Topic : Body Positions, Subject : Nursing Foundation

Topic : Body Positions, Subject : Nursing Foundation

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  POSITIONS
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  INTRODUCTION • Patient positioninginvolves properly maintaining a patient’s neutral body alignment by preventing hyperextension and extreme lateral rotation to prevent complications of immobility and injury. • In most settings, proper positioning of patients provides airway management and ventilation, maintains body alignment, and provides physiologic safety.
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  DEFINITION “Positioning is definedas planning the person in a proper body alignment for the purpose of preventive, promotive, curative and rehabilitative aspects of health or placing the patient in good body alignment as needed therapeutically.”
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  PURPOSES • To promotecomfort to the patient • To relieve pressure on various parts • To stimulate circulation • To provide proper body alignment • To carry out nursing intervention • To perform surgical and medical interventions • To prevent complications caused by immobility • To promote normal physiological functions
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  PRINCIPLES • Maintain goodbody mechanics • Wash hands before and after procedure • Ensure patient’s comfort • Obtain assistance as required • Ensure that mattress is firm and level of bed is at working hide • Follow safety measures to prevent accidents • Follow the systematic and orderly way of doing • Use right technique at right time
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  TYPES OF POSITIONS •Supine position • Prone positions • Lateral positions • Lithotomy position • Fowler’s position • Dorsal Recumbent position • Sims position • Tredlenberg position • Reverse Tredlenberg position • Knee Chest position • Orthopenic position
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  SUPINE POSITION
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  Introduction • Supine positionrefers to a horizontal position with the face and upper body facing up. • In the supine position, the ventral side is up and the dorsal side is down. • The patient lies on his back with his head and shoulders are slightly elevated. Indication • Usual position • Examination of the chest and abdomen
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  Procedure • Place thepatient 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 or foam pads under the heels to reduce the pressure. • Place footboard under bottom of feet. • If the patient is a paralyzed, place hand role in hand. • Align the patient’s body in good position.
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  PRONE POSITION
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  Introduction • Position inwhich the patient lies on the abdomen with the head turned to one side with one small pillow under the ankle. Indications • Post operatively • Patient with pressure sores, burns, injuries and operations on the back. • To relieve abdomen distension • Renal biopsy. • Examine the back • For patients after 24 hours of amputation of lower limbs
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  Procedure • Explain theprocedure. • 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 . • Place both arms at the side of the head and support arm in flexed position at level of shoulder. • Support lower legs with pillows to elevate toes
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  LATERNAL POSITION
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  Introduction • The clientlies on the side with weight on hip and shoulder or the patient lies on his side with both arms forward and his knees and hips flexed. • The upper leg is flexed more than the lower leg. • The upper knee and hip should be at the same level. • A pillow is given under the head, back and front to support the arms and abdomen. • A small pillow is given in between the knees.
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  Indications • Patients whorequires periodic position changes. • In immediate post-operative patients. • Used for examination of perineum. • Inserting suppositories. • For taking rectal temperature. • Giving back care. • For giving enema and colonic irrigation.
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  Procedure • Explain theprocedure & Provide privacy. • Lower the head of bed as low as patient can tolerate. • Position the patient to side of bed & Turn the patient to one side. • Place the air ring under the hips to reduce pressure in trochanters and at the hip joints. • Position both arms in flexed position. • Upper most arms are supported by pillow on level with shoulder and Place pillow under back. • Place pillow under semi flexed upper leg at hip, from groin to foot. • Place sand bag parallel to plantar surface of dependent foot.
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  LITHOTOMY POSITION
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  Introduction • The clientlies supine with hips flexed. • The legs are separated and thighs are flexed. • The patient’s buttocks are kept at the edge of the table and legs are supported by stirrups. Indications • For delivery of baby. • For rectal examination & surgeries. • For vaginal examination & hysterectom.
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  Procedure • Explain theprocedure 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 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.
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  FOWLERS POSITION
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  Introduction • Fowler’s position,also known as semi-sitting position, is a bed position wherein the head of the bed is elevated 45 to 60 degrees. • Variations of Fowler’s position include - low Fowler’s (15 to 30 degrees), - semi-Fowler’s (30 to 45 degrees) - high Fowler’s (nearly vertical).
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  Indications • To relievedyspnea • To improve circulation • To relax the muscles of the abdomen, back and thighs. • To relieve tension on abdominal stature
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  Procedure • Explain theprocedure • Elevate the head of the bed • Rest the head against mattress or small pillow. • Use pillow to support arm. • Place a small pillow at lower back. • Place foot board at bottom of patient’s feet. • Place the patient in sitting position with arms at sides and knees raised with pillow.
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  DORSAL RECUMBENT POSITION
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  Introduction • Patient lieson back, knees fully flexed, thighs flexed and externally rotated feet flat on the bed. • In this position clients with painful disorders are more comfortable with knees flexed. • This position should not be used for abdominal assessment because it promotes contraction of abdomen muscles.
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  Indications • It isused for catheterization, vaginal douche, vulval, vaginal and rectal examination. • It is also used for vaginal operations and insertion of tampons. Procedure • Place the patient on back in bed with two or more pillows under the head for patient’s comfort. • Place the air ring under the hips and cotton rings or foam pads under the heels to reduce pressure.
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  SIMS POSITION
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  Introduction • In thisposition the client lies on either the right or left side. • The lower arm behind the body and upper arm is bent at the shoulder and elbow. • The knees are both bent, with the upper most leg more acutely bent. • These positions similar to the lateral position except that the patient’s weight is on the anterior aspect of the patient’s shoulder girdle and hip.
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  Indication • Vaginal andrectal examination. • Administration of enema and suppository. • Used for relaxation in antenatal exercises. • Position for sigmoidoscopy and protoscop.
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  Procedure • Explain theprocedure to the patient. • Provide privacy . • Place the patient on the side. • Place small pillow under head and neck. • Place pillow under flexed upper arm, supporting arm level with shoulder. • Place pillow under flexed upper leg, supporting leg level with hip. • Place sand bags parallel to plantar surface of dependent foot.
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  TREDLENBERG POSITION
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  Introduction • In thisthe patient lies on the back with the head low. • The foot of the bed is elevated at 45˚ angle. • Entire frame of bed is tilted with head of bed down. Indications • Used in emergency situations like shock, hemorrhage and hypotension. • Postural drainage. • Patients with deep vein thrombosis.
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  Procedure • Explain theprocedure to patient. • Place the patient in supine position. • Lower the head end of the bed or if it is not adjustable type, use bed block at foot end and tilt entire frame of bed down. OR elevate the foot end at 45˚angle. • The patient is carefully supported to prevent from slipping.
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  REVERSE TREDLENBERG POSITION
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  Introduction • In thisthe patient lies on the back with the head high. • The head of the bed is elevated at 30˚ angle. • Entire frame of bed is tilted with foot of bed down. Indications • Gastrointestinal problems. • Prevent rapid change of position. • Prevent esophageal reflux. • Laparoscopic surgeries including gallbladder, biliary tract, and stomach procedures
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  Procedure • Explain theprocedure to patient. • Place the patient in supine position. • Lower the foot end of the bed or if it is not adjustable type, use bed block at head end and tilt entire frame of bed down. OR elevate the head end at 30˚angle. • The patient is carefully supported to prevent from slipping.
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  KNEE CHEST POSITION
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  Introduction • The patientrests on the knees and the chest. • The body is at 90˚ angle to the hips with back straight, the arm above the head, and the head turned to one side. • The abdomen remains unsupported. Indications • Used for vaginal and rectal examination. • Used in first aid treatment in cord prolapse or retroverted uterus . • As exercise for postpartum and gynecology patients.
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  Procedure • Explain theprocedure to the patient. • Make the patient rest on the knees and chest. • The head is turned to one side with the cheek on a pillow. • The arm should be extended on the bed and flexed at the elbows to support the patient partially.
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  ORTHOPNEIC POSITION
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  Introduction • High fowler’sposition with over bed table to be placed across the front of the patient. • Patient to rest both hands on over bed table/on pillow placed in it and leans forward. • Leaning forward facilitates respiration by allowing maximum chest expansion by reducing pressure of abdominal organs on diaphragm. Indications • Patients with severe dyspnea • Cardiac patients • Position for thoracocentesis • Patient with chest drainage tubes
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  Support Devices forPatient Positioning The following are the devices or apparatus that can be used to help position the patient properly. • Bed Boards. • Foot Boots. • Hand Rolls. • Hand-Wrist Splints. • Pillows. • Sandbags. • Side Rails. • Trochanter Rolls. • Wedge Pillows.
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  Documenting Patient Positioning Documentingchange of patient position in the patient’s chart. Note the following: • Date and time of the procedure. • Explanation of the procedure to the patient. • Notation of the position the patient was placed in, including rationale. • Pertinent teaching is given. • Patient’s response to the procedure.