Lab guide 6

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Questions and Answers

Which areas are at the greatest risk for decubiti when a patient is in a supine position?

Sacrum, heels, and elbows (correct)

Ankles, wrists, and shoulders

Back, neck, and thighs

Shoulders, hips, and knees

What is a primary difference between LT and ST positioning when the patient is supine?

LT is used for short-term care, while ST is for long-term recovery

LT provides better alignment of the spine than ST

LT is focused on comfort, while ST emphasizes stability (correct)

LT allows for increased mobility, while ST restricts it

Which of the following is NOT a major consideration when positioning a patient long term?

Family member consent (correct)

Frequent repositioning schedule

Patient's respiratory function

Skin integrity maintenance

Which statement best describes how to determine if a device is a restraint?

If it limits the patient's mobility without consent Signup and view all the answers

A patient with a bilateral above-knee amputation (BKA) is at greatest risk for which of the following contractures?

Hip flexion and knee flexion Signup and view all the answers

In which of the following positions is the risk for decubiti noticeably different?

Sitting versus sidelying Signup and view all the answers

What is a primary consideration when positioning a patient long-term in sidelying?

Orientation of limbs relative to gravity Signup and view all the answers

How can the effectiveness of a device as a restraint be evaluated?

By determining if it restricts movement or normal functioning Signup and view all the answers

Which of the following represents common contractures in the lower extremities?

Hip flexion, knee flexion, ankle plantarflexion Signup and view all the answers

Which of the following should be prioritized to ensure patient safety while positioning?

Maintaining the body’s center of gravity Signup and view all the answers

Which technique is best for preventing contractures in a supine position?

Abducting the arms and supporting them with pillows Signup and view all the answers

What is the recommended method for relieving pressure on the sacrum in a supine position?

Repositioning the patient every 2 hours or using sidelying techniques Signup and view all the answers

Which practice is most effective for managing edema in patients positioned in sitting?

Elevating the legs as needed during sitting Signup and view all the answers

What positioning technique contributes most to safety while a patient is in sitting?

Positioning the patient with knees slightly higher than hips Signup and view all the answers

What is a critical consideration when positioning a patient with lower extremity amputations in supine?

Maintaining hips in neutral position and not letting thighs hang off the bed Signup and view all the answers

What should be the positioning of the top leg and underside leg when in sidelying to prevent contractures?

Underside leg straight, top leg flexed Signup and view all the answers

When positioning a patient with hemiplegia on the affected side, what is crucial for the upper extremity?

Keep the wrist in a neutral position with the hand open Signup and view all the answers

What is a key practice to minimize the risk of pressure ulcers during long-term positioning?

Minimized gravity creating shearing forces Signup and view all the answers

How should hand edema be managed in the uppermost arm during sidelying?

Propping the arm at or above heart level Signup and view all the answers

Which action should NOT be taken when positioning a patient long-term?

Allowing full freedom of movement without support Signup and view all the answers

What positioning consideration is vital for patients with an above-knee amputation?

Providing stable support for the residual limb Signup and view all the answers

In a long-term positioning scenario, what is the primary goal concerning the patient's environment?

Optimize interaction with the environment Signup and view all the answers

What critical aspect should be included in the long-term positioning checklist?

Frequent repositioning to ensure comfort Signup and view all the answers

When ensuring good spinal alignment during positioning, what should be done?

Center the patient within the bed Signup and view all the answers

To effectively prevent contractures in a patient, which positioning technique is recommended?

Frequent passive range of motion exercises Signup and view all the answers

Study Notes

Decubitus Risk Areas By Position

Sitting: Sacrum, ischial tuberosities, greater trochanters
Supine: Sacrum, heels, scapulae
Sidelying: Greater trochanter, medial malleolus, lateral malleolus, ear

LT vs. ST Supine Positioning

LT Positioning: Placement of the patient on their left side with the right side raised.
ST Positioning: Placement of the patient on their right side with the left side raised.
Rationale: Promotes drainage from the lungs.

Long-Term Positioning Considerations

Breathing: Maintain airway and adequate lung expansion.
Pressure Relief: Prevent decubiti and pressure ulcers.
Alignment: Promote correct body posture and maintain joint mobility.
Comfort: Ensure patient comfort and minimize pain.

Safety in Positioning

Supervision: Frequent monitoring of patient to ensure safety and comfort.

Restraint or Assist Device

Restraint: Device that restricts movement for the benefit of staff and not the patient.

Common Contractures

UE: Shoulder adduction, elbow flexion, wrist flexion.
LE: Hip flexion, knee flexion, ankle plantar flexion

BKA Patients

Risk: Hip flexion, knee flexion contractures.

Head of Bed (HOB) Elevation

Importance: Promotes lung expansion and drainage.

Areas at Greatest Risk for Decubiti

Sitting: Ischial tuberosities, sacrum, and greater trochanters
Supine: Sacrum, heels, scapulae, and occiput
Sidelying: Greater trochanter, lateral malleolus, and iliac crest

LT vs ST Positioning in Supine

LT positioning: Left side lying
ST positioning: Right side lying
Difference: The positioning of the patient's heart and lungs
- LT: Heart and lungs are on the left side of the body, which can help prevent complications from heart failure.
- ST: Heart and lungs are on the right side of the body, which can be more challenging, especially in patients with a history of respiratory problems.

Considerations for Long-Term Positioning

Pressure points: Areas where bony prominence is in direct contact with the bed, making them prone to pressure ulcers.
Respiratory status: Whether positioning compromises airflow and lung expansion.
Comfort: Patient's comfort and ability to maintain positioning.
Contractures: Whether the body position is comfortable for the patient and promotes proper physiological alignment.

Safety Measures

Regular turning schedules: Rotating the patient's position to take pressure off of vulnerable areas.

Restraint vs. Non-Restraint Devices

Restraints: Devices used to restrict the patient's movement, especially if used as a safety measure for the patient or others.
Non-Restraints: Devices that do not limit a patient's freedom of movement or safety.

Typical Contractures

UE: Shoulder adduction, elbow flexion, wrist flexion, and finger flexion
LE: Hip flexion, knee flexion, and ankle plantarflexion

BKA Contractures

Hip and knee flexion are the most common due to the position of the residual limb after amputation.

HOB Elevation

Reduces pressure on the lungs: Promotes better breathing by allowing the lungs to expand fully.
Promotes drainage: Improves drainage from the lungs.
Decreases edema: Can help to decrease edema in the lower extremities in some cases.

Long Term Positioning

Long term positioning (LTP) is used for patients who are unable to move themselves and require assistance.
The blanching test is used to determine pressure points.
LTP should consider safety, comfort, and prevention of pressure ulcers.
Repositioning should occur every 2 hours, or every 15 minutes when sitting.

Supine Positioning

The head should be supported with a pillow to maintain spinal alignment.
Special cushions should support the scapulae and sacrum to prevent pressure ulcers.
A pillow should be placed under the lower legs to prevent pressure on the heels, but avoid knee hyperextension.
Arms should be abducted and supported to prevent edema.
Hips should be neutral and knees extended, but not hyper-extended.
Ensure heels are supported to avoid pressure points.

Sitting Positioning

Ensure the patient has a call bell, is upright, and their trunk is slightly reclined.
Use lateral trunk and arm supports to provide stability.
Ensure the patient’s weight is evenly distributed.
Provide lumbar supports to help with spinal alignment.
Knees should be slightly higher than hips, and a cushion can be used between the knees for support.
Ensure the patient's feet are supported.
Arms should be supported and slightly abducted.
Provide padding as needed for contact points.

Prone Positioning

Ensure a clear airway and means for calling for help.
A pillow should be placed under the abdomen and hips to maintain alignment.
Arms should be overhead or at the patient's side.
Special cushions may be used to relieve pressure on the anterior shoulder and iliac crests.
A pillow under the lower legs helps prevent pressure on the dorsum of the feet.
Prone positioning is especially useful in preventing hip flexor contractures.

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Description

Test your knowledge on the key aspects of patient positioning, including risk areas for decubitus ulcers in various positions, long-term positioning considerations, and safety measures. Understand the rationale behind left and right supine positioning and the importance of patient comfort and supervision.