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.