Positioning Flashcards
What position is when the patient is lying on their back?
supine
What is another word for supine?
dorsal recumbent
What are modifications for the supine position?
- lithotomy
- sitting/semi-sitting
- trendelenburg and reverse trendelenburg
Define lithotomy
the patient is supine and the legs are placed in stirrups
define sitting/semi-sitting
the patient is placed in a sitting or semi-sitting position
define trendelenburg and reverse trendelenburg
- the upper torso is lowered and the feet are raised - trendelenburg
- head-up, feet down, supine position.
What position is when the patient is lying on their non-operative side?
lateral
How does a patient get into the lateral position?
Patient is anesthetized in the supine position on the OR bed and then log rolled onto their non-operative side
What position is the patient in when they are lying face down?
prone
How does a patient get into the prone position?
the patient is anesthetized on a transport vehicle in the supine position and then log rolled onto their abdomen on the OR bed.
What is a variation of the prone position?
Jack-knife, or Kraske position
What patient factors do you want to assess that might place a patient at risk for a positioning injury during surgery?
- age
- height and weight
- skin condition
- nutritional status - dehydration, low albumin
- preexisting conditions
- physical/mobility limits
- body mass index
- presence of jewelry
- lab results
What are procedural factors that you might want to assess that might place a patient at risk for a positioning injury during surgery?
- type of anesthesia
- length of surgery
- position required during surgery
How should arms be positioned when a pt. is in supine?
arm extensions should be less than 90 degrees to avoid compression of the brachial plexus
What is an alternative arm placement for supine position?
at the sides with thumbs up
What do you want to place under a pt.’s knees in supine?
a soft pillow to prevent stress on the lower back
Where should a safety strap go when the pt. is in supine?
2 inches above the knees with a sheet or blanket placed between the strap and the patient’s skin.
Where should pad pressure points go?
occiput, scapulae, thoracic vertebrae, olecranon process, sacrum/coccyx, elbows
What should you do with a pregnant patient in supine?
insert a wedge under the patient’s right side to displace the uterus to the left
What can use to redistribute heel pressure when a pt. is in supine?
wide pressure-redistributing surface or heel-suspension device
What 4 procedures is supine used for?
- abdominal procedures
- head and neck procedures
- vascular surgery
- breast surgery
How is a pt. positioned in lithotomy to prevent strain on the sacrum?
the patient’s buttocks are positioned even with the lower break in the OR bed and should not extend over the break
Where should a pt.’s arms go in lithotomy?
place the patient’s arms on padded arm boards
What should you protect when manipulating the OR bed and adding positioning attachments to the OR bed?
hands and fingers
What 3 physiological changes can occur when a pt. is placed in lithotomy?
- When the legs are raised and placed in stirrups, the abdominal organs shift, which increases pressure on the diaphragm, leading to respiratory compromise.
- A shift in the circulatory volume can occur when legs are removed from the stirrups after surgery.
- The circulatory and respiratory systems may be compromised due to compression of the abdominal contents on the
inferior vena cava and abdominal aorta.
After surgery how should you handle the pt.’s legs who have been in lithotomy?
lower the patient’s legs slowly when removing them from he stirrups
what nerve damage can occur when a pt. is placed in lithotomy?
to femoral, obturator, and perineal nerves can occur
What procedures is lithotomy used for?
- vaginal
- rectal
- urological
- colorectal
- reproductive laparoscopic procedures
What angle is created between the posterior surface of the patient’s thighs and OR bed surface? standard
80 degrees to 100 degrees
What is a modification of lithotomy that puts one of the patient’s legs up?
semi lithotomy
What angle is created between the posterior surface of the patient’s thighs and OR bed surface with low lithotomy?
40-60 degrees
What angle is created between the posterior surface of the patient’s thighs and OR bed surface with high lithotomy?
110-120
What angle is created between the posterior surface of the patient’s thighs and OR bed surface with exaggerated lithotomy?
130-150
What is another 2 words to describe semi-sitting?
semi fowler or beach chair
What is another word to describe sitting?
fowler
What procedures are done in the sitting and semi-sitting position?
- shoulder
- posterior cervical spine
- posterior or lateral head
How much do you want to flex the pt.’s knees in sitting/semi-sitting?
30 degrees to prevent stress on the sciatic nerve
What are the angle measurements for the pt. in trendelenburg?
patient’s feet are higher than the patient’s head by 15 degrees to 30 degrees
What procedures is trendelenburg used for?
- pelvic organ and low intestinal procedures
2. first line intervention in the treatment of acute hypotension and/or shock
What are the angle measurements for the pt. in reverse trendelenburg?
the pt.’s head is 15-30 degrees
What procedures is reverse trendelenburg used for?
head, neck, and upper abdominal procedures
Why is the surgical site elevated above the heart in reverse rendelenburg?
- to improve drainage of body fluids away from the surgical site
- reduce intracranial pressure
- decrease bleeding in the surgical field
What kind of procedures are performed in the lateral position?
- thoracotomy
- kidney surgery
- hip surgery
What positioning device and/or equipment is not used when placing a patient in the lateral position?
boot stirrup
Why do the feet need to be maintained in the prone position?
to prevent foot drop
Why do you want to pad the eyes and avoid pressure?
to prevent conjunctival edema, corneal abrasion, or retinal ischemia
How should you rotate the arms in prone? why?
rotate the arms slowly when placing them on arm boards to prevent brachial plexus injuries
What can improper positioning in the prone position do?
pressure on the inferior vena cava and femoral veins
What can pressure on the inferior vena cava and femoral veins do in prone?
can reduce venous return and produce hypotension
What can pressure on the carotid artery from the head being turned do in prone?
can produce hypotension and arrhythmias
In the prone position, what is the patient most vulnerable to?
to respiratory problems due to compression of the diaphragm, which impairs gas exchange
What can occur from the effects of body weight against the abdominal wall in the prone position?
increased airway pressure and difficulty in ventilation
What is the prone position used for?
back, rectum, and other dorsal areas
What is an example of a procedure with prone?
lumbar laminectomy
What kind of procedure is the jack-knife position used for?
hemorrhoidectomy and pilonidal sinus
What is a non-blanchable erythema of intact skin?
stage 1 pressure injury
What is a partial-thickness skin loss with exposed dermis
stage 2 pressure injury
What is full-thickness skin loss?
stage 3 pressure injury
What is full-thickness skin and tissue loss?
stage 4 pressure injury
what is obscured full-thickness skin and tissue loss?
unstageable pressure injury
What is persistent non-blanchable, deep red, maroon, or purple discoloration?
deep tissue pressure injury
What are 2 other pressure injuries that that do not fit into the stage 1,2,3, or 4 pressure categories?
- mucosal membrane pressure injury
2. medical device-related pressure injury
What is the result of opposing movement of skeletal structure and the skin. Perpendicular force causes this?
shear
Maceration can occur when the skin is exposed to what for prolonged time, causing the tissue to break down?
moisture
Exposure to this occurrence reduces peripheral circulation, reducing oxygen to the skin and tissues>
cold
Layers of materials, such as extra linen, adds rigidity and can produce high and inconsistent pressure?
negativity
What should happen with patients that are greater than 18 weeks pregnant?
placed in left lateral tilt, with a wedge placed under the right pelvis or lumbar region.
What is pressure injury risk assessment tool designed for surgical patients?
munro pressure ulcer risk assessment scale
Who is responsible for pt. positioning?
surgical team
To position a patient who is obese in the supine position, you should what?
use padded arm guards to contain the arms at the sides
When the patient is in the supine position with the arms at the sides, where should you tuck the draw sheet?
underneath the patient
Raising the patient’s legs into the lithotomy position shifts blood from the legs into the central circulation and…
increases cardiac output and venous return
What is a standardized, structured, perioperative nursing language that reflects the perioperative nursing process. It can be used as a method to gather, organize, and document perioperative nursing care to create and implement an individualized care plan for each perioperative patient.
Perioperative nursing data set
What is softened, separated, and wasted away as a result of moisture.9 A patient’s
skin can become macerated when it is in contact with blood, bodily fluids, and other fluids for a period of time?
macerated
What is a localized injury to the skin and/or underlying tissue
during an inpatient hospital stay and a result of pressure, shear, or both?
hospital-acquired pressure injury (HAPI)
What is a pediatric pressure injury risk assessment tool?
glamorgan scale
What is the 65 to 74 years of age?
the young-old
What is the 75 to 84 years of age?
the middle-old
What is the 85 to 99 years of age?
the old-old
What is the 100 years of age or more?
the elite-old
What is when the patient’s body is dragged across the bed linens instead of being lifted?
friction
If your BMI is 18.5 to less than 25 what is your classification?
normal weight range
If your BMI is 25 to less than 30 what is your classification?
overweight range
If your BMI is 30 or higher what is your classification?
obese range
If your BMI is less than 18.5?
underweight range
What is class 1 adult obesity?
BMI of 30kg/m2 to <35kg/m2 (obese)
What is class 2 adult obesity?
BMI of 35 kg/m2 to < 40 kg/m2 (obese)
What is class 3 adult obesity?
BMI of 40 kg/m2 or higher (extremely obese)
