Draping and Positioning

Question 1

What does draping accomplish?

Answer 1

Protects pt’s modesty and dignity, provides warmth and comfort, protection of vulnerable skin, and protections of pt’s clothing.

Question 2

What can you not use as pt’s drape?

Answer 2

pt’s clothing

Question 3

What items can be used for positioning?

Answer 3

pillow, towels, bolster, wedges, etc

Question 4

Positioning is to reduce tension where?

Answer 4

tendon, joints, ligaments, muscles, nerves

Question 5

Why is positioning important?

Answer 5

Comfort, support, stability, prevent contractures, pressure relief

Question 6

What is short term positioning for?

Answer 6

for therapy intervention or activities, to provide pt safety, comfort and access

Question 7

What is long term positioning for?

Answer 7

For pt who are unable to move voluntarily in a way that maintains optimal health, to prevent negative effects

Question 8

What are some key points of short term positioning?

Answer 8

pt safety, spinal alignment, necessary body area accessible, trunk and extremities support for comfort.

Question 9

What are some key points of long term positioning?

Answer 9

clear airway, spinal alignment, minimal pressure over bony prominences and gravity shearing forces, cushioned support to minimize pressure, immobile extremities elevated, support and stabilize trunk and extremities, allow pt maximal long term function, optimize interaction with environment, special needs accommodated, prevent contractures.

Question 10

Common contracture during supine is?

Answer 10

shoulder flexion, elbow flexion, hip flexion, hip adduction, knee flexion, ankle PF

Question 11

Common contracture during prone is?

Answer 11

Ankle PF, shoulder extension/add/IR/ER, neck rotators to L or R

Question 12

Common contracture during prone is?

Answer 12

Shoulder flexion/add, Scapular protraction, elbow flexion, hip flexion, knee flexion, ankle PF

Question 13

Common contracture during sitting is?

Answer 13

Hip and knee flexion, hip add/IR, shoulder add/ext/IR

Question 14

What are some special considerations for positioning?

Answer 14

decrease/loss of sensation, paralysis, poor nutrition, impaired circulation, conditions that predispose to contracture development, incapable of independent position alteration, unable to express or communicate discomfort.

Question 15

How long do dependent pt’s last for in supine and sitting inbtwen supervision?

Answer 15

supine: 2 hours
sitting: 15 minutes

Question 16

When should skin be inspected and where?

Answer 16

over bony prominences, before and immediately after treatment.

Question 17

What does redness indicate?

Answer 17

excessive pressure

Question 18

What does blanched/pale indicate?

Answer 18

severe, dangerous pressure

Question 19

What is the blanching test?

Answer 19

Quick subjective visual skin assessment, most effective on light skin, provide pressure with 1 or 2 fingers on the area of the skin at risk and release. If not quickly return to pink , and goes to non-blancing(remains red/purple) indicates compromised skin.

Question 20

What are susceptibilities to pressure ulcers?

Answer 20

decreased mobility, fragile skin, incontinence, impaired sensation, impaired circulation, cachexia(skinny), muscle atrophy, postural impairment, nutritional deficiencies, medication that affects mobility or awareness, friction or shear of skin.

Question 21

Special positioning for LE amputations?

Answer 21

TFA & TTA: avoid prolong hip and knee flexion, do not elevate RL (remaining leg) on pillow for more than a few minutes, limit sitting to 40 minutes/hour, hip abd, maintain pelvis in level position, in standing keep RL in extension, periodical prone lying needed.

Question 22

What does RL stand for?

Answer 22

remaining leg of amputtee

Question 23

Special positioning for CVA? (Trunk and UE)

Answer 23

Trunk and UE avoid: lateral flexion of head and trunk towards involved side, head rotation toward unaffected side, depression and retraction of scap, IR/add of shoulder, elbow flexion, forearm pronation and finger flexion, W/A faccid arm to prevent gravity from pulling arm out.

Question 24

Special positioning for CVA? (LE)

Answer 24

Avoid retraction and elevation of pelvis, hip ext/add with knee extension, hip and knee flexion, ankle PF.

Question 25

How should you position pt S/P CVA in supine?

Answer 25

head and trunk in midline, small pillow/towel under scapula to promote protraction, arm resting on pillow extended in abduction(distal elevation), wrist and finger in extension, small pad under pelvis, leg in neutral rotation, small towel under knee to prevent hyperextension, ankle DF

Question 26

How should you position pt S/P CVA in sitting?

Answer 26

Upright with head and trunk in midline, symmetrical WB on both buttocks, hip in neutral rotation, hip and knee in 90, flat feet, scap protration, UE supported on lap tray or trough.

Question 27

pt with burns should avoid what?

Answer 27

prolonged positioning of affected joints, beware of comfort positions, contractures more likely to develop, prolonged flexion or adduction when burns or grafts are on these sides of joints, encourage pt to perform gentle and careful movement for joint mobility, adhere to MD instructions.

Question 28

How should you position pt with THA?

Answer 28

utilize A frame pillow, HOB (head of bed) be limited to 30 degrees, avoid low chairs for OOB, precautions, flexion past 90, IR, adduction past neutral.

Question 29

How should you position pt with TKA?

Answer 29

While laying in bed and out of immobilizer, no pillow under operated knee, prior to ambulating make sure knee immobilizer is on, esp on pt with femoral nerve block catheter.

Question 30

With NWB what can you use?

Answer 30

crutch/walker

Question 31

With PWB what can you use?

Answer 31

(~30%) crutch/walker

Question 32

With TTWB what can you use?

Answer 32

crutch/walker

Question 33

For either Arthroplasty or Hemiarthroplasty pt: what is posteriolateral approach?

Answer 33

no hip flexion past 90, IR, or add past midline

Question 34

For either Arthroplasty or Hemiarthroplasty pt: what is anterolateral approach?

Answer 34

no hip extension, abduciton/ER

Question 35

For either Arthroplasty or Hemiarthroplasty pt: what is anterior approach?

Answer 35

avoice excessive hip extension

Question 36

For spinal surgery/LBP what to note?

Answer 36

no excessive bending, lifting, or twisting, when transfering OOB elevate HOB to 30 degrees, roll pt onto side with hip and knees flexed, use abdominal binders or TLSO (thor/lumb/sac orth)

Question 37

For hemiplegic pt note what?

Answer 37

beware of flaccid extremeities esp. shoulders, never grab or pull affected arm, use sling if needed, protect affected UE during rolling, transfer.

Question 38

For SCI note what?

Answer 38

recent injuty may be protect by external devices or fixation, avoid rotation and distractive forces, do not pull LE, use log roll, possible orthostatic hypotension.

Question 39

For long term SCI note what?

Answer 39

osteoporotic changes and risk for fractures

Question 40

For burns or decubiti note what?

Answer 40

sliding creates shearing forces, friction disrupts healing process, elevate body or extrem. during bed mobility or transfers, use draw sheet to assist.