Positioning and Restraints

Question 1

Describe the ideal positioning for a patient in sitting, sidelying, and supine.

Answer 1

Sitting

• Align Joints in as normal position as possible
• Same as for ergonomics
• Upright
• Lumbar curve
• LE 90, 90, 90
• Arms supported (in lap OK)

Sidelying

• Scapula abducted
• Head & neck in neutral
• Legs bent at knee, one slightly in front of other

Supine

• Head, neck, trunk in neutral
• Scapula neutral or abducted
• Hips in neutral
• Check pressure on heels
• Positioning depends on secondary problems
• paralysis
• Spasticity
• surgeries

Question 2

What are some complications that can develop if a person is not positioned correctly?

Answer 2

Common Problems with Poor Positioning

• Contractures
• Footdrop
• Skin breakdown
• Difficulty eating & swallowing
• Interact with environment
• Incontinence
• Edema

Question 3

List different devices that can be used for positioning.

Answer 3

• Cushions
• Lap trays
• Seatbelts
• Pillows
• Head Wedges
• Footrests
• Leg belts
• dycem

Question 4

Define a chemical restraint.

Define a physical restraint

Answer 4

• Chemical: any pharmacological used for convenience or disciplinary reasons and not deemed medically necessary

Examples: sedatives, psychotropics

• Physical: any device, equipment, or material or positioning that cannot be removed independently or easily which restricts freedom of movement or normal access to one’s body

Question 5

What are the OBRA regulations for restraint use?

Answer 5

• Must use least restrictive device necessary for medical condition and safety
• Patient has the right to the least restrictive environment possible
• Cannot restrain for the POTENTIAL for injury or risk only
• Person may request–family may not
• Facility must have restraint policy and restraint reduction program

Question 6

Describe when you can and cannot use a restraint.

Answer 6

Can use restraint

• When device is an enabler of function
• When medically necessary to prevent interference or injury
• After all less restrictive alternatives tried and failed
• For limited time to address safety issues on emergency basis
• Must have MD order

Cannot restrain

• Staff convenience
• Punishment
• Family request
• Before trying less restrictive alternatives
• For at risk only

Question 7

What are some alternate methods for use of restraints?

Answer 7

• B & B program
• Good activities
• Alarms
• Behavior modification
• “Patient-proof” environment
• Bed on floor
• 1:1 staffing

Question 8

What are the risks and precautions for using restraints?

Answer 8

• Falls
• Skin breakdown
• Injury
• Death
• Deconditioning
• Contractures
• Decreased ability to ambulate
• Increased confusion and agitation
• Depression
• Respiratory problems
• isolation

P​ost Surgical Precautions

• THA
• TSA
• Spinal Sx
• Cardiac
  
  • Post MI
  • Post pacemaker implant
• Positional
  
  • BP- orthostatic hypotension
  • s/p shunt
• S/P CVA, TB (hemiparesis)
  
  • Contracture Manamgement
  • Joint and soft tissue management
  • Edema management
  • Swallowing precuations (dsyphagia)
• Peg tube