BASIC BODY POSITIONS we _ ° POSITIONS USED IN NURSING » When the body is in good alignment, undue strain is not exerted on the musculoskeletal system. A healthy person assumes the position that is most comfortable without even thinking about the constant changes. However, in sickness, patients are not always able to independently move and position themselves hence need the assistance of the nurse.‘Ute Definition: Positioning is defined as planning the person in a proper body alignment for the purpose of preventive, promotive, curative and rehabilitative aspects of health or placing the patient in good body alignment. —_ What is Patient Positioning? » In surgery, specimen collection, or other treatments, proper patient positioning provides optimal exposure of the surgical/treatment site and maintenance of the patient’s dignity by controlling unnecessary exposure. In most settings, positioning patients provide airway management and ventilation, maintaining body alignment, and provide physiologic safety.» Maintain good body mechanics » Wash hands before and after procedure » Ensure patients comfort » Obtain assistance as required » Follow safety measures to prevent accidents —_ ae Goals of Patient Positioning » The ultimate goal of proper patient positioning is to safeguard the patient from injury and physiological complications of immobility. Specifically, patient positioning goals include: 1. Provide patient comfort and safety. Support the patient’s airway and maintain the circulation throughout the procedure (e.g., in surgery, in examination, specimen collection, and treatment). 2. Maintaining patient dignity and privacy. In surgery, proper positioning is a way to respect the patient’s dignity by minimizing exposure of the patient who often feels vulnerable perioperatively. &Goals of Patient Positioning 3. Allows maximum visibility and access. Proper positioning allows ease of surgical access as well as for anesthetic administration during perioperative phase. = to promote comfort of the patient — to relieve pressure on various parts ,, ~ To stimulate circulation To provide proper body alignment ~ To carry out Nursing interventions To perform surgical and medical interventions (maximum exposure to the surgical site ) To prevent complications caused ~ by immobility \ j= omote normal physic eeGuidelines for Patient Positioning » Proper execution is needed during patient positioning to prevent injury for both the patient and the nurse, Remember these principles and guidelines when positioning clients: » 1. Explain the procedure. Provide explanation to the client on why his or her position is being changed and how it will be done. » Rapport with the patient will make them more ), likely to maintain the new position. Guidelines for Patient Positioning 2. Encourage Client to assist as much as possible. » Determine if the client can fully or partially assist. Clients that can assist will save strain on the nurse. It will also be a form exercise, increase independence, and self-esteem for the client. 3. Get adequate help. When planning to move or reposition the client, ask help from other caregivers /s.o. Positioning may not be a one-person task. 4. Use mechanical aids. & Bed boards, slide boards, pillows, patient lifts and slings can facilitate ease of changing positionsGuidelines for Patient Positioning 5. Raise client’s bed. Adjust or reposition the client’s bed so that the weight is at the level of the nurse’s center of gravity. 6. Frequent position changes. » Note that any position, correct or incorrect, can be detrimental to the patient if maintained for a long period. Repositioning the patient every 2 hours helps prevent complications like pressure ulcers and skin breakdown. (decubitus ulcer) 7. Avoid friction and shearing. » When moving patients, lift rather than slide * ta event friction that can abrade the skin 1... to skin breakdown. Guidelines for Patient Positioning 8. Proper body mechanics. Observe good body mechanics for you and your patient’s safety Position self close to the client. Avoid twisting your back, neck, and pelvis by keeping them aligned. Flex your knees and keep feet wide apart. Use your arms and legs and not your back. Tighten abdominal muscles and gluteal muscles in preparation for the move. Person with the heaviest load coordinates efforts of ‘iates the count to 3. ——Common Patient Positions » Supine or Dorsal Recumbent Position a the patient lies flat on the back with head and shoulders slightly elevated using a pillow unless contraindicated (e.g., spinal anesthesia, spinal surgery). Dis SUN TeexorTnaON Supine or Dorsal Recumbent Position » Variation in position. In supine position, legs may be extended or slightly bent with arms up or down. It provides comfort in general for patients under recovery after some types of surgery. Most commonly used position. Supine position is used for general examination or physical assessment. » Watch out for skin breakdown. Supine position may put patients at risk for pressure ulcers and nerve damage. Assess for skin breakdown and pad bony prominences.Supine position — Pressure points Calcaneus Sacrum Thoracic ee fe Seapulae Occiput coccyx Supine or Dorsal Recumbent Position Support for supine position. Small pillows may be placed under the head to and lumbar curvature. Heels must be protected from pressure by using a pillow or ankle roll. Prevent prolonged plantar flexion and stretch injury of the feet by placing a padded footboard. Supine position in surgery. Supine is frequently used on procedures involving the anterior surface of the body (e.g., abdominal area, cardiac, thoracic area). A small pillow or donut should be used to stabilize the head.Dorsal recumbent position allowing the pelvic On back, with gs bs le bent and spared area to be easily bea examined and observed. e.g. Internal Examn (IE) Common Patient Positions » 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) 60 to 90 degrees angle. Fowler's position is named after George Ryerson Fowler who saw it as a way to decrease mortality of perito: a eee.High Fowler’s position --A pillow is under the head,neck and upper back. —Apillow support both arms. — Head raised 90°. o® Gye. Fowler's Position bd + rowers * High Fowlers ———_— v0 + Semitowlers(Low te =Fowler’s position » 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. as — Fowler’s position » 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. SISTING TO DANGLE :Fowler’s position » 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. Definition + inability to raise the front part of foot due to weakness or paralysis of tibialis anterior muscle that lift the foot » Foot drop occur due to peroneal nerve injury » Can happen to unilateral or bilateral foot Common Patient Positions » Orthopneic or Tripod Position places the patient in a sitting position or on the side of the bed with an overbed table in front to lean on and several pillows on the table to rest on.Orthopneic or Tripod Position » Indications: » Maximum lung expansion. Patients who are having difficulty breathing are often placed in this position because it allows maximum expansion of the chest. ° Helps in exhaling. Orthopneic position is particularly helpful to patients who have problems exhaling because they can press the lower part of the chest against the edge of the overbed table. oe Common Patient Positions » Prone Position the patient lies on the abdomen with head turned to one side and the hips are not flexed.Prone position Indications: Extension of hips and knee joints. Prone position is the only bed position that allows full extension of the hip and knee joints. It also helps to prevent flexion contractures of the hips and knees. Contraindicated for spine problems. The pull of gravity on the trunk when the patient lies prone produces marked lordosis or forward curvature of the spine thus contraindicated for patients with spinal problems. rone position should only be used when vo se ck is correctly aligned. pS A a 4 Prone position » Indications: Drainage of secretions. Prone position also promotes drainage from the mouth and useful for clients who are unconscious or those recover from surgery of the mouth or throat. Nursing Responsibility: Placing support in prone. To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen. In surgery. Prone position is often used for neurosurgery, in most neck and spine surgeries.Common Patient Positions & » Lateral Position In 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. i LATERAL POSITION Lateral position Indications: » Relieves pressure on the sacrum and heels. Lateral position helps relieve pressure on the sacrum and heels especially for people who sit or are confined to bed rest in supine or Fowler’s position. » Body weight distribution. In this position, most of the body weight is distributed to the lateral aspect of the lower scapula, the lateral aspect of the ilium, and the greater trochanter of the femur. » Support pillows needed. To correctly position the patient in lateral position, use of support pillows are needed. asCommon Patient Positions Right Lateral Recumbent or semiprone position is when the patient assumes a posture halfway between the lateral and the prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. The upper leg is more acutely flexed at both the hip and the knee, than is the lower one.Sim’s position Indications: » » » » oe Prevents aspiration of fluids. Sims’ may be used for un€onscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids. Reduces lower body pressure. It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip. Sim’s position Indications: Pregnant women comft Pregnant women may — Bee je for sleeping Perineal area visualization and treatment. It is often used for clients receiving enemas and occasionally for clients undergoing examinations or treatments of the perineal area. c—Sim’s position Nursing Responsibility: » Promote body alignment with pillows. » Support proper body alignment in Sims’ position by placing a pillow underneath the patient’s head and under the upper arm to prevent internal rotation. Place another pillow between legs. Common Patient Positions » Lithotomy Po: jon a patient position in which the patient is on their back with hips and knees flexed and thighs apart.Lithotomy position Indication: » Lithotomy position is a common position for surgical procedures and medical examinations involving the pelvis and lower abdomen, as well as a for vaginal examinations and commonly used for childbirth. oe Common Patient Positions xh y » Trendelenburg’s Position » 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Trendelenburg Position Indications: » 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. EE Common Patient Positions » Reverse Trendelenburg’s Position © a patient position wherein the the head of the bed is elevated with the foot of the bed down. It is the opposite of Trendelenburg position. I) r eS EOSReverse Trendelenburg Posi Indications: » Gastrointestinal problems. Reverse trendelenburg is often used for patients with gastrointestinal problems as it helps minimize esophageal reflux. Prevent esophageal reflux. Promotes stomach emptying and prevents reflux for clients with hiatal hernia. Nursing Responsibility: Prevent rapid change of position. Patients with decreased cardiac output may not tolerate rapid movement or change from a supine to a more erect position. Watch out for rapid hypotension. minimized by gradually changing the pati: -cseonc. som Common Patient Positions on » Knee-Chest Position (genu-pectoral) Two ways. Knee-chest Position can be lateral or prone. » In lateral knee-chest position, the patient lies on their side, torso lies diagonally across the table, hips and knees are flexed. In prone knee-chest position, the patient kneels on the table and lower shoulders on to the table so chest and face rests on the table.Common Patient Positions » Knee-chest position (lateral) Tk tk ed yy Common Patient Positions » Knee-chest position ( prone }Common Patient Positions Knee-chest position Sigmoidoscopy. Usual position adopted tor sigmoidoscopy without anesthesia. Gynecologic and rectal examinations. Knee- chest position is assumed for a gynecologic or rectal examination. Used for rectal and vaginal examinations and as treatment to bring uterus into normal position. » Patient dignity. Prone knee-chest pos | be embarrassing for some patien ay ; Common Patient Positions » Jackknife Position » also known as Kraske, 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.» In surgery. Jackknife position is frequently used for surgeries involving the anus, rectum, coccyx, certain back surgeries, and adrenal surgery. » Requires team effort. At least four people are required to perform the transfer and position the patient in the operating table. Sitting position » Full expansion of lungs and better visualization of symmétry of upper body parts thorax, axilla, heait: vital signs, lungs, breast, upper extremities. oeIdeal position for the induction of spinal anesthesia Sitting Position Positions EE = * Sitting position -pationt should sit on the table wih knees resting on the edge, + fogs Ranging over the side and feet supported by a stool below