Positioning and Draping Flashcards
What are goals for proper positioning?
- Safety
- Comfort
- Access
- Prevention/Promotion
What are we preventing and promoting with positioning?
- Integumentary integrity
- Musculoskeletal integrity
- Neuromuscular integrity
- Cardiovascular/ pulmonary integrity
What are we preventing in regards to the integumentary system with positioning?
Preventing the development of ulceration due to pressure or friction
What are we preventing in regards to the musculoskeletal system with positioning?
Preventing loss of ROM
What are we preventing in regards to the neuromuscular system with positioning?
Preventing peripheral nerve impingement due to pressure
What are we assisting in regards to the cardiovascular/ pulmonary system with positioning?
Using changes in positioning to assist in secretion elimination, breathing patterns, and vascular flow
What do we use long term positioning for?
- Preventing pressure ulcers and contractures
- Promoting better breathing positions
- Promoting better access to environment
What do we use short term positioning for?
- Allowing for treatment of different areas
- Example: manual therapy, modalities application, etc
For long term positioning you want to reposition your patient every ____ ____, to do what?
2 hours; to maintain integrity of all 4 movement systems
For short term positioning you want to reposition your patient every _____ _____.
15 minutes
You need to pay special attention to skin in what areas?
Skin covering bony prominence
- if redness appears, allow it to resolve prior to positioning a patient over that area again
Prolonged redness is indicative of what?
Tissue damage
It is ideal that your patient maintains a _____ spinal alignment as much as possible.
Neutal
What is a way you can provide your patient with a way to call for help if needed?
Call light within reach
With long term positioning what are our objectives?
- Prevention
- Comfort
- Safety
- Access
What kind of prevention are we doing in long term positioning?
- Prevent development of pressure injuries, contractures and edema
- Promote efficient function of bodily systems
What kind of comfort are we looking to provide with long term positioning?
- Good spinal alignment and cushioning
- Relieve stress on joints
What kind of safety do we want to address with long term positioning?
- Open airways
- Avoid falls
- Accommodate medical limitations
What kind of access are we providing with long term positioning?
- Access to the environment
When in supine where are the greatest areas of pressure?
- Occipital tuberosity
- Spinous Processes of the vertebrae
- Inferior angle of scapulae
- Olecranon process
- Posterior iliac crests
- Sacrum
- Posterior calcaneus (heels)
When in prone where are the greatest areas of pressure?
- Forehead or lateral ear
- Tip of the acromion process
- Anterior humeral head
- Sternum
- ASIS
- Patella
- Tibial crest
- Dorsum of the foot
When in side-lying where are the greatest areas of pressure?
- Lateral ear
- Lateral ribs
- Lateral acromion process
- Lateral humeral head
- Medial or lateral epicondyles of the humerus
- Greater trochanter of the femur
- Medial and lateral condyles of the femur
- Medial and lateral malleolus
When sitting where are the greatest areas of pressure?
- Ischial tuberosities
- Posterior thigh
- Sacrum
- Spinous processes or vertebrae
- Medial epicondyles and olecranons (if resting on hard surfaces like arm rests of lap table)
There are many things that can lead to increased susceptibility to pressure injuries. Name some of these things.
- Decreased mobility
- Fragile skin
- Incontinence
- Impaired sensation
- Impaired circulation
- Cachexia
- Muscle atrophy
- Postural impairments
- Nutritional deficiencies
- Impaired cognition
- Medication that affects mobility or awareness
- Friction or shear
What is the skin blanching test?
When pressed, healthy, lighter colored skin will blanche and quickly return to healthy pink
If skin does not blanche what does this indicate?
Compromised/ damaged tissue
* do not position patient with pressure on a compromised area
Who is at risk for skin break down?
Patients with increased pigmentation
*be intentional in your skin screening as to not miss this
_____ surface area , _____ load = increased pressure
decreased surface area ; increased load
_____ cushioning, _____ load = increased pressure
decreased cushioning; increased load
_____ load over time, _____ period of time —> injury
increased load over time; decreased period of time
_____ load over a _____ period of time —> skin breakdown
decreased load over a increased period of time
How can we prevent pressure injuries?
- Limit direct contact with bony landmarks
- Increase surface area
- Increase cushioning
- Decrease load
- Decrease time
What kinds of contractures are most common?
Flexion contractures
What are some clinical considerations for ankle plantar flexion contractures?
Prevented or minimized with braces, splints, weight bearing and footwear
What are some clinical considerations for hip and knee flexion contractures?
- Watch for prolonged positioning with pillows under the knees and if legs of bed are raised
- Certain neurological conditions will cause the hip and knee to pull into flexion when at rest
What are some clinical considerations for hip external rotation contractures?
External rotation is the “open” position of the hip joint and is the preferred position if the patient is weak
What are some clinical considerations for cervical spine flexion contractures?
- Patients are at risk for cervical flexion contractures when positioned with too many pillows or with HOB > 30 degrees for extended periods
- Higher risk for patients with swallowing restrictions or dysfunction, cardiac conditions, lung conditions because they cannot safely lie flat
What are some clinical considerations for wrist flexion contractures?
- Increased spasticity of muscles from neurological disease or injury or general disuse
- Generally, accompanies finger and thumb flexion contractures
How can you prevent edema and cardiopulmonary complications?
- Position extremities at or above the level of the heart
- Vary demand of the heart by including more upright positioning
- Vary positions to promote lung drainage
T/F - Patients using positioning devices must still be frequently repositioned and monitored?
True
Why are positioning devices used?
- Reduce or eliminate load on the tissues
- Help patient maintain a static position
What is friction?
force of rubbing two surfaces against each other
What is shearing?
Friction + Gravity
Summary Table for Short Term Positioning
Slide 40 … too much to type
What do you want to prioritize with short term positioning?
Safety, Comfort, and Access
What do you want to prioritize with long term positioning?
Safety, Prevention, Comfort
Why do we drape?
- Maximize patient comfort and dignity
- Respect culture
- Potential history of trauma
- Position-Specific draping
*using linens or towels
What are the principles of draping?
- Use clean linen
- Expose only areas to be examined or treated
- Avoid exposing sensitive areas
- Remove or reduce folds and wrinkles
- Instruct patient on the position required and draping to use
- Ensure patient comfort/ warmth
- Protect patient’s clothing
When exposure of the body is required for examination or intervention, members of some cultures may…
- prefer a same gender health care provider
- be embarrassed when dressed in a hospital gown
- not want to wear attire previously worn by others
- have certain items of clothing that are not to be removed
Exposure may trigger intense emotional reactions at what time during your exam?
At any time during patient interaction
For patients that have survived abuse or trauma, it is best to implement…
- good communication
- informed consent
- respect for boundaries
- active patient involvement
- monitoring for signs of discomfort throughout the session
Gowns are typically open in the back so its is best to put a second gown where?
On like a robe (apply a second gown opening to the front as a cover)
How many areas should you expose at one time?
One
