What are 2 reasons for putting a client in a specific position during or after a procedure, surgery or injury?
- prevent a complication (ex: prevent bleeding by placing a client with a liver biopsy on the right side)
- promote something good (ex: promote good breathing/oxygen exchange by placing a client in semi- or high-fowler's position)
What are contractures and what causes them?
Contractures are joint and muscle rigidity from staying in the same position for too long.
What are pressure ulcers and what causes them?
Pressure ulcers are injuries of the skin and tissue due to prolonged pressure on the skin.
Why do we change the client's position by turning them at least every 2 hours?
Change position every 2 hours by turning to:
- prevent pressure ulcers (decubitus ulcers/bed sores)
- prevent pneumonia by breaking up mucus secretions in lungs
- prevent contractures
What does HOB mean?
Head of Bed refers to the position that the head of the bed is in.
ex: "HOB elevated" or "HOB flat"
What is the most common position?
The most common position is Fowler's position: HOB is elevated
This position prevents pressure of the diaphragm on the lungs and heart to promote breathing. It is common with cardiac and respiratory diseases.
What position is:
- low- Fowler's
- standard Fowler's
low-Fowler: HOB elevated 15 - 30 degrees
semi-Fowler's: HOB elevated 30 - 45 degrees
standard Fowler's: HOB elevated 45 - 60 degrees
high-Fowler's: HOB elevated 60 - 90 degrees
What position is supine?
Supine is on the back.
What position is prone?
Prone is on the stomach.
What position is semi-prone or sim's?
Semi-prone or sim's is forward side-lying.
What position is right lateral recumbent?
Right lateral recumbent is on the right side.
What position is left lateral recumbent?
Left lateral recumbent is on the left side.
What position is lithotomy?
Lithotomy is on the back with legs apart.
What position is Trendelenburg?
Trendelenberg is supine with head lower than the feet.
What position is reverse Trendelenburg?
Reverse Trendelenberg is supine with head higher than the feet.
What position is best after a cardiac catheterization?
Position after a cardiac catheterization is supine with leg straight for 2-6 hours afterwards.
This prevents bleeding and promotes good circulation.
What position is best during and after tube feedings?
Position during and after tube feeding: semi-Fowler's: HOB elevated at least 30 degrees
This prevents aspiration.
What position is best after a liver biopsy?
After a liver biopsy place on right side with pillow splint for 2 hours.
This is to prevent bleeding since the liver is vascular and on the right side.
What position is best during a thoracentesis?
Position during a thoracentesis is:
- leaning over the bedside table or
- in bed with the affected side up
This is to promote separation of the ribs in order to reach the pleural space better and to get the excess fluid out.
What position is best with most neurological problems?
For neurological problems: semi-Fowlers: HOB elevated and head midline
This is to prevent increased intracranial pressure and promote blood flow to the brain.
How should a client with spinal cord injuries be moved?
For spinal cord injuries logroll keep the head in midline with the rest of the body when moving
This is to prevent additional spinal injuries.
What position is best for varicose Veins?
Varicose veins: eleVate Veins - keep legs up to prevent swelling
This is to promote blood circulation because the valves of the veins are not strong enough to move the blood back to the heart.
(Remember the V in eleVate and Veins)
What position for the legs is best for peripheral arterial disease?
Peripheral arterial disease: dAngle Arteries - keep legs down
This is to promote blood circulation because the arteries are hardening making them stiff and unable to dilate well.
(Remember the A in dAngle and Arteries)
What is the best position after a hip replacement?
Hip replacement position:
- legs abducted (apart) using a wedge pillow
- avoid hip flexion > 90 degrees ( no bending over, no sitting on a low toilet)
Prevent hip from dislocating.
What is the best position after an amputation?
After an amputation elevate extremity for 24 hours post-op
This is to prevent edema.
What is the best position 24 hours after a leg amputation?
For leg amputations help client get into the prone position for 20-30 minutes daily.
This is to prevent a contracture.
What is the best position for an enema?
Enema: left sim's position
This position will allow gravity to help fluid come back out.
What are foot boots?
Foot boots help to keep the foot flexed at the proper angle and to prevent foot drop.
Remove once per shift to assess for skin breakdown and joint mobility.
What are hand rolls?
Hand rolls help to keep the fingers slightly flexed to prevent contractures.
What are pillows for?
Pillows help to support and elevate body parts to prevent contractures and pressure ulcers.
Make sure the pillow is not too big or too small for the area being supported.