Patient Positioning

Purpose of Positioning in PT patient comfort prevent pressure ulcers prevent joint contractures provide treatment.

Frequency of Positioning When patient are confined to bed they should be repositioned every 2 HOURS. If they have frail skin, poor circulation or decreased sensation positions should be changed more often. Patient confined to WC should be taught to relieve pressure on buttocks and thighs every 15 minutes.

Positions

Preparing The Environment Preparing the environment assists in safe and effective turning and positioning. Preparing the environment includes having a clear area for movement and having all necessary supplies i.e. sheets, pillows, and towels. Additional personnel if necessary

1. Smooth all sheets, towels and patient clothing to avoid increase of pressure and/or irritation on skin. 2. Pillows, rolled blankets, or towels are used to support body parts and to avoid strain or pressure on ligaments, nerves and muscles. Ensure that enough clear area exists and equipment is ready to move safely.

4. Ensure that sufficient personnel trained in moving and positioning patients is present and ready to assist. 5. Draping should allow appropriate positioning, while maintaining patient modesty and warmth. 6. Whenever possible, patient should participate actively during moving and positioning.

Supine (fig 13-1, p 218) Place small pillow under head to keep head and neck neutral, small pillow under popliteal area and small roll under ankle to relieve pressure under calcaneus.

Bony Prominences susceptible to developing pressure sores in supine: Occipital Tuberosity Medial Epicondyle of the Humerus Spine and Inferior Angle of Scapula Vertebral Spinous Processes Posterior Iliac Crest Sacrum Greater Trochanter of Femur Head of Fibula Lateral Malleolus Posterior Calcaneus

Sidelying (fig 13-2, p 218) lying in lateral recumbent position resting on (L) or (R) side, hips and knees flexed. Head should be supported with 1-2 pillows. The uppermost UE should be placed forward with a pillow supporting. The uppermost LE should be placed slightly forward with folded pillow between the knees.

Bony Prominences susceptible to developing pressure sores in sidelying: Lateral ears, ribs and acromion process Lateral head of humerus, Medial and lateral epicondyle of humerus Greater Trochanter of Femur Medial and lateral condyles of femur Malleolus of fibula and tibia

Prone (fig 13-3, p 219) Horizontal with face down. Place pillow or towel roll under head, instruct pt. to turn head (R) or (L). Place a pillow under the lower abdomen to lordosis. A rolled towel can be placed under each anterior shoulder. Elbows can be bent to 90 degrees. A pillow can be placed under anterior ankle

Bony Prominences susceptible to developing pressure sores in prone: Forehead, lateral ear, and tip of the acromion process Anterior head of humerus Strenum Anterosuperior iliac spine Patella Dorsum of foot

Sitting (fig 13-4, p 219) patient should sit with adequate support. Feet should be on a footstool or footrest. Hips and knees should be bent to 90 degrees and ankle neutral.

Bony Prominences susceptible to developing pressure sores in sitting Scapula Vertebral Spinous Processes Ischial Tuberosities