2. Protecting Your Patients AND Yourself

3.  Why do we need to learn about positioning? ◦ Patient comfort/decrease pain ◦ Support and stability to pt’s truck and extremities ◦ Easier access to area(s) being treated ◦ Decrease edema ◦ Increase function ◦ Prevent pressure sores (l-t setting) ◦ Prevent joint contractures (l-t setting)

4.  What is most comfortable for the patient may not be the best position for them  May need to be positioned to aid in the treatment of a specific diagnosis or condition

5.  Who is at risk? ◦ Elderly ◦ Those unable to change to their own position ◦ Those with decreased sensation ◦ Those who may be unable to communicate their discomfort

7.  Pillows  Blankets  Sheets  Wedges  Bolsters  Others?

8.  Supine  Prone  Side-lying  Sitting

9.  Pillow under head to keep c-spine neutral  Small pillow or towel roll for cervical support (HP)  Support under popliteal space to decrease lumbar lordosis  Ankle support to relieve pressure under the calcanei  Support under elbows to relieve pressure on bony prominences

11.  Properly place your patient in a supine position 2:001:591:581:571:561:551:541:531:521:511:501:491:481:471:461:451:441:431:421:411:401:391:381:371:361:351:341:331:321:311:301:291:281:271:261:251:241:231:221:211:201:191:181:171:161:151:141:131:121:111:101:091:081:071:061:051:041:031:021:011:000:590:580:570:560:550:540:530:520:510:500:490:480:470:460:450:440:430:420:410:400:390:380:370:360:350:340:330:320:310:300:290:280:270:260:250:240:230:220:210:200:190:180:170:160:150:140:130:120:110:100:090:080:070:060:050:040:030:020:01End2:00

12.  Pillow under head (or pillow wedge)  Pillow under lower abdomen/hips to decrease lumbar lordosis  Towel rolls under anterior shoulders to retract scapulae  Towel roll/pillow/bolster under ankles to reduce pull on hamstrings and allow the pelvis and low back to relax

14.  Properly place your patient in a prone position 2:001:591:581:571:561:551:541:531:521:511:501:491:481:471:461:451:441:431:421:411:401:391:381:371:361:351:341:331:321:311:301:291:281:271:261:251:241:231:221:211:201:191:181:171:161:151:141:131:121:111:101:091:081:071:061:051:041:031:021:011:000:590:580:570:560:550:540:530:520:510:500:490:480:470:460:450:440:430:420:410:400:390:380:370:360:350:340:330:320:310:300:290:280:270:260:250:240:230:220:210:200:190:180:170:160:150:140:130:120:110:100:090:080:070:060:050:040:030:020:01End2:00

15.  Patient in center of bed  Head, trunk, pelvis in alignment  LEs are flexed at the hips and knees with pillows between knees and top LE slightly forward of bottom LE  Pillow at chest and/or back to keep them from rolling  Pillow under top arm to keep chest open

17.  Properly place your patient in a side-lying position 2:001:591:581:571:561:551:541:531:521:511:501:491:481:471:461:451:441:431:421:411:401:391:381:371:361:351:341:331:321:311:301:291:281:271:261:251:241:231:221:211:201:191:181:171:161:151:141:131:121:111:101:091:081:071:061:051:041:031:021:011:000:590:580:570:560:550:540:530:520:510:500:490:480:470:460:450:440:430:420:410:400:390:380:370:360:350:340:330:320:310:300:290:280:270:260:250:240:230:220:210:200:190:180:170:160:150:140:130:120:110:100:090:080:070:060:050:040:030:020:01End2:00

18.  There are a variety of sitting positions  Remember to soften bony prominences  Support arms and legs (and head if necessary)  Elbows at approx. 90° of flexion

19.  Properly place your patient in a seated position 2:001:591:581:571:561:551:541:531:521:511:501:491:481:471:461:451:441:431:421:411:401:391:381:371:361:351:341:331:321:311:301:291:281:271:261:251:241:231:221:211:201:191:181:171:161:151:141:131:121:111:101:091:081:071:061:051:041:031:021:011:000:590:580:570:560:550:540:530:520:510:500:490:480:470:460:450:440:430:420:410:400:390:380:370:360:350:340:330:320:310:300:290:280:270:260:250:240:230:220:210:200:190:180:170:160:150:140:130:120:110:100:090:080:070:060:050:040:030:020:01End2:00

20.  Why do we drape?  How do you feel at the doc’s office with no clothes on? ◦ Privacy/modesty/dignity ◦ Warmth ◦ Hygiene

21.  If you need pt to change into a gown, leave the room; knock before reentering  If patient needs assistance, suggest it; ask permission before helping them  Only the area to be treated should be exposed; the rest of the pt stays covered ◦ Gown, blanket, sheet, towel ◦ Consider which drape is best  Pt comfort is the key when working on difficult areas

22.  Be sure you keep legal considerations in mind ◦ What is the policy of the facility on doors being closed/slightly open? Curtains? ◦ Comments and touch mean different things to different people – keep in mind appropriate vs. inappropriate  Protect yourself and your employer by being professional at all times

23.  Practice draping for:  Shoulder  Low back  Groin  Mid-upper back