FUNDAMENTALS OF NURSING

PROCEDURE 1
HANDWASHING
POSITIONING & DRAPING
VITAL SIGNS
POSITIONING
AND
DRAPING
Objectives:
1. Define positioning and draping.
2. Enumerate the special consideration in
performing positioning and draping.
3. Perform the different position according to
its indication or uses.
POSITIONING
- is the technique of placing the patient on bed
or examination table safely, comfortably,
conveniently and effectively in preparation for
any procedure.

DRAPING
- is the manner of exposing only the necessary
body parts to be examined, treated or cleaned.
 Special Consideration
• A comfortable position will help the patient relax.
• Do not leave a patient who is:
– Weak
– Dizzy
– At risk for falling
• Keep the patient covered with appropriate
draping.
• Assess client’s physical abilities (e.g. muscle
strength)
 Support Devices
• Pillows
• Mattresses
• Bed boards
• Chair beds
• Foot boot
• Foot board
 PRE-PROCEDURE
ACTION

1. Verify doctor’s order.

2. Perform hand washing.

3. Prepare all materials needed.

4. Identify the patient.

5. Introduce self to the patient

.
6. Provide privacy for the patient.

7. Explain procedure to the patient.

8. Position patient
ERECT/UPRIGHT/ STANDING POSITION
• Typical position for examination of
- male patient’s genitals
- assessment for inguinal
hernia
• For examination of the vertebral and
spinal columns.
• Allow patient to walk to observe the
client’s gait.
• Facilitates examination the body
contours.
 ERECT POSITION PROCEDURE
ACTION
1. Assist the patient to stand with either slippers on or
bare feet on a piece of paper.
2. Untie the gown and leave the uppermost tape. Fold
back the gown over both shoulders towards the front.
 SUPINE POSITION
• Also called Horizontal Recumbent Position or Dorsal
Position
• First position before turning to other side
• Used for most physical examinations.
• Position for the examination of the: anterior thorax,
head, breast and extremities.
• Contraindicated to patients with dyspnea or at risk
aspiration.
 SUPINE POSITION PROCEDURE
ACTION
1. Assist the patient to life flat on his/her back with legs
together, extended or slightly flexed.

2. Place one pillow under the head and a smaller one may be
placed under the knees.

3. Place the arms along the sides of the body or flexed.

4. Cover the patient to the shoulders with sheets hanging

loose at the side.
 DORSAL RECUMBENT POSITION
• Used in vaginal examination.
• Used when performing abdominal examination,
perineal care, catheterization and other treatments
done at the productive area.
DORSAL RECUMBENT PROCEDURE
ACTION
1. While patient is lying on his/her back, assist patient near the edge of the
bed.
2. Separate the legs, flex the knees so that the soles of the feet are flat on bed.
Place the arms either above the head or flex with the hands on the chest.

3. Place one pillow under the head.

4. Place the draping sheet diagonally on the patient so that the opposite
corner covers the legs. Fold back the top corner over the chest.

5. Wrap the corners on the right side around the right foot and do the same on
the left foot.
6. Fold the lower corner of the sheet back on the abdomen to expose the part
to be examined when the doctor is ready to do so.
 DORSAL LITHOTOMY
• Used for examination of pelvic, perineal and rectal area.
• Use during delivery of the baby and dilatation and
curettage.
• Contraindicated for patient with immobility arthritis and
joint deformity.
 DORSAL LITHOTOMY PROCEDURE
ACTION
1. Assist the patient to lie on his back. Buttocks should be
towards the folding edge of the table.
2. Insert leggings or stockinettes PRN.
3. Adjust the stirrups according to the size of the patient.
4. Separate the legs and flex the thighs deeply towards the
abdomen. Elevate the lower legs and support them with the
stirrups.

5. Raise the arms above the head or flex them with the hands
on the chest.
6. Drape as in dorsal recumbent.
 SIDE LYING POSITION

• The client lies on the side with his/her weight on the hip
and shoulder.
• Choice position for clients with pressure on the body
prominences of the back and sacral pressure sores.
• Contraindicated for patients with hip injury or other
orthopedic injury.
 SIDE LYING POSITION PROCEDURE
ACTION
1. Slide hands underneath the client. Move the client to one side of the bed by
lifting the client’s body toward the nurse by:
a. The trunk
b. Lower trunk
c. The legs
Do not drag the client across the sheet.

2. Roll the patient to a side-lying position by placing the client’s inside arm next
to the client’s body with palm the hand against the hip.
3. Cross the client’s outside arm and logroll the client’s outside shoulder and hip.

4. Place additional pillow to support the top leg, side leg; fully and equally
supporting the thigh, knee, ankle and foot.
5. Move the lower arm forward slightly at the shoulder and bend the elbow for
comfort. Place pillow behind the back.
 SIM’S/SEMI-PRONE POSITION
• Used for examination of rectum and colon.
• Used for procedures such as giving enemas and insertion of
rectal suppository or thermometer.
• May be used for unconscious clients; prevents aspiration of fluid
• Position of comfort for pregnant women.
• Contraindicated for patients with spinal injury.
 SIM’S POSITION PROCEDURE
ACTION
1. Assist the patient to lie on either side preferably on the
left with the body inclined forward.
2. Extend the left arm behind the back and flex the elbow
of the right arm forward.
3. Flex the right thigh towards the abdomen with the knee
drawn up higher than the left knee which is only slightly
flexed.
4. Lay out the draping sheet as in horizontal recumbent
position. Fold back or gather a side of sheet to expose the
area to be examined.
 PRONE POSITION
• Patient lies on abdomen with head turned to one side for
comfort.
• Promotes drainage from the mouth; used for unconscious
clients or client recovering from surgery of mouth or throat.
• Contraindicated after an abdominal surgery and to clients
with respiratory or spinal problems.
 PRONE POSITION PROCEDURE
ACTION
1. Help the patient to assume a horizontal recumbent position

2. Assist him to turn over onto the abdomen.

3. Turn the head to one side and arms at the sides or flex or
extends upwards.
4. Allow the feet to hang over the edge of the mattress or
support a pillow high enough to keep the toes from touching the
bed

5. Drape as in supine/horizontal position.

 SITTING POSITION

• Auscultation of heart & lungs

• Examination of head, eyes,
ears, nose & throat
• Parts of the neurological exam
• Drape sheet extended on lap
& legs
ORTHOPNEIC POSITION
• The client sits either in
bed or on the side of the
bed with an overbed
table across the lap.
• This position facilitates
respiration allowing
maximum chest
expansion.
 SEMI-FOWLER’S/FOWLER’S POSITION
• Also known as sitting position.
• Used to promote drainage or ease breathing.
• This position improves cardiac output and
promotes ventilation
• Contraindicated for spine or brain surgery
• Head rest is adjusted to desired height and
bed is raised slightly under patient's knees
• Semi-Fowler’s – 15 to 45 degrees
• High Fowler's – 90 degrees
SEMI-FOWLER’S/FOWLER’S POSITION
 SEMI-FOWLER’S/FOWLER’S POSITION
PROCEDURE
ACTION

1. Place the patient in a horizontal recumbent position

and elevate the head of the bed 450 or 900 angle.

2. Flex the knees slightly and support them with knee

rolls or pillow.

3. Drape as in dorsal horizontal position.

 MODIFIED TRENDELEBURG
POSITION
• The head is level with the body and legs are passively raised in
the supine position.
• The head is 30-40 degrees lower than the feet.
• Increase venous return to the heart It is used as an
immediate intervention to improve hypotension and
hypovolemic shock.
 MODIFIED TRENDELEBURG POSITION
ACTION
1. Assist the patient to a horizontal recumbent position

2. Elevate the foot of the bed so that the lower trunk is

higher than the head and shoulders.

3. Support the shoulders and knees and drape as in

horizontal recumbent position.
 KNEE-CHEST POSITION
• Client lies in prone with buttocks elevated and knees drawn
to the chest to accommodate a rectal procedure or
examination
• Contraindicated for clients with arthritis or other
deformities.
 KNEE-CHEST POSITION PROCEDURE
ACTION
1. Place the patient in a prone position, assist him to kneel
with the knees slightly separated.
2. Bend forward so that the chest is resting on the bed and
the thighs are perpendicular to the legs.
3. Turn the head to one side and place the arms either
above head or flex at the elbow and rest along side of the
head.

4. Drape the patient diagonally so that the area to be

examined is exposed.
 POST-PROCEDURE
ACTION

a. Return back the patient to comfortable position after the

procedure.

b. After care of supplies and equipment used.

c. Wash hands.

d. Document.
THANK YOU!