Nurb Test 1: ortho positioning

Question 1

1. When in bed, the patient should be turned every two hours to the unaffected side and back.
2. While in bed or chair, the patient may be placed in any position of comfort as long as they are not positioned on the affected side.
3. patients should be non-weight bearing on the affected extremity when standing or ambulating. (Verify weight – bearing status with orthopaedic surgeon’s order)
4. patients should be up in chair twenty - four hours after surgery. Use gait belt and assistive devise to stand and pivot patient to chair. Remember! Non-weight bearing on the affected extremity! (unless orthopedic surgeon orders otherwise)
5. The patient can sit in any kind of chair as long as it has arms. The patient needs to use the arms of the chair to assist in standing.
6. Never allow the feet to dangle! Feet should be flat on the floor. Use pillows or a trashcan placed on the side with a pillow on top to support feet if they can’t touch the floor.

Answer 1

Positioning the Open Reduction Internal Fixation (ORIF) Patient

Question 2

1. HOB up no more than 60 degrees while patient is laying on their back
2. Pillow or abductor splint between legs while patient is laying on his back (to maintain abduction)
3. Head of bed flat when turning or getting patient out of bed
4. No hyper-extension of pelvis (NO Bedpans, no lifting hips up to straighten a pad)
5. No internal or external rotation of the hip. (pigeon toes or duck walking) Prevent this by keeping patient’s toes straight. When lying on the back the toes should point toward the ceiling. When lying on the unaffected side, toes should all point one way – either right or left depending on which side the patient is turned to.
6. Two staff members must always turn the patient. One staff member should always have control of the affected extremity.
7. Always have abductor splint between legs to turn patient
8. Always put a pillow between the feet at the end of the abductor splint to prevent internal rotation

Answer 2

Total Hip Precautions

While in Bed

Question 3

1. Legs hip width apart
2. Stand up straight.
3. Toes pointed straight forward. No internal or external rotation of feet
4. No bending past 90 degrees
5. No twisting
6. Generally full weight bearing or weight bearing as tolerated(WBAT) - verify with orthopedic surgeon’s order

Answer 3

When ambulating total hip

Question 4

1. No bending past 90 in chair
2. Knees below the hips
3. No pillow behind back (will cause to bend past 90)
4. Must sit in cardiac chair or standard chair with back and arms.
5. If in standard chair with arms, have pt. sit on foam pillow to keep knees below hips
6. Use elevated commode
7. No sitting in wheel chairs (unless sitting on foam pillow to maintain rigid seating surface), sling back chairs, overstuffed chairs or lazy boy chairs

Answer 4

When in chair

total hip

Question 5

1. HOB no more than 30 degrees when patient is on their back.
2. You may place a pillow under the knees of the patient when the patient is on their back to take the strain off the lower back. Be careful NOT to allow the edge of the pillow to occlude the popliteal artery behind the patient’s knee. Have the whole pillow resting under the knees to avoid occluding the popliteal artery.
3. Head of bed flat when patient is turned to his/her side.
4. Use log roll technique. Do not allow the patient to twist or turn abdomen or back while turning from side to side or side to back.
5. If a lumbar brace it ordered, it must be on the patient whenever the patient is out of bed. Unless the Surgeon gives specific orders to allow the patient to put on the brace while sitting up, you must have the patient log roll from side to side to put on the brace. Place the brace on over a tee shirt or closed gown. Do not place brace directly on the patient’s skin.

Answer 5

Positioning Lumbar Spine Surgery Patients

Question 5

6. When transferring from bed to chair have the patient sit up from a side lying position.
   • Have the patient log roll to his/her side.
   • Assist the patient in pushing up with his/her arms.
   • Do not allow the patient to twist the abdomen or back while assisting the patient into a sitting position.
   • Once seated upright on the side of the bed, ensure that the patient’s back is in straight alignment and that the patient’s feet are flat on the floor.
   • Have the patient push off the bed with both hands and then reach for the walker.
   • Have the patient walk to the chair, turn and back into the chair until he/she feels the chair with the back of the legs. Do not allow the patient to twist his/her trunk when turning to back into the chair.
   • Have the patient reach back for the arms of the chair
   • Have the patient lower him/herself into the chair. Do not let the legs dangle.
7. Have the patient sit in a chair with back and arms. Do not allow the feet to dangle.
8. Encourage ambulation as ordered by the surgeon.

Answer 5

Lumbar spinal surgery chair