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POSITIONING
BY;
ANUSHRI SRIVASTAVA
KEY TERMS
• Prone : Face down
• Supine : Lying on back
• High Fowler’ s : Head of bed elevated 80-90
degree
• Dorsal Recumbent : Supine with legs flexed in an
elevated position
• Flexion : Movement that decreases the
angle between two body
parts
• Extension : Straightening movement that
increases the angle
between two body parts
• Hyperextension : Excessive movement of a joint in
one direction (straightening)
INTRODUCTION
• Therapeutic Positions are used to promote comfort
of the patient.
• Proper turning and positioning allows the health
care provider to make clients, as comfortable as
possible, prevent contractures, and pressure sore,
and facilitate diagnostic test for surgical
intervention.
• To relieve pressure to new positions every 2 hours.
• Three factors significant in positioning are-
Pressure, Friction and Shear
DEFINITION
• According to Annamma Jacob,
Positioning is defined as placing the patient in
good body alignment as needed
therapeutically.
• According to nurseinfo.in,
Positioning is defined as placing the person in
such a way to perform therapeutic
interventions to promote the health of an
individual
PURPOSE
• To promote comfort
• To prevent complication
• To stimulate circulation
• To promote normal physiologic functions.
ARTICLES
• Clean, dry, firm bed
• Different types of mattress
• Bed Boards
• Pillows
• Footboards/ Foot boot
• Sandbags
• Hand rolls
• Trochanter rolls
• Bed blocks
• Over bed Table
• Additional Sheets
• Trapeze bar
PRINCIPLES
• Maintain good body mechanics.
• Obtain assistance as required.
• Ensure that mattress is firm and level of bed is at
working height.
• Ensure that sheets are clean and dry.
• Avoid placing a body part directly over another to
prevent pressure.
• Plan a regular position change schedule for the
patient for 24 hours..
• Ensure patient comfort.
• Wash hand before and after procedure.
1. Fowler’ s Position
2. Orthopenic Position
3. Prone Position
4. Lateral/ Side Lying Position
5. Sims’ s Position/ Semi- Prone Position
6. Lithotomy Position
7. Trendelenburg Position
8. Reverse Trendelenburg Position
9. Supine Position
10. Dorsal Recumbent Position
11. Knee-chest Position
12. Rose Position
FOWLER’ S POSITION
Purpose
• To relieve or minimize dyspnea
• To relieve tension on abdominal sutures
Procedure:
NURSING ACTION RATIONALE
1. Inform patient of the
position, he will be in and
provide needed explanation
Understanding reduces
anxiety and promotes
relaxation
2. Elevate head of the bed
Fowlers (45-90)
Semi- Fowler (15- 45)
High Fowler (90)
Increases comfort and
relaxation
3. Rest head against mattress
and small pillow
Prevents cervical flexion and
contractures
NURSING ACTION RATIONALE
4. Use pillow to support arms. Prevents shoulder dislocation,
promote circulation and
prevents flexion contractures
of arms and wrists
5. Place a small pillow at
lower back
Supports lumbar vertebra and
prevents exaggerated flexion
of vertebrae
6. Place a small pillow/ roll
under thigh
Prevents hyperextension of
knee and occlusion of
popliteal artery from pressure
of body weight
7. Place small pillow under
ankle
Prevents prolonged pressure
on heels
8. Place footboard at bottom
of patients feet
Maintains dorsiflexion and
prevents foot drop
ORTHOPENIC POSITION
• High fowler’ s position with over bed table
placed in front of the client.
• Client to rest with both hands on over the bed
table/on pillow placed on it and lean forward.
Leaning forward facilitates respiration by
allowing maximum chest expansion.
Indications:
• Patient with severe dyspnea
• Cardiac Patients
• Position for thoracentesis
• Patient with chest drainage tubes
• Relieve Respiratory distress
• Pericarditis
• ARDS
• COPD
• Emphysema
• Asthma
PRONE POSITION
• The client is in flat position only abdomen with
head turned to one side. The head rest on a pillow,
one or both hands beyond the head or at the
sides.
Indication
• Patients with pressure sores, burns, injuries, and
operations on back
• For patients after 24 hours of amputation of
lower limbs
• Position for renal biopsy
• To prevents aspiration
• NTD
• Recovery positions after anesthesia
Procedure:
NURSING ACTION RAT IONALE
1. After providing
explanation about the
procedure, roll patient
over, with arm positioned
close to the body with
elbows straight, and
hands under hips.
Position the patient on
abdomen in center of bed
with bed flat
2. Turn the patient’ s head
to one side and support
with a small pillow
Reduces flexion or
hyperextension of cervical
vertebrae
NURSING ACTION RAT IONALE
3. Place small pillow under
abdomen below the
diaphragm
Reduces hyperextension of
lumbar vertebrae and strain on
lower back. Reduces pressure
on breasts for women and on
genitals for men
4. Support arm in flexed
position at level of
shoulder
Reduces risk of shoulder
dislocation
5. Support lower legs with
pillows to elevate toes
Reduces foot drop and
external rotation of legs.
Reduces pressure of mattress
on toes
LATERAL POSTION
• Also known as SIDE LYING POSITION.
• Client lies on the side with weight on his
hips, shoulder pillow support, and stabilizes.
Upper most leg, arm, head and back.
• In this position, trunk is right angle to bed.
Indication
• To promote lung and cardiac function
• During seizure attack and air embolism (Left
lateral)
• Patient with pyloric stenosis after meals
(Right lateral)
• Patients who required periodic positions
changes- bed ridden patients
• In immediate post-operative patients to
prevent the risk of aspiration (except in spinal
and epidural anesthesia)
Procedure:
NURSING ACTION RATIONALE
1. Provide explanation and
prepare patient for the
position change
2. Lower head of bed as
low as patient can
tolerate
3. Position patient to side
of bed
NURSING ACTION RATIONALE
4. Turn the patient to one side (in
helpless patient) flex’ s patient
knee that will be away from
mattress, place hand on that
side to patient’ s hip and the
other hand at shoulder, then roll
patient to one side
Prevents injury and trauma to tissue
5. Place pillow under patient’ s
head and neck.
Maintain’ s alignment , reduces
lateral neck flexion and decreases
strain on sternocliedomastoid
muscle
6. Bring shoulder blade forward Prevents weight from resting directly
over shoulder joint
7. Position both the arms in flexed
position. Upper most arm is
supported by pillow on level with
shoulder
Decreases internal rotation and
adduction of shoulder. Ventilation is
improved as chest can expand
NURSING ACTION RATIONALE
8. Place tuck-back pillow
under back (pillow folded
lengthwise and smooth
area tucked under back)
Provides support to maintain
patient on side
9. Place pillow under
semi-flexed upper leg level
at hip, from groin to foot
Prevents hyperextension of leg,
maintains alignment and
prevents foot drop
10.Place sand bag parallel to
plantar surface of
dependent foot
Prevents foot drop
SIM’ S POSITION
• Also known as Semi- Prone position
Indication
• Vaginal and rectal examination
• Administration of enema and suppository
• Position for sigmoidoscopy and proctoscopy
• To prevent aspiration
Procedure:
NURSING ACTION RATIONALE
1. Provide explanation and
prepare patient for the
position
2. Place head of the bed
flat
3. Place patient in supine
position
4. Turn patient onto lateral
position lying partially on
abdomen
NURSING ACTION RATIONALE
5. Place small pillow under
head and neck
Maintains alignment and
prevents lateral neck flexion
6. Place pillow under flexed
upper arm supporting arm
level with shoulder
Prevents internal rotation of
shoulder
7. Place pillow under flexed
upper leg, supporting leg
level with hip
Prevents internal rotation of
hip.
Maintains proper alignment
8. Place sandbags parallel to
plantar surface of
dependent foot
Prevents plantar flexion
LITHOTOMY POSITION
Indications
• For vaginal delivery and vaginal examination
• For rectal surgeries, example Hemorrhoidectomy,
Fissurotomy
• Childbirth
• For vaginal hysterectomy
• Transurethral Resection of Prostrate (TURP)
Procedure:
NURSING ACTION RATIONALE
1. Place patient in supine
position
2. Place pillow under head
and neck
Prevents hyperextension of
neck
3. Place both legs flexed at
hip and knee at angle 90
with legs supported on
stirrups
TRENDELENBURG POSITION
• Entire frame of bed tilted with head of bed down
Indication
• Postural drainage
• Management of hypotension and shock
• Patients with deep vein thrombosis
• Cord prolapse patient
• To shift abdominal organs upward in certain
surgeries
NURSING ACTION RATIONALE
1. Explain procedure to
patient
2. Place patient in supine
position
3. Lower head end of the
bed using bed key. If
bed key is not
adjustable type, used
bed block at foot end
and tilt entire frame of
bed down
Procedure
REVERSE TREDELENBURG
POSITION
• It is just opposite to Trendelenburg position.
In this position, head of the bed is elevated
then the foot level with no flexion at waist
level
Indication
To minimize gastro esophageal reflex
SUPINE POSITION
• It is a back lying position with arms on the
side
Indication
• Physical Examination
• Resting
• Undergoing anesthesia
• Lung biopsy
DORSAL RECUMBENT POSITION
It is also a back lying position, in this
position’ s head and shoulder may be
elevated on a small pillow. Arms are resting
on side. Legs are apart with knees flexed
and foot resting on the bed
Indication
• Physical examination of abdominal and genital
area
• Perineal area
• PV examination
KNEE – CHEST POSITION
(Genu-pectoral Position)
• Patient rests on the knees and chest with head is turned
to one side, arms extended on the bed, and elbows flexed
and resting so that they partially bear the patient weight;
the abdomen remains unsupported, though a small pillow
may be placed under the chest.
• In this position severe hypotension occurs because of
pooling of blood in the extremities.
Indication
• Sigmoidoscopy
• Lumbar Laminectomy
ROSE POSITION
• Both the head and neck are extended, done
by keeping a sand bag under the supine
patient’ s shoulder blade.
Indication
• Tonsillectomy
• Adenoidectomy
Contraindication
• Down Syndrome
For Colorectal
surgeries
For kidney surgeries
BEACH CHAIR POSITION
Commonly used position in upper extremity
surgery
CONCORDE POSITION
Neurosurgery
SQUATTING POSITION
•Strength training
•Exercise for legs and muscles
•Birth position
THREE QUARTER PRONE POSITION
For parieto-occipito surgery
CARDIAC CHAIR POSITION
Provide relief to the lungs and circulatory system
STANDING POSITION
SITTING POSITION
PARK BENCH POSITION
•Neurosurgery
LLOYD DAVIS POSITION
This position is used to assess the pelvis for
gyanecological, urological and colorectal procedures
Passive Leg Raising POSITION
This position is used in
hypovolumic shock
SUMMARY
Today I deal with ‘ Positioning’ . In this
topic, I discussed key terms, introduction of
positioning, definition of positioning,
purpose and articles required for
positioning, general principles in
positioning and various types of positions,
their purpose, procedures and uses.
CONCLUSION
Positioning the patient ensures comfort to
the patient, prevent complications like
contractures and decubitus ulcer and also
help to do therapeutic and diagnostic
procedures. Position of the client should be
change every 2 hours.
BIBLIOGRAPHY
• Jacob annamma, R rekha, Tarachand jadhav
sonali. Clinical Nursing Procedures: The Art of
Nursing Practice. Edition III. New Delhi: The
Health Science Publishers; Page number
137-42
• Correia cecy sister. Principles and Practice of
Nursing Art of Nursing Procedures. Volume I.
New Delhi: Jaypee Brothers Medical
Publishers; Page number 44-49
• https://nurseinfo.in/patient-positioning-nursin
g-procedures/ 2019 May
thanking
you !

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POSITIONING.pdf

  • 2. KEY TERMS • Prone : Face down • Supine : Lying on back • High Fowler’ s : Head of bed elevated 80-90 degree • Dorsal Recumbent : Supine with legs flexed in an elevated position • Flexion : Movement that decreases the angle between two body parts • Extension : Straightening movement that increases the angle between two body parts • Hyperextension : Excessive movement of a joint in one direction (straightening)
  • 3. INTRODUCTION • Therapeutic Positions are used to promote comfort of the patient. • Proper turning and positioning allows the health care provider to make clients, as comfortable as possible, prevent contractures, and pressure sore, and facilitate diagnostic test for surgical intervention. • To relieve pressure to new positions every 2 hours. • Three factors significant in positioning are- Pressure, Friction and Shear
  • 4. DEFINITION • According to Annamma Jacob, Positioning is defined as placing the patient in good body alignment as needed therapeutically. • According to nurseinfo.in, Positioning is defined as placing the person in such a way to perform therapeutic interventions to promote the health of an individual
  • 5. PURPOSE • To promote comfort • To prevent complication • To stimulate circulation • To promote normal physiologic functions.
  • 6. ARTICLES • Clean, dry, firm bed • Different types of mattress • Bed Boards • Pillows • Footboards/ Foot boot • Sandbags • Hand rolls • Trochanter rolls • Bed blocks • Over bed Table • Additional Sheets • Trapeze bar
  • 7. PRINCIPLES • Maintain good body mechanics. • Obtain assistance as required. • Ensure that mattress is firm and level of bed is at working height. • Ensure that sheets are clean and dry. • Avoid placing a body part directly over another to prevent pressure. • Plan a regular position change schedule for the patient for 24 hours.. • Ensure patient comfort. • Wash hand before and after procedure.
  • 8. 1. Fowler’ s Position 2. Orthopenic Position 3. Prone Position 4. Lateral/ Side Lying Position 5. Sims’ s Position/ Semi- Prone Position 6. Lithotomy Position 7. Trendelenburg Position 8. Reverse Trendelenburg Position 9. Supine Position 10. Dorsal Recumbent Position 11. Knee-chest Position 12. Rose Position
  • 10. Purpose • To relieve or minimize dyspnea • To relieve tension on abdominal sutures
  • 11. Procedure: NURSING ACTION RATIONALE 1. Inform patient of the position, he will be in and provide needed explanation Understanding reduces anxiety and promotes relaxation 2. Elevate head of the bed Fowlers (45-90) Semi- Fowler (15- 45) High Fowler (90) Increases comfort and relaxation 3. Rest head against mattress and small pillow Prevents cervical flexion and contractures
  • 12. NURSING ACTION RATIONALE 4. Use pillow to support arms. Prevents shoulder dislocation, promote circulation and prevents flexion contractures of arms and wrists 5. Place a small pillow at lower back Supports lumbar vertebra and prevents exaggerated flexion of vertebrae 6. Place a small pillow/ roll under thigh Prevents hyperextension of knee and occlusion of popliteal artery from pressure of body weight 7. Place small pillow under ankle Prevents prolonged pressure on heels 8. Place footboard at bottom of patients feet Maintains dorsiflexion and prevents foot drop
  • 14. • High fowler’ s position with over bed table placed in front of the client. • Client to rest with both hands on over the bed table/on pillow placed on it and lean forward. Leaning forward facilitates respiration by allowing maximum chest expansion.
  • 15. Indications: • Patient with severe dyspnea • Cardiac Patients • Position for thoracentesis • Patient with chest drainage tubes • Relieve Respiratory distress • Pericarditis • ARDS • COPD • Emphysema • Asthma
  • 16. PRONE POSITION • The client is in flat position only abdomen with head turned to one side. The head rest on a pillow, one or both hands beyond the head or at the sides.
  • 17. Indication • Patients with pressure sores, burns, injuries, and operations on back • For patients after 24 hours of amputation of lower limbs • Position for renal biopsy • To prevents aspiration • NTD • Recovery positions after anesthesia
  • 18. Procedure: NURSING ACTION RAT IONALE 1. After providing explanation about the procedure, roll patient over, with arm positioned close to the body with elbows straight, and hands under hips. Position the patient on abdomen in center of bed with bed flat 2. Turn the patient’ s head to one side and support with a small pillow Reduces flexion or hyperextension of cervical vertebrae
  • 19. NURSING ACTION RAT IONALE 3. Place small pillow under abdomen below the diaphragm Reduces hyperextension of lumbar vertebrae and strain on lower back. Reduces pressure on breasts for women and on genitals for men 4. Support arm in flexed position at level of shoulder Reduces risk of shoulder dislocation 5. Support lower legs with pillows to elevate toes Reduces foot drop and external rotation of legs. Reduces pressure of mattress on toes
  • 21. • Also known as SIDE LYING POSITION. • Client lies on the side with weight on his hips, shoulder pillow support, and stabilizes. Upper most leg, arm, head and back. • In this position, trunk is right angle to bed.
  • 22. Indication • To promote lung and cardiac function • During seizure attack and air embolism (Left lateral) • Patient with pyloric stenosis after meals (Right lateral) • Patients who required periodic positions changes- bed ridden patients • In immediate post-operative patients to prevent the risk of aspiration (except in spinal and epidural anesthesia)
  • 23. Procedure: NURSING ACTION RATIONALE 1. Provide explanation and prepare patient for the position change 2. Lower head of bed as low as patient can tolerate 3. Position patient to side of bed
  • 24. NURSING ACTION RATIONALE 4. Turn the patient to one side (in helpless patient) flex’ s patient knee that will be away from mattress, place hand on that side to patient’ s hip and the other hand at shoulder, then roll patient to one side Prevents injury and trauma to tissue 5. Place pillow under patient’ s head and neck. Maintain’ s alignment , reduces lateral neck flexion and decreases strain on sternocliedomastoid muscle 6. Bring shoulder blade forward Prevents weight from resting directly over shoulder joint 7. Position both the arms in flexed position. Upper most arm is supported by pillow on level with shoulder Decreases internal rotation and adduction of shoulder. Ventilation is improved as chest can expand
  • 25. NURSING ACTION RATIONALE 8. Place tuck-back pillow under back (pillow folded lengthwise and smooth area tucked under back) Provides support to maintain patient on side 9. Place pillow under semi-flexed upper leg level at hip, from groin to foot Prevents hyperextension of leg, maintains alignment and prevents foot drop 10.Place sand bag parallel to plantar surface of dependent foot Prevents foot drop
  • 26. SIM’ S POSITION • Also known as Semi- Prone position
  • 27. Indication • Vaginal and rectal examination • Administration of enema and suppository • Position for sigmoidoscopy and proctoscopy • To prevent aspiration
  • 28. Procedure: NURSING ACTION RATIONALE 1. Provide explanation and prepare patient for the position 2. Place head of the bed flat 3. Place patient in supine position 4. Turn patient onto lateral position lying partially on abdomen
  • 29. NURSING ACTION RATIONALE 5. Place small pillow under head and neck Maintains alignment and prevents lateral neck flexion 6. Place pillow under flexed upper arm supporting arm level with shoulder Prevents internal rotation of shoulder 7. Place pillow under flexed upper leg, supporting leg level with hip Prevents internal rotation of hip. Maintains proper alignment 8. Place sandbags parallel to plantar surface of dependent foot Prevents plantar flexion
  • 31. Indications • For vaginal delivery and vaginal examination • For rectal surgeries, example Hemorrhoidectomy, Fissurotomy • Childbirth • For vaginal hysterectomy • Transurethral Resection of Prostrate (TURP)
  • 32. Procedure: NURSING ACTION RATIONALE 1. Place patient in supine position 2. Place pillow under head and neck Prevents hyperextension of neck 3. Place both legs flexed at hip and knee at angle 90 with legs supported on stirrups
  • 33. TRENDELENBURG POSITION • Entire frame of bed tilted with head of bed down
  • 34. Indication • Postural drainage • Management of hypotension and shock • Patients with deep vein thrombosis • Cord prolapse patient • To shift abdominal organs upward in certain surgeries
  • 35. NURSING ACTION RATIONALE 1. Explain procedure to patient 2. Place patient in supine position 3. Lower head end of the bed using bed key. If bed key is not adjustable type, used bed block at foot end and tilt entire frame of bed down Procedure
  • 37. • It is just opposite to Trendelenburg position. In this position, head of the bed is elevated then the foot level with no flexion at waist level Indication To minimize gastro esophageal reflex
  • 38. SUPINE POSITION • It is a back lying position with arms on the side
  • 39. Indication • Physical Examination • Resting • Undergoing anesthesia • Lung biopsy
  • 41. It is also a back lying position, in this position’ s head and shoulder may be elevated on a small pillow. Arms are resting on side. Legs are apart with knees flexed and foot resting on the bed Indication • Physical examination of abdominal and genital area • Perineal area • PV examination
  • 42. KNEE – CHEST POSITION (Genu-pectoral Position)
  • 43. • Patient rests on the knees and chest with head is turned to one side, arms extended on the bed, and elbows flexed and resting so that they partially bear the patient weight; the abdomen remains unsupported, though a small pillow may be placed under the chest. • In this position severe hypotension occurs because of pooling of blood in the extremities. Indication • Sigmoidoscopy • Lumbar Laminectomy
  • 44. ROSE POSITION • Both the head and neck are extended, done by keeping a sand bag under the supine patient’ s shoulder blade. Indication • Tonsillectomy • Adenoidectomy Contraindication • Down Syndrome
  • 46. BEACH CHAIR POSITION Commonly used position in upper extremity surgery
  • 48. SQUATTING POSITION •Strength training •Exercise for legs and muscles •Birth position
  • 49. THREE QUARTER PRONE POSITION For parieto-occipito surgery
  • 50. CARDIAC CHAIR POSITION Provide relief to the lungs and circulatory system
  • 54. LLOYD DAVIS POSITION This position is used to assess the pelvis for gyanecological, urological and colorectal procedures
  • 55. Passive Leg Raising POSITION This position is used in hypovolumic shock
  • 56. SUMMARY Today I deal with ‘ Positioning’ . In this topic, I discussed key terms, introduction of positioning, definition of positioning, purpose and articles required for positioning, general principles in positioning and various types of positions, their purpose, procedures and uses.
  • 57. CONCLUSION Positioning the patient ensures comfort to the patient, prevent complications like contractures and decubitus ulcer and also help to do therapeutic and diagnostic procedures. Position of the client should be change every 2 hours.
  • 58. BIBLIOGRAPHY • Jacob annamma, R rekha, Tarachand jadhav sonali. Clinical Nursing Procedures: The Art of Nursing Practice. Edition III. New Delhi: The Health Science Publishers; Page number 137-42 • Correia cecy sister. Principles and Practice of Nursing Art of Nursing Procedures. Volume I. New Delhi: Jaypee Brothers Medical Publishers; Page number 44-49 • https://nurseinfo.in/patient-positioning-nursin g-procedures/ 2019 May