Positioning and Draping

Presented by: Neil P. Cabilatazan Section 1 Group 7

Positioning

Why do we spend time on positioning? Patient comfort/decrease pain Support and stability to pts trunk & extremities Prevent development of pressure sores Prevent joint contractures To have easier access to area being treated Decrease edema Increased function

Positioning

The most comfortable for the pt may not be the best for them May need to be positioned to aid in the treatment of a specific diagnoses or condition What about restraints?

Considerations with positioning

Who is at risk?

Elderly Those unable to change their own position Those with decreased sensation Those who may be unable to communicate their discomfort

Pressure Points To Consider

When do we change position

Medicare standards = common practice standards

Change every 2 hours

At the conclusion of treatment

Check with nursing on preference

What do we use

Pillows blankets Heel protectors Splints, slings & braces Seat cushions Wedges Others??

Standard Positions
Supine Prone Side-

lying Semi-fowler Sitting

Standard Positions

Supine

Pillow under head to keep c-spine neutral Small pillow or towel roll for cervical support Support under popliteal space to lumbar lordosis Ankle support to relieve pressure on calcaneus Support under elbows to relieve pressure on bony prominence

Supine Position

Standard Positions

Prone

Pillow under head Pillow under lower abdomen to lumbar lordosis Rolled towel under anterior shoulder to adduct (retract) scapula Towel roll/pillow/bolster under ankles to relieve stress on hamstrings, also allows pelvis and lumbar spine to stay relaxed

Prone Position

Standard Positions

Sidelying

Pt in center of bed not near edge Head, trunk, pelvis in alignment LEs are flexed at hip & knee with pillows btwn legs & top Le slightly forward of bottom LE Pillow at chest &/or back for to prevent pt from rolling Pillow under top arm to keep chest open

Sidelying Position

Standard Positions

Semi-fowler

Head of bed is lifted 30 - can use pillow, wedge or bolster as well Pillow under popliteal space Used for breathing, eating, visiting For a Fowler position head of bed is 45

Semi-Fowler Position

Standard Positions

Sitting

Variety of seated positions

Straight, recumbent, semi-recumbent

Remember to soften bony prominences Arms and legs supported (head if necessary) Elbows at 90

Draping

Reasons for draping pts:

Privacy/modesty/dignity Warmth Hygiene

How do you feel at the Drs office with no clothes on????

Draping

If you need pt to change to gown leave room knock before re-entering If pt needs assistance suggest it, ask permission before helping them Only area being treated is exposed, the rest of the pt is covered

Gown, blanket, sheet, towel

Pt comfort is the key to working on difficult areas

Draping

Be sure you keep legal considerations in mind

What is the policy of the facility on door being closed, slightly open? Curtains? Inappropriate comments or touch mean different things to different people Protect yourself by being professional at all times