Ptha 1405 positioning
- 1. PTHA 1405 Basic Patient Care DRAPING AND POSITIONING
- 2. Basic Patient Care Decubitus Decubitus (pressure sore)- ulceration of soft tissue caused by unrelieved pressure and/or shearing forces. Shearing forces- the forces applied to the movement of tissues away from skin held in place by friction. Pressure ulcers are most commonly found over boney prominences subject to external pressures.
- 3. Basic Patient Care Decubitus Prevention 95 % of all pressure sores are located over 5 locations: sacrum, heels, greater trochanters, lateral malleolus, and ischial tuberosity.
- 4. Basic Patient Care Pressure Locations Supine Prone Side-lying Sitting Occipital Forehead Lateral ear Ischial tuberosity tuberosity Spine of scapula Lateral ear Lateral ribs Spine of scapula Inferior angle of ASIS Medial eipcondyle Inferior angle of the scapula scapula Medial epicondyle Humeral head Greater trochanter Medial epicondyle Spinous processes Patella Medial condyle Spinous process Posterior iliac Anterior tibia Lateral malleolus crest Sacrum Dorsum of foot Medial malleous Greater trochanter Head of fibula Heels Lateral malleolus
- 5. Basic Patient Care Positioning Positioning should be tailored to the patient’s needs Positioning should prevent skin breakdown Prevent soft tissue / joint contractures Support the trunk and extremities Promote efficient function of organ systems Encourage awareness of affected side (CVA, TBI) Provide access to treatment area Provide patient comfort (with a few exceptions)
- 6. Basic Patient Care Positioning Position Description Fowler Supine with head of bed elevated between 45 and 60 degrees Semi-Fowler Supine with head of bed elevated to 30 degrees Trendelenburg Head down with trunk and LE elevated Supine Lying on back Semi-supine Upper and/ or lower body ½ way between supine and side lying Side lying On left or right side Prone Lying on belly Semi-prone Upper and/ or lower body ½ way between prone and sidelying
- 7. Basic Patient Care Positioning Supine Place pillow under the patient’s head Place pillow under popliteal fossas to maintain a moderate lumbar lordosis Place a small towel under the posterior anterior ankles to relieve pressure on calcaneus, but avoid knee hyperextension.
- 8. Basis Patient Care Positioning Prone Place pillow under the patient’s head or place a towel role under the forehead Place a pillow under the lower chest or abdomen (with a few exceptions) Place a pillow under anterior ankles
- 9. Basic Patient Care Positioning Side-lying Place pillow under the patient’s head Place a pillow under the uppermost UE Place pillow under the uppermost LE (between knees and ankles) Place pillow along posterior trunk to prevent patient from rolling back
- 10. Basic Patient Care Positioning for Specific Diagnosis Diagnosis Positioning considerations Respiratory-Orthopenea Difficulty breathing in any position except an erect position. Fowler, Semi- Fowler, 2 plus Pillows Respiratory- COPD Fowler, Semi-Fowler Respiratory- Tracheotomy Avoid Prone Cardiovascular-venous insufficiency Elevate the involved extremity Cardiovascular- Arterial insufficiency Place involved extremity in flat of dependant position Pregnancy Avoid prolonged lying on right side and supine during 3rd trimester to avoid pressure on the vena cava
- 11. Basic Patient Care Positioning Neurological- CVA Support affected shoulder to avoid subluxation Maintain neutral wrist and finger alignment Maintain neutral ankle alignment to avoid PF contracture Amputation-AKA Avoid prolonged hip flexion Recommend periodic prone positoning Amputation-BKA Avoid prolonged hip and knee flexion Burns and Grafts -Avoid positions of comfort -Stress and tension of the healing tissue is necessary for healing and function -Avoid direct pressure on graft sites
- 12. Basic Patient Care Pressure Relief In bed – the patient should be or encourage to reposition every 2 hours. Positions should be alternated. Sitting- Patients in wheelchairs should perform pressure relief every 15 minutes for 15-30 seconds each time. Patients that are unable to perform pressure relief should be assisted and or have equipment at assist repositioning. Example tilt in space wheelchair
- 13. Basic Patient Care Positioning
- 14. Basic Patient Care Pressure Relief Techniques WC push up Forward lean Sideways lean
- 15. Basic Patient Care Questions???