Proper patient positioning Wright Medical Center 4/21/11

Positioning If patient is immobile, at risk for pressure sores, confused, medicated etc., position will need to be changed AT LEAST every two hours. For many at risk patients position change will need to be more often Most positions can be easily modified at the 1 hour mark, allowing pressure relief but not a full position change Avoid placing flaccid or weak extremities in a gravity dependent position which will allow for dependent edema. In this case the most distal part of the extremity should be higher than the heart

Use a turning schedule :

** The patient should be comfortable in whatever position they are stationed. This rule may depend on patient problem and diagnosis. Some patient problems do not allow the patient to assume a position of comfort. Examples of this are patients with burns to their axilla. In this case patient will be most therapeutically positioned in shoulder abduction, not usually a position of comfort. The position of comfort is often the position of contracture.

pillows or adjunctive devices Sidelying Left or Right: Body well aligned Avoid direct sidelying. particularly if patient has a flaccid extremity Lower extremity in neutral. avoid excessive internal or external rotation at hips.Positions : Supine : Body well aligned (head only in line with shoulders. pillow should not be too high Heels off bed Elbows supported or protected Hands higher than elbow. may need to support with towel rolls. should be about 30 degrees off 180 Carefully monitor lower most shoulder position May need to bridge lower most greater trochanter Knees slightly flexed with pillow between legs and legs not on top of each other. depending on patient comfort Support lower most foot well to avoid excess pressure on lateral malleolus or 5th metatarsal head .

dorsum of feet are protected or lifted and ankles are not too far plantar flexed. tipping or push-ups (all are good for assisting with upper extremity strength) Avoid restraints Feet should be in properly fitting shoes and well supported on properly aligned foot and leg rests . avoid sling back and sling seat designs Use wheelchair seat cushions Patient needs to be educated to do pressure relief with either leaning.Prone : Body well aligned Caution (this position is not well tolerated for 2 hours for older adults. A change at 30 minutes will often need to be made ) This position is not appropriate for those with some breathing problems Have pillows and towel rolls readily available such that as the patient is rolled from sidelying to prone there is a pillow under abdomen to put back in neutral or slight flexion. this position needs to be modified AT LEAST every 15 minutes Properly fitting wheelchair that enhances upright posture. patella are protected or bridged. feet may hang off end of support surface if not in danger of injury Sitting : Unlike lying down.

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