A middle-aged woman in the lithotomy position
Outline the risks associated with the following positions, and the actions you would take to ameliorate them. Provide rationales for your responses.
What will be an ideal response?
Answer:
Risks
There are a number of identified risks associated with placing a middle-aged woman in the lithotomy position.
Reduced range of motion in hip and knee joints, particularly if the patient has osteoarthritis. The presence of total hip or knee prostheses further increases the risk of dislocation of the hip joints and overstretching of the femoral nerves.
Lumbosacral strain and sciatic nerve damage can further exacerbate any pre-existing backache.
Blood pressure fluctuations when limbs are raised and lowered during positioning.
Increased VTE risk due to the patient undergoing an intra-abdominal or pelvic procedure, where surgery is longer than 45 minutes and the patient is aged >40 years. The patient may also be taking oral contraception or hormone replacement medications, which have been shown to increase the risk of complications associated with VTE.
Risk of nerve damage and compartment syndrome as a result of pressure on calves and feet from stirrups and foot straps.
Fingers can be crushed.
Actions
The patient requires supervision and guidance in order to transfer herself over to the operating table, as well as adequate numbers of surgical team members to assist.
Rationale: Care must be taken when transferring the patient, particularly if she already has an intravenous (IV) cannula or IV infusion in place. Dislodgement can create discomfort and replacement is time-consuming. The staff member guiding the patient should instruct her to feel for the sides of the operating table as she moves across, so that she can be confident she is centrally located. The trolley or bed should not be moved away until the patient is securely positioned and confirms this, to prevent the patient from sustaining a fall. A minimum number of staff should be determined for the safe transfer of the patient following assessment of the patient's mobility status.
Team members should provide instruction, support and reassurance and ensure that the patient's dignity is maintained during the transfer process.
Rationale: The patient is at high risk of compromise to dignity and psychological discomfort related to the surgical positioning. Preservation of patient privacy, confidentiality and dignity is a must. Minimising patient exposure and using discretion is a priority. Once the patient is anaesthetised, she will be placed into the lithotomy position.
Use of a pressure-relieving mattress or gel overlay on the OR table and padding on stirrups.
You might also like to view...
The nursing student asks the mental health nurse why pancuronium was administered to the patient before electroconvulsive therapy was performed. What is the mental health nurse's best response?
A) To prevent aspiration of vomitus B) To reduce the pain of the procedure C) To put the patient to sleep D) To reduce the intensity of muscle contractions
Which of the following is the legal authority for nursing practice and action according to each state?
a. The Joint Commission c. Nurse Practice Act b. State boards of nursing d. NCLEX
A premature newborn is unable to suck at the breast. The nurse plans care for the mother, who is going to hand-express milk. Arrange the steps for milk expression in the correct order. Click and drag the options below to move them up or down
1. Roll the thumb and fingers simultaneously forward. 2. Position the thumb at 12:00 and the forefinger and middle finger at 6:00 around the areola. 3. Repeat the sequence multiple times to completely drain the breasts. 4. Stretch the areola back toward the chest wall without lifting the fingers off the breast.
The nonsurgical management for a child with vesicoureteral reflux focuses most on which one of the following goals?
a. Urine will be produced at 15-40 cubic centimeters per hour. b. There will be no episodes of urinary tract infection. c. Medication will be taken 100% of the time. d. The child will remain in school 100% of the time.