Positioning

Question 1

Short Term Positioning

Answer 1

Interventions/exercises
30 minutes

Question 2

Long Term

Answer 2

• 2-3 hours
• Preventing pressure injuries
• Preventing contractures
• Preventing cardiopulmonary complications

Question 3

Positioning for specific conditions

Answer 3

Total hip arthroplasty
CVA with hemiplegia
LE amputation

Question 4

Short Term Positioning Objectives

Answer 4

• Safety -protect vulnerable body parts without creating additional safety hazards
• Comfort -Maintain normal spinal alignment as much as possible and position extremities comfortably
• Access -position patient so that the appropriate intervention can be performed

Question 5

Short Term: Supine

Answer 5

Question 6

Short Term Prone

Answer 6

Question 7

Short Term Sidelying

Answer 7

Could also add a pillow between the knees

Question 8

Alternate Short Term Sidelying

Answer 8

Question 9

Short Term Sitting

Answer 9

More than 90 degrees of flexion takes a lot of pressure off the back.
90/90/90; Back can have a little more flexion

Question 10

Short Term Sitting Alternate

Answer 10

Use a chair with a back NOT wheels.

Question 11

Long term positioning objectives

Answer 11

• Safety—open airways, avoid falls, accommodate medical limitations
• Comfort—good spinal alignment, cushioning, relieve stress on joints
• Prevention—prevent development of pressureinjuries, contractures, and edema; promoteefficient function of bodily systems

When lying down can only use anterior lungs due lying down

30 minutes to 2 hours

Question 12

Negative Effects of Immobility: Integumentary

Answer 12

Poor circulation
Pressure Ulcers

Question 13

Negative Effects of Immobility: Musculoskeletal

Answer 13

Atophy of muscle
Decreased ROM (Muscle development and muscle contracture)
Decreased BMD

Question 14

Negative Effects of Immobility: Cardiopulmonary

Answer 14

Can’t recruit proper mechanisms
DVT risk
Decreased endurance

Question 15

Negative Effects of Immobility: Neurological

Answer 15

Peripheral Neuropathy
Takes longer time to learn motor tasks with less movement

Question 16

Negative Effects of Immobility: Behavorial

Answer 16

Depression
Helplessness
Lack of socialization
Fear of movement

Question 17

High Fowler’s Position

Answer 17

Typically the position of comfort for patients in hospital beds—can increase shearing forces and promote contractures.

Question 18

Trendelenburg Position

Answer 18

Facilitates circulation
Gravity can help move a patient
Utilized in abdominal surgeries and at times, following lower extremity surgeries

Question 18

Trendelenburg Position

Answer 18

Facilitates circulation
Gravity can help move a patient

Question 19

Increased Susceptibility to Pressure Injuries

Answer 19

• Decreased mobility
• Fragile skin
• History of skin breakdown
• Incontinence
• Impaired sensation
• Impaired circulation
• Cachexia (condition of severe weight loss including muscle wasting)
• Muscle atrophy
• Postural impairment
• Friction or shear
• Nutritionaldeficiencies
• Impaired cognition
• Medication that affectsmobility or awareness

Question 20

Preventing Pressure Injuries

Answer 20

• Maximum of 2 hours in one position in bed
• Maximum of 15 minutes in one position in sitting
• Reposition more frequently if patient has increased risk factors.

Question 21

Braden Scale for Predicting Pressure Sore Risk Considerations:

Answer 21

• Sensory Perception
• Presence of Moisture
• Patient Activity Level
• Patient Mobility Level
• Nutrition
• Friction and Shear Forces

Question 22

Braden Sclae for Predicting Pressure Sore Risk Score

Answer 22

High score = lower risk
Lower score = higher risk

Question 23

Pressure Injuries Checking for Skin Damage: Skin Blanching Test

Answer 23

• Using 1-2 fingers, press gently on the skin area in question and quickly release
• When pressed, healthy lighter-colored skin will blanche and quickly return to healthy pink.
• If the skin does not blanche, it indicates compromised tissue.
• Darker colored skin may not change colors as well
• Do not position a patient with pressure on a compromised area - “redness rule”

Question 24

Preventing Edema and Cardiopulmonary Complications

Answer 24

* Position distal extremities at or above the level of the heart. * Vary demand on the heart by including more upright positioning. * Vary positions to promote lung drainage. | Proning patients promotes lung drainage

Question 25

High Risk Areas for Pressure Injuries: Supine/Prone

Answer 25

Heels and sacrum especially at risk

Question 26

Sidelying pay attention to:

Answer 26

Medial aspect of knees and ankles

Question 27

Positioning Devices

Answer 27

* Positioning devices are designed to reduce or eliminate load, or to help patients maintain static stability. * Left to Right > multi-podus boot > Heel protector > UE support splint

Question 28

Preventing Contractures

Answer 28

* Flexion contractures tend to be most common. * May need to avoid positions of comfort. * Reposition frequently.

Question 29

Long Term Positioning: Supine

Answer 29

Note heel protection, pillow under arm, towels under legs. ## Footnote LTP on left; STP on right

Question 30

Long Term Positioning: Sidelying

Answer 30

* Full prone is rarely used * More commonly modified sidelying, either ¾ supine or ¾ prone. * When positioning a patient in prone or semi-prone, ensure a clear airway and the patient’s ability to call for help.

Question 31

Prone Positioing

Answer 31

Beneficial for ARDS (Acute Respiratory Distress Syndrome)

Question 32

Long Term Positioning: Sitting

Answer 32

* Increase frequency of repositioing * May require small lumbar roll * Approximate 90°-90°-90° position (90° hip flexion, 90° knee flexion, and neutral ankle) * Avoid sacral sitting * Support arms

Question 33

As is the pelvis, so goes the head

Answer 33

Move the sacrum to allow the head to align

Question 34

Restraints

Answer 34

* Only do one limb at a time * Check length * IF A PATIENT CAN DO IT THEMSELVES IT IS NOT A RESTRAINT * One rail must be down or is considered a restraint

Question 35

Positioning After a Total Hip Arthroplasty **Posterolateral Approach**

Answer 35

* Avoid hip **flexion** beyond 90 degrees * Avoid hip **adduction** past 0 * Avoid hip **internal rotation** past 0 ## Footnote Can't cross leg, put sock on, reaching toward the ground, reaching and rotation of the UE. Need to move feet and body together. No twist, cross or bend. Getting out of chair or toilet, cannot do nose over toes.

Question 36

Positioning after a CVA with hemiparesis

Answer 36

1. Prevent contractures 2. Prevent wrist and hand edema 3. Avoid distraction of the hemiplegic shoulder ## Footnote Supporting the involved arm and hand reduces tension on the shoulder joint and minimizes edema in the wrist and hand.

Question 37

CVA and subluxation

Answer 37

Because the shoulder joint is stabilized primarily by muscle activity, hemiplegia can put the affected shoulder at increased risk for subluxation.

Question 38

CVA with hemiparesis - common contracture patterns - UE and LE

Answer 38

Upper extremity * Scapular retraction * Shoulder adduction, flexion, and internal rotation * Elbow, wrist, and finger flexion Lower Extremity * Hip adduction, flexion, and internal rotation * Knee flexion * Ankle plantarflexion | Make sure to have patients have arms stretched out sometimes.

Question 39

CVA Supine Positioning

Answer 39

Question 40

CVA Sidelying position

Answer 40

Question 41

LE Amputatioon Positioning: DO

Answer 41

* Keep the hips in neutral rotation. * Extend the knee. * Minimize sitting time with the knee flexed. * Avoid pressure on non-healed surgical sites.

Question 42

LE Amputation Posititoning: DON'TS

Answer 42

* Let the residual limb hang off the edge of the bed. * Place a pillow under the hip or knee while the patient is supine. * Place a pillow under the low back. (Due to pelvic position we want to keep it neutral) * Allow the patient to lie with the knees flexed. * Allow the patient to cross legs.

Question 43

Positioning after an LE Amputation

Answer 43

Prone can also be very good to help in preventing hip and knee flexion contractures.

Question 44

A braden scale of ____ is considered "at-risk" status

Answer 44

18 or less