positioning and bed mobility

purposes of proper positioning

body mechanics for pt and PTA, patient comfort, provide access and minimize exposure to areas being treated, provide support and stability for trunk and extremities, increase their stability in the position, facilitate mobility, can be part of treatment, prevents complications of immobilization

immobilization definition

when a person or an extremity is in a static position for a prolonged period of time

causes of immobilization

extreme weakness, disease, depression, mechanical factors (cast, traction)

CNS complications of immobilization

altered sensation, decreased motor activity, emotional state changes, after 4 weeks can have decrease of intellect

Skeletal complications of immobilization

loss of bone mass an joint stiffness

respiratory complications of immobilization

impairment of coughing

muscular complications if immobilization

decreased muscle strength (10-15% per week of bed rest), up to 20% in the first week, muscle atrophy (up to 48 hours of bed rest, losses greater in older adults), decreased endurance and motor control

cardiovscular complications of immobilization

orthostatic hypotension, blood clots, decreased circulation, aerobic deconditioning

Other complications of immobilization

depression, UTI, constipation

Pressure ulcers (decubitus ulcers)

result of prolonged pressure between 2 firm surfaces like a bony prominence and the seat of a chair (tissue doesn’t receive enough oxygen)

stage 1 of pressure wound

persistenet redness of skin

stage 2 of pressure wound

the formation of bubbles

stage 3 of pressure wound

damage to skin

stage 4 of pressure wound

skin necrosis (death of tissue)

places prone to pressure ulcers

foot/ankles, hips and knees, pelvis, elbows, shoulder, back of head

best ways to prevent pressure ulcers

proper positioning, dry/clean skin, wrinkle free linens, frequent skin inspection, minimize friction, high protein diet, hydration, pressure reducing devices

goals for long term positioning (rest and comfort)

safety, changed position every 2 hours, position modification after 1 hour to avoid full position change, turning schedule

short term positioning (intervention)

safety, comfort, access to area of treatment

when to use restraints

patient safety or others safety, must be as least restrictive as possible, must be discontinued asap, must be in pocket or physicians orders, should be reevaluated regularly

restraint

device that restricts patients mobility ( if it allows them to achieve meaningful function it is not a restraint) can be physical chemical or seclusion

purpose of draping

expose areas for treatment, protect modesty, keep warm, protect clothes, wounds, incision, absorb sweat, water, medicine and lube

functional mobility progression

mobility, stability, functional mobility, skill

Total hip

60-90 flexion, 0 internal rotation, 0 adduction