October 7, 2005 PTA 110
Positioning
Draping
Bed Mobility
Positioning
Why do we spend time on positioning? Patient comfort/decrease pain Support and stability to pt’s trunk &
extremities Prevent development of pressure sores Prevent joint contractures To have easier access to area being treated Decrease edema Increased function
Positioning
The most comfortable for the pt may not be the best for them
May need to be positioned to aid in the treatment of a specific diagnoses or condition
What about restraints?
Considerations with positioning
Who is at risk? Elderly Those unable to change their own position Those with decreased sensation Those who may be unable to communicate
their discomfort
Pressure Points To Consider
When do we change position
Medicare standards = common practice standards Change every 2 hours
At the conclusion of treatment Check with nursing on preference
What do we use
Pillows blankets Heel protectors Splints, slings & braces Seat cushions Wedges Others??
Standard Positions
Supine Prone Side- lying Semi-fowler Sitting
Standard Positions
Supine Pillow under head to keep c-spine neutral Small pillow or towel roll for cervical support Support under popliteal space to lumbar
lordosis Ankle support to relieve pressure on
calcaneus Support under elbows to relieve pressure on
bony prominence
Supine Position
Standard Positions
Prone Pillow under head Pillow under lower abdomen to lumbar
lordosis Rolled towel under anterior shoulder to
adduct (retract) scapula Towel roll/pillow/bolster under ankles to
relieve stress on hamstrings, also allows pelvis and lumbar spine to stay relaxed
Prone Position
Standard Positions
Sidelying Pt in center of bed – not near edge Head, trunk, pelvis in alignment LE’s are flexed at hip & knee with pillows btwn
legs & top Le slightly forward of bottom LE Pillow at chest &/or back for to prevent pt from
rolling Pillow under top arm to keep chest open
Sidelying Position
Standard Positions
Semi-fowler Head of bed is lifted 30° - can use pillow,
wedge or bolster as well Pillow under popliteal space Used for breathing, eating, visiting
For a Fowler position head of bed is 45°
Semi-Fowler Position
Standard Positions
Sitting Variety of seated positions
Straight, recumbent, semi-recumbent Remember to soften bony prominences Arms and legs supported (head if necessary) Elbows at 90°
Draping
5 minute Break
Draping
Reasons for draping pt’s: Privacy/modesty/dignity Warmth Hygiene
How do you feel at the Dr’s office with no clothes on????
Draping
If you need pt to change to gown – leave room – knock before re-entering
If pt needs assistance suggest it, ask permission before helping them
Only area being treated is exposed, the rest of the pt is covered Gown, blanket, sheet, towel
Pt comfort is the key to working on difficult areas
Draping
Be sure you keep legal considerations in mind What is the policy of the facility on door being
closed, slightly open? Curtains? Inappropriate comments or touch mean
different things to different people Protect yourself by being professional at all
times
Bed Mobility
What are the goals of bed mobility? How do we define bed mobility? How will patients benefit from bed
mobility prior to a transfer activity? Why do we teach bed mobility?
Most Common Movements Of Bed Mobility:
Turning from supine to sidelying position and returning.
Supine to prone positioning and returning. Moving in bed-upward, downward, side to
side. Rolling Bridging exercises Moving from lying to sitting EOB.
How do you actively involve the patient in bed mobility instruction?
What are some ways/techniques you can use to reduce the patient’s and your energy expenditure during bed mobility activities?
Bed Mobility Exercises
Bed Mobility exercises don’t always have to be done in bed.
A patient can greatly benefit from bed mobility work on a mat table. Why would that be?
Examples of bed mobility exercises we will cover today in lab are on pages 132-140.
Modifications to bed mobility
On Wednesday Jamie will cover bed mobility for the orthopedic patient and how precautions alter how bed mobility is instructed for these types of patients.