverse relationship
- greater the pressure the less time is needed to cause the same amount of pressure; less pressure greater time
What is normal capillary pressure and what pressure is needed for changes to occur?
16-33mmHg
- greater than 66mm Hg pressure = hyperemia (redness)
- 50 mm Hg pressure = histamine response
what is shearing stress/force?
- tangential force caused by gliding of superficial tissues over deeper tissue structures.
- bones are moving in one direction while the skin and overlying skin or other soft tissue structures move the other way.
shear results are mroe internal and a deep tissue injury compared to friction
shear and friction are not the same but usually occur together
coefficient of friction changes depending on the surface
What other factors contribute to skin breakdown
- Med/Surg Conditions
* Moisture/Wetness - Motor weakness
- Cognitive Status
- Decreased Sensation
- Anemia
- Poor nutrition
- Poor hygiene
- Smoking
- Heat
- Infection
- Psychological Stress
- Age
- Vascular Competency
- Glycemic control/DM
*
what is the difference betwen eliminating pressur eand dispersing it?
eliminating pressure = get rid of it
dispersing pressure = add surface area to spread out pressure
should a pt do thereapeutic positioning if the person can move?
No, will not move if they can move themselves, instead instruct them how to move
