Draping, Positioning, & Bed Mobility Skills Flashcards
Describe what draping is used for
- 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
Examples of cultural sensitivity for draping
- 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
Proper draping
- cover sensitive areas
- expose the smallest area to be treated
- use different layers
Define hook line position
- patient supine with knees bent
Positioning checklist
- 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
Benefits for effective positioning
- 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
How often should you change positions for short term positioning
- every 30 minutes to an hour
Describe supine positioning
- float the heels
- one pillow under head
- slight bend in the knees
Describe prone postitioning
- float the feet
- if possible put head in the face hole
Describe sidelying positioning
- 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
Describe wheelchair sitting positioning
- 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
What are the common areas for pressure ulcers to occur at
- sacrum
- ischial tuberosity
- greater trochanter
- heels
- lateral malleolus
- elbow
- occiput
Factors that increase susceptibility to pressure injuries
- 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
Braden Scale Grading
19-23 = no risk
15-18 = mild risk
13-14 = moderate risk
< 9 = severe risk
Define CCDD for positioning
- Control centrally, direct distally
Describe shearing forces
- 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
Describe the relationships between, surface area, load, cushioning, time, & pressure as they lead to injury
- decreased surface area + increased load = injury
- decreased cushioning + increased load = injury
- increased time + decreased pressure = injury
Causes of pressure wounds
- 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
How long do the different stages of pressure ulcers take to heal
Stage 1: 1-7 days
Stage 2: 5-90 days
Stage 3: 30-180 days
Stage 4: 180-360 days
How often do you reposition someone is a hospital bed and someone seated in a wheelchair
Hospital Bed: reposition every 2 hours
Seated in W/C: pressure relief every 15-30 minutes
Define Fowlers position
- patient is seated at either 0, 30, 45, or 90 degrees
Define plantigrade position
- patient is standing straight up without assistance
Define trendelenburg position
- patient is supine on a tilting table with legs above their head
Define reverse trendelenburg position
- patient is supine on a tilting table with head above their legs
Define modified plantigrade position
- patient is standing slightly leaning forward with the support of a table
- PT is assisting patient at the hips from behind
Define Pilot’s chair/chair positioning
- 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
Describe contractures
- 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
Common joint contractures in supine
- hip & knee flexors
- ankle plantar flexors
- shoulder extensors, adductors, & IR/ER rotators
Common joint contractures in side lying
- hip & knee flexors
- hip adductors & IR rotators
- shoulder adductors & IR rotators
Common joint contractures in sitting
- hip & knees flexors
- hip adductors & IR rotators
- shoulder adductors, extensors, & IR rotators
Common joint contractures in prone
- ankle plantar flexors
- shoulder extensors, adductors, & IR/ER rotators
- neck rotators R or L
Positioning precautions to avoid skin breakdown
- 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
Positioning after a total hip arthroplasty (THA)
- 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
Positioning after a CVA (cerebrovascular accident/stroke) with hemiplegia
- prevent contractures
- prevent wrist & hand edema
- avoid distraction of the hemiplegic shoulder
Common pattern of contracture development in a CVA patient with hemiplegia
- scapular retraction
- shoulder adduction, flexion, & IR
- elbow, wrist, & finger flexion
- hip adduction, flexion, & IR
- knee flexion
- ankle plantar flexion
Positioning after an LE amputation
- keep the hips in neutral rotation
- extend the knee
- minimize sitting time with the knee flexed
- avoid pressure on non-healed surgical sites
General guidelines when completing positioning/bed mobility tasks in the hospital
- 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
Key points of control to provide assistance
- 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
Special circumstances for hemiplegia patients
- 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
Supine to sitting for THA
- 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
Supine to sidelying to sitting for hemiplegia
- 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
Special circumstances following back surgery: Log Roll
- 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
Following back surgery sidelying to sitting
- 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
Special circumstances for spinal cord injury (SCI)
- 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
How to document transfers
- 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
