S2_L1: Proper Positioning, Turning, & Draping Flashcards
It is the reduced functional capacity of body system or systems. It warrants treatment as a separate entity from the disease itself.
Deconditioning
Pressure ulcer / sore grading for erythema and the skin is intact and does not blanch with pressure.
Grade 1
Pressure ulcer / sore grading for superficial ulceration that extends to the dermis. The ulcer appears moist and pink with no necrotic tissue. There is skin loss and a partial thickness wound albeit superficial.
Grade 2
Pressure ulcer / sore grading for the ulcer advances to subcutaneous tissue. There is a full thickness wound which may be deep and necrotic tissue might be present. Tunneling or undermining is also present.
Grade 3
Pressure ulcer / sore grading for the ulcer affecting muscle, it extends up to the fascia or the muscle tissue.
Grade 4
Pressure ulcer / sore grading for extensive ulcer with extensions into bursa of joints / body cavities.
Grade 5
Determine the corresponding classification of the predisposing factors to skin breakdown
- Skin condition
- Friction or shear forces on skin
- General health status
- Active infection on the area
- Adequate blood flow to wound
- Reduced activity leading to immobility
A. Extrinsic factor
B. Intrinsic factor
- B
- A
- B
- A
- B
- A
Determine the corresponding classification of the predisposing factors to skin breakdown
- Skin maceration due to perspiration or skin
to skin contact - Location of wound
- Pressure to soft tissue exceeding normal
capillary pressure of local circulation - Nutrition status
- Body build & composition
A. Extrinsic factor
B. Intrinsic factor
- A
- B
- A
- B
- B
TRUE OR FALSE: Pressure / bed sores occur when the external pressure is greater than the capillary pressure. This results in occlusion (blockage) of blood flow, leading to ischemia, and necrosis.
True
TRUE OR FALSE: Redistribution of body fluids is an effect of immobilization.
True
It is the arrangement of body parts in relation to one another. A technique of placing the patient safely, comfortably, and effectively in preparation for any procedure.
Positioning
Adaptive shortening or tightening of the skin, muscle, fascia, or joint capsule that cross a joint resulting in LOM which prevents normal movement or flexibility of the involved structure.
Contracture
Enumerate the 3 factors that affect contracture formation
- Duration of immobilization
- Limb position
- Mobilization of joint
Muscles may shrink to ___% its original size in 2 months
50
Type __ muscle fibers are more subject to
immobilization atrophy.
I
Decreased bone tissue (bone mass) per unit volume (bone density) of anatomical bone that occurs due to immobilization. The decrease in bone mass is accompanied by a decrease in mineral content.
Immobilization osteoporosis
This law explains bone morphology and density are dependent upon the forces that act on the bone. When patient is immobilized, stresses on the bone is clearly decreased due to lack of activity.
Wolff’s Law
The impaired ability of the circulatory system to adjust to the upright position. Occurs due to decreased venous return from LE, decreased filling of the LV, decreased cardiac output, leading to decreased cerebral perfusion and dizziness or syncope / fainting spells.
Postural / orthostatic hypotension
Additional: Adaptation to upright posture is completely lost after 3 weeks of being bedridden. Retraining would take around 20-72 days.
Determine whether the following is true regarding the signs and symptoms of orthostatic hypotension
- Increased pulse rate (> 20 bpm) from
baseline - Increased pulse pressure
- Tingling, burning in the LE
- Increased systolic BP (> 20 mmHg) from
baseline - Pallor, unhealthy, pale appearance
- Sweating, light-headedness, dizziness, fainting, vertigo
A. True
B. False
- A
- B
- A
- B
- A
- A
A thrombus is a clot in big veins. The ___ veins are the most common site of a thrombus due to decreased muscle pumping.
Calf
A traveling thrombus in the venous circulation
Embolus
An effect of immobilization is reduced cardiac efficiency, where HR progressively increases by 0.5 bpm/day; 12-13 bpm in 10 days. This increase is known as?
Immobilization tachycardia
A decrease in plasma volume results to ___ RBC and increased blood viscosity, leading to thrombus formation.
greater / more
Medical term for lung collapse
Atelectasis
TRUE OR FALSE: Voiding is difficult in the supine position.
True
Gravity plays an important role in kidney drainage
TRUE OR FALSE: Sensory deprivation is a silent hazard of prolonged bed rest, where
intelligence is compromised, emotional lability and anxiety occurs, and there is impaired balance and coordination d/t altered neural control.
True
Positioning equipment that promotes positioning of the ankle in neutral and
prevents contracture in plantar flexion.
Foot board
Positioning equipment that the patient holds onto this when turning. When in a static position, this prevents patients from falling.
Side rails
Positioning equipment that gives an equal distribution of body weight, thus countering development of pressure ulcers.
Mattress (Air)
In positioning and turning to a new position, it is important to check the patient’s skin after ___ to note signs of undue pressure.
5-10 mins
TRUE OR FALSE: In guidelines for positioning and turning, the patient must be lifted rather than dragged.
True
In guidelines for positioning and turning, the patient must be repositioned at least every ___ to avoid development of erythema on bony prominences.
2 hours
In the supine position, avoid excessive neck and upper back flexion or scapular ___.
abduction
For patients with burns on the ventral area, it is better to place them in a/an ___ position to properly expose areas that are to be treated.
extended
TRUE OR FALSE: In the supine position, PTs place a stress ball on patient’s hands when leaving a patient with UE synergies and/or under an unconscious state to prevent tightness and contracture of the muscles and joints of the wrist and hand.
True
For stroke patients, PTs place a ___ at the sole of their feet to prevent the shortening of the
Achilles tendon and to conserve the sensory
mechanisms of the feet.
footrest / foot board
In the prone position, a rolled towel is placed under each ___ to adduct the scapula.
anterior shoulder
In the prone position, a pillow is placed underneath the abdomen to reduce lumbar ___.
lordosis
In the prone position, a small pillow is placed underneath the ankles of the patient for a short period only, to relieve the tension / pressure on their ___ muscles
hamstring
In the side-lying position, the uppermost LE should be supported on pillows and
positioned slightly ___ of the lowermost extremity.
forward
A patient should not be positioned for more than ___.
30 mins
After positioning the patient, check after 30 minutes for any signs of unnecessary pressure over bony prominences
TRUE OR FALSE: As a precautionary measure, observe the patient’s skin color only during and after the treatment.
False
This should be done before, during, and after treatment
TRUE OR FALSE: The presence of clothing or linen folds beneath patient may cause undue pressure on skin or bony
prominence.
True
For patients who underwent transfemoral amputation (AKA), what 2 hip positions should be avoided?
prolonged hip flexion and hip abduction
For patients who underwent transtibial amputation (BKA), avoid positioning in prolonged hip and knee ___.
flexion
Patients who underwent amputation (transfemoral & transtibial) may sit for no more than __ mins. of each hour
40
Periodic ___ lying is recommended for patients who underwent amputation to promote lengthening of tissues in the
posterior portion of the lower limb.
prone
In patients with hemiplegia and UE synergy, what motion/s of the shoulder should be avoided?
shoulder adduction and internal rotation
In patients with hemiplegia and UE synergy, what motion/s of the elbow and forearm should be avoided?
elbow flexion and forearm pronation
In patients with hemiplegia and UE synergy, what motion/s of the wrist and hand should be avoided?
wrist and finger flexion,
thumb flexion and adduction
In patients with hemiplegia and LE synergy, what motion/s of the hip and knee should be avoided?
hip and knee flexion, hip external
rotation
In patients with hemiplegia and LE synergy, what motion/s of the ankle should be avoided?
Ankle plantarflexion and inversion
TRUE OR FALSE: Patient’s clothes may be used for draping.
False
In upper back and lower back draping, how many towels are generally used for each?
Two
Enumerate the 4 possible maneuvers used when transitioning from supine to long sitting
- Pt does it by themselves, PT directs / instructs / assists them
- PT gradually adds pillows to pt’s back
- PT manually brings pt into long-sitting, PT is on their knees behind pt with a pillow between the PT and pt’s back
- Pt holds onto PT’s flexed arm, PT counts to 3 when bringing pt up
Discuss transitioning from supine to sitting for S/P THR step by step
- PT removes abduction pillow
- Asks pt to prop on their elbows for support
- PT counts to three while slowly pivoting the patient
