6 - Positioning and Draping

• When must patient positioning be considered?


  Before, during, and after treatment
• What can lead to soft tissue contracture in patients?

  Position of comfort without frequent changes
• How often should a patient change position to prevent contractures?

  Every 2 hours
• Where does the greatest pressure occur in patients?

  On tissues covering bony prominences
• What should caregivers be cautious about regarding patients?

  Decreased sensation to pressure
• What are pressure sores?

  Injuries to skin and underlying tissue
• What can happen if pressure sores progress?

  Infection of bone or blood can occur
• What are the four stages of pressure sores?

  1. Stage 1: Reddened skin, no open wounds
  2. Stage 2: Skin breaks open, forms ulcer
  3. Stage 3: Extends into tissue, small crater
  4. Stage 4: Very deep, reaches muscle and bone
• What characterizes Stage 1 pressure sores?

  Reddened skin, no breaks or tears
• What happens in Stage 2 pressure sores?

  Skin breaks open, forms an ulcer
• What is observed in Stage 3 pressure sores?

  Sore extends into tissue, small crater
• What occurs in Stage 4 pressure sores?

  Deep damage to muscle and bone
• What is a Deep Tissue Injury (DTI)?

  Suspected damage without open wound
• What indicates a DTI?

  Purple or dark red skin, blood-filled blister
• What are common pressure points in the upper extremity for different positions?

  • Supine: Medial epicondyle of humerus
  • Prone: Anterior head of humerus
  • Side-Lying: Lateral head of humerus
  • Sitting: Medial epicondyle
• What are common pressure points in the lower extremity for different positions?

  • Supine: Posterior calcaneus, greater trochanter
  • Prone: Patella, ridge of tibia
  • Side-Lying: Greater trochanter of femur
• What are common pressure points in the head and trunk for different positions?

  • Supine: Occipital tuberosity, spine of scapula
  • Prone: Forehead, lateral ear
  • Sitting: Ischial tuberosity
• What does "unstageable" mean in pressure sores?

  Stage not clear due to tissue covering
• What should be used to drape a patient?

  Clean and unused linen
• Why should patient clothing not be used as a drape?

  It may become soiled and uncomfortable
• What should be done to support body segments during treatment?

  Use pillows or rolled towels
• What is the importance of a firm mattress in patient positioning?

  Enhances proper positioning and support
• What should be done to avoid increased skin pressure?

  Remove folds or wrinkles in linen
• What should be done with soiled linen after use?

  Dispose of it immediately
• What are the special considerations in patient positioning?

  • Loss of sensory awareness
  • Paralysis
  • Decreased skin integrity
  • Poor nutrition
  • Impaired circulation
• What indicates excessive pressure on a patient’s skin?

  Red areas or complaints of numbness
• What should be done for patients with extensive paralysis?

  Use temporary restraints for safety
• What are the goals of proper patient positioning?

  1. Prevent contractures
  2. Provide comfort
  3. Support trunk and extremities
  4. Access areas to be treated
  5. Promote organ function
  6. Relieve pressure
• How should a pillow be placed under a patient's head?

  Avoid excessive neck and upper back flexion
• What should be avoided when placing items behind the knees?

  Avoid encouraging hip and knee flexion
• What is the effect of placing a pillow under the lower abdomen?

  Reduces lumbar lordosis
• What areas experience the greatest pressure when prone?

  Forehead, lateral ear, and sternum
• What can be used to alleviate stress to interscapular muscles?

  Forearm rests on treatment tables
• Where should the patient be positioned initially?

  In the center of the bed or table
• What is placed under each anterior shoulder to adduct the scapula?

  Rolled towel
• How does placing a towel under the anterior ankles help the patient?

  It relieves stress on hamstring muscles
• What can happen if a pillow is placed at the ankles?

  Knee flexion may occur
• In what position may upper extremities be placed?

  In a "T" position
• What can make prone-lying patients more comfortable?

  Resting forehead on a folded towel
• What type of treatment table is most comfortable for patients?

  One with a cut-out for the face