Positioning Flashcards
Fowlers Position
Fowler’s position, is a bed position wherein the head and trunk are raised 40 to 90 degrees.
Fowler’s position is used for people who have difficulty breathing because in this position, gravity pulls the diaphragm downward allowing greater chest and lung expansion.
In low Fowler’s or semi-Fowler’s position, the head and trunk are raised to 15 to 45 degrees; in high Fowler’s, the head and trunk are raised 90 degrees.
This position is useful for patients who have cardiac, respiratory, or neurological problems and is often optimal for patients who have nasogastric tube in place.
Using a footboard is recommended to keep the patient’s feet in proper alignment and to help prevent foot drop.
Orthopneic or Tripod
Orthopneic or tripod position places the patients in a sitting position or on the side of the bed with an overbed table in front to lean on and several pillows on the table to rest on.
Patients who are having difficulty breathing are often placed in this position since it allows maximum expansion of the chest.
Dorsal Recumbent
In dorsal recumbent or back-lying position, the client’s head and shoulders are slightly elevated on a small pillow.
This position provides comfort and facilitates healing following certain surgeries and anesthetics.
Supine or Dorsal
Supine is a back-lying position similar to dorsal recumbent but the head and shoulders are not elevated.
Just like dorsal recumbent, supine position provides comfort in general for patients recover after some types of surgery.
Prone
In prone position, the patient lies on the abdomen with head turned to one side; the hips are not flexed.
This is the only bed position that allows full extension of the hip and knee joints.
Prone position also promotes drainage from the mouth and useful for clients who are unconscious or those recover from surgery of the mouth or throat.
Prone position should only be used when the client’s back is correctly aligned, and only for people with no evidence of spinal abnormalities.
To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen.
Lateral
In lateral or side-lying position, the patient lies on one side of the body with the top leg in front of the bottom leg and the hip and knee flexed.
Flexing the top hip and knee and placing this leg in front of the body creates a wider, triangular base of support and achieves greater stability.
The greater the flexion of the top hip and knee, the greater the stability and balance in this position. This flexion reduces lordosis and promotes good back alignment.
Lateral position helps relieve pressure on the sacrum and heels in people who sit for much of the day or confined to bed rest in Fowler’s or dorsal recumbent.
In this position, most of the body weight is distributed to the lateral aspect of the lower scapula, the lateral aspect of the ilium, and the greater trochanter of the femur.
Right side promotes excretion of stomach contents
Left side promotes retention of stomach contents and increased perfusion/no venacava compression
Sims
Sims’ is a semi-prone position where the patient assumes a posture halfway between the lateral and prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. Both legs are flexed in front of the client. The upper leg is more acutely flexed at both the hip and the knee, than is the lower one.
Sims’ may be used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids.
It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip.
It is often used for clients receiving enemas and occasionally for clients undergoing examinations or treatments of the perineal area.
Pregnant women may find the Sims position comfortable for sleeping.
Support proper body alignment in Sims’s position by placing a pillow underneath the patient’s head and under the upper arm to prevent internal rotation. Place another pillow between legs.
Trendelenburg’s
Trendelenburg’s position involves lowering the head of the bed and raising the foot of the bed of the patient.
Patient’s who have hypotension can benefit from this position because it promotes venous return.
Useful for prolapsed cord
Reverse Trendelenburg
Reverse Trendelenburg is the opposite of Trendelenburg’s position.
Here the HOB is elevated with the foot of bed down.
This is often a position of choice for patients with gastrointestinal problems as it can help minimize esophageal reflux.
Bronchoscopy
After: Semi-Fowler’s
To reduce aspiration risk from difficulty of swallowing
Cerebral angiography
During: Flat on bed with arms at sides; kept still.
After: Extremity in which contrast was injected is kept straight for 6 to 8 hours. Flat, if femoral artery was used.
Apply firm pressure on site for 15 minutes after the procedure.
Myelogram (air contrast)
Pre-op: surgical table will be moved to various positions during test.
Post-op: HOB is lower than trunk.
To disperse dye
Myelogram (oil-based dye)
Pre-op: surgical table will be moved to various positions during test.
Post-op: Flat on bed for 6 to 8 hours
To disperse dye.To prevent CSF leakage.
Lung biopsy
Flat supine with arms raised above head and hands health together; head and arms on pillow.
To expose and provide easy access to the area.
Renal biopsy
PRONE with pillow under the abdomen and shoulders.
To expose the area.
Arteriovenous fistula
Post-op: Elevate extremity Don’t sleep on affected side; encourage exercise by squeezing a rubber ball.
Don’t use AV arm for BP reading and venipuncture.
Peritoneal Dialysis
When outflow is inadequate: turn patient from side to side. Turning facilitates drainage; check for kinks in the tubing.
Possible to have abdominal cramps and blood-tinged outflow if catheter was placed in the last 1-2 weeks.
Cloudy outflow is never normal.
Meniere’s Disease
Meniere’s Disease Change position slowly; bedrest during acute phase
Provide protection when ambulating
Heart failure with pulmonary edema
Sitting up, with legs dangling
To decrease venous return and reduce congestion; promotes ventilation and relieves dyspnea.
Myocardial infarction
Semi-Fowler’s To help lessen chest pain and promote respiration.
Pericarditis
High-Fowlers, upright leaning forward.
To help lessen pain.
Shock
Flat on bed.
To improve or increase circulation.
Trendelenburg is no longer a recommended position.
Deep vein thrombosis
Bed rest with affected limb elevated.
After 24 hours after heparin therapy, patient can ambulate if pain level permits.
To promote circulation.
Varicose veins, leg ulcers, and venous insufficiency
Elevate extremities above heart level.
To prevent pooling of blood in the legs and facilitate venous return; avoid prolonged standing.
Sickle Cell Anemia
HOB elevated 30 degrees, avoid knee gatch and putting strain on painful joints
To promote maximum lung expansion and assist in breathing.
Abdominal aneurysm
Post-op: HOB no more than 45 degree
To avoid flexion of the graft.
Dehiscence
Place in low-Fowler’s position then raise knees or instruct knees and support them with a pillow.
To decrease tension on the abdomen
Dumping Syndrome, prevention of
Take meals in reclining position, lie down for 20-30 minutes after. To delay gastric emptying time.
Restrict fluids during meals, low carb, low fiber diet in small frequent meals.
Gastroesophageal reflux disease (GERD)
Reverse Trendelenburg, slanted bed with head higher.
Pediatric: prone with HOB elevated.
To promote gastric emptying and reduce reflux.
Pyloric stenosis
RIGHT side-lying position after meals. To facilitate entry of stomach contents into the intestines.
