Turning & Positioning: ch. 7

7 Goals of pt positioning

1. Ensure pt comfort

2. Maintain skin integrity

3. Maintain musculoskeletal integrity

4. Maintain neuromuscular integrity

5. Maintain cardiovascular/ pulmonary integrity

6. Provide pt access to environment

7. Provide proper positioning for specific interventions/ treatments

2 types of positioning

long and short term

short term positioning

changes of position required for tests and measures

long term positioning

prolonged periods in one position

long term positioning can affect...

1. musculoskeletal structures

2. Neuromuscular tissue

3. Circulation

Musculoskeletal structures in long term positioning

respond positively to appropriate stress resulting from movement

musculoskeletal structures with no movement in long term positioning (5)

Loss of ROM,Decreased joint stress,Loss of strength,Tissue shortening (ex. muscle, tendon, ligament, capsule),Tissue degeneration

Neuromuscular changes in long term positioning

pressure on peripheral nerves will interfere with function

Neuromuscular changes in long term positioning can result in... (3)

1. Pain

2. Decreased sensation

3. Loss of tissue mobility

Circulation in long term positioning

May be reduced bye prolonged periods in a position

Circulation in long term positioning can result in... (2)

1. Decreased blood flow

2. Orthostatic hypotension

3 Decreased blood flow results...

1. Exacerbate skin problems

2. Pain

3. Decreased nutrition to tissue

Pt positioning responsibility

ALL healthcare workers in contact with pt

Pt skin check frequency (when in new position)

5 to 10 minutes

General pt repositioning rule

Reposition every 2 hours when in supine, side-lying, or prone

Needs inspected after pt repositioning

skin color and integrity

Location of pt skin inspection after repositioning

area pt was lying on

where pressure must be relieved when pt sits

buttocks and sacrum

Frequency pressure should be released from pt buttocks and sacrum when sitting

At least every 10 minutes

How can we teach the pt to relieve pressure

1. Side-to-side weight shifts

2. w/c push up

3. Ant. trunk lean

pt responsibility in therapist and pt repositioning

Pt should participate as much as possible on their own

When to have ALL necessary supplies for treatment

Before moving pt

What to check for prior to moving pt

Pt equipment (tubes, Lines, Monitor leads)

Why to check for pt equipment before moving pt

to avoid disconnecting or compromising equipment accidentally

How to move pt safely

ensure enough clear area exists and equipment is ready to move with pt

Why to avoid wrinkles in sheets, blankets, and clothing

Decreases risk of skin breakdown

How to add support to pt to decrease pressure

1. Pillows

2. Rolled blankets

3. Towels

What to avoid when moving pt

wrinkles in sheets, blankets, and clothing

How to transfer pt

Lifted, NOT dragged

Draping should allow for...

appropriate positioning while maintaining pt modesty and warmth

Patients role in transfer

1. Actively participate when possible

2. Pt should be encouraged to perform task and therapist adds necessary assistance

Supine position

position where pt lies face up on supporting surface

Supine body positioning

shoulders parallel to hips and a straight spine

Pillow position for head in supine

2 pillows under head

LE pillow position in supine

1-2 pillows horizontally or 3+ pillows vertically

1-2 horizontal pillows for LE in supine

decreases pressure on low back

3+ vertical pillows for LE in supine

decreases hip and knee extension

What to do prior to rolling pt over

Identify good side of the body

12 Steps in turning from supine to prone

• Bridge patient to the side of the table.

• Cross ankles (outer LE over inner LE).

• Position inner UE by head or at side.

• Stand on the side patient will roll toward.

• Place pillows for end position (except LE).

• Get a second person if needed.

• Turn head toward rolling side if able.

• Confirm readiness and give cues.

• Roll using hands on shoulder and hip.

• Slow down halfway through and during descent.

• Reposition head and extremities.

• Adjust pillows for comfort and under LE.

Bridging technique

moving one segment at a time

Prone position

Pt lies on stomach, face down

Prone body positioning

shoulders parallel to hips with straight spine. head can look to either side or straight

Prone UE position

alongside trunk or head (check for circulation/ sensation)

Prone position pillow placement

1-2 under head, 1 under hips, 2 under low shin or top part of foot (or feet can hang off table)

9 steps in turning from prone to supine

1. position pt on edge of bed

2. Outer LE placed over inner LE

3. Inner UE placed by head OR ADD to side

4. Therapist positioned on side pt is rolling toward

5. Pt turns head away from therapist

6. Position pillows in appropriate end position (except LE)

7. Place hands on should and hip

8. Therapist initiates and controls roll

9. Reposition pt head and extremities with pillows

Turning on floor mat

Steps identical as on table

Therapist position when rolling pt on mat

Half kneeling position on side pt will roll to

Side-lying position

pt is lying on side

Side-lying body positioning

1. UE and LE positions vary depending on whether trunk is rotated

2. Most common is 2 pillows under head. 2-3 pillows b/t LE. 1 folded pillow for UE

7 steps in turning from supine to side-lying

1. Pt positioned of table

2. Inner UE ABD to 45 degrees

3. Outer LE crossed over inner LE

4. Therapist positioned to side pt is rolling towards

5. Hand positioned on shoulder and hip

6. Pt rolled to side-lying

7. Reposition head and extremities with pillows

2 types of sitting position

Supported and unsupported

Dictates type of sitting position

pt functional ability, medical problems, and starting position

If pt is unable to maintain sitting position

1. NEVER leave pt unguarded

2. Have supplies gathered/ ready prior to positioning pt to sitting

Supine long sitting

pt sits with hips flexed to 90 degrees and knees fully extended on a supporting surface

If assisting pt to supine long sitting

1. Place arm behind pt back

2. Pt can pull up by pulling on therapist arm

3. Can ask for 2nd person assistance

4. If available, use trapeze bar for pt w/ minimal weakness

6 steps in side-lying to sitting on side of table

1. Pt should side-lie near edge of table where they will sit

2. Educate pt on how you will assist and where pt should place hands

3. Lower LE ov er edge of table

4. Therapist places arms under pt lower should and upper hip

5. Legs act as counterweights and help rotate pt into sitting

6. Pt should use lowermost UE to assist into sitting

3 steps in supine to sitting on side of table

1. Therapist places arm behind pt shoulders

2. Therapist places arm under pt thighs

3. Therapist pivots to lower pt legs off table (weight of legs helps bring pt to sitting position)