Patient positioning involves properly maintaining a patient's neutral body alignment to prevent complications from immobility or injury. There are several positions used in patient care like supine, lateral, prone, and lithotomy positions. Factors like the patient's needs, abilities, disease, and hospital protocols must be considered when positioning. Positioning aims to provide comfort, relieve pressure, improve circulation, prevent deformities, and allow for interventions. Proper techniques and safety measures are followed to position patients in a systematic way.
Bed-making is the act of arranging the bedsheets and other bedding on a bed, to prepare it for use. It is a household chore, but is also performed in establishments including hospitals, hotels, and military or educational residences. Bed-making is also a common childhood chore.
Bed-making is the act of arranging the bedsheets and other bedding on a bed, to prepare it for use. It is a household chore, but is also performed in establishments including hospitals, hotels, and military or educational residences. Bed-making is also a common childhood chore.
Nurse /doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
Nurse /doctor will insert two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. During this part of the exam, your doctor will check the size and shape of your uterus and ovaries, noting any tender areas or unusual growths.
Therapeutic Positions are used to promote comfort of the patient.
Proper turning and positioning allows the health care provider to make clients, as comfortable as possible, prevent contractures, and pressure sore, and facilitate diagnostic test for surgical intervention.
To relieve pressure to new positions every 2 hours.
Three factors significant in positioning are- Pressure, Friction and Shear
According to Annamma Jacob,
Positioning is defined as placing the patient in good body alignment as needed therapeutically.
According to nurseinfo.in,
Positioning is defined as placing the person in such a way to perform therapeutic interventions to promote the health of an individual
PURPOSE
To promote comfort
To prevent complication
To stimulate circulation
To promote normal physiologic functions.
ARTICLES
Clean, dry, firm bed
Different types of mattress
Bed Boards
Pillows
Footboards/ Foot boot
Sandbags
Hand rolls
Trochanter rolls
Bed blocks
Over bed Table
Additional Sheets
Trapeze bar
PRINCIPLES
Maintain good body mechanics.
Obtain assistance as required.
Ensure that mattress is firm and level of bed is at working height.
Ensure that sheets are clean and dry.
Avoid placing a body part directly over another to prevent pressure.
Plan a regular position change schedule for the patient for 24 hours..
Ensure patient comfort.
Wash hand before and after procedure
TYPES OF POSITIONING
Fowler’s Position
Orthopenic Position
Prone Position
Lateral/ Side Lying Position
Sims’s Position/ Semi- Prone Position
Lithotomy Position
Trendelenburg Position
Reverse Trendelenburg Position
Supine Position
Dorsal Recumbent Position
Knee-chest Position
Rose Position
Other Position
FOWLER’S POSITION
Purpose
To relieve or minimize dyspnea
To relieve tension on abdominal sutures
ORTHOPENIC POSITION
High fowler’s position with over bed table placed in front of the client.
Client to rest with both hands on over the bed table/on pillow placed on it and lean forward. Leaning forward facilitates respiration by allowing maximum chest expansion.
Indications:
Patient with severe dyspnea
Cardiac Patients
Position for thoracentesis
Patient with chest drainage tubes
Relieve Respiratory distress
Pericarditis
ARDS
COPD
Emphysema
Asthma
PRONE POSITION
The client is in flat position only abdomen with head turned to one side. The head rest on a pillow, one or both hands beyond the head or at the sides.
Indication
Patients with pressure sores, burns, injuries, and operations on back
For patients after 24 hours of amputation of lower limbs
Position for renal biopsy
To prevents aspiration
NTD
Recovery positions after anesthesia
LATERAL POSTION
Also known as SIDE LYING POSITION.
Client lies on the side with weight on his hips, shoulder pillow support, and stabilizes. Upper most leg, arm, head and back.
In this position, trunk is right angle to bed.
Indication
To promote lung and cardiac function
During seizure attack and air embolism (Left lateral)
Patient with pyloric stenosis after meals.
Moving, lifting, transferring of the patient
MOBILIZATION
FUNDAMENTAL OF NURSING
UNIT XII
DEFINITION: Moving and lifting the patient means transferring the patient from one place to another (or) changing the position of the patient.
PURPOSE: To prevent bed sores
Maintain good body mechanism
Perform procedures such as back care
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Definition
Positioning defined as placing the person in such
a way to perform therapeutic interventions
and to promote the health of an individual.
3. Contd…
Positioning defined as placing the person in a
proper body alignment for the purpose of
preventive, promotive, curative, and
rehabilitative aspects of health.
4. Contd…
Patient positioning involves properly maintaining
a patient’s neutral body alignment by preventing
hyperextension and extreme lateral rotation to
prevent complications of immobility and injury.
Positioning patients is an essential aspect of
nursing practice and a responsibility of the
registered nurse.
5. Purpose
● To provide comfort to the patient
● To relieve pressure on various parts
● To improve circulation
● To prevent formation of deformity
● To carry out investigations
6. Contd…
● To perform surgical and medical investigations
● To prevent pressure sores
● To provide proper body alignment
● To conduct delivery/labor
● To carry out nursing interventions
7. Principles of positioning
● Systemic and orderly way of doing
● Cooperation between two
● Follow safety measure to prevent accidents
● Active participation
● Using a right technique at right time
8. Factors involved in positioning
● Need of an individual
● Self care ability
● Extend of disability
● Nature of disease condition
● Level of consciousness
● Protocol of the hospital
9. Types of position
● Supine position
● Dorsal position (Lying on back)
● Dorsal recumbent position
● Lithotomy position
● Lateral position
10. Contd…
● Prone position
● Slim’s position
● Knee-chest position
● Trendelenburg’s position
● Fowler’s position / Semi fowler’s position
11. SUPINE POSITION
Supine position, the patient lies on his back with
his head and shoulders are slightly elevated. One
pillow is given under the head. His legs should be
slightly flexed. A small pillow is placed under his
knees.
12.
13. Indication
● The usual position used by the patient
● Used for examination of the chest and
abdomen
14. Procedure
● Place the patient on back with one pillow
under the head, arms and hands at the sides,
knees flexed and separated.
● Place the air ring under the hips and cotton
rings or foam pads under the heels to reduce
the pressure.
15. Contd…
● Align the patient’s body in good position.
● Support the body parts in good alignment for
comfort when the patient is paralyzed.
16.
17.
18. Contraindication
● Elderly patients
● Patients with operation on abdomen, breast
and thorax
● Prone to hypostatic pneumonia
● Patients with long standing illnesses and
neurological conditions
19. LATERAL POSITION
Patient lies on left side with legs flexed at thighs.
The upper leg is flexed more than the lower. A
pillow is kept in front of the abdomen and at the
back and one under the upper leg.
20.
21. Indication
● Lateral position is used for giving back care
enemas and colonic irrigation
● Used for examination of perineum or rectum
inserting suppositories
● For taking rectal temperature
● For change of position
● Later position is a relaxing position
● Giving back care
22. Procedure
Explain the procedure to the patient
● Provide privacy.
● For left lateral position, place the patient on
left side with buttocks to the edge of bed,
both thighs flexed and left arm underneath.
23. Contd…
● For right lateral position, place the patient on
right side with buttocks to the edge of bed,
both thighs flexed and right arm underneath.
● Place air ring under the hips to reduce
pressure on trochanters and at the hip joints,
the cotton rings or foam pads under the
ankles of lower legs to reduce the pressure
on ankles.
24.
25. Contd…
● Align the patient in good position and make
sure the patient is not lying on his arm.
● Support the body parts in good alignment for
comfort.
Left lateral position: with one pillow under the
head, patient is placed to lie on the left side.
26. Contd…
Use of left lateral positions:
● For giving edema
● For inserting suppositories
● To take rectal examination
● To take rectal temperature
28. PRONE POSITION
A patient lies flat on abdomen. Head turned to
sideways. One soft pillow is given under head.
An extra pillow is given under the ankles to keep
toes from touching the bed.
29.
30. Indication
● This position used postoperatively to prevent
aspiration of saliva and mucus
● Used in postoperative cases, tonsils,
vesicovaginal fistula and spinal cases
● To prevent bed sores
● To relieve abdominal distention
● Used for patients having injuries and burns on
back
31. Procedure
● Explain the procedure to the patient
● Provide privacy
● Place the patient flat on abdomen with one
pillow under the head
● Turn patients head to one side and align the
patient in good position
● Support the body parts in good alignment for
comfort
● Place both arms lies at the sides of the heads
35. Indication
● It is used for catheterization, vaginal douche,
vulval, vaginal and rectal examination
● It is also used for vaginal operations and
insertion of tampons
● Patients who are convalescent period
36. Contd…
● Patients with gastric conditions
● Patients with chest conditions
● Patients with abdominal or pelvic operations
unless erect sitting position is indicated
37. Procedure
● Place the patient on back in bed with two or
more pillows under the head and one pillow
under the knees or maintain his position by
elevating the top of bed on blocks.
38. Contd…
● Place the air ring under the hips and cotton
rings or foam pads under the heels to reduce
the pressure.
● Align the patient’s body in good position.
● Support the body parts in good alignment for
comfort when the patient is paralyzed.
39.
40. FOWLER’S POSITION
Fowler’s position is a sitting position in which the
head is elevated, at least, a 45 degree angle.
Back rest and two pillows are used for the back
and head. Fowler’s position the main weight
bearing areas of the patient are the heels,
sacrum and the posterior aspects of the ileum.
41.
42. SEMI-FOWLER’S POSITION
The semi-fowler’s position is the position of a
patient who is lying in bed in a supine position
with the head of the bed at approximately 30 to
45 degrees.
43.
44. Indications
● To relieve dyspnea
● To improve circulation
● To prevent thrombosis
● Postoperatively to assist drainage from
abdominal or pelvic cavity
45. Contd…
● To relax the muscles of the abdomen, back
and thighs
● To relieve tension on the abdominal sutures
● To promote comfort
● To localize infection, e.g. priorities
● To relieve edema of the chest and abdomen
46. Procedure
● Explain the procedure of the patient
● Arrange the articles needed at the bedside
● Provide privacy
● Place the patient in sitting position with arms
at the sides and knees raised with pillow
47. Contd…
● Maintain this position; elevate the head of bed
to an angle from 45-60 degree (semi-fowler) or
60-90 degree (high-fowler)
● Elevate the knee rest to an angle of 15 degree
or place a small pillow under the knees
48.
49. LITHOTOMY POSITION
The patient lies on her back. The legs are
separated and thighs are flexed on the abdomen
and the legs are on the thighs. The patient’s
buttocks are kept the edge of the table and legs
are supported by stirrups.
50.
51. Indication
● This position is given during gynecological
examinations, treatments, and operations on
genitourinary system
● For delivery of baby
● For rectal examinations and operations
52. Procedure
● Explain the procedure to the patient
● Provide privacy
● Position the patient to lie on his back with
one pillow under the head
● Keep the legs well separated and the thighs
are well flexed on the abdomen and the legs
on the thighs
● Buttocks are kept on the edge of the table
and the legs are supported on stirrups
58. KNEE CHEST POSITION
Patient rests on the knees and the chest. The
head is turned to one side with one check on a
pillow. A pillow is placed under the chest. The
weight is on the chest and knees.
59. ASSISTING THE PATIENT IN KNEE-CHEST
POSITION
A prone position in which the individual rests on
the knees and upper part of the chest, assumed
for gynecologic or rectal examination. It is also
called genupectoral position.
60. Indication
● This position is used for sigmoidoscopy
● Used for vaginal and rectal examination
● Used in first aid treatment in cord prolapse or
retroverted uterus
● As exercise for postpartum and gynecology
patients
61. Procedure
● Explain the procedure to the patient
● Collect the needed articles at the bedside
● Provide privacy
● Make the patient rests on the knees and chest
● The head is turned to one side with the cheek
on a pillow
62. Contd…
● The arms should be extended on the bed and
flexed at the elbows to support the patient
partially
● The weight should rest on the chest and knees
which are flexed so that the thighs are at right
angles to the legs
64. CARDIAC POSITION
The client is propped-up in a sitting position by
means of back rest and pillows. Place an over
bed table in front with a pillow on it. The client
has an air cushion to sit and a small pillow under
the knees.
65. TRENDELENBURG’S
POSITION
The patient lies on his back. The patient’s head is
low. The foot of the bed is elevated at 45 degree
angle. The body is on an inclined place and the
legs hang downward over the end of the table.
66.
67. Indication
● Used in emergency situations like shock and
hemorrhage
● This position is used for vaginal surgeries
● Used to displace intestines from pelvic cavity
into upper abdomen
● Used during operations on the pelvic organs
● To arrest bleeding from lower limb
68. Procedure
● Explain the procedure to the patient
● Arrange the article need at the bedside
● Provide privacy (if needed)
● Place the patient lied on his back
● Elevate the foot end at 45 degree angle
69. Contd…
● The body is on an inclined place with hips
higher than the bed
● The knees are flexed
● The patient is carefully supported to prevent
slipping
● Draping done depends upon the kind of
operation to be performed
70. SIM’S POSITION
Sim’s position is similar to the lateral position
except that the patient’s weight is on the anterior
aspects of shoulder girdle and hip. The patient’s
lower arm is behind him and the upper arm is
flexed at the shoulder and elbow.
71.
72. Indication
● This position is used for unconscious patient
● It is used for rectal examinations
● Used for vaginal examinations
● Used for relaxation in antenatal exercises
73. Procedure
● Explain the procedure to the patient
● Collect articles need at the bed side
● Provide privacy
● Place the patient on the side
● One pillow is placed under the head with the
left check resting on it
74. Contd…
● The left arm is drawn behind the body and the
right arm may be in any position comfortable
for the patient
● The right thigh is flexed against the abdomen
● The left leg is extended well
● Cover the patient with top sheet neatly
76. C-SHAPED POSITION
● Patient should be lying in the lateral
decubitus position
● Ensure the vertical plane of the patient’s back
is perpendicular to the bed
● Flex knees and hips so that knees are close
to the chest
● While flexion of the neck is often taught as
important, evidence suggests that this has no
effect of the size of the interspinous opening
77.
78. TYPES OF PATIENTS NEED
SPECIAL CARE
● Unconscious patient
● Infant and children
● Hemiplegic and paraplegic position
● Immediate postoperative patients
● Orthopedic patients
● Cardiac patients
79. GENERAL INSTRUCTIONS
● Maintain good body alignment of the patient at
all times.
● Support body parts in good alignment by using
supportive devices to promote comfort and
prevent undue muscle strain.
80. Contd…
❖ Avoid prolonged flexion of any one body
segment by changing the position at least
every two hours.
❖ Reduce the pressure caused by body weight
of his or her body or object by changing the
position and using protective devices.
81. PRELIMINARY ASSESSMENT
● Check the patient’s general condition
● Check the physician’s order for any limited
movements
● Assess the self-care ability of an individual
● Arrange the comfort devices near the bedside
82. Contd…
● Identify the deformed extremity
● Support the immobilize area during positioning
● Identify the rationale before positioning
83. EQUIPMENT
● Extra man power if needed
● Extra pillows
● Sheets and sheet rolls
● Comfort devices such as back rest, cardiac
table, sand bag, etc
84. Procedure
● Explain the procedure to the patient
● Provide privacy
● Arrange the articles and manpower (if needed)
● Untie the bed sheets
● Turn/lift/ambulate gently
● Place and support with extra pillows under
pressure points
85. Contd…
● Special care taken at pressure areas
● Cover the patient with top sheet
● Hand wash
● Record the time, position and condition of the
skin
86. Contd…
● Positioning a patient in bed is important for
maintaining alignment and for preventing bed
sores (pressure ulcers), foot drop, and
contractures.
Proper positioning is also vital for providing
comfort for patients who are bedridden or
have decreased mobility related to a medical
condition or treatment.
87. Contd…
When positioning a patient in bed, supportive
devices such as pillows, rolls, and blankets,
along with repositioning, can aid in providing
comfort and safety.
88. Contd…
Good body alignment can be achieved in any of
the bed rest positions. The following points
should be checked.
● Head should be in midline with the trunk
● Back should be straight, with normal body
curves (cervical, thoracic, and lumbar)
maintained
89. Contd…
● Ribs should be elevated to prevent
constriction of the chest
● Arms and legs should be in a position of
function (the position for maximum
usefulness of the joints, feet and hands)
90. Contd…
Position of function of leg and feet. This position
favors standing upright and walking. In general, if
the toes point to the ceiling when in a back-lying
position and point to the floor when in a front-
lying position, the feet, legs, and hips are in good
alignment.
91. Contd…
Position of function of arms and hands. This
position favors raising arms and grasping things
with the fingers. The hand should not droop at
the wrist, be clenched in a fist, or be flat. The
position of function for the hand is dorsiflexion (at
a slight upward angle) at the wrist, with the
fingers and thumb in position to write with a
pencil.
Systemic and systematic and are two words that describe systems and processes, respectively.
Systemic refers to something that affects an entire system, like lack of transparency in a governing body.
Systematic refers to an attribute of a process itself, specifically, that it is machine-like in its efficiency and organization.