04-02: Positioning, Draping, Transfers Flashcards
7 purposes of positioning
- Ensure comfort
- Prevent skin breakdown
- Prevent contractures
- Prevent peripheral nerve impingement
- Cardiovascular and pulmonary support
- Access environment
- Participation in specific interventions
Skin examination
- 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
Skin breakdown - Causes
- Wrinkles in sheets/clothing can cause pressure
- Dragging across linens can cause skin shearing
- Positioning of bony prominences
- Moisture (excessive sweat, incontinence)
Repositioning for pressure relief - Frequency
Bed/Table: Reposition every 2 hours
W/C: Every 10 minutes (sitting pushups, weight shifts lateral, ant to post)
Posiitoning of pillows
Position above and below bony prominences to reduce pressure “bridging”
Positioning for cardiovascular
- Orthostatic hypotension
- place patient in more elevated position (gradual instead of sudden change)
Positioning - General preparation
- Clear area
- Gather supplies: sheets, towels, pillows
- Get assistance if needed
- Check for tubes and attachments to machines
Positioning - Preparing surface
- 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
Levels of Assistance (7)
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)
LOA - Supervision
Pt can do everything, PTA provides no assistance, watches for LOB or proper use of ADs
LOA - Stand By Assistance (SBA)
Pt can do everything, PTA is close by, provides VC; occasional support for LOB if necessary
LOA - Contact Guard Assistance (CGA)
PTA maintains contact so pt can do or maintain movement/balance
LOA - Minimum Assistance (Min A)
Pt performs 51%-75% of effort
LOA - Moderate Assistance (Mod A)
Pt performs 26%-50% of effort
LOA - Maximum Assistance (Max A)
Pt performs 1%-25% of effort
LOA - Total Assistance (Total A)
Pt performs 0% of effort; dependent
Supine - Positioning
- 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
Prone - Positioning
- 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
Side-lying - Positioning
- 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
Turning from Supine to Prone
- 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
Turning from Supine to Prone
- 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
Long Sitting
Legs straight out in front of pt
Short Sitting
Sitting with LEs in flexed position over edge of chair or mat (side of bed or table)
Sit > Stand
- 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
Stand > Sit
- 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)
Trendelenburg Position
- Pt supine on a surface inclined at 45˚
- Pelvis higher than head
Reverse Trendelenburg Position
LEs leveled lower than head and neck
Fowler’s Position
- 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˚
Levels of Transfer (3)
- 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
Guidelines for Transfers
- Gait belt
- Align w/c at 45˚ angle to surface
- Stand and guard on involved side
- Have patient do as much as possible
