Positioning & Draping

Question 1

What are the areas of greatest pressure for a patient lying in the prone position?

Answer 1

Forehead, lateral ear, tip of acromion process, patella, dorsum of foot, ridge of tibia

Question 2

What comfort procedures would be used to ensure patient comfort when lying prone?

Answer 2

• towel roll for forehead or have patient place face in hole on plinth (lined with pillowcase)
• pillow under stomach to avoid lower back pain
• wedge or roll under lower legs to reduce pressure to toes

Question 3

What are common areas of soft tissue contracture when lying prone?

Answer 3

Ankle plantar flexors, shoulder extensors/adductors/IR/ER, neck rotators

Question 4

What are the areas of greatest pressure when the patient is lying in the supine position?

Answer 4

Occipital tuberosity, spine/inferior angle of scapula, spinous processes of vertebrae, posterior iliac crests, sacrum, posterior calcaneus

Question 5

What procedures would be used to ensure patient comfort when lying in the supine position?

Answer 5

• pillow under head
• pillow under knees to relieve pressure from the pelvis on the lower back
• towel roll or small bolster under ankles the relieve pressure on calcaneus

Question 6

What are the common areas of soft tissue contracture when lying supine?

Answer 6

Hip & knee flexors, ankle plantar flexors, shoulder extensors/adductors/IR, hip external rotators

Question 7

What are the areas of greatest pressure when a patient is side-lying?

Answer 7

Lateral ear, lateral ribs, lateral acromion process, greater trochanter, lateral and medial condyles of femur, malleolus of fibula/tibia

Question 8

What procedures would be used to ensure patient comfort when side-lying?

Answer 8

• pillow under head
• pillow between knees to keep upper leg and hip parallel
• pillow for patient to hug to support the upper shoulder

Question 9

What are the most common areas of soft tissue contracture when side-lying?

Answer 9

Hip & knee flexors, hip adductors and internal rotators, shoulder adductors and internal rotators

Question 10

What are the greatest areas of pressure when a patient is seated upright?

Answer 10

Ischial tuberosities, posterior thighs, sacrum

Question 11

What procedures are used to ensure patient comfort when seated upright?

Answer 11

• stabilize chair (no rolling stools)
• provide lap pillow to support arms
• ensure feet are flat on floor or stool

Question 12

What are the most common areas of soft tissue contracture when a patient is seated upright?

Answer 12

Hip & knee flexors, hip abductors and internal rotators, shoulder adductors/extensors/IR

Question 13

What are preventative positions and in what situations do they apply?

Answer 13

Positions to avoid- situations requiring preventative positions include transfemoral/transtibial amputation, hemiplegia, rheumatoid arthritis, and burns/grafts

Question 14

What are the positions to avoid for a patient with a transfemoral amputation?

Answer 14

• prolonged hip flexion (do not elevate the residual limb in supine), 40 min/hr max in sitting
• hip abduction

Recommended position: prone with residual limb in neutral alignment

Question 15

What are the positions to avoid for a patient with a transtibial amputation?

Answer 15

-prolonged hip and knee flexion

Question 16

What are the positions to avoid for a patient with hemiplegia?

Answer 16

UE: prolonged shoulder adduction & internal rotation; elbow flexion; forearm supination or pronation; finger/thumb adduction; support the weight of the arm to prevent subluxation

LE: prolonged hip & knee flexion; hip external rotation; ankle plantar flexion & inversion

Head/trunk: support proper alignment in sitting and lying

Question 17

What are the positions to avoid for patients with rheumatoid arthritis?

Answer 17

Prolonged immobilization; joint flexion

Question 18

What are the positions to avoid for patients with burns/grafts?

Answer 18

Prolonged positioning; prolonged flexion/adduction of peripheral joints; positions of comfort

Question 19

Why should proper draping be used when treating a patient?

Answer 19

• provide modesty for the patient
• maintain appropriate body temperature during treatment
• provide access and exposure to areas to be treated while protecting other areas
• protect patient’s skin/clothing from being soiled or damaged