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INTRODUCTION

Chanda

Chanda is 7 months pregnant and is undergoing an examination for pain in the sacrum and low-back pain.

What is the best way to position Chanda in a way that allows you to examine her low back visually and manually?

Katsu

Katsu has very limited voluntary motor function in her right arm and leg because of a recent stroke (cerebrovascular accident). Her children are very supportive, and at least one family member has been present in her room since Katsu was admitted to the hospital through the emergency department.

What are the objectives of Katsu’s positioning?

Are there particular precautions you may need to consider?

How might you involve her family?

INTRODUCTION

Positioning, or placing a patient in a static resting posture, can be used to increase stability and facilitate mobility, enhancing patient abilities at different points along the stability–mobility continuum. image Careful and consistent positioning of patients who will be in one position for a long time promotes flexibility of joints and soft tissues, which allows patients to maintain the capacity for mobility. Positioning patients to keep them from falling out of bed or to receive treatment of a sacral wound, on the other hand, is a matter of establishing temporary static stability, the ability to maintain a position while stationary (purposeful nonmovement). Positioning a seated patient securely in a chair with adequate trunk support creates a stable core from which a person is better able to achieve purposeful controlled mobility (dynamic postural control—or purposeful, intentional movement) of the upper extremities.

Because their objectives are different, a basic distinction needs to be made between procedures for short-term positioning and long-term positioning. The first question you must answer when deciding how to position your patient most effectively is, “What am I trying to accomplish?” Your answer will guide your decision-making process (see Table 7-1).

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Table 7-1 Situations Calling for Short-Term and Long-Term Positioning

Short-Term Positioning Is Used When

Long-Term Positioning Is Used When

  • A patient is preparing for a short-term therapeutic intervention (e.g., inspection or palpation of the posterior cervical spine).

  • A patient is performing a specific exercise (e.g., range of motion of the lower extremity).

  • A patient is able to make minor positional adjustments during treatment and is able to change positions when treatment is complete.

  • A patient must remain in one position for an extended period.

  • A patient’s mobility limitations prevent independent positional adjustments, usually because of impairments such as:

    • Muscle weakness

    • Decreased sensation

    • Neurologically impaired muscle control

Basic principles apply to procedures for both short-term and long-term positioning, including allowing the patient to do as much as possible as normally as possible AMAP/ANAP and image remembering to consider the dynamics of person, task, and environment.

  • Explain to the patient what you plan to do ...

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