04-02: Positioning, Draping, Transfers

Question 1

7 purposes of positioning

Answer 1

• Ensure comfort
• Prevent skin breakdown
• Prevent contractures
• Prevent peripheral nerve impingement
• Cardiovascular and pulmonary support
• Access environment
• Participation in specific interventions

Question 2

Skin examination

Answer 2

• Examine after 5-10 in new position and frequently thereafter
• Redness: Move off position so skin not compressed, provide support to see if redness subsides

Question 3

Skin breakdown - Causes

Answer 3

• Wrinkles in sheets/clothing can cause pressure
• Dragging across linens can cause skin shearing
• Positioning of bony prominences
• Moisture (excessive sweat, incontinence)

Question 4

Repositioning for pressure relief - Frequency

Answer 4

Bed/Table: Reposition every 2 hours

W/C: Every 10 minutes (sitting pushups, weight shifts lateral, ant to post)

Question 5

Posiitoning of pillows

Answer 5

Position above and below bony prominences to reduce pressure “bridging”

Question 6

Positioning for cardiovascular

Answer 6

• Orthostatic hypotension

- place patient in more elevated position (gradual instead of sudden change)

Question 7

Positioning - General preparation

Answer 7

• Clear area
• Gather supplies: sheets, towels, pillows
• Get assistance if needed
• Check for tubes and attachments to machines

Question 8

Positioning - Preparing surface

Answer 8

• Smooth all under sheets, towels, pt clothing
• Use pillows, rolled blankets, towels to support body parts, bridge bony prominences
• Drape pt as appropriate
• Allow pt to assist with movement

Question 9

Levels of Assistance (7)

Answer 9

Supervision, Stand By Assistance (SBA), Contact Guard Assistance (CGA), Minimum Assistance (Min A), Moderate Assistance (Mod A), Maxmium Assistance (Max A), Total Assistance (Total A)

Question 10

LOA - Supervision

Answer 10

Pt can do everything, PTA provides no assistance, watches for LOB or proper use of ADs

Question 11

LOA - Stand By Assistance (SBA)

Answer 11

Pt can do everything, PTA is close by, provides VC; occasional support for LOB if necessary

Question 12

LOA - Contact Guard Assistance (CGA)

Answer 12

PTA maintains contact so pt can do or maintain movement/balance

Question 13

LOA - Minimum Assistance (Min A)

Answer 13

Pt performs 51%-75% of effort

Question 14

LOA - Moderate Assistance (Mod A)

Answer 14

Pt performs 26%-50% of effort

Question 15

LOA - Maximum Assistance (Max A)

Answer 15

Pt performs 1%-25% of effort

Question 16

LOA - Total Assistance (Total A)

Answer 16

Pt performs 0% of effort; dependent

Question 17

Supine - Positioning

Answer 17

• Shoulders parallel to hip, spine straight
• Pillow under head for comfort
• Pillow under knees relieves low back strain
• Pillow under knee can cause hip and knee flexion tightness (loss of extension)
• Pillow lengthwise under knees (not heels) can relieve pressure at heels
• Can place pillow under UE

Question 18

Prone - Positioning

Answer 18

• Lying on stomach
• Pillow under trunk prevents excessive spine curvature
• Pillow crosswise and distal to breast can provide comfort
• Pillow under lower legs (reduces plantarflexion)
• Feet can also be placed over edge of treatment table

Question 19

Side-lying - Positioning

Answer 19

• Lower trunk and at last 1 LE is slightly flexed
• Trunk may be rotated slightly forward or slightly backward
• Pillow under head for comfort
• Pillow between LEs
• Top UE supported on pillow
• Top LE supported on pillow

Question 20

Turning from Supine to Prone

Answer 20

• Move pts upper trunk/head to side of table
• Move pts lower trunk to side of table
• Move pts LE to side of table
• Pts LE over each other, Adduct UE against hip
• Position pillow under trunk
• Roll pt towards PTA, reposition hands to anteriorif necessary at halfway point
• Adjust pillow at trunk, place arms in slight abduction, uncross pts feet if necesary and place 6-8 inches apart

Question 21

Turning from Supine to Prone

Answer 21

• Move pts upper trunk/head to side of table
• Move pts lower trunk to side of table
• Move pts LE to side of table
• Place hand over which pt will roll under hip
• Position face away from PTA
• Roll pt towards PTA, reposition hands to posterior if necessary at halfway point
• Place pillow at head, under knees, and UE for comfort

Question 22

Long Sitting

Answer 22

Legs straight out in front of pt

Question 23

Short Sitting

Answer 23

Sitting with LEs in flexed position over edge of chair or mat (side of bed or table)

Question 24

Sit > Stand

Answer 24

• Scoot forward
• Place feet shoulder width apart
• Place feet under and slightly behind knees
• Place hand on the arm rests
• Shoulders over knees (nose over toes)
• Push up with hands and legs

Question 25

Stand > Sit

Answer 25

• Back up to chair till you feel the chair with the back of your knees
• Reach back for arm rests
• Bend, stick out your rear end
• Sit down (gently, under control)

Question 26

Trendelenburg Position

Answer 26

• Pt supine on a surface inclined at 45˚

- Pelvis higher than head

Question 27

Reverse Trendelenburg Position

Answer 27

LEs leveled lower than head and neck

Question 28

Fowler’s Position

Answer 28

• Head is elevated
• High Fowler’s: Sitting upright in bed (60-90˚)
• Regular Fowler’s: 45-60˚
• Low Fowler’s: 30-45˚
• Semi-Fowler’s: Head and Torso up to 30˚

Question 29

Levels of Transfer (3)

Answer 29

• Independent: Pt doesn’t need help
• Assisted: Pt participates actively, but requires assistance from one or more clinicians
• Dependent: Pt does not participate activiely or very minimally and one or more clinicians does the work of the transfer

Question 30

Guidelines for Transfers

Answer 30

• Gait belt
• Align w/c at 45˚ angle to surface
• Stand and guard on involved side
• Have patient do as much as possible