Positioning Clients Flashcards
1
Q
Positions to ensure safety and comfort:
Integumentary System
A
- Autograft: site is immobilized usually for 3 to 7 days (provide time for graft to adhere).
- Burns (face and head): elevate head of the bed to prevent edema.
- Circumferential burns of extremities: elevate the extremities above level of the heart to prevent or reduce edema.
- Skin graft: Elevate and immobilize the graft site to prevent disruption of tissue.
2
Q
Positions to ensure safety and comfort:
Reproductive System
A
- Mastectomy: Semi-fowler’s position with affected arm elevated to promote lymphatic fluid return. Turn only to back and unaffected side.
- Perineal and vaginal procedures: Lithotomy.
3
Q
Positions to ensure safety and comfort:
Endocrine System
A
- Hypophysectomy: elevate head of bed to prevent increased intracranial pressure.
- Thyroidectomy: semi-f to fowler’s to reduce neck swelling and edema. Devices may be used to support the head and neck. Avoid neck extension.
4
Q
Positions to ensure safety and comfort:
Gastrointestinal System
A
- Hemorrhoidectomy: lateral (side-lying) position to prevent pain and bleeding.
- Gastroesophageal reflux: reverse trendelenburg’s to promote gastric emptying.
- Liver biopsy: position client in supine with upper abdomen exposed and right arm raised and extended behind the head. After procedure, assist to lateral (side-lying) position and place small pillow under the puncture site.
- Paracentesis: semi-fowler or sitting upright on the side of bed or in chair with the feet supported.
- Nasogastric tube: during insertion position in high-fowler with head tilted forward. Irrigation and feedings, use fowler to semi-f.
- Rectal enema and irrigation: LEFT sims’ position.
- Sengstaken-Blakemore and Minnesota: elevation of the head of bed.
5
Q
Positions to ensure safety and comfort:
Respiratory System
A
- COPD (DPOC): sitting position, leaning forward, and arms above several pillows.
- Laryngectomy: Semi-f to fowler.
- Bronchoscopy post procedure: semi-fowler.
- Postural drainage: lung segment to be drained should be in the uppermost position. Trendelemburg’s may be used.
- Thoracentesis: during procedure, position sitting on edge of the bed leaning over a bedside table, with feet supported. OR lying on the unaffected side in fowler’s.
6
Q
Positions to ensure safety and comfort:
Cardiovascular System
A
- Abdominal aneurysm resection: after surgery, limit elevation of head of bed to 45 degrees to avoid flexion of graft. Client may turn to side.
- Amputation of lower extremity: first 24 hours elevate foot of bed and support residual limb with pillows to reduce edema. Consult PHCP, and if prescribed, use prone position twice a day for 20 to 30 min.
- Arterial vascular grafting of extremity: bed rest for approx 24 hours and affected extremity is kept straight. Limit movement and avoid flexion of the hip and knee.
- Cardiac catheterization: if femoral vessel was accessed maintain bed rest for 4 to 6 hours. May turn from side to side. Affected extremity is kept straight and head is elevated no more than 30 degrees.
- Heart failure and pulmonary edema: client upright, preferably with the legs dangling over the side of bed to decrease venous return.
- Peripheral arterial disease: elevate feet at rest, but not above heart.
- Deep vein thrombosis: if extremity is red, edematous, and painful, heparin may be initiated and bed rest with leg elevation may also be prescribed. Clients with low-molecular-weight heparin usually can be out of bed in 24 hrs if pain level permits.
- Varicose veins: leg elevation above heart. Advised to minimize prolonged sitting and standing.
- Venous insufficiency: leg elevation.
7
Q
Positions to ensure safety and comfort:
Sensory System
A
- Cataract surgery: post-op semi-f to fowler’s, client on back or nonoperative side to prevent edema.
- Retinal detachment: if large, bed rest and bilateral eye patching may be prescribed to minimize eye movement.
8
Q
Positions to ensure safety and comfort:
Neurological System
A
- Autonomic dysreflexia: high-fowler to prevent hypertensive stroke.
- Cerebral aneurysm: 30 to 45 degrees to prevent pressure on site.
- Cerebral angiography: bed rest as prescribed and extremity in which the contrast was injected is kept straight and immobilized for 6 to 8 hrs.
- Stroke: hemorrhagic elevate to 30 degrees to reduce intracranial pressure. Ischemic, usually flat. Maintain head in midline, neutral position to facilitate venous drainage. Avoid extreme hip and neck flexion.
- Craniotomy: should not be positioned to the side that was operated. Elevate 30 to 45 degrees, maintain head in midline and neutral position. Avoid extreme hip and neck flexion.
- Laminectomy and other vertebral surgery: often out of bed post-op with back brace. Back is kept straight with feet resting on floor.
- Increased intracranial pressure: elevate 30 to 45 degrees, head in midline and neutral, and avoid hip and neck flexion.
- Lumbar puncture: side lying, knees flexed up and neck flexed down. After procedure, supine for 4 to 12 hours AP.
- Spinal cord injury: immobilize spinal and head, logroll.
9
Q
Positions to ensure safety and comfort:
Musculoskeletal System
A
- Total hip replacement: positioning depends on surgical technique, method of implantation, prosthesis and surgeon’s preference. Avoid extreme internal and external rotation. Avoid ADDUCTION. Maintain ABDUCTION when supine position or nonoperative side.
