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.