Principles of Positioning & Bed Mobility: Exam 1

Question 1

Goals of pt. positioning:

Short Term

Answer 1

• Pt safety
  
  • prevent skin breakdown
  • prone lying for sacral wounds
    
    • unsafe if pt cannot clear airway
    • ask yourself if proposed pos sturdy or pose fall risks?
• Pt comfort
• therapist access

Question 2

Tips for positioning:

use for skills check!!!

Answer 2

• explain everything to pt
• Have pt participate as much as possible!!!
• approx. norm pos as much as poss
• body mechanics!!!
• avoid press to high risk areas
  
  • bony proms
  • support and protect circumferentially
  • support/pos. aids
• maintain pt ortho precautions
• always pos. pt w/ call bell w/in reach

Question 3

Positioning in Supine

Answer 3

• center bed/mat
• normal spinal curve
  
  • pillows to DEC inc’d lumbar lordosis
• UE along side body or on abdomen
• utilize pillows!!
  
  • under legs, under head

Question 4

Positioning in Prone

Answer 4

• center bed/mat
• typ. spinal curves
• pillows under abdomen—dec lordosis
  
  • under lower limbs to dec press on toes

Question 5

Position in Sidelying

Answer 5

• center bed/mat
• pillows to support C/S, UE, lower legs

Question 6

Positioning in Sitting

Answer 6

• hips centered AND all way back against chair support
• support norm spinal curves
  
  • lumbar support roll
• LEs–> 90/90
• UEs–> fully supported by arm rests or pts lap

Question 7

Fowler’s

Answer 7

semi reclined w/ knees somewhat flexed

HOB elevated 45-60deg

used post-abdominal sx

Question 8

Trendelenberg Position

Answer 8

supine w/ HOB LOWER than FOOT of bed

**used during abdominal sx

*historically used to INC BP

not typ used for PT

Question 9

Long Term positioning GOALS

Answer 9

• pts w/ cond’s predisposing them to immob will req more prolonged pos solutions
  
  • GOALS:
    
    • safety
    • prevention
      
      • pres injuries
      • contractures
      • edema/CV comps
        
        • DVT==red, swollen, hot, painful limb
    • pt comfort

Question 10

Supine Tasks (3)

Answer 10

1. hooklying
2. bridging
3. scooting

Question 11

Supine tasks:

Hooklying

Answer 11

pos. w/ hips and knees flexed while in supine

Question 12

Supine tasks:

Bridging

Answer 12

pos. allowing pt to lift hips and lower back

Question 13

Supine tasks

Scooting

mvmts done in segments

Answer 13

• side to side in bed
  
  • ​bridge, push down w/ elbows and feet, lift body/hips and scoot over, neck flexed
• towards HOB
  
  • ​bridge, push down w/ elbows and feet, lift body/hips and push UP
• towards foot of bed
  
  • ​bridge, pull trunk DOWN towards foot of bed w/ feet as elbows dig into bed

Question 14

WHY is Rolling important?

Answer 14

• change pos’s
• pre-req for OOB acts
• used for self-care
• initial mobility AND inc’s strength and endurance of core mm’s and joints
• motor function/control
• enhance sensory integration
• promotes pressure relief

Question 15

Rolling Technique

Guarding/Assist pt

ALWAYS roll pt towards…

Answer 15

YOU!!!

Question 16

Rolling Technique

Guarding/Assist pt

Manual contacts thru where?

Answer 16

pts hips and shoulders

*avoid “grabbing”—> use open and wide spread fingers during hands on assist

Flex LEs, scoot bottom to side OPP role, let legs drop to side

Question 17

Tips to facilitate Rolling

Answer 17

• FLEX head/neck while looking in direction of roll
• cross ankles
• Enlist help of UEs
  
  • ​get the patient to HELP YOU AS MUCH AS YOU CAN!!!
• Utilize momentum

Question 18

Rolling:

Does direction matter?

TEACH BOTH!!!

Answer 18

• Turning to affected side
  
  • ​improves proprioception and body awareness thru wt. bearing
    
    • forced use neglected side
  • can use unaffected arm to push UP w/ and to reach for bed rail
• turning toward unaffected side forces affected side to MOVE and be USED

Question 19

Tech. for Transitioning to sitting

Answer 19

MANY!!!

• depends on pt preference & poss precautions preventing one way over another
• Log roll
  
  • use to sit thru sidelying
• supine to sit through “sit-up” method
  
  • NOT rec’d for:
    
    • post op abd. sx
    • cardiac inpts
      
      • incisions & Valsalve pot.

Question 20

NO SHORT SITTING POS FOR THA!!!

Answer 20

Contraindicated

NO flex hip past 90deg

NO IR

NO ADD .

Question 21

Pts req’ing assist for mobility

Answer 21

*remember ortho precautions

*mobility aids

*enlist help if/when needed

*protect skin! Avoid shearing forces!

Question 22

Pts req assist

Gen. Technique

Answer 22

• FOR PATIENTS:
  
  • rolling to either side
    
    • flex unaffected hip/knee and scoop affected leg on top in crossed leg pos.
    • have pt grasp affected arm out in front of pt and pull across body
    • if rolling towards involved side, can grasp side rail of bed w/ uninvolved hand

Question 23

Supine to sitting

Answer 23

Scoop and Turn

• pt in hooklying, roll pt on side using shoulder and hips for key points
• scoop pt under shoulder and knees
• use LEs as counter-wts (momentum)
• bring to sitting

Question 24

Supine to Sitting for THA

Remember the THA precautions!!!

Answer 24

YOU CAN ONLY DO SQUAT PIVOT TRANSFER!!!

have them use there UEs to help you but NO flexion @ hips or ADD or IR for posterolat. approach

Spinal Precautions you can only do log roll, and stand pivot also!!!!

Question 25

guarding/assist pt

Answer 25

Short-sitting EOB:

• front of pt
• hands near pts shoulders and/or hips to prevent falls/lose balance
  
  • NEVER LET GO OF YOUR PATIENT!!!
• feet on floor/stool—more supportive pt encouraged FIRST!!!