The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [221]
(c) Patient preference, lifestyle, position of stoma, consistency of effluent, state of peristomal skin, dexterity of patient, type of stoma.
(d) Cognitive ability, lifestyle, patient dexterity, position of stoma, state of peristomal skin, type of stoma, consistency of effluent, patient preference.
9 What type of diet would you recommend to your patient who has a newly formed stoma?
(a) Encourage high-fibre foods to avoid constipation.
(b) Encourage lots of vegetables and fruit to avoid constipation.
(c) Encourage a varied diet as people can react differently.
(d) Avoid spicy foods because they can cause erratic function.
10 What would be your main objectives in providing stoma education when preparing a patient with a stoma for discharge home?
(a) That the patient can independently manage their stoma, and can get supplies.
(b) That the patient has had their appliance changed regularly, and knows their community stoma nurse.
(c) That the patient knows the community stoma nurse, and has a prescription.
(d) That the patient has a referral to the District Nurses for stoma care.
These multiple choice questions are also available for you to complete online. Visit www.royalmarsdenmanual.com and select the Student Edition tab.
Answers to the multiple choice questions can be found in Appendix 3.
Chapter 7
Moving and Positioning
Overview
The aim of this chapter is to provide guidance on various aspects of moving and positioning patients, acknowledging the need to be clinically effective and, where possible, evidence based. It relates to moving and positioning of adults and does not specifically cover positioning in children or neonates.
The main objectives of the chapter are to:
1. outline the general considerations of moving and positioning
2. provide guidance on the principles of moving and positioning whether the patient is in bed, sitting or preparing to mobilize
3. consider optimal moving and positioning including modifications for patients with different clinical needs.
The principles of moving and positioning will relate to the effect on the patient, but the practitioner needs to ensure that they consider their own position regarding the safety aspects of manual handling. For recommendations and further information on safe manual handling, refer to government (HSE 2004) and local trust policy (HSE 1992), the manual handling advisor or the physiotherapist (PT).
In this chapter the general principles of moving and positioning will be discussed first followed by considerations of positioning for patients with specific clinical needs, which will require modification or additional considerations of the general principles. The first specific clinical area covered will be moving and positioning of unconscious patients and patients with an artificial airway. Following this, there will be a section looking at additional considerations and modifications for patients with different respiratory requirements. The next section of the chapter will relate to the specific moving and positioning needs of patients with a neurological problem, including the management of patients with spinal cord compression. The final clinical area to be considered will relate to considerations and modifications necessary for upper and lower limb amputees.
All terms marked with an asterisk are explained in the Glossary at the end of the chapter.
Moving and positioning
Definition
The verb ‘to position’ is defined as ‘a way in which someone or something is placed or arranged’ (Pearsall 2001). In medical terms, the word ‘position’ relates to body position or posture. Moving and positioning lie within the broader context of manual handling, which incorporates ‘transporting or supporting a load (including lifting, putting down, pushing, pulling, carrying or moving) by hand or bodily force’ (HSE 1992).
Anatomy and physiology
The human body is a complex structure relying on the musculoskeletal system to provide support and