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PCM Mid Term > Positioning and Draping > Flashcards

Positioning and Draping Flashcards

1
Q

What are goals for proper positioning?

A
  • Safety
  • Comfort
  • Access
  • Prevention/Promotion
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2
Q

What are we preventing and promoting with positioning?

A
  • Integumentary integrity
  • Musculoskeletal integrity
  • Neuromuscular integrity
  • Cardiovascular/ pulmonary integrity
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3
Q

What are we preventing in regards to the integumentary system with positioning?

A

Preventing the development of ulceration due to pressure or friction

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4
Q

What are we preventing in regards to the musculoskeletal system with positioning?

A

Preventing loss of ROM

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5
Q

What are we preventing in regards to the neuromuscular system with positioning?

A

Preventing peripheral nerve impingement due to pressure

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6
Q

What are we assisting in regards to the cardiovascular/ pulmonary system with positioning?

A

Using changes in positioning to assist in secretion elimination, breathing patterns, and vascular flow

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7
Q

What do we use long term positioning for?

A
  • Preventing pressure ulcers and contractures
  • Promoting better breathing positions
  • Promoting better access to environment
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8
Q

What do we use short term positioning for?

A
  • Allowing for treatment of different areas
  • Example: manual therapy, modalities application, etc
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9
Q

For long term positioning you want to reposition your patient every ____ ____, to do what?

A

2 hours; to maintain integrity of all 4 movement systems

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10
Q

For short term positioning you want to reposition your patient every _____ _____.

A

15 minutes

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11
Q

You need to pay special attention to skin in what areas?

A

Skin covering bony prominence
- if redness appears, allow it to resolve prior to positioning a patient over that area again

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12
Q

Prolonged redness is indicative of what?

A

Tissue damage

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13
Q

It is ideal that your patient maintains a _____ spinal alignment as much as possible.

A

Neutal

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14
Q

What is a way you can provide your patient with a way to call for help if needed?

A

Call light within reach

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15
Q

With long term positioning what are our objectives?

A
  • Prevention
  • Comfort
  • Safety
  • Access
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16
Q

What kind of prevention are we doing in long term positioning?

A
  • Prevent development of pressure injuries, contractures and edema
  • Promote efficient function of bodily systems
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17
Q

What kind of comfort are we looking to provide with long term positioning?

A
  • Good spinal alignment and cushioning
  • Relieve stress on joints
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18
Q

What kind of safety do we want to address with long term positioning?

A
  • Open airways
  • Avoid falls
  • Accommodate medical limitations
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19
Q

What kind of access are we providing with long term positioning?

A
  • Access to the environment
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20
Q

When in supine where are the greatest areas of pressure?

A
  • Occipital tuberosity
  • Spinous Processes of the vertebrae
  • Inferior angle of scapulae
  • Olecranon process
  • Posterior iliac crests
  • Sacrum
  • Posterior calcaneus (heels)
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21
Q

When in prone where are the greatest areas of pressure?

A
  • Forehead or lateral ear
  • Tip of the acromion process
  • Anterior humeral head
  • Sternum
  • ASIS
  • Patella
  • Tibial crest
  • Dorsum of the foot
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22
Q

When in side-lying where are the greatest areas of pressure?

A
  • 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
23
Q

When sitting where are the greatest areas of pressure?

A
  • Ischial tuberosities
  • Posterior thigh
  • Sacrum
  • Spinous processes or vertebrae
  • Medial epicondyles and olecranons (if resting on hard surfaces like arm rests of lap table)
24
Q

There are many things that can lead to increased susceptibility to pressure injuries. Name some of these things.

A
  • 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
25
Q

What is the skin blanching test?

A

When pressed, healthy, lighter colored skin will blanche and quickly return to healthy pink

26
Q

If skin does not blanche what does this indicate?

A

Compromised/ damaged tissue
* do not position patient with pressure on a compromised area

27
Q

Who is at risk for skin break down?

A

Patients with increased pigmentation
*be intentional in your skin screening as to not miss this

28
Q

_____ surface area , _____ load = increased pressure

A

decreased surface area ; increased load

29
Q

_____ cushioning, _____ load = increased pressure

A

decreased cushioning; increased load

30
Q

_____ load over time, _____ period of time —> injury

A

increased load over time; decreased period of time

31
Q

_____ load over a _____ period of time —> skin breakdown

A

decreased load over a increased period of time

32
Q

How can we prevent pressure injuries?

A
  • Limit direct contact with bony landmarks
  • Increase surface area
  • Increase cushioning
  • Decrease load
  • Decrease time
33
Q

What kinds of contractures are most common?

A

Flexion contractures

34
Q

What are some clinical considerations for ankle plantar flexion contractures?

A

Prevented or minimized with braces, splints, weight bearing and footwear

35
Q

What are some clinical considerations for hip and knee flexion contractures?

A
  • 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
36
Q

What are some clinical considerations for hip external rotation contractures?

A

External rotation is the “open” position of the hip joint and is the preferred position if the patient is weak

37
Q

What are some clinical considerations for cervical spine flexion contractures?

A
  • 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
38
Q

What are some clinical considerations for wrist flexion contractures?

A
  • Increased spasticity of muscles from neurological disease or injury or general disuse
  • Generally, accompanies finger and thumb flexion contractures
39
Q

How can you prevent edema and cardiopulmonary complications?

A
  • 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
40
Q

T/F - Patients using positioning devices must still be frequently repositioned and monitored?

A

True

41
Q

Why are positioning devices used?

A
  • Reduce or eliminate load on the tissues
  • Help patient maintain a static position
42
Q

What is friction?

A

force of rubbing two surfaces against each other

43
Q

What is shearing?

A

Friction + Gravity

44
Q

Summary Table for Short Term Positioning

A

Slide 40 … too much to type

45
Q

What do you want to prioritize with short term positioning?

A

Safety, Comfort, and Access

46
Q

What do you want to prioritize with long term positioning?

A

Safety, Prevention, Comfort

47
Q

Why do we drape?

A
  • Maximize patient comfort and dignity
  • Respect culture
  • Potential history of trauma
  • Position-Specific draping
    *using linens or towels
48
Q

What are the principles of draping?

A
  • 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
49
Q

When exposure of the body is required for examination or intervention, members of some cultures may…

A
  • 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
50
Q

Exposure may trigger intense emotional reactions at what time during your exam?

A

At any time during patient interaction

51
Q

For patients that have survived abuse or trauma, it is best to implement…

A
  • good communication
  • informed consent
  • respect for boundaries
  • active patient involvement
  • monitoring for signs of discomfort throughout the session
52
Q

Gowns are typically open in the back so its is best to put a second gown where?

A

On like a robe (apply a second gown opening to the front as a cover)

53
Q

How many areas should you expose at one time?

A

One

PCM Mid Term (6 decks)

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