PT Fundamentals Week 6

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Questions and Answers

What is the primary concept emphasized in the introduction to patient positioning?

Conducting a physical examination

Developing a treatment plan

Establishing a therapeutic alliance (correct)

Maximizing patient mobility

Which guideline is essential for establishing rapport with a patient?

Using complex medical jargon

Ignoring the patient's personal biases

Using language that the patient understands (correct)

Discussing only the clinician's preferences

What should clinicians be aware of before engaging with a patient?

Their own biases and how they affect patient care (correct)

The assistant's availability

The patient's level of education

The economic status of the patient

Which of the following is NOT a part of the patient-environment-task model discussed?

The therapist's reputation Signup and view all the answers

What is a clinician's responsibility within ethical and professional boundaries?

To empower patients to meet their goals Signup and view all the answers

What is the primary purpose of obtaining consent from a patient before recommending a procedure?

To make sure the patient agrees and understands the benefits of the procedure. Signup and view all the answers

What should be done if there is no response after knocking on a patient's door?

Knock again and introduce yourself before entering. Signup and view all the answers

Why is managing lines and tubes essential during patient interventions?

To prevent kinking or pulling out important medical lines. Signup and view all the answers

What should be established as a baseline before recommending a task to a patient?

The patient's vital signs and relevant medical history. Signup and view all the answers

What role does mental imagery play in the process of engaging a patient in a task?

It helps patients visualize and understand the purpose of the task. Signup and view all the answers

What is the primary focus when a therapist guards a falling patient?

To ensure the patient is close to their center of mass. Signup and view all the answers

What is the difference between directing and controlling a patient in therapy?

Directing involves providing cues for independence, while controlling is about managing the patient's movements. Signup and view all the answers

What considerations should be taken into account for safe patient positioning?

Spinal alignment, safety, and accessibility to the environment. Signup and view all the answers

What role does the EMR play when entering a space with a patient who may already be laying down?

It assists in developing a tailored plan of care based on the patient’s history. Signup and view all the answers

What is the primary purpose of adding pillows under the knees when lying supine?

To bring the pelvis into a posterior tilt Signup and view all the answers

Which positioning adjustment can help maintain cervical curve when in a prone position?

Using a facial cutout and properly placed pillows Signup and view all the answers

What should be avoided when positioning a patient in sideline alignment?

Allowing the hips or shoulders to rotate Signup and view all the answers

In what scenario would a patient need to be positioned with their head and upper mid-back elevated?

When undergoing an x-ray while having a nasal gastric tube Signup and view all the answers

How can positioning be used as an intervention in treating low back pain?

By transitioning from supine to prone on the elbows Signup and view all the answers

What is a suitable reason for choosing a wider plinth table for a client with right-side weakness after a stroke?

To accommodate their body mechanics during therapy Signup and view all the answers

Why is it important to consider the safety of a patient's position when they have a chest tube?

To avoid constricting the tube and limiting fluid drainage Signup and view all the answers

What should therapists do to promote patient comfort during positioning?

Use pillows to support the spine while ensuring proper spinal alignment Signup and view all the answers

What is a potential consequence of a patient's discomfort during therapy?

Higher risk of not returning for future therapy sessions Signup and view all the answers

What should therapists ensure regarding emergency assistance for patients?

That instructions are provided for reaching assistance in outpatient settings Signup and view all the answers

Study Notes

Introduction to Patient Positioning

Positioning a patient involves placing them in a static resting posture for reasons like safety, comfort, spinal alignment, and facilitating treatment.
Positioning can be used in various settings like acute care, skilled nursing facilities, home health, outpatient clinics, and sports-based clinics.
Short-term positioning is suitable for patients with independent mobility, while long-term positioning is used for individuals with limited mobility.
Prone positioning involves lying face down, sidelying involves lying on either side, and supine positioning involves lying face up.

Positioning Considerations

When evaluating a patient for positioning, consider factors like safety, spinal alignment, accessibility, comfort, and accommodation for special needs.
Ensure the support surface is appropriate for the patient's abilities and impairments.
The support surface should be protective but not overly restrictive.
Consider the weight limits of the equipment and ensure it is compatible with the patient's weight.
The patient's position should cater to their needs and avoid potential harm, like constricting tubes.
The patient should have access to a call system or a way to request assistance.

Patient Comfort and Safety

Patient comfort should be considered paramount, as it can significantly influence their safety and participation in therapy.
Uncomfortable positions can increase the risk of falls and other injuries, and may deter patients from seeking further therapy.
Promoting patient comfort should encompass both physical and interpersonal aspects.
Correct spinal alignment is essential for comfort, as poor alignment can cause imbalances and lead to increased pain.
Normal spinal curves should be maintained during positioning by using pillows or other supports.
Always re-check for safety, comfort, and accessibility after positioning the patient and allow them time to adjust and provide feedback.

Positioning for Comfort and Safety

Supine Positioning: Pillows placed under the knees create a posterior pelvic tilt, flattening the lower back into a comfortable curve.
Prone Positioning: A table cutout maintains the normal cervical curve, pillows under the knees and lower legs support the typical curvature and alignment of the pelvis and low back.
Sideline Positioning: Maintaining a straight spinal alignment is crucial, with pillows used to support the arms and promote comfort.
Sitting Alignment: Elevating feet by adding support reduces pressure on the distal thighs and helps maintain normal lumbar spinal alignment. A small spinal roll can help improve spinal alignment in sitting.
Alternatives for Positioning: Be flexible and adaptable when accommodating patient needs. Adapt positioning for patients with special circumstances like nasal gastric tubes or hip fractures, ensuring safety and comfort.

Interventions Using Positioning

Prone Positioning: Used to improve spinal alignment in low back pain cases, progressing from flat prone to prone on elbows.
Prone Positioning: Used to increase hip extension range of motion in patients with transfemoral amputations, addressing hip flexion contractures.
Trendelenburg Position: Short term intervention where the head of the bed is lowered below the foot of the bed. May be used for patients with hypotensive episodes or spinal cord injuries.

Long-Term Positioning

Reasons for Long-Term Positioning: Safety, prevention of pressure injuries, contractures, and swelling, promoting physiological function, and compensatory function, as well as improving quality of life.
Common Long-Term Positions: Modified side-lying position for patients at risk of developing pressure injuries. Fowler's position, a semi-reclined position with the head of the bed raised, allowing for comfort and participation in the environment.
Contractures: Adaptive shortening of ligaments, tendons, and muscles due to prolonged immobility, leading to reduced joint motion, and potentially becoming permanent.
Pressure Injuries: Localized injuries to the skin caused by unrelieved pressure, shearing forces, and prolonged positioning.

Risk Factors for Pressure Injuries

Immobility: Longer periods of inactivity increase the chance of developing pressure injuries.
Medical Conditions: Conditions such as poor nutrition, incontinence, and chronic illnesses increase the risk of pressure injuries.
Advanced Age: Older adults are more susceptible to pressure injuries.
Specific Body Types: Thin individuals or those with excess body weight are also at higher risk.
**Positioning: ** Incorrect or prolonged positioning can lead to pressure injury due to increased pressure on specific body areas.

Promoting Cardiopulmonary Health in Long-Term Positioning

Cardiopulmonary Considerations: Prolonged immobility can reduce cardiac demand, leading to orthostatic hypotension when moving to an upright position.

Key Facts and Figures:

Cost of Pressure Injury: Managing a full thickness pressure injury can cost as high as $127,000.
Pressure Injury Biomechanics: Load, pressure, and time contribute to pressure injury development.
Shearing Forces: Pulling or sliding patients instead of lifting can cause shearing forces, contributing to pressure injury risk.
Fowler's Position: While comfortable, prolonged use can lead to contractures and pressure injury risk in specific areas.
Pressure Injury Prevention: Regularly repositioning patients, using appropriate cushions, and reducing shearing forces are vital to prevent pressure injuries.

Bed Mobility

Bed mobility refers to moving a person from one position to another on a flat surface, including rolling, scooting, and transitions between supine, sitting, and standing positions.
It improves patient mobility and functional independence.

Repositioning in Bed

Frequent repositioning is essential to prevent pressure ulcers and sores, especially for patients who slide down in bed.
A slouched position can increase pressure on the sacrum and spine, and make breathing more difficult.

Basic Bed Mobility Techniques

Hooklying: Supine position with flexed knees and feet flat on the floor, hips flexed to 45-55 degrees, and knees at 90 degrees. Helps engage the gluteus maximus and quadriceps.
Bridging: From hooklying, squeeze the gluteus maximus to lift hips off the surface. Facilitates pressure relief and assists with activities like scooting.
Scooting: Using hooklying and bridging to move up, down, or sideways in bed.
Dependent Draw Sheet Transfer: Used for patients unable to assist with transfers, using a sheet to lift and move the patient from one surface to another.
Scooting Sideways: Segmentally lifting, shifting, and lowering the upper and lower body, typically initiated from hooklying.
Bed Rails for Scooting: Patients can use bed rails to assist with scooting up in bed, but it's important to eventually transition to scooting without rails for home independence.

Rolling Techniques

Rolling to Sideline: Scoot to the opposite side of the bed, turn the head and eyes toward the desired direction, bring the knee up and over, push down through the elbow, and use the opposite arm for support.
Rolling Supine to Prone: Roll to sideline and continue rolling until the stomach is flat on the surface. Keep the arm on the side rolling over close to the body to avoid pinning it underneath.

Sitting Techniques

Long Sitting: Legs extended, on a floor, mat, or bed.
Short Sitting: Hips and knees flexed, typically at the edge of the bed (EOB).
Supine to Sitting: Flex the knee, roll to sideline, press up on the elbow, use abdominal muscles and momentum to lift the torso, and use the upper extremities to assist with sitting up.
Scooting Sideways While Sitting: Abduct the arm on the side of the movement, push down with both arms to lift and shift the pelvis, and use the toes for balance and support.

Additional Considerations

Bedpan Use: If a patient needs to use a bedpan and is unable to get out of bed, roll them to the opposite side, place the bedpan under the pelvis, roll them back to supine, elevate the head of bed, ensure they are securely on the bedpan, and elevate the bed rails for safety.
Prone Positioning: Rarely used for long-term positioning, but may be needed for pressure relief, wound care, or other interventions.
Sitting Benefits: Relieves bed-induced pressure, assists lung clearing, stimulates cardiac function, facilitates swallowing, and allows for sensory input and social interaction.
Physical Restraints: Devices or materials used to limit a patient's movement, typically used after surgery to ensure safety. Requires a medical prescription and is highly regulated.
Orthostatic Hypotension: Decreased blood pressure by at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of standing.
Edema: Swelling, often occurs in immobile extremities placed in a dependent position (below the level of the heart). Elevate extremities above heart level to prevent or reduce edema.
DVT (Deep Vein Thrombosis): A blood clot in a deep vein, potentially caused by immobility. Therapists should be aware of the potential for DVT and take precautions to prevent it.
Positioning Devices: Used to alleviate, prevent, or protect specific areas. Examples include heel suspension boots, abduction pillows, limb guards, and support splints.
Blood Pressure Monitoring: Important during positioning and movements, especially during transitions like supine to sit, and sit to stand. Monitors patient's tolerance to activity and helps determine the intensity of planned activities.

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Description

This quiz evaluates your understanding of patient positioning concepts and the ethical responsibilities of clinicians. It covers essential guidelines for establishing rapport and the patient-environment-task model. Test your knowledge on critical aspects of patient engagement and professionalism in clinical settings.

PT Fundamentals Week 6 - Transcripts

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