Positioning (Exam 2)

Question 1

What is part of standard 8: Patient positioning

Answer 1

• collaborate with team, assess, monitor proper body alignment
• use protective measures to mainain perfusion and protect pressure points and nerve plexus

Question 2

What effects does supine positioning have on CV/respiratory physiology?

Answer 2

• Increase VR, increase preload, stroke volume and CO
• Decreased Vt and FRC

Question 3

What complications can occur due to supine positioning

Answer 3

• backache
• pressure alopecia
• brachial plexus or axillary nerve injury if arms abducted >90
• ulnar nerve injury if palms are pronated (facing down)
• stretch injury when neck is simultaneously extended and turned to the side (brachial plexus)

Question 4

When positioning patient with tucked arms (adduction) palms should face what directions?

Answer 4

Neutral (towards body) or prone

Question 5

Where is your head during Trendelenburgh

Answer 5

DOWNNNNNN

Question 6

What positioning devices/considerations should you consider with T-burg?

Answer 6

• Non-sliding mattress
• avoid should braces/bean bags
• Mark patients head position at beginning to help monitor any sliding

Question 7

Shoulder braces during T-burg pose what risk to the patient?

Answer 7

compression injury of the brachial plexus

Question 8

How much can cardiac output increase 1 minute into Tburg positioning?

Answer 8

~ 9%

Question 9

T-burg positioning is contraindicated for what patients?

Answer 9

Patients with increased ICP

Question 10

What negative post-op complications arise due to t-burg positioning

Answer 10

• post-op vision loss
• edema of face, conjunctiva, larynx, tongue
• increased intrabdominal pressure (aspiration)
• decreased FRC /compliance
• main stem intubation d/t shifting of everything cephalad
• brachial plexus and ulnar nerve injury also possible d/t supine position

Question 11

Patients with kyphosis, scoliosis, or a hx of back pain may benefit from what positioning inverentions

Answer 11

extra padding/ slight flexion at the hip and knee.

Question 12

What’s more common ulnar nueropathy or brachial plexus injuries?

Answer 12

Brachial plexus is more common in recent claims data

Question 13

A patient in reverse T-burg’s head will be above or below the feet

Answer 13

Head ABOVE feet

Question 14

Safety considerations for reverse trendelenburg

Answer 14

pad feet, foot rest, non-sliding mattress

Question 15

Pathophysiology of reverse trendelenburg

Answer 15

hypotension, venous pooling, decreased brain perfusion

Question 16

A patient is in reverse T-burg, where should you level/zero your arterial line?

Answer 16

circle of willis

Question 17

When in the sitting (beach chair) position how many finger breadths should be maintained between the chin and sternum

Answer 17

2 fingers