NURSING 1F03 Lecture Notes - Lecture 8: Humerus, Popliteal Artery, Autonomic Nervous System
1I02: Week 10 - Patient Positioning and Transfer
Mobility and Immobility (pg 1221-1231)
Positioning Devices and Techniques:
- Patients with impaired function of the nervous, skeletal, or muscular system and with
general weakness often require help to attain proper body alignment while in bed or
sitting.
- You must assess skin integrity regularly for pressure points or skin breakdown when
using positioning devices
Positioning Devices include:
• Pillows
- They provide support, elevate body parts, and can splint incisional areas, reducing
postoperative pain during activity or coughing and deep breathing.
- Determine the appropriate size of pillow for the patient: A thick pillow under the
patient’s head increases cervical flexion. A thin pillow under body prominences may
be inadequate to protect skin and tissue from damaged caused by pressure
- Folded sheets, blankets or towels can be used as positioning aids
• Wedge (or abductor) Pillow
- Triangular- shaped pillow made of heavy foam used to maintain the legs in abduction
after total hip replacement surgery
• Foot Boot
- Maintains feet in dorsiflexion
- Made of rigid plastic or heavy foam
- Keep the foot flexed at the proper angle and the weight of the bedsheets off the toes
**Remove the foot boots two or three times a day to assess skin integrity and joint
mobility
• Trochanter Roll
- Prevents external rotation of the hips when the patient is in a supine position
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- It is formed by folding a cotton bath blanket lengthwise to a width that will extend from
the greater trochanter of the femur to the lower border of the popliteal space
- The blanket is placed under the buttocks and then rolled counterclockwise until the
thigh is in neutral position or inwards rotation (when correct alignment of the hip is
achieved, the patella faces directly upwards)
• Sandbags
- Sand- filled plastic tubes or bags that can by shaped to body contours
- Can be used in place of or in addition to trochanter rolls
- They immobilize an extremity or maintain body alignment
• Hand Rolls
- Maintain the thumb in slight adduction and in opposition to the fingers
- It maintains the hand, thumb and fingers in a functional position, thus preventing
contractures
- Hand rolls are most often used for patients whose arms are paralyzed or who are
unconscious
**Rolled wash- cloths should not be used as hand rolls, because they do not keep the
thumb well abducted (especially in patients who have spastic paralysis)
• Hand - Wrist Splints
- Individually moulded for the patient to maintain proper alignment of the thumb (slight
adduction) and wrist (slight extention)
• Trapeze Bar
- Triangular device that descends from a securely fastened overhead bar attached to
the bed frame
- Allows the patient to use his or her upper extremities to raise the trunk off the bed, to
assist in transfer from bed to wheelchair, or to perform arm exercises
- It is useful in helping to increase patients independence, maintain upper body
strength, and decrease the shearing action from sliding across or up and down in bed
Guidelines For Positioning Devices:
- By following the guidelines for each procedure for patients that require positioning
assistance, you reduce the risk of injury to the musculoskeletal system
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- When joints are unsupported, their alignment is impaired — Joints must be positioned
in a slightly flexed position or their mobility is decreased.
- During positioning, it is important to also assess bony prominences (pressure points)
— when actual or potential pressure areas exist, nursing interventions involve
removal of the pressure, thus decreasing the risk for development of pressure ulcers
and further trauma to the musculoskeletal system
Supported Fowler’s Position:
- The head of the bed is elevated 45 - 60 degrees
- The patient’s knees are slightly elevated without pressure; the patient is sitting up in
bed
- Do not elevate the head of the bed more than 60 degrees (this would increase
shearing force on the patient’s back and heels)
- The angle of the head and knee elevation and the length of time that the patient
should remain in the supported Fowler’s position vary depending on the patient’s
illness and overall condition
- Supports must permit flexion of the hips and knees and proper alignment of the
normal curves in the cervical, thoracic, and lumbar vertebrae
Trouble Areas for the patient in this position:
• Excessive cervical flexion because the pillow at the head is too thick and the head
thrusts forward
• Hyperextension of the knees, allowing the patient to slide to the foot of the bed
• Pressure on the posterior aspect of the knees, decreasing circulation to the feet
• External rotation of the hips
• Arms handing unsupported at the patient’s sides
• Unsupported feet or pressure on the heels
• Unprotected pressure points at the sacrum and heels
Supine Position:
- A back- lying position
- The relationship of body parts is essentially the same as in good standing alignment
except that the body is in the horizontal plane
- Pillows, trochanter rolls, and hand rolls or arm splints are used to increase comfort
and reduce injury to the skin or musculoskeletal system
- The mattress should be firm enough to support the cervical, thoracic and lumbar
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Document Summary
1i02: week 10 - patient positioning and transfer. Patients with impaired function of the nervous, skeletal, or muscular system and with general weakness often require help to attain proper body alignment while in bed or sitting. You must assess skin integrity regularly for pressure points or skin breakdown when using positioning devices. They provide support, elevate body parts, and can splint incisional areas, reducing postoperative pain during activity or coughing and deep breathing. Determine the appropriate size of pillow for the patient: a thick pillow under the patient"s head increases cervical flexion. A thin pillow under body prominences may be inadequate to protect skin and tissue from damaged caused by pressure. Folded sheets, blankets or towels can be used as positioning aids: wedge (or abductor) pillow. Triangular- shaped pillow made of heavy foam used to maintain the legs in abduction after total hip replacement surgery: foot boot. Made of rigid plastic or heavy foam.