Bed Mobility: Positioning

Question 1

Pressure Injury - Definition and Cause

Answer 1

An injury to the skin and underlying tissue resulting from prolonged pressure.
Sustained pressure, friction and shear are the cause.

Question 2

In supine position, where can you have pressure injuries?

Answer 2

Occipital tuberosity
Spine or inferior angle of scapula
Spinous processes
Sacrum!
Olecranon
Calcaneus 
Greater trochanter?

Question 3

In prone position, where can you have a pressure injury?

Answer 3

Forehead, zygoma
Lateral ear
Acromion
Sternum, breasts (female)
ASIS, pubic symphysis
Clavicle
Patella
Ridge of tibia
Dorsum of foot, metatarsals

Question 4

In side lying, where can you have a pressure injury?

Answer 4

Lateral ear, ribs, acromion.
Lateral head of humerus
Medial/lateral epicondyle of humerus
Greater trochanter 
Medial and lateral condyles of femur
Medial and lateral malleolus
5th metatarsal

Question 5

In sitting position, where can you have a pressure injury?

Answer 5

Ischial tuberosities
scapula and spinous processes if leaning against chair
Sacrum if patient is slouched
Olecranon if resting on hard surface
Greater trochanter
Popliteal fossa
Calcaneus if resting against hard surface

Question 6

Stage 1 Pressure Injury

Answer 6

Non-blanchable erythema of intact skin.

Red discoloration of skin, when pressured does not turn white.

Question 7

Stage 2 Pressure Injury

Answer 7

Partial-thickness skin loss with exposed dermis.

This stage should not be used to describe moisture associated skin damage (MASD) or traumatic wounds.

Question 8

Stage 3 Pressure Injury

Answer 8

Full-thickness skin loss without exposure of fascia, muscle, tendon, ligament, cartilage and/or bone.

Question 9

Stage 4 Pressure Injury

Answer 9

Full-thickness skin and tissue loss with epibolic (rolled) edges, undermining and/or tunneling often occur.

Question 10

Unstageable/ unclassified pressure Injury

Answer 10

Obscured full thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.

Question 11

Deep Tissue Pressure Injury (DTPI)

Answer 11

Persistent non-blanchable deep red, maroon or purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister.

Question 12

Positive and Negative Aspects of Pressure Relief with Pillow or Mattress

Answer 12

Positive: reducing pressure in one point by redistributing it,
can be used to prevent pressure injuries.
Negative: reducing proprioceptive stimulation, can increase the risk of other complications related to muscle tone adaptation.
Use in conjunction with repositioning of patient!

Question 13

When should patients, at risk of having pressure injuries, be repositioned?

Answer 13

Every 6 hours.

Question 14

When should patients, at high risk of having pressure injury, be repositioned?

Answer 14

Every 4 hours.

Question 15

How often should children be repositioned?

Answer 15

Risk: at least every 4 hours.

High risk: more frequent than 4 hours.

Question 16

Hip Precautions

Answer 16

In all positions, adduction, internal rotation and flexion over 90° should be avoided. No crossing of the legs. Good to place pillow between legs. Operated side on top when in side-lying.

Question 17

Positions After Total Hip Replacement

Answer 17

Supine best option, put pillow between legs to avoid adduction.
If in side-lying: Not ideal. laying on non-affected side with pillow between legs.
If in prone: Not ideal, can be uncomfortable for patient. Pillow in-between legs.

Question 18

Position After Total Knee Replacement

Answer 18

Supine, cushion to stabilize the knee, stimulating knee extension in a 45° inclination (elevating the leg with a straight knee), blocking the torsion.

Question 19

Positioning of a Highly Dependent Patient

Answer 19

At least 2 therapists.
Sliding sheet or a hoist.
Patient is unconscious or with severe awareness deficit.

Question 20

Positioning with Assisted Maneuver

Answer 20

Patient is able to understand most of procedure and cooperate at some level.
Main purpose here is to guide the patient through the transfer, offering assistance as needed, aiming education if possible. Facilitating the movement of the patient.

Question 21

Types of Transfers - Supine to Sitting

Answer 21

Supine - Sitting

Supine - Side lying - Sitting

Question 22

Types of Transfers - Sitting to Sitting

Answer 22

Passive with pivot (therapist doing the work)
Assisted with pivot (therapist helping)
Assisted with manual guidance (hoist)
Assisted step transfer
With supervision
Independent (without supervision)

Question 23

Types of Transfers - Sitting to Standing

Answer 23

Assisted (manual)
Self-assisted (surface of support)
With supervision

Question 24

Before transferring a patient, what should we be aware of?

Answer 24

• Precautions: Recognize and follow the precautions and
  red-flags present for each particular case.
• Amount of assistance given: Assisted as needed, we want patient to be as independent as possible.
• Physical and emotional condition, level of consciousness: be aware of patient’s health status and all possibilities and barriers it brings.
• Level of assistance
• State of patient
• Type of transfer
• Equipment needed
• Safety of environment