POSITIONS:
INTRODUCTION:
INTRODUCTION:
• Therapeutic positions are used to promote comfort of the client
• Proper turning and positioning allows the health care provider to
make clients as comfortable as possible, prevent contractures
and pressure sores.
• Proper position help in diagnostic tests or surgical intervention
and procedure and allow clients greater access to their
environment.
DEFINITION:
Definitions:
• Positioning is defined as placing the person in such a way to
perform therapeutic interventions to promote the health of an
individual.
• Positioning defined as placing the person in a proper body
alignment for the purpose of preventive, promotive curative and
rehabilitative aspects of health.
PURPOSE OF POSITIONING:
Purpose of Positioning:
• To provide comfort to the patient.
• To relieve pressure on various parts.
• To improve circulation.
• To prevent formation of deformity.
• To carry out investigations.
• To perform surgical and medical investigations .
• To prevent pressure sores.
• To provide proper body alignment.
• To conduct delivery/labor.
• To carryout nursing interventions.
PRINCIPLES OF POSITIONING:
Principles of Positioning:
• systematic and orderly.
• Cooperation between two.
• Follow safety measure to prevent accidents.
• Active participation.
• Using a right technique at right time.
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.
TYPES OF POSITION USED:
Types of Positions Used:
• Dorsal position.
• Dorsal recumbent position.
• Lithotomy position.
• Lateral position.
• Prone position.
• Sims position.
• Knee-chest position.
• Trendelenburg's position.
• Fowler's position.
TYPES OF PATIENTS NEED SPECIAL CARE:
Types of Patients Need Special Care:
• Unconscious patient
• Infant and children.
• Hemiplegic and paraplegic patients.
• Immediate postoperative patients
• Orthopedic patients.
• Cardiac patients
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
muscle strain.
• Avoid prolonged flexion of any one body segment by changing the position at least every two hours.
• Reduce the pressure caused by bodyweight of his or her body or object by changing the position and
using protective devices.
PRELIMINARY ASSESSMENT:
Preliminary Assessment :
• Check the patient's general condition.
• Check the physicians order for limited movements.
• Assess the self-care ability of an individual.
• Arrange the comfort devices near the bedside.
• Identify the deformed extremity.
• Support the immobilize area during positioning.
• Identify the rationale before positioning.
Equipment:
• Extra manpower if needed.
• Extra pillows.
• Sheets and sheet rolls.
• Comfort devices such as backrest:
• cardiac table, sandbag, etc.
PROCEDURE:
Procedure:
• Explain the procedure to the patient.
• Provide privacy.
• Arrange the articles and manpower (if needed).
• Untie the bedsheets.
• Turn/lift/ambulate gently.
• Place and support with extra pillows under pressure points.
• Special care taken at pressure areas.
• Cover the patient with top sheet.
• Hand wash.
• Record the time, position and condition of the skin.
SUPINE/ DORSAL POSITION:
Supine/Dorsal 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.
Cont;
Indications :
• The usual position used by the patient.
• Used for examination of the chest and abdomen.
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.
• Align the patient's body in good position
• Support the body parts in good alignment for comfort when the patient
is paralyzed.
Cont;
Contraindications :
• Elderly patients.
• Patients with operation on abdomen, breast and thorax.
• Prone to hypostatic pneumonia.
• Patients with long-standing illnesses and neurological conditions.
DORSAL RECUMBENT POSITION:
Dorsal Recumbent Position:
Patient lies on back, knees fully-flexed, thighs flexed and externally
rotated feet flat on the bed.
Cont;
Indication:
• Examination of vagina and rectum
• Catheterization and care
• For doing procedures in the rectum, vulva and vagina
Procedure:
• Place the patients on back in bed with no or more pillows under the
head and one pillow under the knees of maintain his position by
elevating the top of bed on blocks.
• 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.
LITHOTOMY POSITION:
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.
Cont;
Indication:
• Vaginal examination.
• Pap smear
• Position during delivery for many women.
• Surgical procedures of genitourinary system.
Procedure:
• Explain the procedure to the patient
• Provide privacy.
• Position the patient in the on his back with one pillow under the head.
• Keep the legs well-separated and the thighs ate well flexed on the abdomen and the legs on the thighs
• Buttocks are kept on the edge of the table and the lega supported on stirrups
Contraindications:
• Contraindication of this position are patients with arthritis or joint deformity may
PRONE POSITION:
Prone position:
Position in which the patient lies on the abdomen with the head
turned to one side with one small pillow under the ankle.
Cont;
Indication:
• This position used postoperatively to prevent aspiration of saliva
and mucus
• Used in postoperative cases, tonsils, vesicovaginal fistula and
spinal cases.
• To prevent bedsores
• To relieve abdominal distention
• Used for patients having injuries and burns on back
Cont;
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.
Contraindications:
• This position is not well-tolerated by the elderly or patients with
cardiovascular or respiratory problems.
LATERAL POSITION:
Lateral Position :
Patient lies on left side with legs flexed at thighs. The upper leg is
more than flexed more than the lower. A Pillow is kept in front of the
abdomen and at the back and under the upper leg.
Cont;
Indication:
• lateral position is used the giving hack care enema and colonic
irrigation.
• Used for examination of perineum of rectum inserting
suppositories.
• For taking rectal temperature.
• For change of position.
• Lateral position is a relaxing position.
• Giving back care.
Cont;
Procedure:
• Explain the procedure to the patient.
• Provide privacy
• For left lateral position place the pattern on left side with buttocks to the
edge of bed, both thighs flexed and left arm underneath.
• 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 foam pads under the ankles of lower legs to reduce
the pressure on ankles.
• Align the patient in good position and make sure the patient is not lying on his
arm
• Support the body parts in good alignment and comfort.
SIMS POSITION:
Sims Position :
Sims position is similar to the lateral position except that the
patient's weight is on the anterior aspects of the patient's shoulder
girdle and hip. The patient's lower arm is behind him and the upper
arm is flexed at the shoulder and elbow.
Cont:
Indications:
• This position is used for unconscious patient.
• It is used for rectal examinations.
• Used for vaginal examination.
• Used for relaxation and antenatal exercise.
Cont;
Procedure:
• Explain the procedure to the Patient
• Collect articles need as the bed Side.
• Provide privacy
• Place the patient on the side.
• One pillow is placed under the head with the left check rest on it.
• 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.
Contraindications:
• Patients with deformities of the hip or knee may be unable to assume this position .
KNEE CHEST POSITION:
KNEE CHEST POSITION:
• The patient rests on the knees and the chest.
• The body is at 90° angle to the hips with back straight, the arm
above the head, and the head turned to one side.
• The abdomen remains unsupported.
Cont;
INDICATION:
• Used for vaginal and rectal examination .
• Used in first aid treatment in cord prolapse or retroverted uterus
• As exercise for postpartum and gynecology patients.
Cont;
Procedure:
• Explain the procedure to the patient.
• Collect the needed articles at the bed side.
• Make the patient rests on the knees and chest.
• The head is turned to one side with the check on a pillow .
• The arms should be extended on the bed and flexed as 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.
Contraindications:
• Patients with cardiovascular and respiratory problem cannot assume this
position.
TRENDELENBURG’S POSITION:
Trendelenburg's Position :
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 leg hang downward Over tha
end of the table.
Cont:
Indications:
• Used in emergency situations like shock and hemorrhage.
• This position is used for vaginal surgeries.
• Used to displace intestines from pelvic cavity in to upper
abdomen.
• Used during operations on the pelvic organs.
• To arrest bleeding from lower limb.
Cont;
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.
• The body is on inched plane with hips higher than the bed.
• The knees are flexed and the legs hang downward over the end of the table.
• The patient is carefully supported to prevent slipping.
• Draping done depends upon the kind of operation to be performed
FOWLER’S POSITION:
Fowler's Position :
• Fowler's position is a sitting position in which the head is elevated,
at least, a 45 degree angle. Backrest 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.
Cont;
Indications:
• To relieve dyspnea.
• To improve circulation.
• To prevent thrombosis.
• Postoperatively to assist drainage from abdominal or pelvic cavity
• 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.
Cont;
Procedure:
• Explain the procedure to 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.
• Maintain this position elevate the head of bed to an angle from 45-60
degree angle (semi-Fowler) or 60-90 degree angle (high-Fowler).
• Elevate the knee rest to an angle of 15 degree or place a small pillow
under the knees.
