Question

1. Upon examination of an elderly patient 3 days after a cerebral vascular accident, redness is noted over the left greater trochanter. What would be an appropriate positioning schedule for this patient?

2. How should a family be instructed to properly position a patient with a recent complete cervical spinal cord injury?

Answer 1

Minimize friction and shear • Use 30-degree side lying position (alternating from the right side, the back and left side) to prevent pressure, sliding and shear- related injury. Minimize Pressure • Schedule regular repositioning and turning for bed and chair bound individuals

2. Side Lying

Patients who have spinal precautions in place benefit from side lying to assist with chest physio, comfort and decrease in pressure related complications such as occipital pressure sores. All patients unless otherwise stated (i.e. unstable thoracolumbar fracture, cervical fracture or pelvic fracture) should intermittently be positioned on their sides using a wedge to ensure that anatomical alignment is maintained.

Log Roll

as per protocol  Insert a long wedge to support the length of the lumbar, thoracic and cervical spine  Sheet is used to keep wedge in place  On the head holders count, roll the patient back to rest against the wedge  The head holder should continue to hold the head until support for the head is put in place. A second person places support such as folded towels under the head to maintain neutral alignment Restrictions on side lying should be documented on the spinal management chart and/or in the patient’s medical record.

Bed tilting

Patients that remain on „spinal precautions‟ have an increased risk of aspiration and restrictions in respiratory function. Patients in this position can have the whole bed tilted head up especially whilst eating and drinking to prevent these complications until their spine has been cleared and spinal precautions have been lifted and documented.

Pillow use

Patients can have a small, flat pillow when;  Cervical spine has been formally cleared and documented  If a cervical spine injury (fracture or ligamentous) has been identified and the management is with a cervical collar  This should be documented in the patient medical record and or on the spinal management chart that the patient can have a pillow in place

Other care

If a patient has had a suspected spine injury, neurovascular observations to the upper limbs and lower limbs should be conducted to establish the presence or absence of spinal cord injury. Neurological assessment is required to establish the presence or absence of spinal cord injury and to classify the extent of the damage. In cervical spinal cord injury, motor weakness is greater in the upper extremities than the lower. Sensory loss is variable, with the patient more likely to lose pain and or temperature sensation than proprioception and or vibration. Dysesthesias (burning sensation in the hands or arms) is common. Any of these signs should be reported immediately to medical staff. If a patient is to be discharged home with a Philadelphia collar instiu, provide the patient with the „Philadelphia collar discharge brochure‟ which can be obtained from ipolicy and ensure the patient and or a family member has been educated regarding the ongoing care for the collar.