Positioning

Question 1

• The ________ determines the position that will facilitate optimal exposure.
• The ________ will be consulted to ensure that the position does not compromise airway management, vascular access, or cardiac stability.
• The ___________ coordinates the activities related to positioning such as; obtaining and preparing positioning aids, devices, and /or equipment based on information obtained from the preoperative assessment.

Answer 1

surgeon

anesthesia care provider

perioperative nurse

Question 2

The AORN Guideline for positioning the patient outlines patient specific positioning but also allows the perioperative nurse to use __________ gathered during the preoperative assessment.

Answer 2

additional precautions based on unique patient considerations

Question 3

Trendelenburg Position:
• Modification of the __________
• Procedure table is tilted so head and upper torso is lower and feet are higher
• Safe anatomic positioning is ensured by placing the _________ to allow flexing of the leg section of the bed
• Use of shoulder braces should be __________

Answer 3

supine position

knees over the break in the table

AVOIDED

Question 4

Lithotomy Position:
• Modification of the supine position
• The patient’s buttocks are _______________ .
• The arms are placed on ___________ to prevent the patient’s fingers from resting in the OR table break.
Physiological effects include:
• Significant drop in the blood pressure if the legs are lowered too quickly.
• The circulatory and respiratory systems may be compromised due to ___________ .
• _________ to femoral, obturator, and perineal nerves can occur with this position.

Answer 4

even with the lower break in the OR bed to prevent lumbosacral strain.

padded arm boards

compression of abdominal contents on the inferior vena cava and abdominal aorta.

Nerve damage

Question 5

Prone Position – The prone position is one of the basic positions. In this position, the patient is anesthetized on a gurney and then log _______ on the OR table.

1. Maintain feet in correct anatomical position to prevent foot drop.
2. Eyes should be padded and pressure avoided to prevent conjunctival edema, corneal abrasion, or retinal ischemia.
3. ________ when placing on arm boards to prevent brachial plexus injuries.
4. If the patient is positioned correctly, minimal cardiovascular effects occur.
5. Improper positioning can result in pressure on the __________ which can reduce venous return and produce hypotension.
6. Pressure on the ______ from the head being turned can produce _________.
7. Most vulnerable to respiratory problems due to _________ which impairs gas exchange.
8. Increased ________ and difficulty in ventilation can occur from the effects of body weight against

Answer 5

rolled over on his/ her stomach

Arms should be rotated slowly

inferior vena cava and femoral veins

carotid artery

hypotension and arrhythmias

compression of the diaphragm

airway pressure

Question 6

Three forces can act on the patient as they lay on the surgical table:

Answer 6

1. Pressure
2. Shearing
3. Friction

Question 7

Pressure - The _______ of pressure is more important than the _________.

Answer 7

duration

intensity

Question 8

Pressure Ulcer formation
Stage I: Intact, reddened skin does not _____ to fingertip pressure.
Stage II: Partial skin loss involving the epidermis and/or dermis. Skin is _________, or has shallow craters.
Stage III: Full-thickness skin loss possibly down to, but not through, the _______. Deep craters with or without undermining adjacent tissue.
Stage IV: Full-thickness skin loss with extensive destruction, __________, or damage to muscle, bone, or supporting structures.

Answer 8

blanch

abraded, blistered

fascial layer

tissue necrosis

Question 9

reduce the risk of ________

Answer 9

shearing

Question 10

Friction

Answer 10

skin surfaces rub over a rough, stationary surface

Question 11

Documentation - Documentation should include, but should not be limited to:

Answer 11

• Preoperative assessment
• Type and location of positioning and/or padding devices
• Names and titles of persons positioning the patient
• Postoperative outcome evaluation