Positioning
Hypotension - ANS-What is the biggest physiologic consequence of position changes?
FRC is decreased by 20% - ANS-What happens to a patient's FRC when placed in the
supine postion?
Compression of the IVC; can cause hypotension in obese, pregnant and volume
depleted patients - ANS-What concerns should you have with obese or pregnant
pateints when placed in the supine position?
Pressure on the occiput can cause alopecia - ANS-Why is it important to pad the back
of the head when the patient is in the supine postion?
If at side must be padded and tucked
Watch fingers !!!!!
On arm boards
Padded, palms up (supinated) less than 90 degree angle - ANS-What are the concerns
for patient's arms when in the supine position?
Backache and Ischemic pressure injuries - ANS-List the major complications of the
supine position.
VQ mismatching
Dependent lung = Underventilated
More perfusion
Nondependent lung =
Overventilated
Less perfusion - ANS-In the lateral decubitus position what happens to each lung?
To prevent compression of the dependent arm's axillary neurovascular bundle (brachial
plexus injury) - ANS-Why are axillary rolls used in lateral decubitus positioning of the
patient?
Place an axillary roll - ANS-What can you do to prevent circumduction of the "down"
shoulder resulting in stretching of the suprascapular nerve in the lateral decubitus
position?
, 0.8 (4-5L) - ANS-What is a normal VQ ratio?
No perfusion
Alveolar dead space
No ventilation
Intrapulmonary shunt (RL) - ANS-VQ mismatch of Infinity means?
VQ mismatch of O means?
Injury to the common peroneal nerve d/t improper positioning or padding - ANS-A
patient develops foot drop following a vaginal hysterectomy. Her ankles were placed in
candy-cane stirrups to assume the classic lithotomy position. What happened?
Sciatic, common peroneal, femoral, saphenous and obturator nerves
Common peroneal nerve injury - ANS-What nerve injuries can occur with the lithotomy
position?
What is the most common?
To avoid stretch injuries to the nerves - ANS-Why is it important to move the legs at the
same time when positioning patient in and out of lithotomy position?
On their side with pillows between legs/feet to relieve pressure, Bottom leg flexed, Arms
parallel and axillary roll placed under torso - ANS-How is a patient placed when in the
lateral decubitus position?
Ischemic
Muscular and ligament strain
**Whiplash injury to cervical spine
Neurologic injuries
Ocular complications (corneal abrasions, dependent edema and blindness in the down
eye) - ANS-What injuries can occur from placing a patient in the lateral decubitus
position?
Age
Body habitus
Baseline Limitations of Mobility
Preexisting neurological symptoms
DM
Hypotension - ANS-What is the biggest physiologic consequence of position changes?
FRC is decreased by 20% - ANS-What happens to a patient's FRC when placed in the
supine postion?
Compression of the IVC; can cause hypotension in obese, pregnant and volume
depleted patients - ANS-What concerns should you have with obese or pregnant
pateints when placed in the supine position?
Pressure on the occiput can cause alopecia - ANS-Why is it important to pad the back
of the head when the patient is in the supine postion?
If at side must be padded and tucked
Watch fingers !!!!!
On arm boards
Padded, palms up (supinated) less than 90 degree angle - ANS-What are the concerns
for patient's arms when in the supine position?
Backache and Ischemic pressure injuries - ANS-List the major complications of the
supine position.
VQ mismatching
Dependent lung = Underventilated
More perfusion
Nondependent lung =
Overventilated
Less perfusion - ANS-In the lateral decubitus position what happens to each lung?
To prevent compression of the dependent arm's axillary neurovascular bundle (brachial
plexus injury) - ANS-Why are axillary rolls used in lateral decubitus positioning of the
patient?
Place an axillary roll - ANS-What can you do to prevent circumduction of the "down"
shoulder resulting in stretching of the suprascapular nerve in the lateral decubitus
position?
, 0.8 (4-5L) - ANS-What is a normal VQ ratio?
No perfusion
Alveolar dead space
No ventilation
Intrapulmonary shunt (RL) - ANS-VQ mismatch of Infinity means?
VQ mismatch of O means?
Injury to the common peroneal nerve d/t improper positioning or padding - ANS-A
patient develops foot drop following a vaginal hysterectomy. Her ankles were placed in
candy-cane stirrups to assume the classic lithotomy position. What happened?
Sciatic, common peroneal, femoral, saphenous and obturator nerves
Common peroneal nerve injury - ANS-What nerve injuries can occur with the lithotomy
position?
What is the most common?
To avoid stretch injuries to the nerves - ANS-Why is it important to move the legs at the
same time when positioning patient in and out of lithotomy position?
On their side with pillows between legs/feet to relieve pressure, Bottom leg flexed, Arms
parallel and axillary roll placed under torso - ANS-How is a patient placed when in the
lateral decubitus position?
Ischemic
Muscular and ligament strain
**Whiplash injury to cervical spine
Neurologic injuries
Ocular complications (corneal abrasions, dependent edema and blindness in the down
eye) - ANS-What injuries can occur from placing a patient in the lateral decubitus
position?
Age
Body habitus
Baseline Limitations of Mobility
Preexisting neurological symptoms
DM
