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Patient Positioning > Patient Positioning > Flashcards

Patient Positioning Flashcards

1
Q

Who is responsible for positioning of pt?

A

Shared responsibility

Nurse
Anesthesia
Surgeon
And other Perioperative personnel

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2
Q

Risk of what type injuries with patient positioning?

A 
Compression
Stretching 
Skin, joints, soft tissue
Bones 
Eyes
Nerves
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3
Q

Why are pts at risk of injury during surgery?

A

Unable to feel pain, numbness, tingling

Cannot communicate

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4
Q

Goals of positioning?

A 
Procide optimal exposure to site
Maintain proper alignment 
Support circulatory/resp function
Protect neuromuscular and skin integrity
Allow access to Iv/monitoring equipment 
Maintain pt privacy and comfort
Secure and safe to avoid moving/shifting
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5
Q

Who is responsibke for selecting neat position for procedure?

A

Surgeon

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6
Q

Basic surgical positions?

A 
Supine
Lithotomy 
Sitting
Trendelenburg
Reverse tren
Lateral
Prone
Jack knife
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7
Q

Pre op assessment for positionint?

A 
Skin assessment 
Medical conditions
Age 
Height 
Weight/BMI
ROM
Nutritional status
Jewlery
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8
Q

Nutritional status affecting injury risk?

A

Decressed muscle mass
Dehydration

Low serum albumin may indicate poor wound healing

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9
Q

What are high risk for injury during surgery?

A

> 2hrs
Vascular sx - blood perfusion may be compromised
Lithotomy position - increased risk of nerve damage
Positions with sustained pressure
Ex. Retraction

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10
Q

Pre op considerations for positioning?

A

Age - geriatric more at risk
Always follow MIFU when selecting equipment
Medical conditions - resp/circulatory, DM, malnutrition, anemia, demineralizing bone conditions
Mobility concerns

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11
Q

Intra op factors related to patient positioning?

A

Types of anesthesia
- general, spinal, moderate sensation

Length of surgery

Position required

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12
Q

Basic positioning practices?

A 
Follow procedure protocols
Respect pt privacy 
Head/neck neutrality 
Protect eyes
Physiologic alignment 
OR beds - padding, avoid metal 
Safety precautions - belts
Repositioning pt - redistribute pressure 
Monitoring pt - pulses, strap tightness
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13
Q

Why protect head and neck during pt positioning?

A

Stretching/hyperextension could cause brachial plexus nerve injury or cardiovascular complications

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14
Q

How to protect eyes?

A

Prevent corneal abrasion, ocular injury by preventing pressure on eyes and taping them shut

Eye protection
-laser

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15
Q

Supine position

A

Most common
Dorsal recumbent, laying on back

Common with abd, head/neck, vascular and breast sx

Arms at side with palms facing towards body or extended on arm boards with palms up
- protect ulnar nerve

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16
Q

Where is safety strap placed in supine?

A

2 inch above knee

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17
Q

Legs during supine?

A

Uncrossed to reduce pressure

Flex knee with pillow under knee to prevent comoression and reduce risk of DVT

Elevate heels

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18
Q

If arms are extended in supine, how far can they be abducted?

A

No more than 90 degrees

Decreases risk for brachial plexus nerve injury

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19
Q

Tucking patients arms with sheet?

A

Arms neutral with palms facing body
Pull sheet up between body and arm
Place sheet over arm
Tuck between arm and matress
Sheet should extend from elbow to fingertips
Ensure secure but not too tight to create pressure

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20
Q

Lithotomy position?

A

Hips flexed until thighs are 80-100 degrees to OR bed
Pt lower legs parallel to OR bed in stirrups

Can be low, hemi, high, exaggerated

Common in vag, rectal, urological, colorectal, reproductive lap procedures

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21
Q

How do patients all start before being positioned in OR?

A

Supine
- OR bed or stretcher

Once pt under anesthesia patient can be positioned

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22
Q

Safety for lithotomy?

A

Do not place safety belt on abd
Place leg holders at even height
One team member per leg minimum
Raise and lower legs into stirrups and back to bed together
- avoid sudden shift in circulatory volume
Always check hands and fingers when moving lower part of bed

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23
Q

Safety positioning of legs in lithotmy?

A

Protect hips from excessive flexion
(> 80-90 degrees)
Or abduction
(> 30-45 degrees)

Puts stress on hip joints and can cause femiral, sciatic, oburator or peroneal neuopathy

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24
Q

What can raising pt legs into stirrups cause?

A

Shift of blood into central circulation and decrease perfusion in the legs
Result in increased cardiac output and venous return

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25
Q

Why can lithotomy lead to resp compromise?

A

Organs shift when legs are placed in stirrups which increases pressure on the diaphragm

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26
Q

Sitting position?

A

Folwers/semi fowlers
Beach chair

Common in shoulder, posterior cervical spine or posterior/lateral head sx

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27
Q

Complications from sitting position?

A 
Venous air embolism
Hemodynamic instability 
Pneumocephalus 
Quadriplegia 
Compressive peripheral neuropathy
28
Q

Positioning pt in sitting?

A

Elevate head/neck/torso 20-90 degrees
Hips flexed 45-60 degrees
Place pad under coccyx to prevent pressure on sciatic nerve/coccyx
Safety belt over thighs
Knees flexed 30 degrees with pillow
- decrease stretching on sciatric nerve
SCDs - prevent pooling, improve venous return

29
Q

Arms during sitting position?

A

Both may be flexed and secured across body

In shoulders non operative arm may be secured across body

30
Q

Sitting position risk of VAE?

A

Venous air embolism

Air or gas enters vascular system above level of heart

31
Q

Advantages of sitting position?

A 
Access to airway 
Ease of mechanical ventilation
Reduced intracranial pressure 
Reduced facial swelling 
Reduced blood pooling in surgical field 
Improved lung expansion
32
Q

Trendelenburg position?

A

Feet higher thsn pt head by 15-30 degrees
Moves abd organs toward head to improve acccess to pelvic organs

Treats hypotension

33
Q

What does trendelenburg position cause?

A

Movement of blood supply from lower extremity to central and pulmonary circulation
Decreases limb perfusion
Decreases venous return from head

34
Q

Safety precautions when in trendelenburg?

A

Do not use shoulder braces
Do not use circumferential wrist restraints
- leads to brachial plexus nerve injury
Keep in trendelenburg for shortest time possible
- intracranial htn, resp deterioration, increased intraocular pressure

35
Q

Reverse trendelenburg?

A

Head up and feet down
Pt head 15-30 degrees above feet

Common in head, neck and upper abd sx

36
Q

Benefits to reverse trendelenburg

A

Head is above heart to improve drainage of body fluids away from surgical site
Reduces intracranial pressure
Shift intestines lower in abd
Decreases bleeding at surgical field

37
Q

Why is reverse trendelenburg at risk of VAE?

A

Benous pooling in the lower body can cause venous air embolism

38
Q

Safety precautions with reverse trendelenburg?

A

Padded foot boards to prevent sliding and injury

39
Q

Lateral position?

A

Positioned laterally on non operative side

Common with thoracotomy, kidney surgery and hip sx

Minimum of 4 people needed to position pt

40
Q

Positioning considerations for lateral?

A 
Two level arm boards
Pillow under head
Monitor dependent ear 
Secure to table with belt 
Pillow between knees 
Pillow under thorax to improve cardiac output
Keep in position for short period 
- decrease risk of rhabdomyolosis   
Reposition to reduce risk of compartment syndrome
41
Q

What is rhabdomyolosis?

A

Breakdown of muscle tissue
Muscle fiber contents released into bloodstream

Causes kidney damage

42
Q

Prone position?

A

Laying face down
Arms at side or on arm boards

Common to access back, rectum, and dorsal areas

Anesthesized on stretcher and log rolled onto OR bed
- minimum 4 people

keep stretcher in room

43
Q

Positioning considerations for prone?

A

Place pt 5-10 degrees into reverse tren to reduce benous congestion in eyes
Chest supports for to allow abd expansion and decreased abd pressure
Protect genitals from torsion
Pad pt knees and elevate toes

44
Q

Common complications from prone?

A 
Increased abd pressure
Increased bleeding
Compartment syndrome
Nerve/pressure injuries
Cardiovascular compromise
Eye injuries 
Airway dislodgement
45
Q

Jack knife position?

A

Kraske position
Modification of prone

Common in rectal procedures

Same as prone with bed control positioned into jack knife (head and feet lowered)

46
Q

Risks of jack knife?

A 
Circulatory changes
Causes pooling 
- use SCDs
Compromises respiration
Exerts pressure on diaphragm 
- use chest rolls
47
Q

What can cause position related injuries?

A

Pressure from body, equipment or team members ex. Leaning

Can be intact or open

48
Q

What is an OR acquired pressure injury?

A

Appears 48-72 hrs post op
Tissues that were subjected to pressure during sx
May be deep tissue
Seldom visible at end of procedure or appears red
Sometimes incorrectly identifiedas a burn

49
Q

What is a HAPI?

A 
Hospital acquired pressure injury
Occurs during hospital stay
Can develop from pressure, shear or both
Associated with pt factors ex. Age
Preventable
Nursing quality error
Expensive to hospital
50
Q

Stage 1 pressure injury?

A

Intact, red skin

Does not blanch

51
Q

Stage 2 pressure injury

A

Partial skin loss involving epidermis and or dermis

Skin abraded, blistered or has shallow craters

52
Q

Stage 3 pressure injury?

A

Full thickness skin loss possibly down to but not through fascial layer
Deep craters with or w/o undermining

53
Q

Stage 4 pressure injury?

A

Full thickness skin loss with extensive destruction, necrosis or damage to muscle, bone or supporting structures

54
Q

Pressure injuries that do not fit into stages?

A

Unstageable
Deep tissue
Mucosal membrane
Medical device related

55
Q

Risk assessment tools?

A

Braden scale - does not include perioperative factors
Braden Q scale - pediatric
Munro scale - surgical
Scott triggers - surgical

56
Q

Munro scale?

A

Risk factors for pressure injury in surgical pts

Calculates a cumulative score of pre op, intra op wnd post op factors

57
Q

Scott triggers tool?

A

Pressure injury assessment took for sx pt

Assess patient factors
- age, albumin, or BMI, estimated length of surgery

58
Q

6 factors causing pressure injury?

A 
Friction
Shear
Moisture
Heat 
Cold
Negativity - layers of material

*duration of pressure

59
Q

Anterior pressure points?

A 
Ear
Wrist
Ilium 
Patella
Toes
60
Q

Posterior pressure points?

A 
Occiput
Scapula
Vertebra
Elbow
Rib
Sacrum
Greater trochanter
Ischial tuberosity 
Medial/lateral condyles 
Heel
Malleous
61
Q

What is brachial plexus?

A

Consists of a bundle of nerve cords that innervate the shoulder, arm and hand

62
Q

Risk and causes of brachial plexus injuries?

A 
Supine position - arms > 90 degrees
Trendelenburg - use of shoulder braces
Jack knife 
Obese pt
Hyperextension of neck
63
Q

Peroneal nerve injuries?

A

Branch of sciatic nerve that supplies movement and sensation to lower leg, foot, toes

64
Q

Positions that increase risk of peroneal nerve injury and solutions?

A

Supine - place safety strap 2 inch above knee
Lithotomy- prevent excessive flexion, abduction
R. Trendelenburg - use padded foot board
Lateral - support pillows

65
Q

Positioning considerations for geriatic pts?

A

Skin protection
Lift never slide
Decreased ROM

66
Q

Positioning considerations for pregnant woman?

A

Uterus can compress aorta and interior vena cava
- causes hypotension

Woman over 18 weeks positon in a left lateral tilt

Place wedge cushion or tilt bed 15-45 degrees to left

Patient Positioning (1 decks)

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