Chapter 6, and 7 ADL Flashcards
Draping
Covering a patient appropriately during a therapeutic intervention
Draping provides
- Protection of patient’s modesty and dignity
- Warmth and comfort.
- Protection of vulnerable skin
- Protection of clothing.
Trauma informed care:
draping makes patients feel less vulnerable so less likely to feel a loss of trust of a violation of boundaries.
Culturally sensitive care
There are many cultural considerations to be aware of before uncovering a person’s body part.
Strong preference for healthcare provider of same gender:
African and Caribbean
South Asian
Chinese
Hindu women
Muslim women
Some Latinx groups
Embarrassment caused by bodily exposure while wearing hospital gowns
Asian
Chinese
Romany traveler
Orthodox Jewish women
Taboos against wearing garments previously warn by others or against taking of garments that should not be removed
Members of the LDS
Rastafarian women
Restrictions on touching
Traditional Egyptians
Hindus
Orthodox Jews
Navajo women
Children in many cultural or geographical groups
Older individuals in some cultural or geographical groups.
If a patient is to be walking
At a minimum the patient should wear a foot covering that provides grip against the floor to prevent falls.
Anytime a patient removes clothing to receive effective therapy
covering with temporary clinical clothing or linens is required.
Providing Chaperones
Safeguard a patient’s dignity. Witness. May hinder communication. May compromise confidentiality.
key to effective draping
minimize exposure in terms of body area and time exposed.
layering with double towls
allows one to be folded back to expose treatment area.
Securing the edges
tucking can add to the patient’s sense of overall security. creates a sense of secure boundaries.
Draping during treatment
Initially provide overall coverage, then expose the necessary area.
Adjust and resecure
secure edges
Min exposure
confidence
after treatment
*Provide materials to remove lotions, gels perspiration or other similar
*Instruct patient to remove temporary linens or clothing and get dressed
*Return valuables
*clean treatment area
static stability
ability to maintain a position while stationary
Controlled mobility
dynamic postural control or purposeful intentional movement
Correct spinal alignment
key component of all positioning.
Objectives of Short term positioning
- protect vulnerable body parts without safety hazards.
- patient comfort
- Therapeutic access.
safety
- support surface appropriate for patient’s abilities and impairments
- Protective enough and not overly restrictive
- weight compatible with support/equipment
- Position work for patient’s needs.
maintain spine
maintain normal curs of cervical, thoracic and lumbar.
`Supine
pillow under head and knees/hips for spinal curves.
pillows can be placed under patient’s arms as well.
Prone
Need either a face cradle or ability to turn head to side.
Small pillow for face, too much has too much cervical lordosis.
pillow to bolster the lower legs to lift the feet off the table.
Sidelying
slight to moderate flexion of one or both hips to add stability
pillows under head, between the legs, and a small pillow or bolster under waist.
Under arm positioned forward.
Sitting
Hips fully back and centered in the chair
If necessary a small bolster or towel roll can be placed behind the back
Raising and supporting the feet helps maintain lumbar spine and reduces pressure on thighs.
Armrests - at right height for shoulders
If leaning forward cushion head to lean on supporting surface.
Trendelenburg position
HOB lower than foot of bed.
Supine. treat hypotensive episodes.
For obese hypotensive patients
Raising the legs without doing a full Trendelenburg may help without causing breathing difficulties.
Immobility and Integumentary system
Decreased perfusion to skin
skin breakdown
immobility and Musculoskeletal
Pain
Joint and tissue contracture
Calcium loss
Deconditioning
Balance impairment
Compression
Immobility and Cardiopulmonary
Peripheral edema
Aerobic deconditioning
Decreased air exchange
Cardiopulmonary compromise
Immobility and Neurological
Vestibular impairment
Neuromuscular deconditioning
Immobility and other
Urinary infection
Depression
Primary objective of long term positionoing
prevent negative effects of long-term immobility and promote overall well-being.
Fowler’s Postion
head of bed elevated to 45 degrees to 60
Low Fowler’s postion
HOB elevated to 30 to 45 degrees.
sidelying position and lungs
can promote drainage of lungs.
High Fowler’s postion
HOB 80 or 90 degrees.
Immobile joints
cause stiffness and decreased ROM
Contractures
limitations in joint movement caused by adaptive shortening in the ligaments, tendons, and muscles.
DVT
deep vein thrombosis
Localized pain, warmth, redness and swelling.
embolus
thrombus that has broken loose. May lodge in pulmonary artery.
Pressure Injury
Bed sore 2.5 million a year in the U.S. 60,000 deaths. Ischemia caused. deep tissue tolerate pressure for two hours or less.
Pressure injury Load Pressure and time
Load: The load is the patient’s body weight
Pressure: the surface area over which the pressure is distributed. Increasing the surface area decreases the pressure.
Time: even a low load over a lengthy enough time can cause breakdown.
Heal pressure
particularly vulnerable to pressure sores do to small area and thinness of tissue over calcaneus.
Sacrum pressure
Another particularly vulnerable site to pressure sores
Friction and shear`
moving patients in bed by pulling or sliding them can create friction and shearing forces between the layers of the skin. Lead to sores.
High risk areas for skin breakdown supine
Occiput
scapulae
spinous processes
elbows
sacrum/coccyx
Ischial tuberosities
Lateral malleoli
Heels
High risk areas for skin breakdown prone
Ear/side of face
chin
anterior surface of shoulders
Iliac crests and anterior superior iliac spines of the pelvis
anterior of knees
dorsal of feet
High risk area for skin breakdown of sidelying
Ear or side of face
Humeral head
Hip or greater trochanter
Lateral femoral condyle - inferior legs
Medial femoral condyles both legs.
lateral malleolus (outside ankle)
Medial malleolus
(both ankles)
High risk areas sitting of skin breakdown
Occiput - high backed chair
scapulae
spinous processes
Elbows
sacrum
ischial tuberosities
heels
blanching test
how quickly pressed on skin turns back to pink.
Redness rule
redness that persists more than 20 min after pressure relief indicates that the body has not yet recovered from previous pressure load.
Fowler’s position point of pressure
sacrum
Low fowler’s is recommended
Repositioning
standard practice for relieving pressure
Longest in one position
2 hours.
Long term positioning supine
knees are only slightly flexed to prevent contracture.
additional cushioning may be necessary for scapulae and head if immobile. place pillows under calves to suspend heels. Means to call for help.
Patient’s trunk rotation in long term positioning of sidelying
if trunk is forward place pillow in front of patient
If trunk is back place pillow behind patient. place superior arm on pillow in in a nearly extended position.
sacral sitting
increased risk of breakdown
Hip replacement positioning
no hip flexion beyond 70 to 90 degree
No hip adduction beyond 0 degree
No internal rotation beyond 0 degree
Pattern of tightness after CVA can include:
Scapular retraction
shoulder adduction, flexion, and internal rotation
Elbow, wrist and finger flexion
Hip adduction, flexion and internal rotation
Knee flexion
Ankle plantar flexion
CVA positioning recomendations
sitting up or sidelying on non-hemiparetic side
Supine with HOB flat is not recommended
Sidelying on hemiparetic side is rarely recommended
.
Supine after CVA
Elevate HOB 30 degree
Pillow under affected shoulder blade
Head neck and trunk in neutral alignment
elevate the flaccid arm
Use pillows to guard against knee flexion and elevate wrist and hand of affected side.
avoid contractures in LE amputations
for transfemoral amputation - Occasional positioning in prone helps prevent flexion contractures.
For transtibial do keep hips in neutral rotation, do extend the knee do minimize sitting time with knee flexed. Do not let residual limb hang. Do not place pillow under thigh Do not place pillow under low back. Do not allow knees to be flexed for long periods Do not allow patient to cross legs for long periods.
Heel suspension braces or boots
prevent breakdown
restraint
any device, material or manual method that limits a client’s ability to move the arms, legs, body or head freely.
only be used as a last resort under orders.
