PTHA 1405Basic Patient CareDRAPING AND POSITIONING
Basic Patient Care Decubitus Decubitus (pressure sore)- ulceration of soft tissue caused by unrelieved pressure and/or shearing forces. Shearing forces- the forces applied to the movement of tissues away from skin held in place by friction.Pressure ulcers are most commonly found overboney prominences subject to externalpressures.
Basic Patient Care Decubitus Prevention 95 % of all pressure sores are located over 5 locations: sacrum, heels, greater trochanters, lateral malleolus, and ischial tuberosity.
Basic Patient Care Pressure LocationsSupine Prone Side-lying SittingOccipital Forehead Lateral ear Ischial tuberositytuberositySpine of scapula Lateral ear Lateral ribs Spine of scapulaInferior angle of ASIS Medial eipcondyle Inferior angle ofthe scapula scapulaMedial epicondyle Humeral head Greater trochanter Medial epicondyleSpinous processes Patella Medial condyle Spinous processPosterior iliac Anterior tibia Lateral malleoluscrestSacrum Dorsum of foot Medial malleousGreater trochanterHead of fibulaHeelsLateral malleolus
Basic Patient Care Positioning Positioning should be tailored to the patient’s needs Positioning should prevent skin breakdown Prevent soft tissue / joint contractures Support the trunk and extremities Promote efficient function of organ systems Encourage awareness of affected side (CVA, TBI) Provide access to treatment area Provide patient comfort (with a few exceptions)
Basic Patient Care PositioningPosition DescriptionFowler Supine with head of bed elevated between 45 and 60 degreesSemi-Fowler Supine with head of bed elevated to 30 degreesTrendelenburg Head down with trunk and LE elevatedSupine Lying on backSemi-supine Upper and/ or lower body ½ way between supine and side lyingSide lying On left or right sideProne Lying on bellySemi-prone Upper and/ or lower body ½ way between prone and sidelying
Basic Patient Care Positioning Supine Place pillow under the patient’s head Place pillow under popliteal fossas to maintain a moderate lumbar lordosis Place a small towel under the posterior anterior ankles to relieve pressure on calcaneus, but avoid knee hyperextension.
Basis Patient Care Positioning Prone Place pillow under the patient’s head or place a towel role under the forehead Place a pillow under the lower chest or abdomen (with a few exceptions) Place a pillow under anterior ankles
Basic Patient Care Positioning Side-lying Place pillow under the patient’s head Place a pillow under the uppermost UE Place pillow under the uppermost LE (between knees and ankles) Place pillow along posterior trunk to prevent patient from rolling back
Basic Patient Care Positioning for Specific DiagnosisDiagnosis Positioning considerationsRespiratory-Orthopenea Difficulty breathing in any position except an erect position. Fowler, Semi- Fowler, 2 plus PillowsRespiratory- COPD Fowler, Semi-FowlerRespiratory- Tracheotomy Avoid ProneCardiovascular-venous insufficiency Elevate the involved extremityCardiovascular- Arterial insufficiency Place involved extremity in flat of dependant positionPregnancy Avoid prolonged lying on right side and supine during 3rd trimester to avoid pressure on the vena cava
Basic Patient Care PositioningNeurological- CVA Support affected shoulder to avoid subluxation Maintain neutral wrist and finger alignment Maintain neutral ankle alignment to avoid PF contractureAmputation-AKA Avoid prolonged hip flexion Recommend periodic prone positoningAmputation-BKA Avoid prolonged hip and knee flexionBurns and Grafts -Avoid positions of comfort -Stress and tension of the healing tissue is necessary for healing and function -Avoid direct pressure on graft sites
Basic Patient Care Pressure Relief In bed – the patient should be or encourage to reposition every 2 hours. Positions should be alternated. Sitting- Patients in wheelchairs should perform pressure relief every 15 minutes for 15-30 seconds each time. Patients that are unable to perform pressure relief should be assisted and or have equipment at assist repositioning. Example tilt in space wheelchair