Positioning Flashcards
Short Term Positioning
Interventions/exercises
30 minutes
Long Term
- 2-3 hours
- Preventing pressure injuries
- Preventing contractures
- Preventing cardiopulmonary complications
Positioning for specific conditions
Total hip arthroplasty
CVA with hemiplegia
LE amputation
Short Term Positioning Objectives
- Safety -protect vulnerable body parts without creating additional safety hazards
- Comfort -Maintain normal spinal alignment as much as possible and position extremities comfortably
- Access -position patient so that the appropriate intervention can be performed
Short Term: Supine
Short Term Prone
Short Term Sidelying
Could also add a pillow between the knees
Alternate Short Term Sidelying
Short Term Sitting
More than 90 degrees of flexion takes a lot of pressure off the back.
90/90/90; Back can have a little more flexion
Short Term Sitting Alternate
Use a chair with a back NOT wheels.
Long term positioning objectives
- Safety—open airways, avoid falls, accommodate medical limitations
- Comfort—good spinal alignment, cushioning, relieve stress on joints
- Prevention—prevent development of pressureinjuries, contractures, and edema; promoteefficient function of bodily systems
When lying down can only use anterior lungs due lying down
30 minutes to 2 hours
Negative Effects of Immobility: Integumentary
Poor circulation
Pressure Ulcers
Negative Effects of Immobility: Musculoskeletal
Atophy of muscle
Decreased ROM (Muscle development and muscle contracture)
Decreased BMD
Negative Effects of Immobility: Cardiopulmonary
Can’t recruit proper mechanisms
DVT risk
Decreased endurance
Negative Effects of Immobility: Neurological
Peripheral Neuropathy
Takes longer time to learn motor tasks with less movement
Negative Effects of Immobility: Behavorial
Depression
Helplessness
Lack of socialization
Fear of movement
High Fowler’s Position
Typically the position of comfort for patients in hospital beds—can increase shearing forces and promote contractures.
Trendelenburg Position
Facilitates circulation
Gravity can help move a patient
Utilized in abdominal surgeries and at times, following lower extremity surgeries
Trendelenburg Position
Facilitates circulation
Gravity can help move a patient
Increased Susceptibility to Pressure Injuries
- Decreased mobility
- Fragile skin
- History of skin breakdown
- Incontinence
- Impaired sensation
- Impaired circulation
- Cachexia (condition of severe weight loss including muscle wasting)
- Muscle atrophy
- Postural impairment
- Friction or shear
- Nutritionaldeficiencies
- Impaired cognition
- Medication that affectsmobility or awareness
Preventing Pressure Injuries
- Maximum of 2 hours in one position in bed
- Maximum of 15 minutes in one position in sitting
- Reposition more frequently if patient has increased risk factors.
Braden Scale for Predicting Pressure Sore Risk Considerations:
- Sensory Perception
- Presence of Moisture
- Patient Activity Level
- Patient Mobility Level
- Nutrition
- Friction and Shear Forces
Braden Sclae for Predicting Pressure Sore Risk Score
High score = lower risk
Lower score = higher risk
Pressure Injuries Checking for Skin Damage: Skin Blanching Test
- Using 1-2 fingers, press gently on the skin area in question and quickly release
- When pressed, healthy lighter-colored skin will blanche and quickly return to healthy pink.
- If the skin does not blanche, it indicates compromised tissue.
- Darker colored skin may not change colors as well
- Do not position a patient with pressure on a compromised area - “redness rule”
Preventing Edema and Cardiopulmonary Complications
- Position distal extremities at or above the level of the heart.
- Vary demand on the heart by including more upright positioning.
- Vary positions to promote lung drainage.
Proning patients promotes lung drainage
High Risk Areas for Pressure Injuries: Supine/Prone
Heels and sacrum especially at risk
Sidelying pay attention to:
Medial aspect of knees and ankles
Positioning Devices
- Positioning devices are designed to reduce or eliminate load, or to help patients maintain static stability.
- Left to Right > multi-podus boot > Heel protector > UE support splint
Preventing Contractures
- Flexion contractures tend to be most common.
- May need to avoid positions of comfort.
- Reposition frequently.
Long Term Positioning: Supine
Note heel protection, pillow under arm, towels under legs.
LTP on left; STP on right
Long Term Positioning: Sidelying
- Full prone is rarely used
- More commonly modified sidelying, either ¾ supine or ¾ prone.
- When positioning a patient in prone or semi-prone, ensure a clear airway and the patient’s ability to call for help.
Prone Positioing
Beneficial for ARDS (Acute Respiratory Distress Syndrome)
Long Term Positioning: Sitting
- Increase frequency of repositioing
- May require small lumbar roll
- Approximate 90°-90°-90° position (90° hip flexion, 90° knee flexion, and neutral ankle)
- Avoid sacral sitting
- Support arms
As is the pelvis, so goes the head
Move the sacrum to allow the head to align
Restraints
- Only do one limb at a time
- Check length
- IF A PATIENT CAN DO IT THEMSELVES IT IS NOT A RESTRAINT
- One rail must be down or is considered a restraint
Positioning After a Total Hip Arthroplasty Posterolateral Approach
- Avoid hip flexion beyond 90 degrees
- Avoid hip adduction past 0
- Avoid hip internal rotation past 0
Can’t cross leg, put sock on, reaching toward the ground, reaching and rotation of the UE. Need to move feet and body together. No twist, cross or bend. Getting out of chair or toilet, cannot do nose over toes.
Positioning after a CVA with hemiparesis
- Prevent contractures
- Prevent wrist and hand edema
- Avoid distraction of the hemiplegic shoulder
Supporting the involved arm and hand reduces tension on the shoulder joint and minimizes edema in the wrist and hand.
CVA and subluxation
Because the shoulder joint is stabilized primarily by muscle activity, hemiplegia can put the affected shoulder at increased risk for subluxation.
CVA with hemiparesis - common contracture patterns - UE and LE
Upper extremity
* Scapular retraction
* Shoulder adduction, flexion, and internal rotation
* Elbow, wrist, and finger flexion
Lower Extremity
* Hip adduction, flexion, and internal rotation
* Knee flexion
* Ankle plantarflexion
Make sure to have patients have arms stretched out sometimes.
CVA Supine Positioning
CVA Sidelying position
LE Amputatioon Positioning: DO
- Keep the hips in neutral rotation.
- Extend the knee.
- Minimize sitting time with the knee flexed.
- Avoid pressure on non-healed surgical sites.
LE Amputation Posititoning: DON’TS
- 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. (Due to pelvic position we want to keep it neutral)
- Allow the patient to lie with the knees flexed.
- Allow the patient to cross legs.
Positioning after an LE Amputation
Prone can also be very good to help in preventing hip and knee flexion contractures.
A braden scale of ____ is considered “at-risk” status
18 or less
