Patient Safety and
Positioning
Unit 2
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Risk factors for injury:
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Patient Safety p.236
Impaired mobility due to injury, disease, or surgery
Medications affecting mental status, balance, coordination
Disorientation due to change in environment or disease
Impaired hearing or vision
Possible causes for falls:
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Misjudged distance
Weak, dizzy
Rapid change in position – losing balance, getting light headed
Hazards on hallways
Poor lighting
Not calling for help
Prevention is key! Study Preventing Patient Falls Figure 15.1 p. 237!!!!!
Restraints p. 237
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Chemical – medications affecting mood/behavior
Physical: any technique or device that restricts movement or normal access to body
Remember: The resident has the right to be free from physical and chemical restraints, so
document objectively what’s going on
Physical restraints are only used when safety of pt or others is at risk and nothing else
works, ex. If pt climbs out of bed to go to bathroom – keep urinal in reach
Always have to try alternatives first, ex. Pt who gets out of WC gets a chair alarm and WC is
placed by the nurse’s station, so everyone can keep an eye on pt
If restraints are necessary, start with least restrictive first
Need a MD order, often family/pt will sign consent, and follow protocol
P. 238 examples of physical restraints
Table 15.1: Complications of restraints !
P. 246: Guidelines for The Use of Restraints!! Especially: check q15mins, release q2hrs for
at least 10 mins etc
Applying Restraints in Bed p. 244
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Ex: wrist, vest, poncho, jacket, belt restraints; Always follow manufacturers guidelines
Center pt’s hips in middle of bed (where it bends when HOB goes up)
Make sure straps are straight, not at an angle
Wrap straps around frame deck (movable part of bed frame that supports mattress)
Don’t wrap on stationary bed frame part (when you move HOB, it gets pulled), side
rails, or on outside of bed, so pt can’t untie it
Use bedspring to tie on strap
Use side rails when pt is restrained in bed
See Figure 15-14
Enablers & Side rails p. 241
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Enabler: Device that empowers, assists pt to function at highest level possible; if used
purely to keep pt from getting up = restraint ex. Wheelchair lap tray Figure 15-9
Postural supports: devices that maintain body position and alignment
Side Rails: can be enablers, can be restraints; 4 rails up=always restraint
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If pt has physical restraints on in bed – side rails must be up
Injuries with side rails: falls = hip fractures, entrapment between mattress and rails see Figures 15-10A
and B p. 242
Padding for side rails: for seizure disorders, blood thinning medications, pt who wants to climb
through side rails
Alternatives to side rails: see all figures on p. 243
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Keep bed in lowest possible position, wheels locked
Padded mats on floors, so no injuries when fall
Meet needs = anticipate reasons for getting up: hunger, thirst, bathroom, pain
Pressure-sensitive bed and chair alarms: sound when pt gets out of bed or chair
Pressure-sensitive mats: sound alarm when someone steps on them
Alternatives to Restraints p. 245
Try before using restraints – document what was tried, how it didn’t work
1. Care for pt’s personal needs promptly
2. Know pt’s with fall risks – monitor them more often
3. Make sure pts walk and transfer correctly
4. Report any physical or mental change that could lead to an accident STAT
5. Maintain safe, quiet, calm environment
6. Comfortable chairs, supportive devices
7. Use Security devices: wrist sensors (go off if pt tries to leave building), bed
or chair alarms
8. Use clothing wisely, often just covering the IV site with long sleeves etc.
keeps pt from pulling on it
Preventing other Incidents p. 247
• Accidental poisoning: lock all chemicals/cleaning solutions; Pt food belongs
in pt refrigerator, labeled with name and date
• Thermal injuries: heat or cold
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Follow procedures accurately when administering warm/cold treatments
Check water temperature
Check food temperature
Store flammables safely
• Skin injuries: lacerations (cuts/breaks in skin)
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Keep sharps locked up: scissors, knives, razors, needles
Dispose of them properly in a _______________
Clean up broken glass immediately
Preventing other Incidents p. 248
• Choking:
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Aspiration: accidental entry of food or object into trachea (windpipe)
Pt having problems with swallowing (dysphagia): cut food small, feed slowly, fluids
between bites, place food in unaffected side (CVA), use thickeners if ordered
Place pt upright, good body alignment before eating; sit up for 30 mins after eating
If pt pockets food, give oral care after meal
Procedures p. 249 - 252
• Procedure: practices and processes used when following facility policies in
patient care
• Prioritizes and orders your responsibilities
• Initial Procedure actions p. 249!!
• Ending Procedure actions p.251!!
Body mechanics for the patient p. 253
• Body alignment: position in which body can properly function
• Maintained by moving, turning, positioning pt so it
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Helps the pt feel more comfortable
Relieves strain
Helps body function more efficiently
Prevents complications like contractures and PUs (pressure ulcer)
Complications of incorrect positioning p. 253
• Pressure ulcers (PUs): unrelieved pressure on a bony prominence interferes
with blood flow leading to tissue breakdown (wounds)
• Contractures:
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Occur when joint is in same position for too long
Can begin in as little as 4 days of immobility
Pt loses ability of free movement after 15 days
Muscles stiffen and shorten, preventing joint from moving fully
Painful, permanent, interfere with mobility
Supportive devices p. 254
• Anything that helps maintain proper body alignment
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Pillows, folded sheets, blankets
Orthotic devices, ex. Splints
Special boots or shoes
Bed cradles to prevent blanket sitting on feet
Footboards to prevent foot drop
Body Positions p. 254
• Prone (abdomen)/ semiprone (variation
• Supine (back)/ semisupine (variation)
• Lateral (side)/ Sims’ (variation)
• Fowler’s position/ high Fowler’s, semi-Fowler’s, orthopneic position
• Regardless the position, it always involves:
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moving pt into proper body alignment, may need to move pt up or to one side of the
bed
Turning pt on back, side, or abdomen
Placing pt’s trunk and extremities in proper position, maintaining alignment with use of
supportive devices
Moving/ lifting pts p. 255
• Responsibility of nursing assistant
• Follow proper body mechanics and safety rules for you and your pt
• ALWAYS find out if you need help moving/lifting pt before beginning
• Ask for help
• Check care plan for special positioning instructions
• Turn sheet /draw sheet:
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Extends from above shoulders to below hips
Used to move heavy or helpless pt
Procedures 14-17!! P. 255-258
• Read/know procedures:
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Turn pt toward you
Turn pt away from you
Moving pt to HOB
Logrolling pt
Positioning pt p. 259
You have to know the positions!!
• Supine Position p. 259
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HOB flat, head 2-3 inches from HOB
Pillow extends 2 inches below pts shoulders, head in middle
Trochanter roll: from above hip to above knee, for affected hip or weak hips (prevents
external rotation)
Pillows everywhere, feet at 90 Degree angles
• Semisupine Position = tilt position (not lateral)
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Relieves pressure from hip, sacrum, coccyx and buttocks
45 Degree angle between pt back and bed
Bottom shoulder slightly forward
Legs and spine are straight
Positioning pt p. 259
• Prone Position p. 260
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Pillow under head extends to shoulders and 5-6 inches beyond face
Small pillow under abdomen (reduces back pressure)
Pillows under arms, lower legs
Legs and spine are staight
• Semiprone Position (not lateral)
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Starts in prone, then pillow under shoulder and chest, under top leg
Lower arm is behind body
Legs and spine are straight
Positioning pt p. 262
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Right Lateral Position p. 262 XXXX Skill check off XXX
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Start in supine, bring pt more to left side of bed, so he can turn right and have enough space
Place pillow under head extending 5-6 inches beyond face and down to shoulders
Position right (lower) arm, so shoulder, elbow are flexed, palm facing up
Place left (upper) arm in comfortable position, support with pillow; shoulder, elbow wrist at
same height
Pillow behind pts back to maintain position
Pillow between legs from above knee to below ankles; hip, knee and ankle at same height
Sims’ position p. 262 (variation of left lateral position)
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Left (lower arm) extended and behind back
Right (upper arm) flexed and forward, supported with pillow
Left leg extended
Right leg flexed
Positioning pt p. 262
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Fowler’s Position (to feed pts, for watching TV etc)
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Start in supine, middle of bed, hip where bed bends
HOB at 30 Degrees = semi-Fowler’s,
HOB 45-60 Degrees = Fowler’s,
HOB 90 Degrees = high Fowler’s
Pillow extends 4-5 inches below shoulders
Flex elbows, support with pillows to prevent pulling on shoulders
Pillow under legs from above knee to ankles to prevent pressure on heels
Footboard/folded pillow to prevent foot drop
Positioning pt p. 263
• Orthopneic Position
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Variation of high Fowler’s when pt has difficulty breathing
Sit pt up as high as possible
Lean pt forward, using overbed table in front of pt as support for extended arms
Pillow behind back for support
• Sitting Position
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In chair or WC
Back and buttocks up against chair back
Stabilize feet on floor or footrests
Feet, knees, thighs at 90 degree angles (90-90-90 position)
Skill 3: Positioning pt
on side
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Google video:
nursing skills youtube chesapeake
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P/F
Performed beginning standards
Explains procedure to resident before care
Provides privacy
Lowers HOB
Raises side rail on side to which body will be
turned
Slowly rolls resident onto side as one unit
towards raised side rail, keeping upper knee
bent in front of lower leg
Keeps resident positioned a safe distance
from the edge of bed
Ensures resident is not lying on lower arm
Places or adjusts pillow under head of bed to
support neck and chin
Supports top arm with supportive device
Supports residents back with supportive
device
Places supportive device between legs so
ankles/knees are separated
Asks resident about comfort during care
Puts call bell within reach
Washes hands
End procedures
Homework
Textbook: Read Unit 15
Workbook: Read Unit summary p. 94, Memorize Initial Procedure Actions,
Memorize Ending Procedure Actions, True/False questions p. 96, Name the
position p. 97