What does appropriate draping provide?
- Access to areas of the body for examination or treatment.
- Protection of patient’s modesty and dignity.
- Patient comfort and warmth.
- Protection of vulnerable sites.
- Protection of patient’s clothing.
When exposure of the body is required for examination or intervention, members of some culture may?
- Prefer a same gender health care provider
- Be embarrassed when dressed in a hospital gown
- Not want to wear attire previously worn by others
- Have certain items of clothing that are not to be removed.
What maximizes comfort and dignity?
- Communication
- Providing privacy
- Same gender chaperone when appropriate
When covering the patient with linens we want to do what?
- Expose only one area at a time
- Layer linens to minimize exposure
- Secure edges
- Dispose of soiled linens
Summary of draping.
- Consider patient dignity and access for treatment.
- Employ a confident touch, and secure edges of linens.
- Any patient may be a survivor of trauma or abuse; watch for signs of discomfort.
- Be aware of cultural preferences.
- Provide chaperones when appropriate.
Short term vs long term patient positioning.
- Short term- During a therapy intervention or activity where pt can make minor adjustments
- Long term- Must remain in a position for an extended period of time and impairments prevent independent adjustment.
Goals for short-term positioning?
- Safety
- Comfort
- Therapist Access
Things to consider for short-term positioning?
- Primary (ideal position) vs. alternative.
- Normal spinal curves
Document alternatives so that people behind you know how it was done exactly
Pillow positioning for patients in:
- Supine
- Prone
- Side-lying
- Sitting in wheelchar
- Sitting at table
-Supine- Pillow under head and knees
-Prone- Pillow around face hole, under hips, and under lower legs
-Side-lying- Pillow under head and under hips for skinnier people
OR
Pillow under head, between legs, and in between arms as something to hold
-Sitting in wheelchair- Box on ground to support feet if no feet rests
-Sitting at table- Enough pillows to support as a headrest
How long is considered long-term patient positioning?
Anything over 30 minutes
Goals for long-term patient positioning?
-Safety (open airways/falls)
-Prevention (Ulcers/contractures)
Comfort (spine alignment/pressure)
Steps to preventing pressure ulcers?
- Maximum of 2 hrs in one position in bed.
- Maximum of 15 minutes in one position while seated because of the smaller area of contact.
- Reposition more frequently if patient has increased risk factors such as a history of frail skin or cognition issues.
Supine high-risk areas for pressure ulcers?
Occipital, shoulders, scapula, elbows, sacrum, heels
Prone high-risk areas for pressure ulcers?
Forehead, ear, chin, shoulder, ASIS, anterior knee, dorsum of foot
Side-lying high-risk areas for pressure ulcers?
Ear, humeral head, hip (greater trochanter), lateral and medial femoral condyle, lateral and medial malleoli
Wheelchair high–risk areas for pressure ulcers?
Scapula (esp inferior angle), elbows, sacrum, ischial tuberosities, heels
If redness is still there after 20 minutes what is likely?
Most likely getting breakdown
What contractures are the most common?
Flexion contractures
How to avoid contractures?
- Avoid positions of comfort
- Reposition frequently
How to prevent edema and cardiopulmonary complications?
- 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.
Keep upright to cause fluid to go back to the center of the body
Long-term positioning checklist.
- Clear airway
- Good spinal alignment
- Minimized pressure over bony prominences
- Minimized gravity creating shearing forces
- Cushioned support surfaces
- Immobile extremities elevated
- Joint and soft-tissue contractures prevented
- Trunk and extremities supported and stabilized
- Long-term functional positions
- Positioned to optimize interaction with the environment (line of sight, communication, etc.)
- Special needs accommodated
What is an indicator of pain in comatose patients?
Heart rate
What is sacral sitting and should it be avoided?
Sitting leaned back.
Yes.
What does the 90,90,90 position refer to?
90 degrees at hip, knees, and ankle while sitting
