Proper Positioning, Turning & Draping

Positioning

Arrangement of body parts in relation to one another; Technique of placing the patient safely, comfortably, and effectively in preparation for any procedure

Positioning

Goal 1: Prevent soft-tissue and joint contractures

Positioning

Goal 2: Provide patient comfort

Positioning

Goal 3: Provide support and stability of patient's trunk and extremities

Positioning

Goal 4: Provide access and exposure to areas to be treated

Positioning

Goal 5: Provide efficient and function of patient's organ systems

Positioning

Goal 6: Provide position changes to relieve excessive pressure

Deconditioning

Reduced functional capacity of body system/s

30 mmhg

Normal capillary blood pressure

Pressure sores

(Bed sores) external pressure > capillary pressure

Pressure sores

Occlusion of blood flow 🡢 ischemia [restriction in the blood supply to the tissues, shortage of O2] 🡢 necrosis (tissue death)

Pressure sores

Pressure to soft tissue exceeding normal, capillary pressure of local circulation, friction or shear forces on skin, skin maceration due to perspiration or skin to skin contact, reduced activity leading to immobility

Common areas for pressure ulcers for seated patients

Ischial tuberosities (sit bones), posterior area of the thigh, sacrum, spinous process of vertebrae [if patient leans, against the chair], medial epicondyle of humerus [elbow rests on hard surface]

Erythema

Grade 1: skin is intact and not blanched with pressure

Superficial ulceration that extends to the dermis

Grade 2: skin loss, ulcer appears to be moist and pink, with no necrotic tissue and partial thickness wound

Ulcer advances to subcutaneous tissue

Grade 3: full thickness wound which may be deep, necrotic tissue may be present and infection over the area

Ulcer affecting muscle (fascia)

Grade 4

Extensive ulcer with extensions into bursa of joints/ body cavities

Grade 5

Contracture

Adaptive shortening of muscle or other tissue that cross a joint resulting in LOM

Contracture formation

Duration of immobilization, limb position and mobilization of joint

1 - 3%

How much muscle strength is lost per day?

10 - 15%

How much muscle strength is lost per week?

50%

How much muscle strength is lost in 3 - 5 weeks?

Decrease in muscle size

Muscle size may shrink to 50% its original size in 2 months

Muscle atrophy

🡣 in oxidative enzymes [creatinine phosphokinase] resulting in 🡣 fuel/energy sources

Type 1 muscle fibers

What type of muscle fiber is more prone to immobilization atrophy?

Wolff's Law

Bone morphology and density are dependent upon the forces that act on the bone

Immobilization osteoporosis

Decreased bone tissue (bone mass) per unit volume (bone density) of anatomical bone

Degenerative joint disease (DJD) and osteoarthritis (OA)

Joint loses its normal lubrication needed for joint nutrition

Postural (orthostatic) hypotension

A significant drop in blood pressure (20 mm Hg systolic or more) after an upright posture is assumed

3 weeks

Adaptation to upright posture is completely lost after how many weeks?

20 - 72 days

Refraining (recovery) would take around how many days?

Postural (orthostatic) hypotension

🡫 venous return from LE - 🡫 filling of left ventricles - 🡫 cardiac output - 🡫 cerebral perfusion = dizziness or syncope (fainting spells)

Postural hypotension signs and symptoms

Tingling, burning in the LE, light - headedness, dizziness, sweating, pallor, increased pulse rate (> 20 bpm), decreased SBP (> 20 mmHg) and decreased pulse pressure

0.5 bpm

Heart rate progressively increases by how much per day?

Immobilization tachycardia

12 - 13 bpm in 10 days

Decrease in cardiovascular performance

In 3 weeks, 25% decrease

Thrombus

Decrease in plasma volume - 🡩 blood viscosity

Lower extremity

Where does the clot in big veins usually at?

Calf veins

Most common site due to decrease in muscle pumping

Embolus

Traveling thrombus

Pulmonary

Decreased diaphragmatic movement and chest expansion, contracture formation of intercostal muscles and costal joints, accumulation of secretions and decreased lung volumes

Atelectasis (lung collapse) and pneumonia

Prolonged immobilization results to ___ in the pulmonary system

Supine

Voiding is difficult in what position?

Genitourinary

Stagnation of urine and incomplete bladder emptying

Kidney stone formation and UTI

Prolonged immobilization results to ___ in the genitourinary system

Gastrointestinal

Atrophy of intestinal mucosa and glands, slower rate of absorption, constipation and fecal impaction and decreased in appetite

DECREASE in lean body mass and INCREASE in body fat content

Prolonged immobilization results to ___ in body composition

Sensory deprivation

What is a silent hazard of prolonged bed rest?

Nervous

Intelligence is COMPROMISED, emotional LIABILITY and anxiety and impaired balance and coordination due to altered neural control

Mattress

Promote equal distribution of body weight countering the development of pressure ulcers

Foot board

Promote positioning of ankle and prevent contracture of the plantar flexion

Side rails

Prevent patients from falling

Overhead trapeze

Aids in patient mobility

Positioning and powered rotating frames

Gradual introduction to upright position

Elbow or heel protector

Prevent bony prominence in developing pressure ulcers

Cardiovascular training

Improve tolerance to upright posture

Exercises

Range of motion, stretching, joint mobilizations and aerobic exercises

True

True or False: Patient must be lifted rather than dragged

5 - 10 mins

In a new position, check the patient's skin after how many minutes to avoid pressure

False; it should NOT BE TUCKED IN TIGHTLY

True or False: Sheets, blankets, or bed linen should be tucked in tightly at the foot of the bed

2 hours

Patient must be repositioned at least how many hours to avoid development of pressure ulcers

At the side, reverse T position or folded on the chest

In what ways the UE may be positioned for comfort?

True

True or False: Put pillow on neck to prevent excessive capital and cervical flexion

False; must not be ADDUCTED or MEDIALLY ROTATED

True or False: Hips must not be abducted or laterally rotated so place a pillow between their legs

Achilles tendon

Placing a foot rest in the soles of the foot prevent shortening of what body structure that conserves the sensory mechanism of the foot

Pelvis and shoulder

Point of control during turning

True

True or False: Pillow underneath the abdomen to prevent lumbar lordosis during prone position

Hyperextension of leg and plantar flexion of ankle

In prone position, a pillow must be placed under their lower leg to prevent what?

Hip flexion

During prone, AKA patients must prevent what?

True

True or False: THR patient's hip should be placed in a neutral position

Semiflex or semiextended

In side-lying position, amputated patient's LE should be placed in what position?

S/P THR on the left

Hip or legs should not be adducted beyond midline, toes should be pointing toward the ceiling and rotation should be kept at minimum or none at all

45 degrees

Abduction beyond __ degrees is not allowed in s/p THR patients

90 degrees

Flexion of the hip beyond __ degrees is not allowed in s/p THR patients

30 minutes

Patient should not be positioned for more than how many minutes?

True

True or False: For AKA patients (transfemoral), avoid prolonged hip flexion and abduction

False; avoid hip and knee FLEXION

True or False: For BKA patients (transtibial), avoid prolonged hip and knee extension

40 min of each hour

For amputated patients, they may sit for not more than ___

Periodic prone lying

For amputated patients, this is the recommended position

Shoulder adduction, internal rotation, elbow flexion, forearm pronation, wrist and finger flexion, thumb flexion and adduction

For hemiplegic patients, avoid positions of synergy in UE

Hip and knee flexion, hip external rotation, ankle plantarflexion and inversion

For hemiplegic patients, avoid positions of synergy in LE

True or false: During arthritis, swollen joints tend to assume the closed - packed position (usually in flexion)

False; assume the OPEN - packed position

True

True or false: For patients with burns and grafted burn areas, avoid positions of comfort

Draping

Manner of arranging the covering with sheets or towels in order to expose the part being examined, treated, or cleaned

Draping

Maintain appropriate/ comfortable body temperature

Draping

Rationale: provide modesty for the patient, expose only the areas to be treated while protecting other areas

True

True or false: Draping protect the patient's skin or clothing from being soiled or damaged