Week 3 Draping and Positioning - Student Notes PDF

Moving the Bar, Part 2: Initiating Mobility Chapter 6 Draping for Minimum Exposure and Maximum Dignity Copyright ©2022 F.A. Davis Company  Initiating Mobility  For the minimally mobile...

Moving the Bar, Part 2: Initiating Mobility Chapter 6 Draping for Minimum Exposure and Maximum Dignity Copyright ©2022 F.A. Davis Company  Initiating Mobility  For the minimally mobile patient, even seemingly small aspects of the clinician’s actions have large effects on the patient’s mobility potential.  Success depends on working effectively with the patient, the environment, and the task. Copyright ©2022 F.A. Davis Company  Initiating Mobility: The Person  Obtain consent.  Establish rapport. Listen with attention. Communicate clearly about goals. Maintain confidentiality. Respect power differences. Use a caring, respectful touch. Explain all procedures before beginning them.  Match your expectations to the patient’s capabilities.  Monitor patient responses. Copyright ©2022 F.A. Davis Company  Initiating Mobility: The Environment  Respect patient privacy. Respect the patient’s space; act as if you are a guest in the patient’s home.  Create a supportive environment.  Position patients for comfort, function, and safety.  Keep the area clean.  Always provide a way for the patient to call for assistance. Copyright ©2022 F.A. Davis Company  Initiating Mobility: The Task  Use equipment to transfer dependent patients.  Engage the patient in the task: Explain procedures; ask for questions. Have patient mentally rehearse.  Establish baselines: Physical mobility Vital signs Copyright ©2022 F.A. Davis Company  Debbie  Patient with spinal damage caused by assault  Wearing full protective spinal brace  Trunk and lower-extremity (LE) weakness expected to improve  Has been homeless for 5 years  How will you position and cover her during your evaluation?  What special considerations might there be when working with this patient? Copyright ©2022 F.A. Davis Company  Overview  Draping considerations Trauma-informed care Culturally sensitive care Maximizing patient comfort and dignity Covering with clinical attire Covering with linens Position-specific draping Copyright ©2022 F.A. Davis Company  Appropriate Draping Provides  Access to areas of the body for examination or treatment  Protection of patient’s modesty and dignity  Patient comfort and warmth  Protection of vulnerable sites  Protection of patient’s clothing Copyright ©2022 F.A. Davis Company  Providing Trauma-Informed Care  Exposure may trigger intense emotional reactions at any time during patient interactions.  It is not always possible to know which patients have a history of abuse or trauma.  For best outcomes, use good communication skills, informed consent, respect for boundaries, active patient involvement, and monitoring for signs of discomfort throughout the session. Copyright ©2022 F.A. Davis Company  Cultural Sensitivity  When exposure of the body is required for examination or intervention, members of some cultures may: Have clothing that should not be removed Find a hospital gown extremely embarrassing Prefer not to wear attire previously worn by others Prefer a same-gender healthcare provider Copyright ©2022 F.A. Davis Company  Maximizing Comfort and Dignity  Communicate clearly with the patient.  Provide privacy for changing into and out of garments.  Include a chaperone who is the same gender as the patient when appropriate. Copyright ©2022 F.A. Davis Company  Covering the Patient  Clinical attire Gowns Pants and tops Copyright ©2022 F.A. Davis Company  Covering the Patient - Linens  Expose only one area at a time  Layering linens can help minimize exposure  Secure edges  Dispose of soiled linens appropriately  Layering towels ↑  Exposing one leg at a time → Copyright ©2022 F.A. Davis Company  Covering the Patient - Draping  Draping in sitting  Draping in sidelying Copyright ©2022 F.A. Davis Company  Knowledge Check  Your patient experienced a right groin injury. Describe how you would drape this patient to allow for inspection and palpation of the involved tissues. What would you say to the patient? How would you monitor the patient’s sense of vulnerability? Copyright ©2022 F.A. Davis Company  Summary  Consider patient dignity in addition to access for treatment.  Explain procedures and obtain consent.  Use a confident touch, and secure edges of linens.  Any patient may be a survivor of trauma or abuse; watch for signs of discomfort.  Be aware of potential cultural preferences.  Provide chaperones when appropriate. Copyright ©2022 F.A. Davis Company  Chapter 7 Positioning Your Patient for Mobility Copyright ©2022 F.A. Davis Company  Katsu Katsu has limited right upper extremity (UE) and lower extremity (LE) function following a cerebrovascular accident (stroke) and has a supportive family.  What are your goals in positioning Katsu?  What precautions must you consider?  How might you involve her family? Copyright ©2022 F.A. Davis Company  General Guidelines  Explain procedures and obtain consent.  Do as much as possible, as normally as possible (AMAP/ANAP)  Maintain normal spinal alignment as much as possible.  Use good body mechanics.  Consider the environment.  Provide a way for the patient to call for help. Copyright ©2022 F.A. Davis Company  Short-Term Positioning  Objectives: Safety, Comfort, Access  Positioning Checklist Patient is safe Good spinal alignment Accessibility of necessary areas of the body Trunk and extremities supported for comfort Positioned well within environment (line of sight, communication, etc.) Special needs accommodated Copyright ©2022 F.A. Davis Company  Short-Term Positioning: Supine  Which one is correct? Copyright ©2022 F.A. Davis Company  Trendelenburg Position Why would you put someone in this position? Copyright ©2022 F.A. Davis Company  Short-Term Positioning: Prone  Which one is correct? Copyright ©2022 F.A. Davis Company  Short-Term Positioning: Side lying with pillows Normal spinal curves in side lying Positioning with pillows in side lying Copyright ©2022 F.A. Davis Company  Short-Term Positioning: Sitting  What’s wrong with  Correct: this picture? Copyright ©2022 F.A. Davis Company  Knowledge Check  After positioning a patient for a therapy session, what should you check to be sure the patient is optimally positioned?  Describe how you would position a patient in supine on a treatment mat. Copyright ©2022 F.A. Davis Company  Long-Term Positioning  Objectives Safety—open airways, avoid falls, accommodate medical limitations Prevention—pressure injuries, contractures, edema Intervention—promote efficient bodily functions Comfort and quality of life—functional independence, comfort, social participation Copyright ©2022 F.A. Davis Company  Bed Positions – Negative Effects  Fowler’s position Negative Effects of Immobility  What are the negative effects on these systems? Integumentary Musculoskeletal Cardiopulmonary Neurological Other Copyright ©2022 F.A. Davis Company  Preventing Contractures Promoting Preventing Cardiopulmonary Contractures Health   Flexion contractures Position distal extremities at or above tend to be most the level of the heart common.  May need to avoid to minimize edema.  Vary demand on the positions of comfort.  Reposition heart by including more upright frequently. positioning.  Common  Vary positions to contracture promote lung drainage. positions/sites? Copyright ©2022 F.A. Davis Company  Preventing Pressure Injuries  No more than 2 hours in one position in bed  No more than 15 minutes in one position in sitting  Shift weight and reposition more frequently if patient has increased risk factors. Copyright ©2022 F.A. Davis Company  Increased Susceptibility to Pressure Injuries  Decreased mobility  Postural  Fragile skin impairment  History of skin  Friction or shear breakdown  Nutritional  Incontinence deficiencies  Impaired sensation  Impaired cognition  Impaired circulation  Medication that  Cachexia affects mobility or  Muscle atrophy awareness Copyright ©2022 F.A. Davis Company  High-Risk Areas for Pressure Injuries  Where are the potential sites for skin breakdown? Copyright ©2022 F.A. Davis Company  What about when sitting? Copyright ©2022 F.A. Davis Company  Inspection and Assessment  Skin blanching test: When examining healthy lighter- darker skin: colored skin will  Ask about history of blanche when pressure injuries. pressed and quickly  Use good lighting. return to healthy  Look for coloration pink when pressure changes. is released.  Palpate for  Do not position a temperature and patient with texture changes. pressure on a  Consider thermal compromised area: “redness rule” imaging for high-risk patients. Copyright ©2022 F.A. Davis Company  BRADEN Scale. SENSORY/PERCEPTION MOBILITY MOISTURE  Float heels off bed surface.  Turn clock (turn Q2hrs).  Moisture barrier.  Prevent direct contact  Add airpump to Atmos Air  Address cause, if possible. between boney prominences. mattress (if applicable).  Prompted voiding &  Position tubes and devices to Offload/reposition when pt in hydration in conjunction with prevent trauma & pressure. chair/WC. turning schedule. NUTRITION ACTIVITY FRICTION/SHEAR  Refer to nutritionist.  Float heels off bed surface.  HOB < 30 degrees (unless  NO lonely meals.  Per PT & OT eating).  Between meal snacks per recommendations.  After moving flat to elevated, nutritionist. Use facility-approved devices for roll sideways to release turning & positioning. shear forces.  Use facility-approved devices for turning & transferring. Copyright ©2022 F.A. Davis Company  Long-Term Positioning Checklist   Clear airway Prevent joint and soft-  Good spinal tissue contractures alignment  Trunk and extremities  Minimized pressure supported and over bony stabilized prominences  Minimized gravity  Long-term functional creating shearing positions forces  Positioned to optimize  Cushioned support interaction with the surfaces environment (line of  Immobile sight, communication, extremities elevated etc.)  Special needs Copyright ©2022 F.A. Davis accommodated Company  Long-Term Positioning  Prone – RARELY USED  Performed by trained team when used to promote lung function in critically ill patients  Supine Copyright ©2022 F.A. Davis Company  Long-Term Positioning: Sidelying  Upper trunk  Use pillow or typically rotated bolster to maintain forward or upper trunk backward. position. Copyright ©2022 F.A. Davis Company  Long-Term Positioning: Modified Sidelying Commonly modified sidelying, either ¾ supine or ¾ prone used instead of full prone. Copyright ©2022 F.A. Davis Company  Long-Term Positioning: Sitting  Increase frequency of repositioning  May require small lumbar roll  Approximate 90 degree-90 degree position  Avoid sacral sitting  Support arms Copyright ©2022 F.A. Davis Company  Positioning Devices  Patients using positioning devices must be monitored for skin integrity. Copyright ©2022 F.A. Davis Company  Restraints  Use only when absolutely necessary.  Requires medical order.  Use the least restrictive device (LRD).  Fasten with quick-release buckles or knots.  Monitor patients closely.  Restraint or trunk support? Copyright ©2022 F.A. Davis Company  Positioning After a Total Hip Arthroplasty (THA): Posterolateral Approach  Avoid hip flexion beyond 60 to 90 degrees.  Avoid hip adduction past 0 degrees.  Avoid hip internal rotation past 0 degrees.  Which of these is correct positioning? Copyright ©2022 F.A. Davis Company  Positioning With Hemiparesis  Prevent  Common pattern of contractures contracture  Prevent wrist and development Scapular retraction hand edema Shoulder adduction,  Avoid distraction of flexion, and internal the hemiparetic rotation Elbow, wrist, and finger shoulder flexion Hip adduction, flexion, and internal rotation Knee flexion Ankle plantarflexion Copyright ©2022 F.A. Davis Company  Positioning With Hemiparesis: Supine  Supine  Sidelyin g Copyright ©2022 F.A. Davis Company  Positioning After Lower Extremity Amputation  DO  DO NOT X Let the residual limb  Keep the hips in hang off the edge of the neutral rotation. bed.  Extend the knee. X Place a pillow under the hip or knee while the  Minimize sitting patient is supine. time with the knee X Place a pillow under the flexed. low back. X Allow the patient to lie  Avoid pressure on with the knees flexed. non-healed surgical X Allow the patient to cross sites. legs. Copyright ©2022 F.A. Davis Company  Which position is correct? Copyright ©2022 F.A. Davis Company  Summary  Maintain normal spinal curves in short- and long-term positioning.  Short-term priorities: safety, comfort, access  Long-term priorities: safety, prevention, comfort  Pressure injuries can result from high pressure over a short time period or low pressure over a long time period.  Certain health conditions sometimes call for additional positioning considerations. Copyright ©2022 F.A. Davis Company