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Theory & Practice I > Draping, Positioning, & Bed Mobility Skills > Flashcards

Draping, Positioning, & Bed Mobility Skills Flashcards

1
Q

Describe what draping is used for

A
  • used to protect privacy & to create a clean or sterile treatment area
  • comfort and warmth
  • respect/dignity
  • cultural sensitivity
  • access treatment areas for examination & treatment
  • protection
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2
Q

Examples of cultural sensitivity for draping

A
  • strong preference for health care provider of the same sex
  • embarrassment due to bodily exposure
  • taboos against wearing garments previously worn by others
  • restrictions on touching
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3
Q

Proper draping

A
  • cover sensitive areas
  • expose the smallest area to be treated
  • use different layers
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4
Q

Define hook line position

A
  • patient supine with knees bent
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5
Q

Positioning checklist

A
  • patient is safe
  • good spinal alignment
  • accessibility of necessary areas to the body
  • trunk & extremities supported for comfort
  • positioned well within environment
  • special needs accommodated
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6
Q

Benefits for effective positioning

A
  • prevention of soft tissue injury & joint contracture
  • increase patient comfort
  • provide support & stabilization of the trunk & extremities
  • provide access & exposure to treatment options or basic ADL’s
  • improve function of the patient’s body systems
  • relieve pressure to the soft tissue, bony prominences, circulatory & neurological structures
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7
Q

How often should you change positions for short term positioning

A
  • every 30 minutes to an hour
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8
Q

Describe supine positioning

A
  • float the heels
  • one pillow under head
  • slight bend in the knees
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9
Q

Describe prone postitioning

A
  • float the feet
  • if possible put head in the face hole
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10
Q

Describe sidelying positioning

A
  • one pillow under head
  • towel roll under patient’s waist
  • pillow in front for patient to hold
  • pillow between the knees with top leg bent
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11
Q

Describe wheelchair sitting positioning

A
  • use the wheelchair leg rest or provide a block to prop the patient’s feet onto
  • make sure that their back is all the way against the back of the wheelchair
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12
Q

What are the common areas for pressure ulcers to occur at

A
  • sacrum
  • ischial tuberosity
  • greater trochanter
  • heels
  • lateral malleolus
  • elbow
  • occiput
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13
Q

Factors that increase susceptibility to pressure injuries

A
  • decreased mobility
  • fragile skin
  • history of skin breakdown
  • incontinence
  • impaired sensation
  • impaired circulation
  • cachexia
  • muscle atrophy
  • postural impairment
  • friction or shear
  • nutritional deficiencies
  • impaired cognition
  • medication that affects mobility or awareness
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14
Q

Braden Scale Grading

A

19-23 = no risk
15-18 = mild risk
13-14 = moderate risk
< 9 = severe risk

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15
Q

Define CCDD for positioning

A
  • Control centrally, direct distally
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16
Q

Describe shearing forces

A
  • deeper tissues, including muscle & subcutaneous fat, are pulled downwards by gravity, while the superficial epidermis & dermis remain fixed through contact with the external surface
  • results in stretching & angulation of local blood vessels & lymphatics
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17
Q

Describe the relationships between, surface area, load, cushioning, time, & pressure as they lead to injury

A
  • decreased surface area + increased load = injury
  • decreased cushioning + increased load = injury
  • increased time + decreased pressure = injury
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18
Q

Causes of pressure wounds

A
  • sustained mechanical deformation of skin
  • lack of sensation to alleviate pressure
  • unable to relieve pressure due to physical limitations
  • improper fitting prosthesis/orthosis
  • failure of staff or family to reposition patient on a regular schedule
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19
Q

How long do the different stages of pressure ulcers take to heal

A

Stage 1: 1-7 days
Stage 2: 5-90 days
Stage 3: 30-180 days
Stage 4: 180-360 days

20
Q

How often do you reposition someone is a hospital bed and someone seated in a wheelchair

A

Hospital Bed: reposition every 2 hours
Seated in W/C: pressure relief every 15-30 minutes

21
Q

Define Fowlers position

A
  • patient is seated at either 0, 30, 45, or 90 degrees
22
Q

Define plantigrade position

A
  • patient is standing straight up without assistance
23
Q

Define trendelenburg position

A
  • patient is supine on a tilting table with legs above their head
24
Q

Define reverse trendelenburg position

A
  • patient is supine on a tilting table with head above their legs
25
Q

Define modified plantigrade position

A
  • patient is standing slightly leaning forward with the support of a table
  • PT is assisting patient at the hips from behind
26
Q

Define Pilot’s chair/chair positioning

A
  • the head of the bed is raised so that patient is sitting up straight
  • foot of the bedd in angled downwards to allow slight knee flexion in sitting
27
Q

Describe contractures

A
  • a contracture is a fixed deformity resulting from immobilization of a joint
  • it is caused by shortening of muscles, tendons, ligaments, & joint capsules or by heterotrophic ossification
28
Q

Common joint contractures in supine

A
  • hip & knee flexors
  • ankle plantar flexors
  • shoulder extensors, adductors, & IR/ER rotators
29
Q

Common joint contractures in side lying

A
  • hip & knee flexors
  • hip adductors & IR rotators
  • shoulder adductors & IR rotators
30
Q

Common joint contractures in sitting

A
  • hip & knees flexors
  • hip adductors & IR rotators
  • shoulder adductors, extensors, & IR rotators
31
Q

Common joint contractures in prone

A
  • ankle plantar flexors
  • shoulder extensors, adductors, & IR/ER rotators
  • neck rotators R or L
32
Q

Positioning precautions to avoid skin breakdown

A
  • avoid clothing or linen folds beneath the patient
  • frequently make note of skin color over bony landmarks
  • talk with nursing regarding a positioning & turning schedule
  • do not position the extremities beyond the support surface
  • avoid extremes of motion, work gradually & deliberate
  • additional caution with confused, comatose, very younger old, paralyzed or pt’s with poor circulation or sensation
  • do not dump and run
33
Q

Positioning after a total hip arthroplasty (THA)

A
  • avoid hip flexion beyond 60-90 degrees
  • avoid hip adduction past 0 degrees
  • avoid hip internal rotation past 0 degrees
  • supine <–> sitting not through sidelying
34
Q

Positioning after a CVA (cerebrovascular accident/stroke) with hemiplegia

A
  • prevent contractures
  • prevent wrist & hand edema
  • avoid distraction of the hemiplegic shoulder
35
Q

Common pattern of contracture development in a CVA patient with hemiplegia

A
  • scapular retraction
  • shoulder adduction, flexion, & IR
  • elbow, wrist, & finger flexion
  • hip adduction, flexion, & IR
  • knee flexion
  • ankle plantar flexion
36
Q

Positioning after an LE amputation

A
  • keep the hips in neutral rotation
  • extend the knee
  • minimize sitting time with the knee flexed
  • avoid pressure on non-healed surgical sites
37
Q

General guidelines when completing positioning/bed mobility tasks in the hospital

A
  • explain mobility procedures/goals of the task to the patient
  • grossly appraise proximal/spinal alignment & placement of the extremities
  • protect yourself & the patient with good body mechanics when assisting with any repositioning
  • after positioning provide a means for the patient to call for help
38
Q

Key points of control to provide assistance

A
  • proximal points of contact (pelvis & shoulders to manage trunk)
  • break movements down into parts
  • use your entire body to assist the patient
  • ensure gait belt application prior to mobilization from a bed or chair
39
Q

Special circumstances for hemiplegia patients

A
  • avoid pulling on the patient’s weaker arm
  • be alert to location of weaker extremities because some patients experience one-sided neglect
  • it’s typically easier for the patient to sit up from sidelying on the weaker side
40
Q

Supine to sitting for THA

A
  • remove abduction wedge
  • prop up on elbows
  • pivot on bed, alternately moving UEs and LEs
  • sit on edge of bed (EOB) with the trunk leaned back
41
Q

Supine to sidelying to sitting for hemiplegia

A
  • flex stronger hip & knee
  • reach stronger arm across the body
  • lay the stronger leg over the weaker leg, turning the torso
  • use the stronger leg to help the weaker leg off the EOB
  • press down into bed with stronger hand, pushing the torso upright
42
Q

Special circumstances following back surgery: Log Roll

A
  • avoid segmental rotation of the thoracolumbar spine
  • flex hip & knee of far leg
  • cross the arms across the chest
  • roll into sidelying, moving the trunk as one unit
43
Q

Following back surgery sidelying to sitting

A
  • abduct the underside arm & place the hand of the other arm on the bed near the waist
  • move legs off the bed while initially pressing down with the hand
  • continue to push the torso upright by pushing with the underside arm
  • avoid segmental rotation of the thoracolumbar spine
44
Q

Special circumstances for spinal cord injury (SCI)

A
  • mobility depends on level of injury
  • C6 injury level is typically the transitional level between dependence & independence in bed mobility
  • rolling is typically led by the head & upper body, using momentum
  • many self care activities are performed in long sitting
45
Q

How to document transfers

A
  • amount or type of assistance to perform the transfer
  • time to complete
  • level of safety demonstrated
  • level of consistency demonstrated
  • equipment or devices used
  • document what was done
  • document what particular technique was selected

Theory & Practice I (16 decks)

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