Patient positioning - scrub/scout

Question 1

Patient poisoning purpose

Answer 1

Pt is placed in a position that will ensure optimum surgical site exposure and access.

Question 2

How is the position determined?

Answer 2

• Type of operation to be performed
• Location of the lesion, injury or operative site
• The age, height, weight and general condition of the pt
• Surgical approach

Question 3

positioning injuries

Answer 3

• Pressure ulcers, bruising, skin lesions, alopecia and muscle and nerve injuries
• must be aware of physiological impact of pt positioning

Question 4

Pressure definition

Answer 4

Underlying force placed upon a pt skin and tissue.
- ensure normal cap refill of 23-32mmHg maintained to prevent PI
- 2-3 hrs of unrelieved pressure can cause pressure ulcer

Question 5

Factors lowering a pt pressure threshold

Answer 5

• Malnutrition
• respiratory and circulatory disorders
• chronic immobility
• anaemia
• steroid therapy
• chronic disease
• dehydration
• old age

Question 6

Shear forces definition

Answer 6

The movement of tissue and skeletal structures whilst the skin remains stationary

Question 7

Friction definition

Answer 7

Force of two surfaces rubbing together

Question 8

Maceration

Answer 8

Prolonged exposure to moisture on the skin can saturate the epidermis, making it more vulnerable to pressure, shear force and friction.
- can occur when left lying in pool of blood.

Question 9

Musculoskeletal injury

Answer 9

Surgical positioning can place unusual stress on the pt muscles, tendons, ligaments and joints.
- Anaesthetic agents can depress the normal protective mechanisms against injury.
- Insensitivity to pain, pressure and the relaxation of normal muscle tone increases pt susceptibility to muscle and joint injury

Question 10

Nerve injury

Answer 10

Anaesthetic agents increase risk of nerve damage as they induce loss of nervous system control and prevent normal sensation to pain.
- Pressure on peripheral nerves can cause temporary or permanent nerve damage

Question 11

Vascular effects

Answer 11

• CV agents cause peripheral vasodilation thus pooling of the blood occurs in the lower limbs and extremities resulting in hypotension.
• Occurs more in pt with hypovolaemia, CVD and obesity
• sudden pt change can cause postural hypotension.

Question 12

Respiratory effects

Answer 12

• Can affect the movement of respiratory muscles and the diaphragm
• Can affect lung ventilation, perfusion and gas exchange.

Question 13

Goals of surgical positioning

Answer 13

• Maintaining patient comfort and safety
• Providing optimum exposure and access to the surgical site
• Maintaining natural body alignment
• Supporting circulatory and respiratory function
• Protecting neuromuscular and skin integrity
  Allowing access to IV sites and anaesthetic support devices.