Positions

Question 1

What are contractures and what causes them ?

Answer 1

Joint and muscle rigidity caused by multiple reasons :
- from staying in the same position for too long
- nerve damage
- muscular dystrophy

Question 2

What are pressure injuries and what causes them ?

Answer 2

Injuries of the skin and tissue due to prolonged pressure on the skin

Question 3

Why do we change the client’s position by turning them at least every 2 hours ?

Answer 3

It helps to :
- Prevent pressure ulcers (decubitus ulcers/ bed sores)
- Prevent pneumonia by breaking up mucus secretions in lungs
- Prevent contractures

Question 4

What does HOB mean ?

Answer 4

Head of Bed

HOB refers to the position that the head of the bed is in.

Example: “HOB elevated” or “HOB flat”

Question 5

What is the most common position to place a client ?

Answer 5

Fowler’s position: HOB is elevated. This position prevents pressure of the diaphragm on the lungs and heart to promote breathing. It is common with cardiac and respiratory diseases

Question 6

Describe the HOB elevation in degrees for each Fowler position:

• low-Fowler’s
• semi-Fowler’s
• standard Fowler’s
• high Fowler’s

Answer 6

• low-Fowler: HOB elevated 15 - 30 degrees
• semi-Fowler’s: HOB elevated 30 - 45 degrees
• standard Fowler’s: HOB elevated 45 - 60 degrees
• high-Fowler’s: HOB elevated 60 - 90 degrees

Question 7

What position is supine ?

Answer 7

On the back

Question 8

What position is prone ?

Answer 8

On the stomach

Question 9

What position is semi-prone or sim’s ?

Answer 9

Forward side-lying

Question 10

What position is right lateral recumbent ?

Answer 10

On the right side

Question 11

What position is left lateral recumbent ?

Answer 11

On the left side

Question 12

What position is lithotomy ?

Answer 12

On the back with legs apart

Question 13

What position is Trendelenburg ?

Answer 13

Supine with head lower than the feet

Question 14

What position is reverse Trendelenburg ?

Answer 14

Supine with head higher than the feet

Question 15

What position is best after a cardiac catheterization?

Answer 15

Supine with legs straight for 2 - 6 hours afterwards

This prevents bleeding and promotes good circulation. If a closing device is used may only need to be supine for 1 - 2 hours

Question 16

What position is best during and after tube feedings ?

Answer 16

Semi-Fowler’s: HOB elevated at least 30 degrees

This prevents aspiration.

Question 17

What position is best after a liver biopsy ?

Answer 17

On the right side with pillow splint for 2 hours.

This is to prevent bleeding since the liver is vascular and on the right side.

Question 18

What position is best during a thoracentesis ?

Answer 18

There are two positions :
- Leaning over the bedside table
- In bed with the affected side up

This is to promote separation of the ribs in order to reach the pleural space better and to get the excess fluid out.

Question 19

What position is best with most neurological problems ?

Answer 19

Semi Fowler’s: HOB elevated and head midline

This is to prevent increased intracranial pressure and promote blood flow to the brain

Question 20

How should a client with spinal cord injuries be moved ?

Answer 20

Logroll

Keep the head in midline with the rest of the body when moving.

This is to prevent additional spinal injuries.

Question 21

What position is best for varicose veins ?

Answer 21

Keep veins elevated by having the legs up to prevent swelling.

This is to promote blood circulation because the valves of the veins are not strong enough to move the blood back to the heart.

Question 22

What position for the legs is best for peripheral arterial disease ?

Answer 22

Dangle arteries by keeping the legs down.

This is to promote blood circulation because the arteries are hardening making them stiff and unable to dilate well.

Question 23

What is the best position after a hip replacement ?

Answer 23

Legs abducted (apart) using a wedge pillow, avoid hip flexion > 90 degrees

Prevents the hip from dislocating.

Remind the patient: no bending over, no sitting on a low toilet

Question 24

What is the best position after an amputation ?

Answer 24

Elevate extremity for 24 hours post-op

This is to prevent edema.

Question 25

What is the best position 24 hours after a leg amputation ?

Answer 25

Help client get into the prone position for 20 - 30 minutes daily.

This is to prevent a contracture

Question 26

What is the best position for an enema ?

Answer 26

left sim’s position

This position will allow gravity to help fluid come back out.

Question 27

What are foot boots for ?

Answer 27

Help to keep the foot flexed at the proper angle and to prevent foot drop.

Remove once per shift to assess for skin breakdown and joint mobility.

Question 28

What are hand rolls for ?

Answer 28

Help to keep the fingers slightly flexed to prevent contractures.

Question 29

What are pillows for ?

Answer 29

To prevent contractures and pressure ulcers.

Pillows help to support and elevate body parts to prevent contractures and pressure ulcers. Make sure the pillow is not too big or too small for the areas being supported.

Question 30

What are trochanter rolls for ?

Answer 30

To prevent external rotation of the legs when in the supine position.

Question 31

What is a trapeze bar for ?

Answer 31

Hangs over the bed so the client can:
- Reach it and reposition themselves in bed.
- Perform exercises.

Question 32

What is a bed board for ?

Answer 32

Placed under or on top of the entire mattress to provide body support and alignment.

Frequently used with CPR or transferring clients from one bed to another.

Question 33

What is the best position for dumping syndrome ?

Answer 33

Supine or flat to slow the absorption of food.

Question 34

What is the best position for GERD or a hiatal hernia ?

Answer 34

Fowler’s position to prevent gastric reflux.

Question 35

What is the best position for a lumbar puncture ?

Answer 35

The “C” position or left lateral for easier needle insertion.

Question 36

What is the best position for a suspected air embolism?

Answer 36

Left trendelenburg to trap the air bubble in the heart and to prevent it from going into the lungs.