Turning and PositioningGroup # 3 Iris Martinez Christopher Lequerica Jobe Idiculla Siby Mathew Guillermo Chea.
Objectives • Understanding proper positioning • Discuss how to determine the amount of time a patient can spend in a position. • Discuss general procedures used to turn and position a patient properly. • Discuss specific procedures used to position patient in: Supine, Prone, Sidelying and Sitting.
Introduction Proper Positioning is a necessary tool to maintain patient function. Physical therapists work with many other healthcare workers to determine the most optimal positions for patients. For patients who are unable to change positions independently, proper positioning is essential for increasing function and preventing complications.
Goals for Proper Positioning The goals for proper positioning are to: • Ensure patient comfort • Maintain intergumentary integrity by preventing development of pressure sores. • Maintain musculoskeletal integrity by preventing deformities. • Maintain neoruskeletal integrity by preventing pressure on peripheral nerves.
Goal for Proper Position • Maintain cardiovascular pulmonary integrityby using changes in position to assist secretion elimination, breathing patterns, and vascular flow. • Provide patient access to the environment. • Provide proper positioning for specific interventions.
Archiving the Goals • Manage patient and environment properly. • Move the patient in and out in a safe and effective matter while Lying. • Check the patients skin and bony area which would be pressure sites after being placed in a new position and 10-15 minutes thereafter. • Move the patient at every two hours. • Patient with compromise systems or fragile skin the time should be reduced. • Check the skin when the patient is repositioned ( color and integrity).
Archiving the goals ( cont) While sitting: • Patient should relieve pressure in the buttock and the sacrum at least every 10 minutes. • Sitting push ups using the arm rest of a chair. • Leaning first in one side then to the other side. • Leaning forward.
Preparing the Environment • It means: having a clear area for movement. • Having all necessary supplies: sheets, pillows, towels. • Wrinkles in the sheets, blankets, and personnel clothing must be avoided. • Number of appropriately trained personnel. • Pillows rolled blankets or towels are used to support body parts. • Ensure that the necessary equipment for moving the patient is ready. • Ensure that all movable equipment must be locked or secure. • Draping should allow appropriate positioning. • Whenever possible, patient should participate actively.
Supine Position • Patient lies on his/her back on a supporting surface. • Shoulders parallel to hips and a straight spine. • Add a pillow to support the head if necessary. • A pillow should be placed under the knee to relive strain on the lower back. • A pillow placed lengthwise under the leg relieve pressure on the heels.
Moving from Supine to Prone • Patient is first moved far enough to one side. • When segmental movement of the trunk and lower extremities is possible, the patient is moved in stages. • If patient can not tolerated such movement, more than one person is needed. • The sequence of the moving from supine to prone • Move the upper trunk and head. • Move the lower trunk. • Move the lower extremities. • The right lower extremity is crossed the left lower extremity. • Right ankle rest over the left ankle.
Moving from supine to Prone (cont) • PT or PTA is positioned on the side to which the patient is turned. • To prevent patient from falling while the therapist is changing position, used enough towel or pillow. • Adducted the right upper extremity, place the hand at the right hip, palm against the hip. • When patient have head control, they can assist turning the head of the roll as turning is initiated. • Ask the patient if he is ready to begin. If yes, a preparatory count is given. • As turning is initiated, the PT, hands are on the patient’s back. • When patient reaches the halfway point, gravity can complete the movement. Replace your hands to maintain control
Prone Position Aprone position is a postion in which a person lies on his or her stomach on a supporting surface. • Patients are positioned with shoulders parrallel to hips and with a straight spine. • Head may be turned to either side, or maintain in the midline • Patients upper extremities may be positioned alongside the trunk or alongside the head.
Turning from Prone to Supine With the patients initial position in prone, the patient is first moved far enough to one side of the treatment table to allow a full turning movement to the prone position without coming too close to the opposite side upon completion of the turning movement. When segmental movement of the trunk and lower extremities is possible, the patient is moved in stages. When patient cannot tolerate such movement, more than one person, or specialized beds, will be needed.
To move a patient from prone to supine, the following steps occur in sequence: • Move the upper trunk and head. • Move the lower trunk • Move the lower extremities • The patient’s hand is placed under the hip with the palm against the body • When treatment table is narrow, personnel assisting in turning the patient should stand next to the patient on the side from which the patient is being turned. • The left upper extremity is adducted, placing the hand at the hip, palm against the hip. The healthcare worker supports the right upper extremity against the patient’s body as the patient is turned
To move a patient from prone to supine, the following steps occur in sequence: 7. As turning from supine to prone, healthcare worker must control both phases of the turning motion. Initially, reaching over the patient, placing their hands on the patient’s anterior surface. 8. When patient reaches halfway pont, gravity can complete the movement, but will do so in an uncontrolled manner. You must therefore reposition hands to the posterior surface of the patient to control the second half of the turning. 9. When turn is complete the first body segments to be repositioned is the head and neck. The extremities are then positioned as in the supine position.
Turning on a Floor Mat When turning a patient on a floor mat, the same steps and sequence are followed as when turning a patient on a treatment table. Proper body mechanics become more impotant in preventing injury to a healthcare worker when turning a patient on a floor mat.
To turn a patient on a floor mat, the following steps occur in sequence: • After patient is moved to one side, the healthcare worker should be positioned on the side to which the patient will turn. You should assume a half-kneeling position, with the down knee at the level of the patient’s hips and the up knee at the level of the patient’s shoulders • Using the right hand, you should place the patient’s left hand on the patient’s left hip. Your left hand is placed on the patient’s right shoulder. The healthcare worker’s hand position must rotate and reposition at the midpoint of the turn, as described for turning on a treatment table.
To turn a patient on a floor mat, the following steps occur in sequence: 3. The healthcare worker must move out of the patient’s way as the turn is completed, allowing the patient to complete the turn without rolling into the healthcare worker.
Conclusion • Maintain good patient body alignment. Think of the patient in bed as though he were standing. • Maintain the patient's safety. • Reassure the patient to promote comfort and cooperation. • Properly handle the patient's body to prevent pain or injury. • Keep in mind proper body mechanics for the practical nurse. • Obtain assistance, if needed, to move heavy or helpless patients. • Follow specific physician's orders.
Conclusion Proper positioning is vital in maintaining patient function and comfort. All healthcare professionals have the responsibility of making sure their patients are positioned properly and handled with care so that no injuries will occur while being treated. This is why the steps of turning and positioning are so essential.
Questions • When a person is lying on his or her stomach with shoulders parallel to hips this position is called what? • A. Supine • B. Prone Answer : B. Prone
Questions 2. When turning a patient from prone to supine the healthcare worker should be on the side on which the patient is being turn to. A. True B. False Answer : B. False
Questions • 3. When is patient is positioned sitting with hips flexed to 90 degrees and knees fully extended on a supporting surface is called? • Long sitting • Sidelying • Prone position • Supine position Answer : A. Long sitting