LECTURE ON NURSING POSITIONING

1. PREPARATION FOR
ASSESSMENT
POSITIONING

2.  Preparation of the environment, equipment, and patient facilitates a
smooth assessment.
 Provide patients privacy to promote their comfort and the efficiency of an
examination.
 In a health care agency, close the door and pull privacy curtains. In the
home examine the patient in the bedroom.
 A comfortable environment includes a warm, comfortable temperature; a
loose-fitting gown or pajamas for a patient; adequate direct lighting;
control of outside noises; and precautions to prevent interruptions by
visitors or other health care personnel.
 If possible, place the bed or examination table at waist level so you can
assess a patient easily.
 During an examination you must protect a patient from falls and injury and
return the bed to a safe height at the completion of the assessment (TJC,
2012).

3. Preparing the Patient
 Prepare patients both physically and psychologically for accurate assessments. A
tense, anxious patient may have difficulty under- standing, following directions, or
cooperating with your instructions.
 To prepare a patient:
 1 Provide comfort by allowing the opportunity to empty the bowel or bladder (a good
time to collect needed specimens).
 2 Provide privacy.
 3 Minimize a patient’s anxiety and fear by conveying an open, receptive, and
professional approach. Using simple terms, thoroughly explain what will be done, what
the patient should expect to feel, and how he or she can cooperate. Even if a patient
appears unresponsive, it is still important to explain your actions.
 4 Provide access to body parts while draping areas that are not being examined.
 5 Reduce distractions. Turn down volume or turn off radio or television.

4.  6 Eliminate drafts, control room temperature, and provide warm blankets.
 7 Help patients assume positions during assessments so body parts are
accessible and patients stay comfortable. A patient’s ability to assume positions
depends on physical strength and limitations. Some positions are uncomfortable
or embarrassing; keep a patient in position no longer than is necessary.
 8 Pace assessment according to an individual’s physical and emotional tolerance.
 9 Use a relaxed tone of voice and facial expressions to put a patient at ease.
 10 Encourage a patient to ask questions and report discomfort felt during the
examination.
 11 Have a third person of patient’s gender in the room during assessment of
genitalia. This prevents a patient from accusing you of behaving in an unethical
manner.
 12 At conclusion of an assessment, ask the patient if there are any concerns or
questions.

5. Position Areas Assessed Rationale Limitations
Head and neck, back,
posterior thorax and
lungs, anterior thorax
lungs, breasts, axillae,
heart, vital signs, upper
extremities
Sitting upright provides
full expansion of lungs
and better visualization
of symmetry of upper
body parts.
Physically weakened or
developmentally
patient is sometimes
unable to sit. Use supine
position with head of
elevated instead.
Positions for Physical Assessment

6. Position Areas Assessed Rationale Limitations
Head and neck,
anterior thorax and
lungs, breasts,
axillae, heart,
abdomen,
extremities, pulses
This is most normally
relaxed position. It
provides easy access
to pulse sites.
If patient becomes short
of breath easily, raise
head of bed.
Positions for Physical Assessment

8. The patient lies on his back with his head and shoulders are slightly
elevated. One pillow is given under the head. His legs should be slightly
flexed. A small pillow is placed under his knees.
Indications
The usual position used by the patient
Used for examination of the chest and abdomen
Procedure
Place the patient on back with one pillow under the head, arms and
hands at the sides, knees flexed and separated
Place the air ring under the hips and cotton rings or foam pads under
the heels to reduce the pressure
Align the patient’s body in good position
Support the body parts in good alignment for comfort when the patient is
paralyzed

9. Position Areas Assessed Rationale Limitations
Head and neck,
anterior thorax and
lungs, breasts, axillae,
heart, abdomen
Position is for abdominal
assessment because it
promotes relaxation of
abdominal muscles.
Patients with painful
disorders are more
comfortable with knees
flexed.
Positions for Physical Assessment

11. Position Areas Assessed Rationale Limitations
Female genitalia
and genital tract
This position provides
maximal exposure of
genitalia and facilitates
insertion of vaginal
speculum.
Lithotomy position is
embarrassing and
uncomfortable; thus
examiner minimizes time
that patient spends in it.
Keep patient well
Patients with arthritis or
other joint deformities
may be unable to
tolerate the position.
Positions for Physical Assessment

13. The patient lies on her back. The legs are separated and thighs are flexed on the abdomen
and the legs are on the thighs. The patient’s buttocks are kept the edge of the table and legs
are supported by stirrups.
Indications
This position is given during gynecological examinations, treatments, and operations on
genitourinary system
For delivery of baby
For rectal examinations and operations
Procedure
Explain the procedure to the patient
Provide privacy
Position the patient to lie on his back with one pillow under the head
Keep the legs well separated and the thighs are well flexed on the abdomen and the legs
on the thighs
Buttocks are kept on the edge of the table and the legs are supported on stirrups
Contraindications
Contraindications of this position are, patients with arthritis or joint deformity may be
unable assume this position

14. Position Areas Assessed Rationale Limitations
Rectum and
vagina
Flexion of hip and knee
improves exposure of
rectal and genitourinary
areas.
Joint deformities hinder
patient’s ability to bend
hip and knee.
Positions for Physical Assessment

16. Sim’s position is similar to the lateral position except that the patient’s weight is on the anterior aspects of shoulder
girdle and hip. The patient’s lower arm is behind him and the upper arm is flexed at the shoulder and elbow.
Indications
This position is used for unconscious patient
It is used for rectal examinations
Used for vaginal examinations
Used for relaxation in antenatal exercises
Procedure
Explain the procedure to the patient
Collect articles need at the bed side
Provide privacy
Place the patient on the side
One pillow is placed under the head with the left check resting on it
The left arm is drawn behind the body and the right arm may be in any position comfortable for the patient
The right thigh is flexed against the abdomen
The left leg is extended well
Cover the patient with top sheet neatly
Contraindications
Patients with deformities of the hip or knee may be unable to assume this position

17. Position Areas Assessed Rationale Limitations
Musculoskeletal
system
This position is for
assessing extension of
hip joint, skin, and
buttocks.
Patients with respiratory
difficulties do not
tolerate this position
Positions for Physical Assessment

19. A patient lies flat on abdomen. Head turned to sideways. One soft pillow is given under head. An extra
pillow is given under the ankles to keep toes from touching the bed.
Indications
This position used postoperatively to prevent aspiration of saliva and mucus
Used in postoperative cases, tonsils, vesicovaginal fistula and spinal cases
To prevent bed sores
To relieve abdominal distention
Used for patients having injuries and burns on back
Procedure
Explain the procedure to the patient
Provide privacy
Place the patient flat on abdomen with one pillow under the head
Turn patients head to one side and align the patient in good position
Support the body parts in good alignment for comfort
Place both arms lies at the sides of the heads
Contraindications
This position is not well tolerated by the elderly or patient with cardiovascular or respiratory
problems

20. Position Areas Assessed Rationale Limitations
Heart This position aids in
detecting murmurs.
Patients with respiratory
difficulties do not
tolerate this position
Positions for Physical Assessment

22. Position Areas
Assessed
Rationale Limitations
Rectum This position provides
maximal exposure of
rectal area.
This position is
embarrassing and
uncomfortable. Patients
with arthritis or other
joint deformities may be
unable to assume it.
Positions for Physical Assessment

24. KNEE-CHEST/GENUPECTORAL POSITION
Patient is rest on the knees and the chest. The head is turned to one side with the cheek on a pillow. A
placed under the chest. The weight is on the chest and knees.
Indications
This position is used for sigmoidoscopy
Used for vaginal and rectal examination
Used in first aid treatment in cord prolapse or retroverted uterus
As exercise for postpartum and gynecology patients
Procedure
Explain the procedure to the patient
Collect the needed articles at the bed side
Provide privacy
Make the patient rests on the knees and chest
The head is turned to one side with the cheek on a pillow
The arms should be extended on the bed and flexed at the elbows to support the patient partially
The weight should rest on the chest and knees which are flexed so that the thighs are at right angles to
the legs
Contraindications
Patients with cardiovascular and respiratory problems cannot assume this position

25. MIDTERM QUIZ 1