Bed Mobility: Positioning Flashcards
Pressure Injury - Definition and Cause
An injury to the skin and underlying tissue resulting from prolonged pressure.
Sustained pressure, friction and shear are the cause.
In supine position, where can you have pressure injuries?
Occipital tuberosity Spine or inferior angle of scapula Spinous processes Sacrum! Olecranon Calcaneus Greater trochanter?
In prone position, where can you have a pressure injury?
Forehead, zygoma Lateral ear Acromion Sternum, breasts (female) ASIS, pubic symphysis Clavicle Patella Ridge of tibia Dorsum of foot, metatarsals
In side lying, where can you have a pressure injury?
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
In sitting position, where can you have a pressure injury?
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
Stage 1 Pressure Injury
Non-blanchable erythema of intact skin.
Red discoloration of skin, when pressured does not turn white.
Stage 2 Pressure Injury
Partial-thickness skin loss with exposed dermis.
This stage should not be used to describe moisture associated skin damage (MASD) or traumatic wounds.
Stage 3 Pressure Injury
Full-thickness skin loss without exposure of fascia, muscle, tendon, ligament, cartilage and/or bone.
Stage 4 Pressure Injury
Full-thickness skin and tissue loss with epibolic (rolled) edges, undermining and/or tunneling often occur.
Unstageable/ unclassified pressure Injury
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.
Deep Tissue Pressure Injury (DTPI)
Persistent non-blanchable deep red, maroon or purple discoloration or epidermal separation revealing a dark wound bed or blood filled blister.
Positive and Negative Aspects of Pressure Relief with Pillow or Mattress
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!
When should patients, at risk of having pressure injuries, be repositioned?
Every 6 hours.
When should patients, at high risk of having pressure injury, be repositioned?
Every 4 hours.
How often should children be repositioned?
Risk: at least every 4 hours.
High risk: more frequent than 4 hours.
Hip Precautions
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.
Positions After Total Hip Replacement
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.
Position After Total Knee Replacement
Supine, cushion to stabilize the knee, stimulating knee extension in a 45° inclination (elevating the leg with a straight knee), blocking the torsion.
Positioning of a Highly Dependent Patient
At least 2 therapists.
Sliding sheet or a hoist.
Patient is unconscious or with severe awareness deficit.
Positioning with Assisted Maneuver
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.
Types of Transfers - Supine to Sitting
Supine - Sitting
Supine - Side lying - Sitting
Types of Transfers - Sitting to Sitting
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)
Types of Transfers - Sitting to Standing
Assisted (manual)
Self-assisted (surface of support)
With supervision
Before transferring a patient, what should we be aware of?
- 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
