MEETING THE PHYSIOLOGICAL NEEDS OF

THE CLIENTS AND CAREGIVERS

MUSCULOSKELETALDISCOMFORT 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

High Fowler’sLow 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.