Patient Positioning for Mobility

Question 1

long term positioning

Answer 1

prevent pressure ulcers, contractures, and cardiopulmonary complications

Question 2

general guidelines

Answer 2

Explain procedures to the patient.

AMAP/ANAP-want patient to do as much as possible as normal as possible.

Maintain normal spinal alignment as much as possible.

Use good body mechanics.

Consider the environment.

Provide a way for the patient to call for help.

Maintain safety throughout

OBTAIN CONSENT (paper or verbal)

Question 3

short-term positioning objectives

Answer 3

safety, comfort, and access

Question 4

normal spinal alignment

Answer 4

cervical lordosis, thoracic kyphosis, and lumbar lordosis

Question 5

lordosis

Answer 5

concavity is anterior

Question 6

kyphosis

Answer 6

concavity is posterior

Question 7

short term supine

Answer 7

• keep neutral spine
• pillow under head, knees, and maybe elbows
• hip flexors will pull spine into excessive lordosis, so place pillow under knees or bend knees to put hip flexors on slack

Question 8

orthopnea

Answer 8

difficulty breathing based on positioning; often described by number of pillows needed under the head in supine (ie. 2 pillow orthopnea)

Question 9

short term prone

Answer 9

• feet off table or pillow under ankles for support
• pillow under abdomen/pelvis for lordosis relief
• turn head sideways or use pillow with hole
• may use towel roll on forehead

Question 10

short term side lying

Answer 10

• clear spine access
• pillows under head, between knees, and held in arms to improve spinal alignment

Question 11

short term sitting

Answer 11

• sit back with hips centered in chair
• 90-90-90: knees, ankles, and hips at 90 degrees

Question 12

fowler’s position

Answer 12

semireclined
- high: 80-90 degrees
- low: about 45 degrees

Question 13

trendelenburg position

Answer 13

supine w/head inverted

Question 14

long term positioning objectives

Answer 14

safety, prevention, comfort

Question 15

preventing pressure ulcers

Answer 15

• no more than 2 hours in one position in bed
• no more than 15 minutes in one position while seated

Question 16

high risk areas for pressure ulcers

Answer 16

Head, shoulders, elbows, sacrum, buttocks, heels, and dorsum of feet.

Sacrum and heels are especially high risk areas for pressure ulcers.

Question 17

checking for skin damage

Answer 17

skin blanching test: blanch quickly then turn back to pink (purple for dark skin tones)

Question 18

pressure ulcers: load, pressure, and time relationship

Answer 18

↓ surface area = ↑ load

↓ cushioning = ↑ load

↑ time @ ↓ pressure = ↑ load overall

Question 19

precautions for patients in long term positions

Answer 19

Routine skin Inspections

Check skin at every repositioning

Do not position onto reddened areas

With delayed integumentary recovery: reposition more frequently

Do not position onto ulcerated area

Question 20

contracture

Answer 20

Limitations in joint motion caused by adaptive shortening of the ligaments, tendons and mss

Question 21

common contractures

Answer 21

head/neck, rounded shoulders, elbow flexion, wrist flexion, hip flexion, knee flexion, hip abduction, ankle PF

Question 22

how to prevent common contractures

Answer 22

patient education, corrective exercises, passive motions

Question 23

edema

Answer 23

ineffective return of blood and lymph fluids proximally towards the heart

Question 24

orthostatic hypotension

Answer 24

drop in BP due to change in position

Question 25

preventing edema and cardiopulmonary complications

Answer 25

Position distal extremities at or above the level of the heart. Vary demand on the heart by including more upright positioning.-makes heart work harder and maintain its ability to pump. Vary positions to promote lung drainage

Question 26

long term positioning checklist

Answer 26

Clear airway Good spinal alignment Minimized pressure over bony prominences Minimized gravity creating shearing forces Cushioned support surfaces Immobile extremities elevated Change positions frequently Joint and soft-tissue contractures prevented Trunk and extremities supported and stabilized Long-term functional positions Positioned to optimize interaction with the environment (line of sight, communication, etc.) Special needs accommodated

Question 27

long term supine

Answer 27

- pillow along tibia - keep GH in neutral position - for sacral relief-bridge an area

Question 28

long term prone

Answer 28

- rarely used - ensure clear airways and ability to call for help - 3/4 supine, 3/4 prone are common variations

Question 29

long term side lying

Answer 29

- upper trunk usually rotated forward or backward - pillow/bolster to maintain upper trunk position - elevate upper hand/arm

Question 30

long term sitting

Answer 30

- increase frequency of repositioning - 90-90-90 positioning - may require small lumbar roll - support arms

Question 31

repositioning in sitting

Answer 31

- "as is the pelvis, so is the head" - CCDD: control centrally, direct distally

Question 32

restraints

Answer 32

device that limits mobility=not allowed

Question 33

positioning after THA posterior approach

Answer 33

Avoid hip flexion beyond 60o to 90° Avoid hip adduction past 0° Avoid hip internal rotation past 0°

Question 34

positioning after CVA with hemiplegia

Answer 34

- prevent contractures - prevent wrist and hand edema - avoid distraction of the affected shoulder

Question 35

post CVA supine

Answer 35

support arm with pillow

Question 36

post CVA side lying

Answer 36

- not against the rules to lean on hemiplegic arm - try to reduce pressure on brachial plexus

Question 37

positioning DOs after LE amputation

Answer 37

Keep the hips in neutral rotation. Extend the knee. Minimize sitting time with the knee flexed. Avoid pressure on nonhealed surgical sites.

Question 38

positioning DON'Ts after LE amputation

Answer 38

Let the residual limb hang off the edge of the bed. Place a pillow under the hip or knee while the patient is supine. Place a pillow under the low back. Allow the patient to lie with the knees flexed. Allow the patient to cross legs.