Turning & Positioning

What are the goals of positioning?

Patient comfort, skin, musculoskeletal, neuromuscular, cardiopulmonary integrity; environmental access; proper positioning for specific treatment

What is short-term positioning?

Positioning changes made for tests and measures.

What is long-term positioning?

Prolonged positioning in one position that may affect musculoskeletal structures, neuromuscular tissues, and circulation.

What can happen to the musculoskeletal system when there is no movement?

Loss of ROM, decreased joint stress, loss of strength, tissue shortening, and tissue degeneration.

What tissues can become shortened with prolonged positioning?

Muscle, tendon, ligament, and joint capsule tissues.

How can positioning affect the neuromuscular system?

Pressure on peripheral nerves can interfere with function and may cause pain, decreased sensation, and loss of tissue mobility.

How can prolonged positioning affect circulation?

It can reduce blood flow, exacerbate skin problems, cause pain, and decrease nutrition to tissues; it can also contribute to orthostatic hypotension.

Who is responsible for proper patient positioning?

All healthcare workers who have contact with the patient.

When should the skin be checked after placing a patient in a new position for the first time?

5–10 minutes after positioning.

How often should a patient generally be repositioned?

At least every 2 hours.

What should be inspected after repositioning a patient?

The skin over the area should be inspected for color and integrity.

How often should a sitting patient relieve pressure from the buttocks and sacrum?

At least every 10 minutes.

Why should patients be encouraged to assist with turning and positioning?

As patient participation increases, the amount of PT/PTA assistance needed can decrease.

What should be checked before beginning a positioning procedure?

Prepare supplies, check lines/leads, clear area, remove wrinkles, and use pillows/rolls for support & pressure relief.

Why must a patient be lifted rather than dragged across sheets?

To avoid excessive friction and potential skin injury.

What is the purpose of draping during positioning?

To maintain patient modesty and warmth.

What should the patient be encouraged to do before the therapist assists with a task?

The patient should attempt to perform the task first, and the therapist should then assist as needed.

What is the supine position?

Lying on the back with the shoulders parallel to the hips and the spine straight.

How can pillows be positioned under the lower extremities in supine?

One to two pillows can be placed horizontally to decrease low-back pressure, or three or more pillows can be placed vertically to decrease hip and knee extension.

How should the knee be supported after a TKA when positioning in supine?

The knee should always be supported with a pillow.

What should be identified before rolling a patient from supine to prone?

The patient's good side.

How should the lower extremities be positioned before rolling from supine to prone?

The outer lower extremity is placed over the inner lower extremity and the ankles are crossed.

How should the inner upper extremity be positioned before rolling from supine to prone?

If mobile, it is placed up by the head; otherwise, it is positioned adducted at the patient's side with the palm toward the hip.

Where should the therapist stand when rolling a patient from supine to prone?

On the side toward which the patient will roll.

What should be considered before beginning a supine-to-prone roll?

Think about the patient's final position and place pillows at all needed locations except under the lower extremities.

Where are pillows normally placed when preparing a patient for supine-to-prone positioning?

Under the trunk, with additional pillows positioned as needed for the final position.

What should happen when the patient reaches the halfway point during a roll?

Gravity becomes a factor, so the therapist should slow the descent and maintain control.

What should be repositioned after completing a supine-to-prone roll?

The head and neck, arms, feet, and pillows; the arms are abducted, the feet are uncrossed and placed apart, and a pillow is placed under the lower extremities.

What is the prone position?

Lying on the stomach with the shoulders parallel to the hips and the spine straight.

How can the head be positioned in prone?

Turned to either side or positioned in midline.

How can the upper extremities be positioned in prone?

Alongside the trunk or up by the head.

What should be checked when a patient is positioned prone?

Circulation and sensation.

Where can pillows be placed when positioning a patient prone?

One to two under the head, one under the hips to flatten the back, and two under the lower shins/top of the feet; the feet may also be placed over the edge.

What is the general relationship between prone-to-supine and supine-to-prone positioning?

The procedures are usually the exact opposite of each other.

What should be identified before rolling a patient from prone to supine?

The patient's good side.

What is the sequence for rolling a patient from prone to supine?

Position the patient near the edge, then move the upper trunk, lower trunk, and lower extremities.

How should the lower extremities be positioned before a prone-to-supine roll?

The outer lower extremity is placed over the inner lower extremity and the ankles are crossed.

How should the head be positioned before rolling a patient from prone to supine?

The head should be turned away from the therapist.

Where are pillows normally placed before a prone-to-supine roll?

At all needed locations except under the lower extremities; they are normally placed under the head.

What should the therapist do during a prone-to-supine roll?

Control both phases of the roll.

What should be done after completing a prone-to-supine roll?

Reposition the patient's head on the pillow and reposition the lower extremities.

How is positioning on a floor mat different from positioning on a treatment table?

The same basic steps are used, but the therapist works from a half-kneeling position.

How should the therapist position the knees during a floor-mat roll?

The down knee is at the patient's hip level and the up knee is at the patient's shoulder level.

What is the sidelying position?

Lying on one side with upper- and lower-extremity positions varying depending on trunk rotation.

What pillows are commonly used in sidelying?

Two pillows under the head, two to three pillows lengthwise between the lower extremities, and one folded pillow for arm support.

How can a patient move from supine to sidelying?

The patient can be positioned toward the side of the table, with the inner arm abducted about 45 degrees and the outer leg bent with the foot on the bed to push while the therapist assists the roll.

Where should the therapist place their hands during a supine-to-sidelying roll?

One hand at the shoulder and one at the hip.

What should be done after rolling a patient into sidelying?

Reposition the head and lower extremities.

What factors determine how a patient should be positioned in sitting?

The patient's function, medical problems, and starting position.

When should a patient never be left unguarded in sitting?

When the patient cannot safely maintain the sitting position independently.

What should be prepared before assisting a patient into sitting?

Have all necessary supplies within reach.

What is long sitting?

Sitting with the hips flexed to 90 degrees and the knees fully extended.

What can a strong patient do when moving from supine to long sitting?

The patient may be able to sit up independently.

How can a therapist assist a patient from supine to long sitting?

Place an arm behind the patient's back so the patient can pull on the therapist's arm; an additional arm may be placed across the thighs, and a second person may be used if needed.

What equipment can assist a patient with minimal weakness when moving from supine to long sitting?

A trapeze bar.

What is the preferred method for moving from sidelying to sitting at the side of the table?

Move the patient into sidelying near the edge, have the uppermost arm push from the table, lower the legs off the edge, and use the legs as counterweights while the therapist assists at the shoulder/hip.

How does the patient assist during a sidelying-to-sitting transfer?

The uppermost upper extremity pushes from the table and the lowermost upper extremity assists with the movement.

How is a dependent or higher-assistance patient moved from supine to sitting at the side of the table?

Use the lower extremities as counterweights while one therapist arm supports the shoulders and the other supports the thighs, pivoting the lower legs to the side while lifting the trunk.

When should a second person assist with moving a patient from supine to sitting?

When the patient requires a heavy-duty lift; one person controls the trunk while the other controls the lower extremities.