Professional Documents
Culture Documents
Materials needed
– 2 full sized sheets
– 2 pillows and pillow cases
– 2 towels
Table Preparation, cont.
– Place one full size sheet (folded
lengthwise) on plinth
– Place a towel at each end of table
– Place a folded sheet on the table to be
used as a drape
– Have additional pillows, towels,
blankets, etc. ready
Preparation of the Patient:
– Instruct the patient in what they are to
take off
Provide gowns & a dressing room
– Tell the person how to position on the
table
Easily understood terms
– Assist them as much as needed to
support weak or injured parts
Help patient “keep their dignity”
Treatment Positioning in Supine
Patient is straight & centered on mat
Small pillow or towel roll
– Under the neck
– Underneath knees (could use a bolster)
– Under bilateral ankles
Treatment Positioning in Prone
Centered on the mat with parallel shoulders and hips
Face/Neck support
– Small roll under forehead
– Turn head to side
– Can use mat cut out
Pillow underneath abdomen to decrease lordosis
Towel roll under bilateral ankles
Drape
Treatment Positioning in Sidelying
Instruct patient to lie on back & roll onto their side
– Stand on side they are rolling toward
Place one pillow under the head
Move hip forward slightly to avoid pressure on the trochanter
Place a pillow between the patient’s knees with the top leg in
slight flexion at the hip and the knee
Place a pillow under the upper arm
Drape
Draping
Reposition
– Level of consciousness
– Medical or surgical precautions
– Are they in pain
– Do they have a loss of sensation
– What is their muscular function
– Do they have spasticity or other abnormal
muscle tone
Assessing the Patient
– Amount of tissue to protect bony prominences
– Any bowel or bladder incontinence
– Can they assist
– Do they have contractures
Acute (developing) or chronic
– Do they have edema, skin rashes, redness,
irritation, infection
Preventing Pressure Ulcers
Lesion caused by unrelieved pressure
– Damage of the underlying tissue
Healthy person should reposition in bed at
least every 2 hours
Maximum repositioning time in sitting
– 15 minutes
Patients who are medically unstable need
to be repositioned more frequently
High Risk Areas for Skin
Breakdown: Supine
• Occiput
• Scapulae especially inferior angles
• Spinous processes
• Elbows
• Sacrum and coccyx
• Ischeal tuberosities
• Lateral malleoli (if hips are in external rotation)
• Heels
High Risk Areas for Skin
Breakdown: Sidelying
• Ear
• Humeral head
• Hip/greater trochanter
• Lateral femoral condyle (underside of inferior leg)
• Medial femoral condyle (inside both knees)
• Medial malleoli (inside ankles of both legs)
High Risk Areas for Skin
Breakdown: Sitting
Occiput (in a high back chair)
Scapulae (inf. Angles)
Spinous processes
Elbows (when resting on
armrests)
Sacrum and coccyx
Ischial tuberosities
Heels
Breathing
– With immobility air exchange is ↓
– Body must rely on gravity to drain moisture
from lungs
Long- Term Positioning: Supine
Be able to call for assistance
No active feeding tubes in
supine
Be sure pt can breathe &
swallow
Cushion head
Shoulders & hips parallel
Legs in neutral rot
Hips in neutral flex
Johansson & Chinworth text page 166
Knees extended
Elevate/float heels
Forearms supported
Hands open
Long-Term Positioning: Sidelying
Be able to call for assistance
Airway clear
Head cushioned
Body aligned and centered on bed
Rotate trunk slightly forward/underside hip forward
Underside knee straight/top leg flexed
Pillow between knees & ankles
Upper arm abducted
Underneath scapula int. rot. (protracted)
Elbow straight
Arm and hand supported
Can tuck pillow behind the pt to maintain position
Long-Term Positioning: Sitting
Means to call for
assistance
Hips to back of the chair
Lateral support
Arms supported
Hips centered
Shoulders above hips
Small lumbar support
Weight distributed evenly
Appropriate seat cushion
Lower leg elevation as
needed
Padding for additional
contact as needed
Special Considerations
Total Hip Arthroplasty
– Posterior approach
No hip flex beyond 90°
Do not cross legs
No IR past neutral
– Anterior approach
No hip ext beyond neutral
No hip adduction
No hip ER past neutral
After amputation
– Support the limb
– No pillows under the hip or knee- why?
S/p stroke
– Position to promote protraction (scapula, pelvis)- why?
– Elevate and handle UE with care
Objectives Re-Visited
Understand the purpose of draping and
positioning
Demonstrate correct draping techniques