PATIENT-POSITIONS-DURING-ASSESSMENT.pptx

Positioning

1. DIFFERENT PATIENT POSITIONS

2. Several positions are frequently required during the physical assessment. It is important to consider the client’s ability to assume a position. The client’s physical condition, energy level, and age should also be taken into consideration Some positions are embarrassing and uncomfortable and therefore should not be maintained for long. The assessment is organized so that several body areas can be assessed in one position .

3. STANDING POSITION

4. Standing Position The client stands still in a normal, comfortable, resting posture. This position allows the examiner to assess posture, balance, and gait. This position is also used for examining the male genitalia.

5. SITTING POSITION

6. Sitting Position The client should sit upright on the side of the examination table, with back unsupported and legs hanging freely. In the home or office setting, the client can sit on the edge of a chair or bed. Areas Assessed: head, neck, lungs, chest, back, breasts, axillae, heart, vital signs, and upper & lower extremities. This position is also useful because it permits full expansion of the lungs, and it allows the examiner to assess symmetry of upper body parts.  Cautions: Elderly and weak clients may require support

7. SUPINE POSITION

8. Supine Position aka “ Horizontal Recumbent ” Ask the client to lie down with the legs together on the examination table (or bed if in a home setting). Back-lying with legs extended A small pillow may be placed under the head to promote comfort. (If the client has trouble breathing, the head of the bed may need to be raised)  Areas assessed: head, neck, chest, breasts, axillae, abdomen, heart, lungs, and all extremities. Cautions: Tolerated poorly by clients with cardiovascular and respiratory problems

9. Fowler’s Position Low Fowler’s position Semi Fowler’s position High Fowler’s position

10. Fowler’s position , also known as  semi-sitting position , is a bed position wherein the head of the bed is elevated 45 to 60 degrees. Variations of Fowler’s position include:  low Fowler’s  (15 to 30 degrees),  semi-Fowler’s  (30 to 45 degrees), and  high Fowler’s  (nearly vertical). USES Promotes lung expansion.  Fowler’s position is used for patients who have difficulty breathing because in this position, gravity pulls the  diaphragm  downward allowing greater chest and lung expansion. Useful for NGT.  Fowler’s position is useful for patients who have cardiac, respiratory, or neurological problems and is often optimal for patients who have  nasogastric tube  in place.

11. Prepare for walking.  Fowler’s is also used to prepare the patient for dangling or walking. Nurses should watch out for dizziness or faintness during change of position. Poor neck alignment.  Placing an overly large pillow behind the patient’s head may promote the development of neck flexion contractures. Encourage patient to rest without pillows for a few hours each day to extend the neck fully. Used in some surgeries.  Fowler’s position is usually used in surgeries that involve neurosurgery or the shoulders Use a footboard.  Using a footboard is recommended to keep the patient’s feet in proper alignment and to help prevent foot drop.

12. DORSAL RECUMBENT

13. Dorsal Recumbent The client lies down on the examination table or bed with the knees bent, the legs separated, and the feet flat on the table or bed. This position may be more comfortable than the supine position for clients with pain in the back or abdomen. Areas assessed: head, neck, chest, axillae, lungs, heart, extremities, breasts, and peripheral pulses.  Cautions: May be contraindicated for client’s who have cardiopulmonary problems. Not used for abdominal assessment because of the increased tension of abdominal muscle

14. PRONE POSITION

15. Prone position The client lies down on his or her abdomen with the head to the side.  Areas assessed: Posterior thorax and hip joint movement Cautions: Often not tolerated by the elderly and people with cardiovascular and pulmonary problems

16. LATERAL OR SIDE-LYING POSITION

17. 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.  Areas assessed: occiput, posterior neck, upper and lower back area, buttocks Cautions: Difficult for elderly and people with limited joint movement.

18. SIMS’ POSITION

19. Sims’ position The client lies on his or her right or left side with the lower arm placed behind the body and the upper arm flexed at the shoulder and elbow. The lower leg is slightly flexed at the knee while the upper leg is flexed at a sharper angle and pulled forward. Areas Assessed: rectum, vagina Cautions: Difficult for elderly and people with limited joint movement.

20. LITHOTOMY POSITION

21. The client lies on his or her back with the hips at the edge of the examination table and the feet supported by stirrups. Areas Assessed: female genitalia, reproductive tracts, and the rectum. Cautions: The client may require assistance getting into this position. It is an exposed position, and clients may feel embarrassed. In addition, elderly clients may not be able to assume this position for very long or at all. 

22. KNEE – CHEST POSITION

23. Prone knee-chest: The client kneels on the examination table with the weight of the body supported by the chest and knees. A 90-degree angle should exist between the body and the hips. The arms are placed above the head, with the head turned to one side Areas assessed: rectum Lateral knee-chest: The patient lies on their side, torso lies diagonally across the table, hips and knees are flexed Areas assessed: low back, used for lumbar puncture Caution: This position may be embarrassing and uncomfortable for the client, and, therefore, the client should be kept in the position for as limited a time as possible. Elderly clients and clients with respiratory and cardiac problems may be unable to tolerate this position.

24. JACKKNIFE POSITION

25. Jackknife position Also known as  Kraske It is wherein the patient’s abdomen lies flat on the bed. The bed is scissored so the hip is lifted, and the legs and head are low. Areas assessed: anus, rectum and lower back area Cautions: Compression of the inferior vena cava from abdominal compression also occurs, which decreases venous return to the heart. This could increase the risk for  deep vein thrombosis . It also puts excessive pressure on the knees.

26. TRENDELENBURG’S POSITION

27. TRENDELENBURG’S POSITION It involves lowering the head of the bed and raising the foot of the bed of the patient. The patient’s arms should be tucked at their sides Not commonly use in assessment. Promotes venous return.  Hypotensive patients can benefit from this position because it promotes venous return. Postural drainage.  Trendelenburg’s position is used to provide postural drainage of the basal lung lobes. Watch out for dyspnea, some patients may require only a moderate tilt or a shorter time in this position during postural drainage. Adjust as tolerated.

28. Other Positions