Positioning of Client.pptx

Fundamental of Nursing
B.Sc. Nursing First Year
Kathmandu University

1. Positioning of Client Prepared by: Geeta Rai, Lecturer

2. Definition Positioning defined as placing the person in such a way to perform therapeutic interventions and to promote the health of an individual.

3. Contd… Positioning defined as placing the person in a proper body alignment for the purpose of preventive, promotive, curative, and rehabilitative aspects of health .

4. Contd… Patient positioning involves properly maintaining a patient’s neutral body alignment by preventing hyperextension and extreme lateral rotation to prevent complications of immobility and injury. Positioning patients is an essential aspect of nursing practice and a responsibility of the registered nurse.

5. Purpose To provide comfort to the patient To relieve pressure on various parts To improve circulation To prevent formation of deformity To carry out investigations

6. Contd… To perform surgical and medical investigations To prevent pressure sores To provide proper body alignment To conduct delivery/labor To carry out nursing interventions

7. Principles of positioning Systemic and orderly way of doing Cooperation between two Follow safety measure to prevent accidents Active participation Using a right technique at right time

8. Factors involved in positioning Need of an individual Self care ability Extend of disability Nature of disease condition Level of consciousness Protocol of the hospital

9. Types of position Supine position Dorsal position (Lying on back) Dorsal recumbent position Lithotomy position Lateral position

10. Contd… Prone position Slim’s position Knee-chest position Trendelenburg’s position Fowler’s position / Semi fowler’s position

11. SUPINE POSITION Supine position, the patient lies on his back with his head and shoulders are slightly elevated. One pillow is given under the head. His legs should be slightly flexed. A small pillow is placed under his knees.

12. Indication The usual position used by the patient Used for examination of the chest and abdomen

13. Procedure Place the patient on back with one pillow under the head, arms and hands at the sides, knees flexed and separated. Place the air ring under the hips and cotton rings or foam pads under the heels to reduce the pressure.

14. Contd… Align the patient’s body in good position. Support the body parts in good alignment for comfort when the patient is paralyzed.

15. Contraindication Elderly patients Patients with operation on abdomen, breast and thorax Prone to hypostatic pneumonia Patients with long standing illnesses and neurological conditions

16. LATERAL POSITION Patient lies on left side with legs flexed at thighs. The upper leg is flexed more than the lower. A pillow is kept in front of the abdomen and at the back and one under the upper leg.

17. Indication Lateral position is used for giving back care enemas and colonic irrigation Used for examination of perineum or rectum inserting suppositories For taking rectal temperature For change of position Later position is a relaxing position Giving back care

18. Procedure Explain the procedure to the patient Provide privacy. For left lateral position, place the patient on left side with buttocks to the edge of bed, both thighs flexed and left arm underneath.

19. Contd… For right lateral position, place the patient on right side with buttocks to the edge of bed, both thighs flexed and right arm underneath. Place air ring under the hips to reduce pressure on trochanters and at the hip joints, the cotton rings or foam pads under the ankles of lower legs to reduce the pressure on ankles.

20. Contd… Align the patient in good position and make sure the patient is not lying on his arm. Support the body parts in good alignment for comfort. Left lateral position: with one pillow under the head, patient is placed to lie on the left side.

21. Contd… Use of left lateral positions: For giving edema For inserting suppositories To take rectal examination To take rectal temperature

22. Contraindication After hip surgery After orthopedic surgery

23. PRONE POSITION A patient lies flat on abdomen. Head turned to sideways. One soft pillow is given under head. An extra pillow is given under the ankles to keep toes from touching the bed.

24. Indication This position used postoperatively to prevent aspiration of saliva and mucus Used in postoperative cases, tonsils, vesicovaginal fistula and spinal cases To prevent bed sores To relieve abdominal distention Used for patients having injuries and burns on back

25. Procedure Explain the procedure to the patient Provide privacy Place the patient flat on abdomen with one pillow under the head Turn patients head to one side and align the patient in good position Support the body parts in good alignment for comfort Place both arms lies at the sides of the heads

26. Contraindication This position is not well tolerated by the elderly or patient with cardiovascular or respiratory problems

27. DORSAL RECUMBENT POSITION Patient lies on back, knees fully flexed, thighs flexed and externally rotated feet flat on the bed.

28. Indication It is used for catheterization, vaginal douche, vulval, vaginal and rectal examination It is also used for vaginal operations and insertion of tampons Patients who are convalescent period

29. Contd… Patients with gastric conditions Patients with chest conditions Patients with abdominal or pelvic operations unless erect sitting position is indicated

30. Procedure Place the patient on back in bed with two or more pillows under the head and one pillow under the knees or maintain his position by elevating the top of bed on blocks.

31. Contd… Place the air ring under the hips and cotton rings or foam pads under the heels to reduce the pressure. Align the patient’s body in good position. Support the body parts in good alignment for comfort when the patient is paralyzed.

32. FOWLER’S POSITION Fowler’s position is a sitting position in which the head is elevated, at least, a 45 degree angle. Back rest and two pillows are used for the back and head. Fowler’s position the main weight bearing areas of the patient are the heels, sacrum and the posterior aspects of the ileum.

33. SEMI-FOWLER’S POSITION The semi-fowler’s position is the position of a patient who is lying in bed in a supine position with the head of the bed at approximately 30 to 45 degrees.

34. Indications To relieve dyspnea To improve circulation To prevent thrombosis Postoperatively to assist drainage from abdominal or pelvic cavity

35. Contd… To relax the muscles of the abdomen, back and thighs To relieve tension on the abdominal sutures To promote comfort To localize infection, e.g. priorities To relieve edema of the chest and abdomen

36. Procedure Explain the procedure of the patient Arrange the articles needed at the bedside Provide privacy Place the patient in sitting position with arms at the sides and knees raised with pillow

37. Contd… Maintain this position; elevate the head of bed to an angle from 45-60 degree (semi-fowler) or 60-90 degree (high-fowler) Elevate the knee rest to an angle of 15 degree or place a small pillow under the knees

38. LITHOTOMY POSITION The patient lies on her back. The legs are separated and thighs are flexed on the abdomen and the legs are on the thighs. The patient’s buttocks are kept the edge of the table and legs are supported by stirrups.

39. Indication This position is given during gynecological examinations, treatments, and operations on genitourinary system For delivery of baby For rectal examinations and operations

40. Procedure Explain the procedure to the patient Provide privacy Position the patient to lie on his back with one pillow under the head Keep the legs well separated and the thighs are well flexed on the abdomen and the legs on the thighs Buttocks are kept on the edge of the table and the legs are supported on stirrups

41. Contraindication Contraindications of this position are, patients with arthritis or joint deformity may be unable assume this position

42. KNEE CHEST POSITION Patient rests on the knees and the chest. The head is turned to one side with one check on a pillow. A pillow is placed under the chest. The weight is on the chest and knees.

43. ASSISTING THE PATIENT IN KNEE-CHEST POSITION A prone position in which the individual rests on the knees and upper part of the chest, assumed for gynecologic or rectal examination. It is also called genupectoral position.

44. Indication This position is used for sigmoidoscopy Used for vaginal and rectal examination Used in first aid treatment in cord prolapse or retroverted uterus As exercise for postpartum and gynecology patients

45. Procedure Explain the procedure to the patient Collect the needed articles at the bedside Provide privacy Make the patient rests on the knees and chest The head is turned to one side with the cheek on a pillow

46. Contd… The arms should be extended on the bed and flexed at the elbows to support the patient partially The weight should rest on the chest and knees which are flexed so that the thighs are at right angles to the legs

47. Contraindication Patients with cardiovascular and respiratory problems cannot assume this position

48. CARDIAC POSITION The client is propped-up in a sitting position by means of back rest and pillows. Place an over bed table in front with a pillow on it. The client has an air cushion to sit and a small pillow under the knees.

49. TRENDELENBURG’S POSITION The patient lies on his back. The patient’s head is low. The foot of the bed is elevated at 45 degree angle. The body is on an inclined place and the legs hang downward over the end of the table.

50. Indication Used in emergency situations like shock and hemorrhage This position is used for vaginal surgeries Used to displace intestines from pelvic cavity into upper abdomen Used during operations on the pelvic organs To arrest bleeding from lower limb

51. Procedure Explain the procedure to the patient Arrange the article need at the bedside Provide privacy (if needed) Place the patient lied on his back Elevate the foot end at 45 degree angle

52. Contd… The body is on an inclined place with hips higher than the bed The knees are flexed The patient is carefully supported to prevent slipping Draping done depends upon the kind of operation to be performed

53. SIM’S POSITION Sim’s position is similar to the lateral position except that the patient’s weight is on the anterior aspects of shoulder girdle and hip. The patient’s lower arm is behind him and the upper arm is flexed at the shoulder and elbow.

54. Indication This position is used for unconscious patient It is used for rectal examinations Used for vaginal examinations Used for relaxation in antenatal exercises

55. Procedure Explain the procedure to the patient Collect articles need at the bed side Provide privacy Place the patient on the side One pillow is placed under the head with the left check resting on it

56. Contd… The left arm is drawn behind the body and the right arm may be in any position comfortable for the patient The right thigh is flexed against the abdomen The left leg is extended well Cover the patient with top sheet neatly

57. Contraindication Patients with deformities of the hip or knee may be unable to assume this position

58. C-SHAPED POSITION Patient should be lying in the lateral decubitus position Ensure the vertical plane of the patient’s back is perpendicular to the bed Flex knees and hips so that knees are close to the chest While flexion of the neck is often taught as important, evidence suggests that this has no effect of the size of the interspinous opening and may be uncomfortable for the patient

59. TYPES OF PATIENTS NEED SPECIAL CARE Unconscious patient Infant and children Hemiplegic and paraplegic position Immediate postoperative patients Orthopedic patients Cardiac patients

60. GENERAL INSTRUCTIONS Maintain good body alignment of the patient at all times. Support body parts in good alignment by using supportive devices to promote comfort and prevent undue muscle strain.

61. Contd… Avoid prolonged flexion of any one body segment by changing the position at least every two hours. Reduce the pressure caused by body weight of his or her body or object by changing the position and using protective devices.

62. PRELIMINARY ASSESSMENT Check the patient’s general condition Check the physician’s order for any limited movements Assess the self-care ability of an individual Arrange the comfort devices near the bedside

63. Contd… Identify the deformed extremity Support the immobilize area during positioning Identify the rationale before positioning

64. EQUIPMENT Extra man power if needed Extra pillows Sheets and sheet rolls Comfort devices such as back rest, cardiac table, sand bag, etc

65. Procedure Explain the procedure to the patient Provide privacy Arrange the articles and manpower (if needed) Untie the bed sheets Turn/lift/ambulate gently Place and support with extra pillows under pressure points

66. Contd… Special care taken at pressure areas Cover the patient with top sheet Hand wash Record the time, position and condition of the skin

67. Contd… Positioning a patient in bed is important for maintaining alignment and for preventing bed sores (pressure ulcers), foot drop, and contractures. Proper positioning is also vital for providing comfort for patients who are bedridden or have decreased mobility related to a medical condition or treatment.

68. Contd… When positioning a patient in bed, supportive devices such as pillows, rolls, and blankets, along with repositioning, can aid in providing comfort and safety.

69. Contd… Good body alignment can be achieved in any of the bed rest positions. The following points should be checked. Head should be in midline with the trunk Back should be straight, with normal body curves (cervical, thoracic, and lumbar) maintained

70. Contd… Ribs should be elevated to prevent constriction of the chest Arms and legs should be in a position of function (the position for maximum usefulness of the joints, feet and hands)

71. Contd… Position of function of leg and feet. This position favors standing upright and walking. In general, if the toes point to the ceiling when in a back-lying position and point to the floor when in a front-lying position, the feet, legs, and hips are in good alignment.

72. Contd… Position of function of arms and hands. This position favors raising arms and grasping things with the fingers. The hand should not droop at the wrist, be clenched in a fist, or be flat. The position of function for the hand is dorsiflexion (at a slight upward angle) at the wrist, with the fingers and thumb in position to write with a pencil.

73. END

74. REFERENCE https://nurseinfo.in/patient-positioning