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Patient Positioning Flashcards

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1
Q

Who is responsible for positioning of pt?

A

Shared responsibility

Nurse
Anesthesia
Surgeon
And other Perioperative personnel

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2
Q

Risk of what type injuries with patient positioning?

A 
Compression
Stretching 
Skin, joints, soft tissue
Bones 
Eyes
Nerves
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3
Q

Why are pts at risk of injury during surgery?

A

Unable to feel pain, numbness, tingling

Cannot communicate

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4
Q

Goals of positioning?

A 
Procide optimal exposure to site
Maintain proper alignment 
Support circulatory/resp function
Protect neuromuscular and skin integrity
Allow access to Iv/monitoring equipment 
Maintain pt privacy and comfort
Secure and safe to avoid moving/shifting
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5
Q

Who is responsibke for selecting neat position for procedure?

A

Surgeon

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6
Q

Basic surgical positions?

A 
Supine
Lithotomy 
Sitting
Trendelenburg
Reverse tren
Lateral
Prone
Jack knife
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7
Q

Pre op assessment for positionint?

A 
Skin assessment 
Medical conditions
Age 
Height 
Weight/BMI
ROM
Nutritional status
Jewlery
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8
Q

Nutritional status affecting injury risk?

A

Decressed muscle mass
Dehydration

Low serum albumin may indicate poor wound healing

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9
Q

What are high risk for injury during surgery?

A

> 2hrs
Vascular sx - blood perfusion may be compromised
Lithotomy position - increased risk of nerve damage
Positions with sustained pressure
Ex. Retraction

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10
Q

Pre op considerations for positioning?

A

Age - geriatric more at risk
Always follow MIFU when selecting equipment
Medical conditions - resp/circulatory, DM, malnutrition, anemia, demineralizing bone conditions
Mobility concerns

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11
Q

Intra op factors related to patient positioning?

A

Types of anesthesia
- general, spinal, moderate sensation

Length of surgery

Position required

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12
Q

Basic positioning practices?

A 
Follow procedure protocols
Respect pt privacy 
Head/neck neutrality 
Protect eyes
Physiologic alignment 
OR beds - padding, avoid metal 
Safety precautions - belts
Repositioning pt - redistribute pressure 
Monitoring pt - pulses, strap tightness
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13
Q

Why protect head and neck during pt positioning?

A

Stretching/hyperextension could cause brachial plexus nerve injury or cardiovascular complications

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14
Q

How to protect eyes?

A

Prevent corneal abrasion, ocular injury by preventing pressure on eyes and taping them shut

Eye protection
-laser

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15
Q

Supine position

A

Most common
Dorsal recumbent, laying on back

Common with abd, head/neck, vascular and breast sx

Arms at side with palms facing towards body or extended on arm boards with palms up
- protect ulnar nerve

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16
Q

Where is safety strap placed in supine?

A

2 inch above knee

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17
Q

Legs during supine?

A

Uncrossed to reduce pressure

Flex knee with pillow under knee to prevent comoression and reduce risk of DVT

Elevate heels

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18
Q

If arms are extended in supine, how far can they be abducted?

A

No more than 90 degrees

Decreases risk for brachial plexus nerve injury

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19
Q

Tucking patients arms with sheet?

A

Arms neutral with palms facing body
Pull sheet up between body and arm
Place sheet over arm
Tuck between arm and matress
Sheet should extend from elbow to fingertips
Ensure secure but not too tight to create pressure

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20
Q

Lithotomy position?

A

Hips flexed until thighs are 80-100 degrees to OR bed
Pt lower legs parallel to OR bed in stirrups

Can be low, hemi, high, exaggerated

Common in vag, rectal, urological, colorectal, reproductive lap procedures

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21
Q

How do patients all start before being positioned in OR?

A

Supine
- OR bed or stretcher

Once pt under anesthesia patient can be positioned

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22
Q

Safety for lithotomy?

A

Do not place safety belt on abd
Place leg holders at even height
One team member per leg minimum
Raise and lower legs into stirrups and back to bed together
- avoid sudden shift in circulatory volume
Always check hands and fingers when moving lower part of bed

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23
Q

Safety positioning of legs in lithotmy?

A

Protect hips from excessive flexion
(> 80-90 degrees)
Or abduction
(> 30-45 degrees)

Puts stress on hip joints and can cause femiral, sciatic, oburator or peroneal neuopathy

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24
Q

What can raising pt legs into stirrups cause?

A

Shift of blood into central circulation and decrease perfusion in the legs
Result in increased cardiac output and venous return

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25
Why can lithotomy lead to resp compromise?
Organs shift when legs are placed in stirrups which increases pressure on the diaphragm
26
Sitting position?
Folwers/semi fowlers Beach chair Common in shoulder, posterior cervical spine or posterior/lateral head sx
27
Complications from sitting position?
``` Venous air embolism Hemodynamic instability Pneumocephalus Quadriplegia Compressive peripheral neuropathy ```
28
Positioning pt in sitting?
Elevate head/neck/torso 20-90 degrees Hips flexed 45-60 degrees Place pad under coccyx to prevent pressure on sciatic nerve/coccyx Safety belt over thighs Knees flexed 30 degrees with pillow - decrease stretching on sciatric nerve SCDs - prevent pooling, improve venous return
29
Arms during sitting position?
Both may be flexed and secured across body | In shoulders non operative arm may be secured across body
30
Sitting position risk of VAE?
Venous air embolism Air or gas enters vascular system above level of heart
31
Advantages of sitting position?
``` Access to airway Ease of mechanical ventilation Reduced intracranial pressure Reduced facial swelling Reduced blood pooling in surgical field Improved lung expansion ```
32
Trendelenburg position?
Feet higher thsn pt head by 15-30 degrees Moves abd organs toward head to improve acccess to pelvic organs Treats hypotension
33
What does trendelenburg position cause?
Movement of blood supply from lower extremity to central and pulmonary circulation Decreases limb perfusion Decreases venous return from head
34
Safety precautions when in trendelenburg?
Do not use shoulder braces Do not use circumferential wrist restraints - leads to brachial plexus nerve injury Keep in trendelenburg for shortest time possible - intracranial htn, resp deterioration, increased intraocular pressure
35
Reverse trendelenburg?
Head up and feet down Pt head 15-30 degrees above feet Common in head, neck and upper abd sx
36
Benefits to reverse trendelenburg
Head is above heart to improve drainage of body fluids away from surgical site Reduces intracranial pressure Shift intestines lower in abd Decreases bleeding at surgical field
37
Why is reverse trendelenburg at risk of VAE?
Benous pooling in the lower body can cause venous air embolism
38
Safety precautions with reverse trendelenburg?
Padded foot boards to prevent sliding and injury
39
Lateral position?
Positioned laterally on non operative side Common with thoracotomy, kidney surgery and hip sx Minimum of 4 people needed to position pt
40
Positioning considerations for lateral?
``` Two level arm boards Pillow under head Monitor dependent ear Secure to table with belt Pillow between knees Pillow under thorax to improve cardiac output Keep in position for short period - decrease risk of rhabdomyolosis Reposition to reduce risk of compartment syndrome ```
41
What is rhabdomyolosis?
Breakdown of muscle tissue Muscle fiber contents released into bloodstream Causes kidney damage
42
Prone position?
Laying face down Arms at side or on arm boards Common to access back, rectum, and dorsal areas Anesthesized on stretcher and log rolled onto OR bed - minimum 4 people *keep stretcher in room*
43
Positioning considerations for prone?
Place pt 5-10 degrees into reverse tren to reduce benous congestion in eyes Chest supports for to allow abd expansion and decreased abd pressure Protect genitals from torsion Pad pt knees and elevate toes
44
Common complications from prone?
``` Increased abd pressure Increased bleeding Compartment syndrome Nerve/pressure injuries Cardiovascular compromise Eye injuries Airway dislodgement ```
45
Jack knife position?
Kraske position Modification of prone Common in rectal procedures Same as prone with bed control positioned into jack knife (head and feet lowered)
46
Risks of jack knife?
``` Circulatory changes Causes pooling - use SCDs Compromises respiration Exerts pressure on diaphragm - use chest rolls ```
47
What can cause position related injuries?
Pressure from body, equipment or team members ex. Leaning Can be intact or open
48
What is an OR acquired pressure injury?
Appears 48-72 hrs post op Tissues that were subjected to pressure during sx May be deep tissue Seldom visible at end of procedure or appears red Sometimes incorrectly identifiedas a burn
49
What is a HAPI?
``` Hospital acquired pressure injury Occurs during hospital stay Can develop from pressure, shear or both Associated with pt factors ex. Age Preventable Nursing quality error Expensive to hospital ```
50
Stage 1 pressure injury?
Intact, red skin | Does not blanch
51
Stage 2 pressure injury
Partial skin loss involving epidermis and or dermis | Skin abraded, blistered or has shallow craters
52
Stage 3 pressure injury?
Full thickness skin loss possibly down to but not through fascial layer Deep craters with or w/o undermining
53
Stage 4 pressure injury?
Full thickness skin loss with extensive destruction, necrosis or damage to muscle, bone or supporting structures
54
Pressure injuries that do not fit into stages?
Unstageable Deep tissue Mucosal membrane Medical device related
55
Risk assessment tools?
Braden scale - does not include perioperative factors Braden Q scale - pediatric Munro scale - surgical Scott triggers - surgical
56
Munro scale?
Risk factors for pressure injury in surgical pts Calculates a cumulative score of pre op, intra op wnd post op factors
57
Scott triggers tool?
Pressure injury assessment took for sx pt Assess patient factors - age, albumin, or BMI, estimated length of surgery
58
6 factors causing pressure injury?
``` Friction Shear Moisture Heat Cold Negativity - layers of material ``` *duration of pressure
59
Anterior pressure points?
``` Ear Wrist Ilium Patella Toes ```
60
Posterior pressure points?
``` Occiput Scapula Vertebra Elbow Rib Sacrum Greater trochanter Ischial tuberosity Medial/lateral condyles Heel Malleous ```
61
What is brachial plexus?
Consists of a bundle of nerve cords that innervate the shoulder, arm and hand
62
Risk and causes of brachial plexus injuries?
``` Supine position - arms > 90 degrees Trendelenburg - use of shoulder braces Jack knife Obese pt Hyperextension of neck ```
63
Peroneal nerve injuries?
Branch of sciatic nerve that supplies movement and sensation to lower leg, foot, toes
64
Positions that increase risk of peroneal nerve injury and solutions?
Supine - place safety strap 2 inch above knee Lithotomy- prevent excessive flexion, abduction R. Trendelenburg - use padded foot board Lateral - support pillows
65
Positioning considerations for geriatic pts?
Skin protection Lift never slide Decreased ROM
66
Positioning considerations for pregnant woman?
Uterus can compress aorta and interior vena cava - causes hypotension Woman over 18 weeks positon in a left lateral tilt Place wedge cushion or tilt bed 15-45 degrees to left

Patient Positioning (1 decks)

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