Title | Patient positions |
---|---|
Author | Samantha Silva |
Course | Professional Nursing I |
Institution | Florida International University |
Pages | 8 |
File Size | 248.9 KB |
File Type | |
Total Downloads | 7 |
Total Views | 145 |
Patient positions...
Cheat Sheet for Patient Positions Condition
Position
Rationale & Additional Info
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.
Myelogram (water-based dye)
Pre-op: surgical table will be moved to various positions during test. Post-op: HOB elevated for 8 hours.
To prevent dye from irritating the meninges.
Liver biopsy
During: Supine with RIGHT side of upper abdomen exposed; RIGHT arm raised and extended behind and and overhead and shoulder. After: RIGHT side-lying with pillow under puncture site.
To expose the area. To apply pressure and minimize bleeding.
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.
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 bloodtinged outflow if catheter was placed in the last 12 weeks. Cloudy outflow is never normal.
Meniere’s Disease
Change position slowly; bedrest during acute phase
Provide protection when ambulating
Arteriovenous fistula
Condition
Position
Rationale & Additional Info
Autografting
Immobilize site for 3 to 7 days.
To promote healing and maximal adhesion.
Internal radiation, during treatment
Strict bedrest while implant is in place
To prevent dislodgement of the implant device. Provide own urinal or bedpan to patient.
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.
Peripheral artery disease
Depending on desired outcome. Slight elevation of legs but not above the heart or slightly dependent. Dangle legs on side of the bed.
To slow or increase arterial return
Shock
Flat on bed.
To improve or increase circulation. Trendelenburg is no longer a recommended position.
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.
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.
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.
Tracheoesophageal fistula (TEF)
HOB elevated 30-45 degrees.
To prevent reflux.
Ventriculoperitoneal shunt (for Hydrocephalus treatment)
After shunt placement: Place on non-operative side in flat position. HOB raised 15-30 degrees if ICP is increased. Do not hold infant with head elevated.
Avoid rapid fluid drainage.
Hyphema Blood in anterior chamber of eye
HOB elevated 30-45 degrees, with night shield.
To allow the hyphema to settle out inferiorly and avoid obstruction of vision and to facilitate resolution
Abdominal aneurysm
Post-op: HOB no more than 45 degrees
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.
Condition
Position
Rationale & Additional Info
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.
Evisceration
Place in low-Fowler’s position.
Instruct not to cough; place on NPO; keep intestines moist and covered with sterile saline until patient can be wheeled to OR.
Gastroesophageal reflux disease (GERD)
Reverse Trendelenburg, slanted bed with head higher. Pediatric: prone with HOB elevated.
To promote gastric emptying and reduce reflux.
Hiatal hernia
Upright position after meals.
To prevent gastric content reflux.
Pyloric stenosis
RIGHT side-lying position after meals.
To facilitate entry of stomach contents into the intestines.
Extremity burns
Elevate extremity.
To reduce dependent edema and pressure.
Facial burns or trauma
Head elevated
To reduce edema
Autonomic dysreflexia
Initially place in sitting position or high Fowler’s position with legs dangling.
To reduce blood pressures below dangerous levels and provide partial symptom relief.
Cerebral aneurysm
HOB elevated 30-45 degrees; bed rest
To prevent pressure on aneurysm site
Heat stroke
Supine, flat with legs elevated.
To promote venous return and maintain blood flow to the head.
Hemorrhagic stroke
HOB elevated 30 degrees.
To reduce ICP and encourage blood drainage. Avoid hip and neck flexion which inhibits drainage.
Increased intracranial pressure (ICP)
Elevate HOB 30-45 degrees, maintain head midline and in neutral position.
To promote venous drainage. Avoid flexion of the neck, head rotation, hip flexion, coughing, sneezing and bending forward.
Ischemic stroke
HOB flat in midline, neutral position.
To facilitate venous drainage and encourage arterial blood flow. Avoid hip and neck flexion which inhibits drainage
Seizure
Side-lying or recovery position.
To drain secretions and prevent aspiration.
Spinal cord injury
Immobilize on spinal backboard, head in neutral position and immobilized with a firm, padded cervical collar. Must be log rolled without allowing any twisting or bending movements
To prevent any movement and further injury.
Head injury
Elevate HOB 30 degrees, head should be kept in neutral position.
To decrease intracranial pressure (ICP). Keep head from flexing or rotating. Avoid frequent suctioning.
Condition
Position
Rationale & Additional Info
Buck’s Traction
Elevate FOB for counter-traction; use trapeze for moving; place pillow beneath lower legs.
Ask patient to dorsiflex foot of the affected leg to assess function of peroneal nerve, weakness may indicate pressure on the nerve.
Casted arm
Elevate at or above level of heart
To minimize swelling
Delayed prosthesis fitting
Elevate foot of bed to elevate residual limb.
To hasten venous return and prevent edema.
Hip fracture
Affected extremity needs to be abducted.
Use splints, wedge pillow, or pillows between legs. Avoid stooping, flexion position during sex, and overexertion during walking or exercise.
Hip replacement
On unaffected side:maintain abduction when in supine position with pillow between legs. HOB raised to 30-45 degrees.
Avoid extreme internal or external rotation.
Immediate prosthesis fitting
Elevate residual limb for 24 hours.
Rigid cast acts to control swelling.
Osteomyelitis
Support affected extremity with pillows or splints
To maintain proper body alignment; avoid strenuous exercises.
Total hip replacement
Help to sitting position; place chair at 90 degrees angle to bed; stand on affected side; pivot patient to unaffected side.
To prevent dizziness and orthostatic hypotension.
Acute Respiratory Distress Syndrome(ARDS)
High Fowler’s
To promote oxygenation via maximum chest expansion.
Air embolism from dislodged central venous line
Turn to LEFT side or place in Trendelenburg.
Patient should be immediately repositioned with the right atrium above the gas entry site so that trapped air will not move into the pulmonary circulation.
Asthma
High Fowler’s Tripod position: sitting position while leaning forward with hands on knees.
To promote oxygenation via maximum chest expansion.
Chronic Obstructive Pulmonary Disease(COPD)
High Fowler’s Orthopneic position
To promote maximum lung expansion and assist in breathing.
Emphysema
High Fowler’s Orthopneic position
To promote maximum lung expansion
Pleural Effusion
High Fowler’s
To provide maximal
Pneumonia
High Fowler’s Lay on affected side Lay with affected lung up
To maximize breathing mechanisms. To splint and reduce pain. To reduce congestion.
Condition
Position
Rationale & Additional Info
Pneumothorax
High Fowler’s
To promote maximum lung expansion and assist in breathing.
Pulmonary edema
High Fowler’s, legs dependent position
To decrease edema and congestion
Pulmonary embolism
High Fowler’s Turn patient to LEFT side and lower HOB
To promote maximum lung expansion and assist in breathing.
Flail chest
High Fowler’s
To provide maximal comfort and maximize breathing mechanisms.
Rib fracture
High Fowler’s
To promote maximum lung expansion and assist in breathing.
Contraction stress test (CST)
Placed in semi-Fowler’s or side-lying position
Monitor for post-test labor onset.
Cord prolapse
Shrimp or fetal position; modified Sims’ or Trendelenburg.
To prevent pressure on the cord. If cord prolapses, cover with sterile saline gauze to prevent drying.
Fetal distress
Turn mother to her LEFT side.
To reduce compression of the vena cava and aorta.
Late decelerations (placental insufficiency)
Turn mother to her LEFT side.
To allow more blood flow to the placenta.
Placenta previa
Sitting position.
To minimize bleeding.
Variable decelerations (cord compression)
Place mother in Trendelenburg position.
To remove pressure off the presenting part of the cord and prevent gravity from pulling the fetus out of the body.
Spina Bifida
Prone (on abdomen).
To prevent sac rupture.
Cleft lip (congenital)
Position on back or in infant seat. Hold in upright position while feeding.
To prevent trauma to suture line.
Prolapsed umbilical cord
During labor: Knee-chest position or Trendelenburg.
Relieves pressure or gravity from pulling the cord. Hand in vagina to hold presenting part of fetus off cord.
Cardiac catheterization(post)
HOB elevated no more than 30 degrees or flat as prescribed.May turn to either side
Affected extremity should be kept straight.
Continuous BladderIrrigation (CBI)
Tape catheter to thigh; no other positioning restrictions
Prevents the catheter from being dislodged.
Ear drops
Position affected ear uppermost then lie on unaffected ear for absorption.
Pull outer ear upward and back for adults; upward and down for children.
Condition
Position
Rationale & Additional Info
Ear irrigation
During procedure: Tilt head towards affected ear. After procedure: Lie on affected side for drainage.
Better visualization and drainage of the medium to the ear canal via gravity.
Eye drops
Tilt head back and look up, pull lid down.
Drop to center of the lower conjunctival sac; blink between drops; press inner canthus near nose bridge for 1-2 min to prevent systemic absorption.
Lumbar puncture
During: Shrimp or fetal position (side-lying with back bowed, knees drawn up to abdomen, neck flexed to rest chin on chest). After: Flat on bed for 4-12 hours.
To maximize spine flexion. To prevent spinal headache and CSF leakage.
Nasogastric tube insertion
High Fowler’s with head tilted forward
Closes the trachea and opens the esophagus; prevents aspiration.
Nasogastric tube irrigation and tube feedings
HOB elevated 30 to 45 degrees; keep elevated for 1 hour after an intermittent feeding. With decreased LOC: RIGHT side-lying with HOB elevated. With tracheostomy:Maintain in semi-Fowler’s position
To prevent aspiration.Promotes emptying of the stomach and prevents aspiration. To prevent aspiration.
Paracentesis
During: Semi-Fowler’s in bed or sitting upright on side of bed with chair; support the feet. Post: Assist into any comfortable position
Empty the bladder before procedure; report elevated temperature; assess for hypovolemia.
Postural Drainage
Trendelenburg
Lung area needing drainage should be in uppermost position
Rectal enema administration
Left side-lying (Sims’ position) with right knee flexed.
Allows gravity to work into the direction of the colon by placing the descending colon at its lowest point.
Rectal enemas and irrigation
Left side-lying, Sims’ position
To allow fluid to flow in the natural direction of the colon.
Sengstaken-Blakemore and Minnesota tubes
HOB elevated
To enhance lung expansion and reduce portal blood flow, permitting esophagogastric balloon tamponade.
Thoracentesis
Before: (1) Sitting on edge of bed while leaning on bedside table with feet supported by stool; or lying in bed on unaffected side with head elevated 45 degrees. (2) Lying in bed on unaffected side with HOB elevated to Fowler’s.
Prevent fluid leakage into the thoracic cavity.
Condition
Position
Rationale & Additional Info
After: Assist patient into any comfortable position preferred. Total Parenteral Nutrition (TPN)
During insertion:Trendelenburg.
To prevent air embolism.
Vascular extremity graft
Bed rest for 24 hours, keep extremity straight and avoid knee or hip flexion
For maximal adhesion.
Perineal procedures
Lithotomy
For better visualization of the area.
Appendectomy
Post-op: Fowler’s position
To relieve abdominal pain and ease breathing.
Cataract surgery
Sleep on unaffected side with a night shield for 1 to 4 weeks. Semi-Fowler’s or Fowler’s on back or on non-operative side.
To prevent edema.
Craniotomy
HOB elevated 30-45% with head in a midline, neutral position. Never put client on operative side, especially if bone was removed.
To facilitate venous drainage.
Hemorrhoidectomy
During: Prone Jackknife position.
Provides better visualization of the area.
Hypophysectomy Surgical removal of the pituitary gland.
HOB elevated.
To prevent increase in ICP.
Infratentorial surgery Incision at back of head, above nape of neck
Flat and lateral on either side; avoid neck flexing.
To facilitate drainage.
Kidney transplant
Post-op: Semi-Fowler’s, turn from back to non-operative side
To promote gas exchange
Laminectomy
Back is kept straight.Patient is logrolled if turned. Sit straight in straight-backed chair when out of bed or when ambulating.
Laryngectomy
HOB elevated 30-45 degrees
To maintain airway and decrease edema.
Mastectomy
Semi-Fowler’s with arm on affected side elevated.
To allow lymph drainage. Turn only on back and on unaffected side.
Mitral valve replacement
Post-op: semi-Fowler’s position.
To assist in breathing.
Myringotomy
Post-op: Position on side of affected ear .
To allow drainage of secretions
Retinal detachment
Bed rest with minimal activity and repositioning.
Helps detached retina fall into place.
Condition
Position
Rationale & Additional Info
Area of detachment should be in the dependent position. Supratentorial surgery Incision front of head below hairline
HOB elevated 30-45 degrees; maintain head/neckline in midline neutral position; avoid extreme hip and neck flexion.
To facilitate drainage.
Thyroidectomy
Post-op: High Fowler’s or semi-Fowler’s. Avoid extension and movement by using sandbags or pillows.
To reduce swelling and edema in the neck area. To decrease tension on the suture line and support the head and neck.
Tonsillectomy
Post-op: prone or side-lying
To facilitate drainage and relieve pressure on the neck.
Bone marrow aspiration/biopsy
Side lying with head tucked and legs pulled up or; Prone with arms folded under chin.
To expose the area. Apply pressure to the area after the procedure to stop the bleeding.
Amputation: above the knee
Elevate for first 24 hours using pillow.Position prone twice daily.
To prevent edema. To provide for hip extension and stretching of flexor muscles; prevent contractures, abduction
Amputation: below the knee