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46 Cards in this Set
- Front
- Back
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Positioning, Draping, and Transfers |
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What does the acronym AMAP/ANAP stand for? |
Have the patient do: As Much As Possible, As Normally As Possible |
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What are the goals for short-term positioning? |
Safety-protect vulnerable parts
Comfort-normal spinal alignment, parallel shoulder/pelvic girdles
Therapist access and body mechanics |
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What are the goals for long-term positioning? |
-Protect bony prominences -Prevent contractures -Provide support and stability -Promote efficient organ function -Accommodate special needs
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What should be considered when positioning a patient in supine? |
-Shoulders and hips are parallel -Normal spinal curves -Hips neutral -Knees neutral -Pressure off of heels |
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What are important bony areas to protect when positioning someone supine? |
-Occiput -Scapulae -Elbows -Hips -Ischial tuberosities -Sacrum -Heel -Ball of foot |
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What are some common contractures to avoid while the patient is in supine? |
-knee flexion -ankle plantarflexion -hip external rotation -elbow flexion -finger flexion -forearm pronation -neck flexion |
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Things to consider while positioning a patient in side lying. |
-Centered on bed -Upper trunk rotated forward or backward -Head on pillow -Top leg forward |
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What are bony areas to protect and common contractures in side lying? |
Bony areas: Shoulder, greater trochanter, head of fibula, lateral and medial malleoli
Contractures: elbow flexion, finger flexion, knee flexion, hip adduction/internal rotation |
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Things to consider positioning prone. |
-Head turned or small pillow under forehead -Small pillow under lower abdomen -Cushion under anterior shoulders -Cushion under anterior ankles -UEs alongside or overhead |
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What are bony areas to protect, contracures to avoid, and stresses to avoid in the prone position? |
Bony areas: forehead, anterior shoulders, patella, ASIS, dorsum of foot
Contractures: ankle plantarflexion
Stresses: hyperextension of knee, excessive neck extention, excessive low back extension |
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Things to consider for position in sitting. |
-Normal spinal curve -Neutral hips -Arms supported
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What are the bony areas to protect and contractures to avoid and stresses to avoid in sitting? |
Bony areas: ischial tuberosities, scapula, spinous processes, hips, back of knees, calves, ankles
Contractures: curvature of the spine, elbow flexion, hip flexion, knee flexion
Stresses: plantarflexion of forefoot, hyperextension of knee if legs elevated, subluxation of shoulder if arm is paralyzed, flexion of knee if BKA |
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What are the negative effects of prolonged immobility? |
-Skin breakdown -UTIs -Edema -Calcium loss (bone demineralization) -Deconditioning -Balance impairment -Joint and tissue contractures -Decreased cardiopulmonary capacity |
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How often should a patient be repositioned? |
-Turn in bed every two hours -Shift weight in chair every 10-15 minutes
***presence of cushions does not mean you do not use repositioning schedules |
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What are decubitus ulcers? |
-Pressure sores or bed sores -Stage I-IV by tissue involvement -Stage I: changes in skin temp., tissue consistency, sensation **Blanching test pg 162 in Mobility in Context |
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What kinds of patients are at risk for ulcers? |
-People with impaired circulation -People with thin or fragile skin -People with impaired sensation |
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Things to remember when placing someone in short or long-term positioning. |
-Always explain what you are about to do -AMAP/ANAP -Provide a way for the patient to call for help -Watch for negative effects of prolonged immobility |
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What is a CVA patient's "position of comfort?" |
-Scapular retraction -Shoulder flexion and IR -Flexed fingers -Pelvic retraction -Hip flexion, adduction, IR -Knee flexion -Ankle PF |
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What is important to AVOID doing while positioning a CVA patient? |
-Do not pull on the limbs -UE adduction, flexion, IR -Pelvic retraction |
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What is the correct CVS patient positioning? |
Lying on hemi side: scapula in full protraction, on scapula and not GH joint, uninvolved LE supported, head neutral, pillow at trunk to prevent rolling
Lying on non-hemi side: hand elevated, head neutral, pillow at trunk to prevent rolling
Supine: scap protracted, hand elev, pelvis protracted |
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What is an amputee's "position of comfort?" |
Transfemoral: hip flexion, abduction, ER
Transtibial: hip flexion, abduction, ER, and knee flexion |
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What is the correct positioning of an amputee post-op? |
-Hip neutral -Knee extended -Minimized sitting time -Prone lying |
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What are the precautions for a total hip replacement (posteriolateral approach)? |
-Precautions generally last 3 months -DO NOT: -Flex hip > 60-90 deg -Adduct hip past 0 deg -IR hip past 0 deg **never lay on affected side during the acute stage
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What is the correct positioning of a THR post-op? |
-Supine with abduction wedge, head of head <70-90 deg, hip in neutral rotation
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-Side lying on uninvolved side, upper leg supported |
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What are the precautions for and anterior approach THR? |
-No hip extension (6 weeks) -No hip rotation |
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Things to consider when using restraints. |
-Positioning -Angle of pelvic belt -Watch for skin breakdown -Quick-release knots
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Pressure Ulcers |
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What causes pressure ulcers? |
-Caused by pressure against skin or underlying tissue that reduces blood supply to that area-the affected tissue dies
-Increased risk if unable to move without help due to pressure that may be combined with shearing or friction
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Causes cont.... |
-Lack of proper nutrition, diabetic or poor circulation
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What are the most common places for pressure ulcers to occur? |
On bony areas: elbows, hips, heels, ankles, shoulders, buttocks, inner knees |
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How are pressure ulcers staged? |
Stage I: reddened area when pressed does not turn white
Stage II: skin blisters or forms an open sore
Stage III: skin breakdown forms a crater, tissue damage below the skin
Stage IV: So deep, damage to muscle, bone, tendons, and joints |
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What are good practices to prevent pressure ulcers while lying? |
-Keep skin clean and dry -Reposition patient every 2 hours during the day -Use pillows and positioning equipment to prevent pressure on bony prominences -Avoid positioning in Fowler's position except when eating |
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What are good practices to prevent pressure ulcers while sitting? |
-Use a cushion for patients in wheelchairs, no donuts or odd shaped cushions -Make sure hips are positioned at the back of the chair |
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What are the biggest areas of pressure while a patient is in the sitting position? |
-Head, shoulder, sacrum, buttock, heels |
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What is the semi-fowlers position? |
Head of the bead is between 30 to 50 deg angle with knees sometimes elevated |
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What is the Trendelenburg position? |
A position in which the feet are higher than the head; used to drain lower lobes of lungs and for BP changes in patients |
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What are the two forces that are involved in causing pressure ulcers? |
Two forces contribute to pressure ulcers. Opposite, but parallel, sliding motions (shear)-like bone moving down and skin moving up-compress blood vessels. Surfaces rubbing (friction) can also cause skin to break down. |
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What is a contracture? |
An abnormal shortening of muscles, tendons, or other tissues, rendering the muscle highly resistant to passive stretching. |
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Define: 1) Abscess 2) Cyanosis 3) Dermatitis 4) Ecchymosis 5) Erythema 6) Jaundice |
1) Collection of pus 2) blueness of the skin 3) inflammation of the skin due to irritant 4) mark caused by blood vessel injury 5) redness 6) yellowness of skin |
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Define: 1) Pallor 2) Pruritus 3) Urticaria |
1) paleness of skin 2) itching 3) allergic reaction, itchy, red, elevated patches called hives |
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What is a burn? |
-A burn is tissue damage caused by UV radiation, intense heat, chemicals, steam, or electricity
-Severe burns can impair the function of other organs-kidneys and heart |
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What are the three types of burns? |
Superficial-epidermis only
Partial thickness-blisters, into the dermis
Full thickness-may extend to the bone |
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The Rule of Nines |
Check out the slide :) |
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What are the common types of skin grafts? |
Allograft-cadaver skin
Xenograft-pigskin or other animal
Human amnion-placenta
Autograft-taken from different site on patient's body |
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What is a common cream used for treatment of burns? |
Silvadene cream |
