Health II Unit 203 Position and Move Patients Principles of Proper Body Alignment good body alignment is essential for the well being of a.
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Transcript Health II Unit 203 Position and Move Patients Principles of Proper Body Alignment good body alignment is essential for the well being of a.
Health II
Unit 203
Position and Move Patients
Principles of Proper
Body Alignment
good body alignment is essential for the
well being of a patient, regardless of
whether they are sitting or lying
Principles of Proper
Body Alignment
when someone is in good alignment, they
“look comfortable”
spine should be straight
shoulders/hips/knees parallel to one
another and parallel to the sides of bed or
chair
no slumping, twisting, bending or
unnatural positions
Complications Related to Poor
Body Alignment
contractures
if position of body is not changed regularly
and detailed attention is not given to
proper body alignment of the patient,
contractures may develop
REMINDER, a contracture is a permanent
shortening/tightening of a muscle
Complications Related to Poor
Body Alignment
pressure areas
areas of pressure are increased when the
body is in poor alignment and not changed
regularly that may cause pressure ulcers
REMINDER: pressure ulcers begin with a
redness of the skin and may continue to large
open and deep sores
Common Alignment Problems
Neck flexion
may cause strain
on the neck
muscles
may restrict the
act of breathing,
leading to shallow
breathing or
possibly an
airway
obstruction and
death
Common Alignment Problems
Shoulder internal
rotation
may cause contracture
at shoulder and loss of
the ability to externally
rotate shoulder
Adduction of shoulder
will lead to loss of
ability to abduct
shoulder
Common Alignment Problems
Wrist flexion
may cause wrist
drop and weak
grasp
Wrist drop
due to hanging
over edge of pillow
in flexed position
Common Alignment Problems
Lumbar spine
convexity
causes low back
pain , due to lack
of support to the
spine
direction of
spine curvature
Common Alignment Problems
Lumbar spine
convexity
to reduce the convex
curve of the back, the
patient’s knees must be
flexed to flatten the
spine against the bed
and gain support or
sometimes a small
pillow under the “small
of the back” may be
necessary
spine flattened
& supported
by bed
Common Alignment Problems
Hip external
rotation
causes hip pain,
decreased range
of motion or
contracture of
the hip
Common Alignment Problems
Knee
hyperextension
(beyond normal
extended position)
causes a painful
stretch of nerves &
blood vessels in
back of knee. This
position may lead
to loss of normal
ROM of the knee
flexed knee
hyperextended
knee with foot
on blanket
Common Alignment Problems
Ankles
may lead to plantar
flexion (“foot
drop”) if the ankle
is not maintained
@ 90 degrees
toes pointed
forward & down
Common Pressure Areas
Common Pressure Areas
Grsaphic:www.info.gov/hk
Common Pressure Areas
Ears/Head
the ears & head may experience pressure
from the pillow or bed when the patient is
placed in prone, side lying and supine
positions
Shoulder/Scapula
shoulder blades will experience pressure
from the bed when patient is placed in the
supine position
Common Pressure Areas
Elbows
the olecranon process of proximal ulna (tip
of elbow) will experience pressure when
the patient is in supine or prone positions
Common Pressure Areas
Sacrum/Coccyx/Hips
the ischial bones that
supports the weight
of the patient while
sitting & the tailbone
may feel pressure
while sitting or lying
greater trochanter
may feel pressure
while patient is
sitting or sidelying
Graphic: www.dinf.ne.jp
Common Pressure Areas
Ankle
medial and lateral malleoli
when the patient is lying in
the side lying position
Heel
while patient is in the
supine, or any of the
Fowler’s positions
Toes
when lying in the prone
position, or heavy bedding
over toes when lying
supine
Graphic: z.about.com
Purpose of Supports
provide comfort
reduce stress and strain on joint
structures and muscles
reduce risk of pressure ulcers
provide elevation of body parts to reduce
edema
support used to reduce effects of
immobility and provide patient comfort
Types of Supports
pillows
Types of Supports
rolled bath
blankets
Bath blanket
rolled towels
rolled
washcloths
Washcloth roll
Towel roll
Types of Supports
splints (upper &
lower extremities)
hand cones
bar prevents
rotation of
lower extremity
ankle splint
Hand
cone
Wrist &
hand splint
Criteria for Selecting Supports
will vary
each patient unique
review chart
communicate with patient about areas of
discomfort
visually inspect body for support needs
Support(s) for Specific
Health Conditions
Paralysis
requires support to the affected area(s)
Fractures
will require support(s) to prevent rotation
of the fractured part, and elevation of the
fractured part to minimize swelling of soft
tissue
Support(s) for Specific
Health Conditions
Diabetic Patients
have diminished circulation that causes
decrease of skin’s ability to recover from
an injury
diabetics are prone to pressure ulcers and
must be monitored carefully
complications from pressure ulcers in a
diabetic patient can result in the
amputation of a lower extremity
Key Factors
Support Devices
the longer the length of immobility, the
more sensitive the skin due to decreased
circulation
protect pressure points the thinner the
patient the more supports that are needed
too much support may limit movement
and have a reverse effect
keep bedding loose
bed linens should be clean dry and
wrinkle free
Supine Position
lying on back, face up
spine straight & parallel
to sides of bed
shoulders, hips, knees
aligned with one another
hips extended, legs are
apart so that skin is not
rubbing against skin of
opposite leg
ankle in a 90 degree angle
with toes up
Consider These Support(s)
for Supine Position
pillow of suitable thickness under head
and shoulders (avoid hyperextension and
hyper-flexion of the neck)
small pillow under lumbar spine to prevent
convex curve
blanket rolls (trochanter roll) to prevent
external rotation of lower extremities
centered at the greater trochanter of each
femur
Consider These Support(s)
for Supine Position
small pillow under thighs for knee flexion
foot splints, foot board, pillows or high top
shoes to keep feet in 90 degree position
towel roll just superior to heels to keep
heels off bed
pillows under elbows with hands above
heart to promote good venous blood return
cone to an affected hand to prevent
contractures
Prone Position
lying face down on
abdomen
spine straight &
parallel w/ bed rails
shoulders, hips &
knees aligned with
one another
arms, position of
comfort, elbows
flexed
hips extended, legs
slightly separated
Consider These Support(s)
for Prone Position
small pillow under head (avoid lateral neck
flexion, select appropriate pillow
thickness)
small pillow under abdomen just below
diaphragm to prevent:
hyper extension of the lumbar spine
reduce pressure of women’s breast
reduce pressure on genitals of men
Consider These Support(s)
for Prone Position
allow feet to fall
naturally over end of
mattress or support
lower legs on pillow so
toes hang over edge of
pillow and not touch
bed to prevent
pressure ulcers
hand cone in affected
hand to prevent
contractures
Toes over
edge of mattress
Advantages of
Prone Position
promotes drainage from the mouth
only position that allows full extension of
the hip and knee that may prevent
contractures of these joints
Disadvantages of
Prone Position
gravity produces lordosis of the spine
(exaggerates the sway back)
should not be used with neck/spine
problems
inhibits chest expansion so should not be
used for patients with cardiac and
respiratory disorders
Fowler’s Position
head of bed elevated 90
degrees, patient sitting
upright
no pillow under head and
shoulders
upper torso supported by
arms on a pillow placed
on an over the bed table
shoulders, hips, knees
aligned with one another
spine parallel to the
sides of bed
Semi-Fowler’s Position
reclining, semisitting position
head of the bed
elevated 15-45
degrees
lower end of bed
elevated to full
potential or pillows
placed under distal
thigh area to cause
knee flexion
Semi-Fowler’s Position
shoulders, hips
and knees
aligned with one
another
spine parallel to
the sides of bed
shoulders and
hips in neutral
position
Consider These Support(s) for
Semi-Fowler’s Position
pillow to support
head, neck & upper
shoulders to prevent
flexion of the neck
small pillows under
distal femur if b
knees to prevent
hyperextension of
knees
Consider These Support(s) for
Semi-Fowler’s Position
“trochanter roll”
lateral side of femur
centered at the
greater trochanter
to prevent lateral
(external) rotation of
femur
Consider These Support(s) for
Semi-Fowler’s Position
towel roll under
ankles to lift heels
off bed
Consider These Support(s) for
Semi-Fowler’s Position
foot board, rolled
pillows, foot/ankle
splints to prevent 90 degree ankle
plantar flexion by angle w/pillow
keeping ankle in a
90 degree
position
90 degree ankle
angle
w/professional
splint
Consider These Support(s) for
Semi-Fowler’s Position
pillow under each elbow
with hand supported
above the elbow to
promote good venous
blood return & prevent
pressure ulcers
hand cone or splint in
affected hand to prevent
contractures
Note: do not let the wrist drop
over the edge of the pillow,
as this may lead to “wrist drop”
Side-lying Position
patient lying on side
spine parallel to sides of bed
hips & shoulders aligned w/
themselves & each other
weight of upper torso
supported on lateral border
of scapula, not directly on
shoulder joint
top leg, top arm, head &
back supported
Note: the greater the flexion of top hip
& knee, the more stable & balanced
the position
Consider These Support(s) for
Sidelying Position
the top leg should be supported with a firm pillow
first, have it near or on bed when patient is turned
use pillow as a catcher’s mitt, and place knee in center
of pillow
this support relieves stress on the back muscles
pillow under head that will not cause lateral
flexion of the neck (size of support will vary per
individual)
Consider These Support(s) for
Sidelying Position
pillow under top arm to prevent internal rotation
of the shoulder that could lead to limited shoulder
movement and may impair chest expansion
during breathing. Do not allow wrist to hang over
edge of pillow
pillow rolled behind back to prevent patient from
falling backwards
pillow or blanket roll to plantar surface of foot to
prevent plantar flexion
hand cone in affected hand to prevent
contractures
SIM’S Position
combination of
sidelying & prone
posture
bottom arm
positioned behind
the patient
upper arm flexed at
shoulder & elbow
near the head
legs flexed, top leg
more flexed than
bottom
SIM’S Position
SIM’S
this position promotes drainage from mouth &
prevents aspiration & may be used with the
unconscious patient
position may be used when administering
rectal medications/enemas or examinations of
the perineal area
used for paralyzed patients to reduce pressure
over sacrum & greater trochanter
pregnant women often prefer this position for
sleeping
Consider These Support(s) for
SIM’S Position
pillow or folded towel (optional) under head. The
wider the patient’s shoulders, the more likely this
will be necessary. Avoid lateral flexion of the
neck
pillow under top arm to prevent internal rotation
of shoulder and arm, reduces pressure on chest
pillow under top knee to prevent internal rotation
and adduction of the hip and leg
Consider These Support(s) for
SIM’S Position
blanket roll or ankle splint to keep ankle in an
extended position (90 degree angle) to prevent
plantar flexion of the top foot
toes of bottom foot should hang over the edge of
the mattress, or washcloth roll placed proximal to
the toes under dorsal aspect of foot to lift toes off
bed & prevent pressure ulcers
hand cone in affected hand to prevent contractures
Clients needing maximum assistance
Bariatrics is the branch of medicine that
deals with prevention, control and
treatment of obesity (Taber’s Dictionary,
6th edition)
Employers want caregivers to move them
safely, but without injury to caregivers
Lift/Draw sheets
A sturdy folded piece of linen that is
placed under a client to assist lifting, so
shearing forces are lessened, yet client
can be made comfortable.
Slide boards
A sturdy, flexible, yet smooth, synthetic
board used to move a client from bed to
cart, or vice versa, with less shearing
force on client’s skin and less stress on
muscles and joints of caregivers.