Positioning (Pt Care Ch. 5)

Question 1

Precautions for positioning

Answer 1

• Avoid clothing or linen folds under pt
• Protect bony prominences from excessive and prolonged pressure
• Observe skin color over bony prominences before and after Tx
• Avoid positioning pt’s extremities beyond the support surface
• Avoid excessive or prolonged pressure on soft tissue, circulatory, and neurologic structures
• Used extra caution when positioning pt’s who are cognitively challenged, confused, comatose, very young, very old, paralyzed, or have decreased circulation or sensation.

Question 2

Positioning for transfemoral amputation

Answer 2

• Avoid prolonged hip flexion
• When supine, don’t elevate limb on pillow for more than a few minutes
• No sitting for >40min each hour
• Avoid hip abduction
• Keep pelvis level and trunk aligned
• When standing or recumbent, keep limb in extension
• Put them in prone periodically

Question 3

Positioning for transtibial amputation

Answer 3

• Avoid prolonged hip and knee flexion
• No sitting for >40 each hour
• When sitting, standing, or recumbent, hip and knee should be kept in extension

Question 4

Positioning for hemiplegia (CVA)

Answer 4

Upper Extremity:
- Avoid prolonged shoulder add and IR
- Avoid prolonged elbow flexion, supination, pronation, or wrist flexion
- Avoid prolonged flexion and adduction of the fingers and thumb (except you want tenodesis)
- Protect flaccid UE from distracting forces that can subluxate it

Lower Extremity:
- Avoid prolonged hip ER, and hip and knee flexion
- Avoid prolonged ankle plantarflexion and inversion
- Maintain normal alignment of pt’s head and trunk
- Exercise extremities several times a day, and do not stay in any one position for a long time

Question 5

Positioning for Rheumatoid Arthritis

Answer 5

• Avoid prolonged immobilization
• Protect bony prominences for pt immobile in bed
• Do not mess with joints in acute flare up
• Gentle, careful, and frequent movement (active or passive) should be performed several times a day
• Actively exercise uninvolved joints

Question 6

Positioning for split-thickness burns and grafted burn areas

Answer 6

• Avoid any prolonged positioning
• Avoid positions of comfort
• Avoid prolonged flexion or adduction of peripheral joint when wound is on flexor or adductor surface
• Keep moving with gentle, careful and frequent passive or active exercise

Question 7

Positioning for SCI

Answer 7

• Turn or reposition every 2 hours to prevent pressure sores on bony prominences
• Avoid overstretching, folding, shearing, or friction of the skin and soft tissues when repositioning or transferring
• 30° sidelying puts less pressure on the greater trochanters than regular sidelying
• When seated, redistribute weight and do arm pushup every 15 min

Question 8

Positioning for TKA

Answer 8

• Keep knee in ext with no pillow
• Neutral hip position
• Active assisted and active exercises
• Get pt out of bed ASAP

Question 9

Positioning for THA

Answer 9

• Avoid excessive add, IR, and flex
• Use adduction pillow
• Prevent hip flexion past 90°