Positioning

• short term positioning

  1. Safety: Choking, falls, call light
  2. Comfort: Maintain spinal alignment, pillows, etc...
  3. Access: Position for activity
• Fowler’s position 


  This position increases shearforces significantly on buttocks,but is, functionally, very useful
• Trendelenburg position


  Great way to let gravity assistwith scooting up in bed
• Long term positioning

  Safety—open airways, avoid falls, accommodate medical limitations

  ▪Prevention—prevent pressure ulcers, contractures, and edema; promote efficient function of bodily systems (cardiac/pulmonary)

  ▪ Comfort—good spinal alignment and cushioning; relieve stress on joints
• Preventing Pressure ulcers


  • Maximum of 2 hr in oneposition in bed• Maximum of 15 min in oneposition while seated• Consider:– Sheer, pressure, friction– Load, surface area, time/duration
• Skin Blanching Test


  When pressed, healthy, lighter colored skin will blanche and quickly return to healthy pink.▪ If the skin does not blanche (non-blanchable erythema), it indicates compromised tissue.
• Levels of Assistance


  Independent = no assistance needed▪ Modified Independent = no assistance, but equipment required▪ Stand-by assistance (SBA) = need someone close▪ Contact guard assistance (CGA) = you are touching the patient, butnot giving physical assist (doesn’t exist in balance)▪ Minimal Assistance = needing assistance up to 25% of task (patientperforming at least 75% of activity)▪ Moderate Assistance = assist of 25-50% (pt providing 50-75% ofeffort)▪ Maximal Assistance = assist of 50-75% (patient performing 25-50%)▪ Dependent = assist for greater than 75% of task (pt doing <25%)
• Edge of Bed Stability

  Ensure that your gait belt and anything you need is around so that you don't leave your patient
• Total Hip (THA) Precuations (posterior approach)

  ▪ No hip flexion beyond 90֯

  ▪ No hip aDduction beyond midline

  ▪ No hip internal rotation beyond neutral

  • Less risk when getting out on NON-operative side
  • Don't put in sidelying
• Positioning after CVA (stroke) with Hemiplegia

  ▪ Prevent contractures - ankle, hand, wrist, elbow primarily▪ Prevent wrist and hand edema. (Don’t leave hand dependent– in sitting too)▪ Avoid distraction of the hemiplegic shoulder.▪ Avoid shoulder retraction for prolonged periods.

  • NO rolling for long period of time, or tucked behind
• Below Knee Amputation (BKA) Procedures

  ✔ Keep the hips in neutral rotation.✔ Extend the knee.✔ Minimize sitting time with the knee flexed.✔ Avoid pressure on non healed surgical sites. CONSIDER PRONE
• Below Knee Amputation (BKA) Procedures

  Do NOT's:

  Let the residual limb hang off the edge of the bed.

  Place a pillow under the hip or the knee while the patient is supine.(length-wise may be ok, but must check the knees)

  Allow the patient to lie with the knees flexed.

  Allow the patient to cross legs
• Spinal Fusion Precuations

  Precautions: (BLTs) No bending, no lifting (10# usually), no twisting▪ Avoid segmental rotation of the thoracolumbar spine.▪ Move trunk as a unit into side-lying (log roll)▪ Flex hip and knee of far leg.▪ Push down with LE.▪ Avoid early use of UEs because this tends to promote trunk rotation.▪ To move from side-lying to sitting, move legs off bed and press downwith the hands, moving the trunk as a unit into upright position.
• True or False-Weight does not affect Ulcer Risk?


  True
• Most common type of contracture?

  flexion
• One of the most common contractures is ankle _

  plantarflexion
• To reduce dependent edema?

  Position distal extremities at or above the level of the heart, especially with flaccid limbs (ie; stroke)
• Purpose of restraints?

  ▪Limit mobility = restraint

  ▪Improve function and participation = positioning device
• Mobility progression

  •STABILITY before MOBILITY

  •LOW Center of Gravity (CoG) before HIGH CoG

  •LARGE Base of Support (BoS) before SMALL BoS

  •MAINTAINING before ATTAINING