Positions used in nursing patients

Positions used in nursing patients
MS. FRANCISCA ACHALIWIE
AND
MS. MABEL APAANYE AVANE
Introduction
• What positions do you normally assume
during rest at home?
• Why do you normally assume such positions
during rest?
Bed Accessories
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Pillows
Back rest
Heart table
Air ring
Sand bags
Donkey pillows
Bed elevators
Trapeze or monkey pulley
Reasons for various positions used in
nursing patients
• To promote comfort
• To restore body functions
• For visibility and accessibility during
procedures
• To prevent deformities
• To stimulate circulation
• To give treatment e.g. postural drainage.
Nursing responsibilities during
positioning of patients in bed
• Help patient assume desired position
• Assist patient achieve proper body alignment
• Support patient’s body in desired position
using pillows
• Frequent monitoring and evaluation of
selected positions
• Provide skin care
Recumbent/supine position
• The patient lies on the back with/without a
pillow with the arms by side or across chest.
The legs are usually extended.
Recumbent position
Uses of the recumbent position
• Examination of the front of face, head, neck
trunk, genitals and limbs
• After spinal surgery or spinal anesthesia
• For rest and relaxation
Dorsal position
• Patient lies flat on back with pillow under
head, knees flexed and feet flat on bed
Figure of dorsal position
Uses
• Rectal and vaginal examinations /treatments
• Deliveries
• Bimanual examination
• Prone position
• Patient lies on the abdomen with head turned to
one side and one pillow under head and another
under the lower chest. Place a small pillow under
the feet to prevent toes from pressing on bed.
Figure: prone position
Uses
• Relieve pressure on the back and areas likely
to develop bed sores
• To nurse some types of fractures of the spine
• To nurse burns and other injuries of the back
Fowler’s(Upright)/Semi-Fowler’s
Position
Description
This is a more erect position, in which an effort
is made to maintain the position of the patient
in sitting posture as nearly upright as possible.
This position can be maintain by means of a
backrest and additional pillows. He may lean
forward over cardiac table which has pillow on
it. A foot support may help to maintain this
position. An air cushion/ring under the
buttocks prevents pressure over the sacrum.
Fowler’s (Upright) position
Figure: Semi-Fowler’s(Semi-upright)
position
Figure: Semi-Fowler’s(Semi-upright)
position
Uses of fowler’s(upright) position
1.In patients with chronic cardiac diseases.
2.In patients with dyspnoea.
3.Post chest and heart operation.
4. For drainage of abdominal cavity.
Lateral or side-lying position
Description
The patient lies on his side with both the knees
slightly flexed towards the abdomen, one
knee more acutely than the other. A pillow
under the head supports the head, a pillow at
the back to support the back, a pillow in front
supports the arms and abdomen, a pillow
between the knees takes the weight of the
upper leg.
Figure: side-lying or lateral position
Uses of lateral position
1.
2.
3.
4.
5.
For giving enemas.
Inserting suppositories.
For taking rectal temperature
For doing rectal examination
Relieve of pressure.
Sim’s lateral position
Description
Exaggeration of the lateral position, patient lies
more towards prone, chest and head resting
on pillow. The left arm is draw behind the
back and the right arm may be in any position
comfortable for patient. The right thigh is
flexed against the abdomen. Patient lies more
to the right in right Sim’s and more to the left
in the left Sim‘s position.
Figure: Sim’s position
Genu-pectoral(knee-chest) position
The patient rests on the knees and the chest.
The head is turn to one side with the cheek
rest on small firm flat pillow. The arms flexed
at the elbows and rest along the sides of the
head, so as to support the person partially.
The knees are flexed as in a kneeling position
and the thighs are at right angle to the legs.
Figure: Genu-pectoral position
Uses of Genu-pectoral position
1. Use for examination of rectum and vagina.
2. For high colonic irrigation.
3. As an exercise for postpartum patients.
4.To obtain better exposure of the vagina, cervix,
and rectum.
5.To examine the bladder.
6.To help correct retroversion of the uterus.
7.To administer caudal and sacral anesthesia.
8.Vaginal and rectal examinations.
9.Operative procedures on the vagina, rectum and
perineum.
Trendelenburg Position
Description
The patient lies on the back. The foot of the bed
is elevated at an angle of 45 degrees. In the
operation theatre, the operation table can be
adjusted to maintain this position. The
patient’s head is low. The body is on an
inclined place and the foot section of the table
is dropped and the legs secured to it. The
arms are by the sides.
Figure: trendelenburg position
Uses of trendelenburg position
1. This position is used during examinations of
pelvic organs in order to displace the
intestines from the pelvic cavity into the
upper abdomen.
2. It is used in the wards to treat shock.
3. To prevent or relieve post-partum
hemorrhage.
Lithotomy position
Description
The patient lies on his back with one pillow under
the head. The legs are well separated and the
thighs are flexed on the abdomen. The patient’s
buttocks are brought to the edge of the table and
the legs are supported on the stirrups. If the calf
muscles are pressed or if the position is
prolonged there is a danger of embolism.
lithotomy position
lithotomy position
Uses of lithotomy position
1.
2.
3.
4.
For evacuation of uterus.
In labour ward for deliveries.
Gynaecological examination
Surgical procedure involving the
genitourinary system.
Changing the Position of a Patient
• Changing patient's position is one of the basic
procedures that nursing personnel perform most
frequently.
• Any position, even the most comfortable one,
will become unbearable after a period of time.
• Whereas the healthy person has the ability to
move at will, the sick person's movements may
be limited by disease, injury, or helplessness.
• It is often the responsibility of the nurse to
position the patient and change his position
frequently.
Reasons for changing the position of a
patient
• To promote comfort and relaxation.
• To restore body function.
– Changing positions improves gastrointestinal
function.
– It also improves respiratory function.
• Changing positions allows for greater lung
expansion.
• It relieves pressure on the diaphragm.
Reasons for changing the position of a
patient Cont’d
• To prevent deformities.
– When one lies in bed for long periods of time,
muscles become atonic and atrophy.
– Prevention of deformities will allow the patient to
ambulate when his activity level is advanced.
• To relieve pressure and prevent strain (which lead to
the formation of decubitus ulcers).
• To stimulate circulation.
• To give treatments (that is), range of motion exercises).
Turning the Adult Patient
• Sometimes the physician will give an order specifying
how often to turn a patient. However, if no order is
given, patient’s position should be changed every 2
hours. You can set up a schedule for turning the adult
patient throughout his "awake" hours. The patient
should be rotated through four positions (unless a
particular position is contraindicated):
• Prone
• Supine
• Left Sim's.
• Right Sim's.
Turning the Adult Patient Cont’d
Plan a schedule and follow it. Record the position change
each time to ensure that all positions are used
An example of a schedule for turning would be:
• 10:00 -- Prone position
• 12:00--Left Sim's position
• 14:00--Supine position
• 16:00--Right Sim's position
• 18:00--Prone position
You notice that in the preceding sequence, the patient is
required to make only a quarter turn rather than a half
turn each time the position is changed. If the patient
experiences pain while turning, a quarter turn will be less
painful than a half turn.