To prevent footdrop in a bedridden patient with lower limb paralysis, which positioning device is most appropriate for the nurse to use?

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

Positioning boots, also known as foot boots, are specifically designed to prevent footdrop (plantar flexion).
They work by holding the foot and ankle in a neutral, dorsiflexed position (90-degree angle to the leg).
This position prevents the shortening of the calf muscles and the Achilles tendon, which causes the foot to become fixed in a downward-pointing position.
Many positioning boots also have the added benefit of elevating the heel, which helps prevent pressure ulcers in that high-risk area.

Option A: A trochanter roll is placed alongside the outer thigh to prevent the leg from rotating outwards at the hip. It does not affect the position of the foot or ankle.
Option B: A hand roll is placed in the palm of the hand to maintain a functional position of the fingers and thumb, preventing hand and finger contractures.
Option D: A trapeze bar is an overhead device that the patient can grasp to help with movement, repositioning in bed, and strengthening the upper body. It does not position the lower limbs.

Visual 1: Diagram - An illustration showing a patient's foot with and without a positioning boot. The 'without' image shows the foot in plantar flexion (footdrop), and the 'with' image shows the foot held in dorsiflexion by the boot.
Visual 2: Image - A photograph of a trochanter roll correctly placed alongside a patient's hip to demonstrate its function in preventing external rotation.

Clinical Relevance

Nursing practice connection: Use the key finding related to Use of positioning devices to prevent complications of immobility to guide bedside assessment, documentation, and the next nursing action.
Preventing footdrop is a critical nursing intervention as it significantly impacts a patient's ability to walk and stand, affecting their long-term mobility and quality of life.
Nurses must perform regular skin assessments when using any positioning device, removing the device at scheduled intervals (e.g., every 2 hours) to check for redness, irritation, or pressure sores, especially over bony prominences like the heel and ankle.
What if? If a commercial positioning boot is not available, a nurse can improvise by using high-top athletic shoes to help keep the foot in a dorsiflexed position, although this is a temporary measure and requires careful monitoring.

How to Approach the Question

First, identify the specific problem the question is asking to prevent: 'footdrop'.
Recall the definition of footdrop: a contracture where the foot points downward (plantar flexion).
Analyze the function of each option provided.
Trochanter roll: relates to the hip.
Hand roll: relates to the hand.
Positioning boots: specifically designed for the foot.

Concept Tested & Keywords

Concept Tested: Use of positioning devices to prevent complications of immobility.
Stem keywords: footdrop, bedridden patient, lower limb paralysis, positioning device
Lead-in keywords: most appropriate
Clinical cues: The patient's condition of lower limb paralysis increases the risk for footdrop due to lack of active movement.

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Practise the full NORCET 2 -2021 (Shift-2)

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