MEETING THE

PHYSIOLOGICAL NEEDS OF
THE CLIENTS AND
CAREGIVERS

MUSCULOSKELETAL
DISCOMFORT AND
PRESSURE
 POSITIONING CLIENTS
 Positioning in a good alignment and changing
the position regularly (every 2 hour) and
systematically are essential aspects of nursing
practice
 Frequent change of position helps to prevent
muscle discomfort, undue pressure resulting in
pressure ulcers, damage to superficial nerves
and blood vessels and contractures.
 Can also maintain muscle tone and stimulate
postural reflexes.
TYPES OF POSITIONING
 FOWLER’S
• Or semi sitting position

• The knees may or may not be flexed.

• In low or semi Fowler’s position, the head

and trunk are raised 15 to 45 degree.
Fowler’s (cont)..

• High fowler’s – the head and trunk are

raised 90 degree
• Is a choice for people who have difficulty
breathing and client’s with heart problems.
• In this position, gravity pulls the diaphragm
downward, allowing greater chest
expansion and lung ventilation.
Fowler’s Position
Low Fowler’s High Fowler’s
 PROCEDURE
FOWLER’S
• Elevate head of bed 45 to 90 degree
• Rest head against mattress or on small
pillow
• Use pillows to support arms and hands if
client does not have voluntary control or
use of hands and arms.
Procedure (cont)..

• Position pillow at lower back

• Place small pillow or roll under thigh

• Place small pillow or roll under ankles.

 CARDIAC / ORTHOPNEIC
• The client’s sits either in bed or in the side
of the bed with an overbed table (cardiac
table) across the lap.

• This position to facilitate respiratory by

allowing maximum chest expension.
Orthopneic position
Cardiac / Orthopneic (cont)..

• This is a variation of high Fowler’s position

and is used for patients who have difficulty
breathing
• The position of the bed remain the same
as high fowler’s (90 degree angle)
• Bring the bedside table across the bed
and place one or two pillows on top of the
table.
Cardiac / Orthopneic (cont)..

• Have the patient lean forward across the

table with her arms on or beside the
pillows. Have her rest her head on the
pillows.

• Place another pillow low behind the

patient’s back for support.
 LATERAL
• The person lies on one side of the body.
• Good for resting and sleeping client’s.
• Help to relieve pressure on the sacrum
and heels in people who sit for much of
the day or who are confined to bed and
rest in fowler’s or recumbent positions
much of the time.
Left lateral position
 PROCEDURE
LATERAL (SIDE LYING)
• Lower head of bed completely or as low as
client tolerate
• Position client to side of bed.
• Prepare to turn client onto side. Flex
client’s knee that will not be next to
mattress. Place one hand on client’s hip
and one hand on client’s shoulder.
Procedure (cont)..

• Roll client onto side toward you

• Place pillow under client’s head and neck

• Bring shoulder blade forward

Procedure (cont)..

• Position both arms in slightly flexed

position. Upper arm is supported by pillow
level with shoulder, other arm by mattress

• Place tuck-back pillow behind client’s back

(make by folding pillow lengthwise.
Smooth area is slightly tucked under
client’s back).
Procedure (cont)..

• Place pillow under semiflexed upper leg

level at hip from groin to foot.

• Place sandbag parallel to plantar surface

of dependent foot.
 RECUMBENT

• The head and shoulders are slightly

elevated with a small pillow (used a pillow)
 SUPINE
• Is position of the body, lying down with
the face up.

• Head and shoulders are not elevated (not

using a pillow).

• Is used for other examination including an

internal autopsy and cardiovascular
assessment.
 PROCEDURE
SUPINE
• Be sure client is comfortable on back with
head of bed flat.
• Place small rolled towel under lumbar area
of back.
Procedure (cont)..

• Place trochanter rolls or sandbag parallel

to lateral surface of client’s thighs.

• Place small pillow or roll under ankle to

elevate heels.

• Place footboard or firm pillows against

bottom of clients feet.
Procedure (cont)..

• Place foot splints on client’s feet.

• Place pillow under pronated forearms,

keep upper arms parallel to client’s body.

• Place hand roll in client’s hand. Consider

physical therapy referral for use of hand
splint.
 PRONE
• The client lies on the abdomen with head turned
to one side.
• Helps to prevent flexion contractures of the hips
and knees.
• Promote drainage from mouth especially for
unconscious clients or those who recovering
from surgery of the mouth and throat.
• But not recommended for clients with cervical or
lumbar spine injury – neck rotated laterally
Prone Position
 PROCEDURE
PRONE
• With client supine, roll client over arm
positioned close to body, with elbow
straight and hand under hip. Position on
abdomen in center of bed.
• Turn client’s head to one side and support
head with small pillow.
Procedure (cont)..

• Place small pillow under client’s abdomen

below level of diagram.

• Support arms in flexed position level at

shoulders.

• Support lower legs with pillows to elevate

toes.
 SIMS’
• This position is a variation of lateral
position with the patient on the left side,
left leg extended and right leg flexed. This
position is often used for rectal
examination and treatments of enemas.
Sims’ position
 SEMIPRONE
• The client’s assumes a posture halfway
between lateral and the prone position.
• The lower arm is positioned behind the
client and the upper arm is flexed at the
shoulder and the elbow.
• Both legs are flexed in front of the client
• May be used for unconscious clients
because it facilitates drainage from mouth
and prevent aspiration of fluids.
Semiprone (cont)..

• It also used for paralyzed client.

• Often used for clients receiving enemas

and occasionally for clients undergoing
examinations or treatments of the perineal
area.
Semiprone position is a variation of prone
Semiprone (cont)..

• This position relieves pressure on the hips.

Breathing is easier in this position than in
the full prone position. Directions given
here are for the patient lying on the left
side. These can be easily adapted for the
right side.
 PROCEDURE
SIMS / SEMI PRONE
• Lower head to bed completely

• Be sure client is comfortable in supine

position.

• Position client in lateral position, with

dependant arm straight along client’s body
and with client lying partially on abdomen.
Procedure (cont)..

• Carefully lift client’s dependent shoulder

and bring arm back behind client.

• Place small pillow under client’s head.

• Place pillow under flexed upper arm,

supporting arm level with shoulder.
Procedure (cont)..

• Place pillow under flexed upper legs,

supporting leg level with hip.

• Place sandbag parallel to plantar surface

of foot.
 DORSAL RECUMBENT
• Is a common position used in delivery
process.
 LITHOTOMY
• Is a common position for surgical
procedures and medical examinations
involving pelvis and lower abdomen.

• The position is most recognizable as the

standard position for child birth; client is
laid on the back with knees bent,
positioned above the hips and spread
apart through the use of stirrups.
 TRENDELENBURG
• The body is laid flat on the back with the
head lower than the pelvis.

• This is a standard position used in

abdominal and gynecological surgery. It
allows better access to the pelvic organs
and intestines move towards the head by
gravity.