Positioning (Ericksen) Exam 2 Flashcards
Which of the following is a primary consideration for patient positioning in the operating room?
A) Ensuring the patient’s position is comfortable for the surgical team.
B) Using protective measures to maintain perfusion and protect pressure points and nerve plexus.
C) Allowing the patient to choose their preferred position.
D) Minimizing the use of positioning devices to reduce costs.
B) Using protective measures to maintain perfusion and protect pressure points and nerve plexus.
Pressure points must be padded
What is a critical aspect to consider regarding the time it takes for nerve damage and other injuries to occur during surgery?
A) These injuries are always reversible
B) It usually takes a long time for nerve damage to become significant.
C) Such injuries can occur quickly and may be irreversible.
D) Nerve damage is rare and usually not a concern.
C) Such injuries can occur quickly and may be irreversible.
How should the positioning process be approached for each patient?
A) Focus primarily on aligning the patient’s head and neck.
B) Use as few positioning devices as possible to minimize complexity.
C) Consider the entire body from head to toe, the devices needed, and the level of assistance required.
D) Rely solely on the surgical team’s preferences for positioning.
C) Consider the entire body from head to toe, the devices needed, and the level of assistance required.
When aligning a patient’s joints during positioning for surgery, under what condition might the usual alignment be intentionally altered?
A) When the patient’s comfort is prioritized over surgical access.
B) When aligning the joints conflicts with the surgical field requirements.
C) To accommodate for the use of additional monitoring equipment.
D) If the patient has pre-existing joint conditions that require special positioning.
B) When aligning the joints conflicts with the surgical field requirements.
Should be as natural as possible!
Safety belts or straps must be used in the ____________ area to secure the patient, in addition to securing the extremities.
A) Chest/abdomen
B) Abdominal/pelvic
C) Pelvic/chest
D) Chest/pelvic
B) Abdominal/pelvic
Avoid placing belts/straps too tightly
What is the most common surgical position used during procedures?
A) Lateral position
B) Supine position
C) Prone position
D) Trendelenburg position
B) Supine position
In the context of surgical positioning, what are the potential respiratory implications of the supine position?
A) Increased tidal volume and functional residual capacity (FRC).
B) Increased risk of respiratory alkalosis due to hyperventilation.
C) Enhanced oxygenation and improved respiratory function.
D) Decreased tidal volume and functional residual capacity (FRC).
D) Decreased tidal volume and functional residual capacity (FRC)
Which of the following correctly matches the pathophysiologic changes associated with the supine position?
A) Decreased venous return and increased tidal volume.
B) Increased preload and stroke volume, and decreased tidal volume.
C) Decreased stroke volume and increased functional residual capacity.
D) Increased preload, cardiac output and increased functional residual capacity.
B) Increased preload and stroke volume, and decreased tidal volume.
When positioning a patient’s arms during surgery, at what angle should the arms be placed relative to the body when abducted?
A) Greater than 90 degrees
B) Exactly 90 degrees
C) Less than 90 degrees
D) There is no specific angle requirement
C) Less than 90 degrees
What is the recommended position for a patient’s arms when they are placed on arm boards during surgery?
A) Prone (palms down)
B) Supine (palms up)
C) Neutral (palms facing each other)
D) Elevated above the head
B) Supine (palms up)
Arm boards used during surgery should be padded and securely attached to the table and to the patient at the __________.
A) Axilla
B) Shoulder
C) Elbow
D) Wrist
A) Axilla
It is important to pad the patient’s __________ to prevent pressure injuries when the arms are positioned on arm boards.
A) Fingers
B) Forearms
C) Wrists
D) Elbows
D) Elbows
When arms are positioned tucked alongside the body during surgery (adduction), how are they typically held in place?
A) With medical tape around the wrists.
B) By a draw sheet that goes under the body and over the arm.
C) Using heavy restraints fastened to the operating table.
D) By placing the arms in stirrups.
Answer: B) By a draw sheet that goes under the body and over the arm.
Adduction
In what position should the hands and forearms be placed when arms are tucked alongside the body?
A) Prone (palms down)
B) Supine (palms up) or neutral (palms toward body)
C) Just neutral (palms toward body)
D) Rotated outward (palms away from the body)
Answer: B) Supine (palms up) or neutral (palms toward body)
Elbows are padded!
Why might one arm be tucked alongside the body while the other is left free during a surgical procedure?
A) To accommodate the surgeon who may need to stand on one side of the patient.
B) To provide the anesthesiologist better access to intravenous lines.
C) To maintain asymmetry in patient positioning.
D) To enhance patient comfort during long procedures.
Answer: A) To accommodate the surgeon who may need to stand on one side of the patient.
What is the action of the arms in A and B?
A. Abduction (Away from the body)
B. Adduction (Towards the body)
What complication can occur due to prolonged pressure on the back of the head in the supine position?
A) Alopecia areata
B) Pressure alopecia
C) Trigeminal neuralgia
D) Occipital neuralgia
Answer: B) Pressure alopecia
Which nerve is at risk of injury if a patient’s arms are abducted more than 90 degrees in the supine position?
A) Radial nerve
B) Median nerve
C) Ulnar nerve
D) Brachial plexus
Answer: D) Brachial plexus
In the supine position, what can lead to an ulnar nerve injury?
A) Arms abducted less than 90 degrees
B) Hand/arm is in a pronated (palm down) position
C) Arms tucked alongside the body
D) Hand/arm is in a supinated (palm up) position
Answer: B) Hand/arm is in a pronated (palm down) position
What type of injury is most likely to occur when the neck is extended and the head is turned away in the supine position?
A) Carotid artery dissection
B) Cervical spine injury
C) Stretch injury to the brachial plexus
D) Thoracic outlet syndrome
Answer: C) Stretch injury to the brachial plexus
A patient in the supine position complains of back pain after a surgical procedure. Which of the following is the most likely cause?
A) Pressure on the lumbar spine
B) Compression of the sciatic nerve
C) Overextension of the legs
D) Pillows under the legs
Answer: A) Pressure on the lumbar spine due to inadequate support
“Loss of tone with the Paraspinal muscles – wake up with a back ache”
Which position is same as supine, but tilting the head of the patient down?
A)Trendelenburg
B) Supine
C) Reverse Trendelenburg
D) Prone
A) Trendelenburg
When positioning a patient trendelenburg, what is the primary reason for using a non-sliding mattress or pad?
A) To provide extra cushioning for the patient’s comfort
B) To ensure the patient does not slide cephalad
C) To elevate the patient’s legs for better circulation
D) To ensure the patient does not slide caudad
B) To ensure the patient does not slide cephalad
In the context of preventing a patient from sliding cephalad, which following tools should be avoided?
Pick 2
A) Non-sliding mattress
B) Shoulder braces
C) Foot braces
D) Bean bags
B) Shoulder braces
D) Bean bags
True/False
Making a mark at the level of the patient’s head on the sheet or pad can help determine if the patient has slid during a procedure.
True
What effect does the Trendelenburg position have on cardiac output (CO)?
A) Decreases CO
B) No effect on CO
C) Increases CO
D) Varies depending on the patient’s condition
Answer: C - Increases CO
Increased venous return from the lower extremities!!
How does the Trendelenburg position affect intracranial pressure (ICP) and intraocular pressure (IOP)?
A) Decreases ICP and IOP
B) Increases ICP and IOP
C) No change in ICP and IOP
D) Only increases ICP, not IOP
Answer: B - Increases ICP and IOP
Edema may develop in the face in Trendelenburg. Where else does this happen?
A) Tongue
B) Conjunctiva
C) Larynx
D) All of the above
D) All of the above
With increased surgical time and prescence of fluid overload.
What is a respiratory effect of the Trendelenburg position due to the cephalad shift of the diaphragm?
A) Increased Functional Residual Capacity (FRC) and pulmonary compliance
B) Decreased Functional Residual Capacity (FRC) and pulmonary compliance
C) No change in FRC or pulmonary compliance
D) Increased Functional Residual Capacity (FRC) and Decreased pulmonary compliance
Answer: B - Decreased Functional Residual Capacity (FRC) and pulmonary compliance
Why might patients in the Trendelenburg position require higher pressures during mechanical ventilation?
A) To prevent hyperventilation
B) To achieve adequate ventilation despite reduced lung volumes
C) To increase cardiac output
D) To avoid hypoxia due to increased pulmonary compliance
Answer: B - To achieve adequate ventilation despite reduced lung volumes
The Trendelenburg position can increase the risk of endobronchial intubation because the abdominal contents push the _______ cephalad.
A) Diaphragm
B) Larynx
C) Carina
D) Bronchioles
C) Carina
How is the Reverse Trendelenburg position different from the standard supine position?
A) The patient’s head is tilted downward.
B) The patient’s head is tilted upward.
C) The patient’s feet are elevated above the heart.
D) The patient is positioned on their side.
B) The patient’s head is tilted upward.
In addition to using a non-sliding mattress or pad, what else can be utilized to prevent the patient from sliding in the Reverse Trendelenburg position?
A) Non-skid socks
B) Duct tape
C) Using a footrest or something under the feet
D) Several tight abdominal/pelvic straps
Answer: C - Using a footrest or something under the feet.
How does the Reverse Trendelenburg position affect venous return and what risk does this pose?
A) It enhances venous return, reducing the risk of venous pooling and hypotension
B) It diminishes venous return, increasing the risk of hypotension due to venous pooling
C) It has no effect on venous return, posing no additional risks.
D) It compresses the inferior vena cava, leading to increased risk of venous pooling and hypotension
Answer: B - It diminishes venous return, increasing the risk of hypotension due to venous pooling in the lower extremities.
Why might the Reverse Trendelenburg position reduce perfusion to the brain?
A) It increases cerebral venous pressure.
B) It elevates the head above the heart, reducing arterial blood flow to the brain.
C) It causes blood to pool in the upper extremities, leading to hyperperfusion.
D) It compresses the carotid arteries, limiting blood flow to the brain.
Answer: B - It elevates the head above the heart, reducing arterial blood flow to the brain.
The Reverse Trendelenburg position results in a downward _______ of abdominal contents and the diaphragm.
A) compression
B) displacement
C) elevation
D) stabilization
B) displacement
Which position is commonly used in shoulder surgeries to minimize hip and leg flexion?
A) Supine position
B) Prone position
C) Jack knife position
D) Beach chair position
D) Beach chair position
Less severe hip flexion and slight leg flexion!!
What is the recommended angle for hip flexion and knee flexion in the beach chair position during surgery?
A) Hip flexed > 90 degrees, knees stabilized
B) Hip flexed > 90 degrees, knee slightly flexed
C) Hip flexed > 90 degrees, knee extended
D) Hip flexed < 90 degrees, knee slightly flexed
Answer: D) Hip flexed < 90 degrees, knee slightly flexed for balance
Reduce stretching of the sciatic nerve!!
How is the head stabilized in the sitting position? Select 2
A) Taped to special headrest
B) Non-skid gel pads
C) Rigid pins drilled into the skull
D) Bean bag
A) Taped to special headrest
C) Rigid pins
During surgery, the patient’s head is supported face down using a prone pillow, horseshoe headrest, or rigid fixation with pins in a neutral position without pressure on ____________. (Select 4)
A) Cheeks
B) Eyes
C) Nose
C) Forehead
D) Chin
E) Mouth
F) Ears
B) Eyes
C) Nose
E) Mouth
F) Ears
See no evil, hear no evil, speak no evil… and smell no evil..
Question 1:
Which of the following describes the lithotomy position?
A) Patient lying on their side with legs in candy cane stirrups
B) Patient lying supine with legs in padded stirrups
C) Patient sitting upright with legs crossed
D) Patient prone with arms and legs extended
B) Patient lying supine with legs in padded stirrups
What is the recommended range of hip flexion and leg abduction angles in the lithotomy position?
A) Hip flexed 45-60 degrees, legs abducted 30-90 degrees
B) Hip flexed 60- 100 degrees, legs abducted 30-45 degrees
C) Hip flexed 80-100 degrees, legs abducted 30-45 degrees
D) Hip flexed 30-60 degrees, legs abducted 30-60 degrees
Answer: C) Hip flexed 80-100 degrees, legs abducted 30-45 degrees
When lowering the foot of the bed in lithotomy position, what precaution should be taken regarding the patient’s hands and fingers?
A) Secure them with padded restraints
B) Keep them elevated above the head
C) Place them on soft cushions
D) Protect them from crush injury
Answer: D) Protect them from crush injury
** Ericken likes to pad the hands
In the lateral decubitus position, which side is considered the dependent side (non-operative) for surgical access?
A) The side facing upward
B) The side facing downward
C) The side with anterior support
D) Both sides equally
B) The side facing downward
Ex: RIGHT lateral decubitus = RIGHT side down
Which support is necessary for maintaining the lateral decubitus position during surgery?
A) Anterior rolls or bean bags
B) Posterior rolls or bean bags
C) No support is necessary
D) Anterior and posterior rolls or bean bags
D) Anterior and posterior rolls or bean bags
