Patient positioning

Question 1

List 6 basic patient positions

Answer 1

1. supine (dorsal decubitus) 2. prone (ventral decubitus) 3. lateral decubitus 4. lithotomy 5. beach chair (sitting)

Question 2

what are the pressue points in supine position?

Answer 2

occiput scapulae elbows wrists sacrum calves heels

Question 3

Where do you tuck the draw sheet if you tucking the arm?

Answer 3

under the patient’s hip

Question 4

True or false. You should restrain the arms on the arm board when the patient is in the supine position

Answer 4

True

Question 5

what type of pillow do you use when the patient is lying prone?

Answer 5

head or proneview pillow – make sure neck is neutral

Question 6

what should be procected from excessive pressure when in the prone position?

Answer 6

eyes upper extremities breasts/genitals hips

Question 7

what cardiovascular changes occur with positioning from erect to supine?

Answer 7

increases — CO, SV, End organ perfusion, venous return

decreases — MAP, HR, SVR (systemic vascular resistance)

Question 8

what respiratory changes occur when changing position from erect to supine?

Answer 8

decreases FRC

Increase dead space

changes in compliance, V/Q mismatch, diaphragm position

Question 9

What are complications of venous statsis?

Answer 9

DVT

monoccular blindness

Question 10

What are some complicatinos of supine position?

Answer 10

posteral hypotension

pressure alopecia

pressure point reactions (compression and ischemia)

ulnar nerve injury

brachial plexus injury

Question 11

what are some complications r/t the lateral decubits position?

Answer 11

damage to eyes or ears

neck injury (lateral flexion)

suprascapular nerve injury

long thoracic nerver injury

Question 12

in the sitting position where would MAP be measured?

Answer 12

at the level of circle of willis (transducer placed at the level of external ear canal)

Question 13

what are logistic concerns of prone position?

Answer 13

risks are

accidental extubation,

loss of vascular access lines, catheters, & monitors;

& accentuation of multiple trauma.

Question 14

What are complication associated with prone position?

Answer 14

damage to the eyes (blindness)

neck injury

breast injury

brachial plexus injuries

Question 15

How should the trunk of the body be supported in prone position?

Answer 15

The chest is supported on long cushions or on a longitudinal support frame, allowing as much diaphragmatic & abdominal movement with ventilation as possible

Question 16

How are the legs positioned in lateral decubitus position?

Answer 16

bottom leg flexed

top leg straight

pillow between

Question 17

what is used to prevent brachial plexus injury and ensure perfusion of decubitus side when in the lateral decubitus position?

Answer 17

axillary roll

Question 18

What is the position in which the patient is on their back with the hips extened 90^o & knees flexed & the thighs apart

Answer 18

lithotomy

Question 19

True or False. When positioning for lithotomy position the patient’s legs should be put into the stirrups one at atime.

Answer 19

False. shoud place then simultaneously

Question 20

What are complications of lithotomy position?

Answer 20

increase pressure in abdomen and thoraci areas

lower limb nerve injuries (sciatic and common fibular (peronal)

….

Question 21

what is purpose of trendelenburg position?

Answer 21

increase venous return during hypotension

improve exposure during abdominal and laproscopic surgery

prevent air emboli & facilitate cannulation during central line placement

Question 22

what are cardiovascular effects of trendelenburg position?

Answer 22

Increases CVP

Increases ICP

Increases IOP

Swelling of face, conjunctiva, trachea, and tongue (prolonged head down)

Question 23

what are pulmonary effects of trendelenburg?

Answer 23

decrease FRC

decrease compliance

increase work of breathing (spont. breathing)

increase intrathoracic pressure (harder to ventilate)

Question 24

what are some cautions of using reverse trendelenburg (head up)?

Answer 24

possible to slide off the table

decrease venous return (hypotension)

more frequent arterial pressure readings to ensure perfusion of brain (level of circle of willis)

Question 25

what are common nerve injuries related to positioning

Answer 25

1 ulnar nerver injury

brachial plexus injury

radial nerve injury

common peroneal nerve injury

Question 26

most nerve injury is caused by what?

Answer 26

Excessive pressure: compression

stretch

ischemia

Question 27

What is Slight or partial paralysis called?

Answer 27

paresis

Question 28

what is Loss or impairment of the ability to move a body part, usually as a result of damage to its nerve supply

Answer 28

paralysis

Question 29

what is abnormal sensation, typically tingling or pricking (“pins and needles”),

Answer 29

paresthesia

Question 30

what is usually temporary failure of nerve conduction due to injury

Answer 30

neurapraxia

Question 31

At what anatomic location is the ulnar nerve most often injured?

Answer 31

at the medial epicondyle of the humerus near the olecranon process (elbow)

Question 32

Describe arm positioning employed to minimize ulnar nerve injury.

Answer 32

supinated

neutral (with thump up when tucked)

pad the elbows

Question 33

List three possible causes of brachial plexus injury

Answer 33

abducted more than 90 when supine (stretch)

compression in the lateral ducubitus position

Question 34

For a supine patient, what role does head position play in potential brachial plexus injury? What type of injury?

Answer 34

avoid head rotation away from abducted arm (stretch)