What are the areas of greatest pressure for a patient lying in the prone position?
Forehead, lateral ear, tip of acromion process, patella, dorsum of foot, ridge of tibia
What comfort procedures would be used to ensure patient comfort when lying prone?
- towel roll for forehead or have patient place face in hole on plinth (lined with pillowcase)
- pillow under stomach to avoid lower back pain
- wedge or roll under lower legs to reduce pressure to toes
What are common areas of soft tissue contracture when lying prone?
Ankle plantar flexors, shoulder extensors/adductors/IR/ER, neck rotators
What are the areas of greatest pressure when the patient is lying in the supine position?
Occipital tuberosity, spine/inferior angle of scapula, spinous processes of vertebrae, posterior iliac crests, sacrum, posterior calcaneus
What procedures would be used to ensure patient comfort when lying in the supine position?
- pillow under head
- pillow under knees to relieve pressure from the pelvis on the lower back
- towel roll or small bolster under ankles the relieve pressure on calcaneus
What are the common areas of soft tissue contracture when lying supine?
Hip & knee flexors, ankle plantar flexors, shoulder extensors/adductors/IR, hip external rotators
What are the areas of greatest pressure when a patient is side-lying?
Lateral ear, lateral ribs, lateral acromion process, greater trochanter, lateral and medial condyles of femur, malleolus of fibula/tibia
What procedures would be used to ensure patient comfort when side-lying?
- pillow under head
- pillow between knees to keep upper leg and hip parallel
- pillow for patient to hug to support the upper shoulder
What are the most common areas of soft tissue contracture when side-lying?
Hip & knee flexors, hip adductors and internal rotators, shoulder adductors and internal rotators
What are the greatest areas of pressure when a patient is seated upright?
Ischial tuberosities, posterior thighs, sacrum
What procedures are used to ensure patient comfort when seated upright?
- stabilize chair (no rolling stools)
- provide lap pillow to support arms
- ensure feet are flat on floor or stool
What are the most common areas of soft tissue contracture when a patient is seated upright?
Hip & knee flexors, hip abductors and internal rotators, shoulder adductors/extensors/IR
What are preventative positions and in what situations do they apply?
Positions to avoid- situations requiring preventative positions include transfemoral/transtibial amputation, hemiplegia, rheumatoid arthritis, and burns/grafts
What are the positions to avoid for a patient with a transfemoral amputation?
- prolonged hip flexion (do not elevate the residual limb in supine), 40 min/hr max in sitting
- hip abduction
Recommended position: prone with residual limb in neutral alignment
What are the positions to avoid for a patient with a transtibial amputation?
-prolonged hip and knee flexion
What are the positions to avoid for a patient with hemiplegia?
UE: prolonged shoulder adduction & internal rotation; elbow flexion; forearm supination or pronation; finger/thumb adduction; support the weight of the arm to prevent subluxation
LE: prolonged hip & knee flexion; hip external rotation; ankle plantar flexion & inversion
Head/trunk: support proper alignment in sitting and lying
What are the positions to avoid for patients with rheumatoid arthritis?
Prolonged immobilization; joint flexion
What are the positions to avoid for patients with burns/grafts?
Prolonged positioning; prolonged flexion/adduction of peripheral joints; positions of comfort
Why should proper draping be used when treating a patient?
- provide modesty for the patient
- maintain appropriate body temperature during treatment
- provide access and exposure to areas to be treated while protecting other areas
- protect patient’s skin/clothing from being soiled or damaged
