Draping and Positioning Flashcards
What does draping accomplish?
Protects pt’s modesty and dignity, provides warmth and comfort, protection of vulnerable skin, and protections of pt’s clothing.
What can you not use as pt’s drape?
pt’s clothing
What items can be used for positioning?
pillow, towels, bolster, wedges, etc
Positioning is to reduce tension where?
tendon, joints, ligaments, muscles, nerves
Why is positioning important?
Comfort, support, stability, prevent contractures, pressure relief
What is short term positioning for?
for therapy intervention or activities, to provide pt safety, comfort and access
What is long term positioning for?
For pt who are unable to move voluntarily in a way that maintains optimal health, to prevent negative effects
What are some key points of short term positioning?
pt safety, spinal alignment, necessary body area accessible, trunk and extremities support for comfort.
What are some key points of long term positioning?
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.
Common contracture during supine is?
shoulder flexion, elbow flexion, hip flexion, hip adduction, knee flexion, ankle PF
Common contracture during prone is?
Ankle PF, shoulder extension/add/IR/ER, neck rotators to L or R
Common contracture during prone is?
Shoulder flexion/add, Scapular protraction, elbow flexion, hip flexion, knee flexion, ankle PF
Common contracture during sitting is?
Hip and knee flexion, hip add/IR, shoulder add/ext/IR
What are some special considerations for positioning?
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.
How long do dependent pt’s last for in supine and sitting inbtwen supervision?
supine: 2 hours
sitting: 15 minutes
When should skin be inspected and where?
over bony prominences, before and immediately after treatment.
What does redness indicate?
excessive pressure
What does blanched/pale indicate?
severe, dangerous pressure
What is the blanching test?
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.
What are susceptibilities to pressure ulcers?
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.
Special positioning for LE amputations?
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.
What does RL stand for?
remaining leg of amputtee
Special positioning for CVA? (Trunk and UE)
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.
Special positioning for CVA? (LE)
Avoid retraction and elevation of pelvis, hip ext/add with knee extension, hip and knee flexion, ankle PF.
How should you position pt S/P CVA in supine?
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
How should you position pt S/P CVA in sitting?
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.
pt with burns should avoid what?
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.
How should you position pt with THA?
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.
How should you position pt with TKA?
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.
With NWB what can you use?
crutch/walker
With PWB what can you use?
(~30%) crutch/walker
With TTWB what can you use?
crutch/walker
For either Arthroplasty or Hemiarthroplasty pt: what is posteriolateral approach?
no hip flexion past 90, IR, or add past midline
For either Arthroplasty or Hemiarthroplasty pt: what is anterolateral approach?
no hip extension, abduciton/ER
For either Arthroplasty or Hemiarthroplasty pt: what is anterior approach?
avoice excessive hip extension
For spinal surgery/LBP what to note?
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)
For hemiplegic pt note what?
beware of flaccid extremeities esp. shoulders, never grab or pull affected arm, use sling if needed, protect affected UE during rolling, transfer.
For SCI note what?
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.
For long term SCI note what?
osteoporotic changes and risk for fractures
For burns or decubiti note what?
sliding creates shearing forces, friction disrupts healing process, elevate body or extrem. during bed mobility or transfers, use draw sheet to assist.
