Patient Positioning and Pressure Ulcer Prevention
Ergonomics in Patient Care
Ergonomics is the science of designing work to fit the user. When applied properly, it can increase energy and work performance by providing solutions to:
- Improve working conditions
- Decrease fatigue
- Prevent injuries
- Increase satisfaction and work performance
Body Positions for Patient Care
Postural changes are used to facilitate patient examination and treatment, prevent injuries, and ensure user comfort. Positions can be divided into:
- Basic Positions: Supine (dorsal decubitus), prone (ventral decubitus), and side decubitus.
- Special Positions: Sims (semi-prone), Fowler, Trendelenburg, anti-Trendelenburg (Morestin), Rose, lithotomy (gynecological), and genupectoral (Mohammedan).
Patient Mobilization and Transport Techniques
A) Mobilization
When a user loses or has diminished mobility, they can develop muscle pathologies. To avoid this, we must implement a mobilization plan, which also promotes circulation. Mobilization exercises are classified as:
- Active: Performed by the patient under professional supervision.
- Passive: Performed by a professional when the patient cannot make the necessary effort. Care must be taken not to force joints. It’s important to understand the range of motion (the degree of mobility each joint allows) and use gentle movements.
B) Changing Position in Bed
Mobilization exercises and repositioning help avoid the appearance of contractures, deformities, and skin lesions (pressure injuries). Changing a patient’s position has a preventive effect and should be done every 2-3 hours. The most common sleep positions are supine, prone decubitus, and lateral decubitus.
Aspects to Evaluate
- The patient’s status and situation, keeping their weight in mind.
- Knowing their pathology and if they can collaborate.
- Our own physical strength and whether we need assistance.
C) Transportation and Mobility
- Transport: The transfer of a patient from a bed to a chair, wheelchair, or stretcher to move them to another room. This must take into account the patient’s degree of mobility and dependency.
- Walking: The act of walking. Patients are encouraged to walk to avoid injuries due to immobility. If the patient has been in bed for a long time, the process of starting to walk again will be slow and gradual.
Understanding Pressure Ulcers
Pressure ulcers (bedsores) are injuries to the skin and underlying tissue resulting from prolonged pressure. They manifest as localized areas of ischemic necrosis, which is cell death caused by an arrest of arterial circulation in a specific area.
Pressure decreases the amount of blood flow to the tissues, causing a lack of oxygen and nutrients that leads to cell death where the skin breaks down. The patient may experience pain or develop infections from microorganisms. Fistulas can form that may affect muscles and bones, and healing is often impaired.
Factors Predisposing to Pressure Ulcers
Extrinsic Factors
These factors act on the patient’s body from the outside and can cause ulcers if they persist for some time.
- Pressure: When position changes are not frequent, the compression on tissues surrounding bony prominences can cause ulcers.
- Friction: Friction between the skin and the surface it rests on can cause ulcers. They may also appear because of probes, tubes, or splints. Wrinkles in the bedsheets also accelerate the process.
- Moisture: Moist skin is more vulnerable to the action of pressure or friction.
- Time: The prolonged action of the previous factors is what produces the lesion.
Intrinsic Factors
These are factors and characteristics specific to each patient, derived from their pathology.
- Age: Their occurrence increases in elderly people (over 75). In older patients, the skin loses elasticity, vascularization decreases, and the amount of subcutaneous tissue is reduced.
- Immobility: Immobility due to a disease causes prolonged pressure on certain areas of the body and reduces movement.
- Incontinence: This increases moisture on the skin, making it more vulnerable.
- Nutritional Status: This is important for several reasons:
- Overweight: Increases pressure on the skin.
- Underweight: The amount of fatty tissue under the skin is less, and the bone is almost touching the skin.
- Lack of vitamins and protein in the diet.
- Dehydration: Lack of fluid.
- Pathologies: Certain diseases affect the body at different levels.
- Brain or spinal injuries can cause a loss of sensitivity to pain and pressure.
- Diseases such as diabetes or kidney failure can interfere with the healing process of ulcers.
- Diseases that cause a decreased level of consciousness.