Positioning A Patient Horizontal Recumbent or Supine Position

Positioning A Patient

Horizontal Recumbent or Supine Position �Used for examination or treatment of the front or anterior part of the body �Patient lies flat on back with legs slightly apart �One small pillow is allowed under the head �Arms are flat at side of body �Drape patient with large sheet or drape �Do not tuck in sheet at sides or bottom �Drape is left loose on all sides to facilitate examination or treatment

Prone Position �Used for examination of back or spine �Patient lies on abdomen with head turned to either side �Small pillow is placed under the head �Arms are flexed at the elbows and positioned on either side of the head or positioned along side of body �Drape patient with large sheet or drape �Do not tuck in sheet at sides or bottom �Drape is left loose on all sides to facilitate examination or treatment

Sims’ or left lateral position �Used for simple rectal or sigmoidoscopic examinations, enemas, rectal temperatures, and rectal treatments �Patient lies on left side �Head rests on small pillow and is turned to side �Left arm is extended behind the back �Right arm is bent at elbow and placed in comfortable position in front of the body �Left leg is bent or flexed slightly �Cont…. .

�Right leg is bent or flexed sharply and brought up to the abdomen �Drape patient with on large sheet or drape �Do not tuck in sheet at sides or bottom �Drape is left loose on all sides to facilitate examination or treatment �Two sheets can also be used to drape patient �One sheet covers upper part of body �Second sheet covers thighs and legs and meets top sheet �Sheet with a hole at examination site may also be used

Knee-chest position �Used for rectal examinations – usually a sigmoidoscopic exam �Patient lies on abdomen or in prone position �Patient raises buttocks and abdomen until weight is resting on upper chest and knees �Head rests on small pillow and is turned to either side �Arms are flexed slightly at the elbows and positioned by the sides of the head �Knees are separated slightly �Cont….

�Thighs are at right angles to the table/bed �Draping can be done different ways �One large sheet can be used to cover the patient �A large sheet with a hole at the rectal area can be used �Two smaller sheets or drapes that meet at the rectal area can be used �Do not tuck in sheets a sides or bottom �Drape is left loose on all sides to facilitate examination or treatment �Cont….

�Special Safety precautions �Do not place patient in this position until the physician is ready to begin the examination �Remain with patient at all times while patient is in knee-chest position �Difficult position to maintain and should be used only as long as absolutely necessary. �After examination is complete, place patient in prone position and then turn over to supine �Watch closely for signs of dizziness or discomfort

Fowler’s position �Used to facilitate breathing; relieve distress; encourage drainage; and examine the head, neck and chest �Patient lies on back with head elevated at different angles �Low-Fowler’s: head elevated at 25 degree angle �Mid-Fowler’s or semi-Fowler’s: head elevated at 45 degree angle �High-Fowler’s: head elevated at 90 degree angle �Place small pillow under patient’s head �Cont…

�Keep legs flat on the table but flex knees slightly and place small pillow under knees �Drape with a large sheet or drape �Do not tuck in sheet at sides or bottom �Drape is left loose on all sides to facilitate examination or treatment

Lithotomy �Used for vaginal examinations, Pap tests, urinary catherization, cystoscopic examinations, and surgery of small pelvic area �Patient lies on back with head on small pillow �Arms rest at sides of body �Patient slides buttocks down on table to where lower end of table folds down or pulls out �Place sheet or drape over patient in diamond position �Put one corner at chest, one corner between legs, and each of other two corners at sides �Wrap each side corner around a foot

Cont… �Flex and separate the knees �Place feet in stirrups on table �Drop lower end of the table or push it in if this is possible �To remove patient from position �Raise end of the table or pull it out so it is level �Lift feet out of stirrups and place on table �Ask patient to slide up on table.

Dorsal recumbent position �Similar to lithotomy position and used for same purposes �Patient is on table without stirrups �Feet are separated but flat on the table �Knees are bent at an angle and separated �Draping is in the same diamond pattern used for lithotomy

Trendelenburg position �Requires a special table or bed and assistance �Care must be taken so patient does not slide off table or bed �Standard trendelenburg position �Used for circulatory shock because it increases circulation of the blood to the brain and head �Patient lies flat on back with head on small pillow �Arms are flat at sides �Entire bed or table is elevated at feet Power table or electric bed raises the feet at an angle so head is lower than feet � Blocks can be placed under the lower frame of a bed �

Surgical trendelenburg �Used for surgery on pelvic organs and pelvic treatments �Patient lies flat on back with head on small pillow �Arms are flat at sides �Top of table is lowered at and angle to lower the head �Bottom of table is lowered at a 45 degree angle to incline legs and feet downward �Straps are frequently used to hold patient in position

Draping for Trendelenburg �Usually, one large sheet is used to drape patient �For surgical procedures, use a large sheet with a hole to expose the surgical area �Two smaller sheets or drapes can also be used and positioned to meet at surgical or treatment area �Do not tuck in sheet at sides or bottom �Drape is left loose on all sides to facilitate examination or treatment �Safety precautions: use straps to secure patient in this position, remain with the patient at all times

Jackknife (proctologic) position �Used for rectal surgery or examinations or for back surgery and treatments �Requires a special table that will break in the middle �Care must be taken so patient will not slide off or be injured in any way �Patient lies in prone position �Secure safety straps on the table around patient �Lower top of table so the feet and legs are inclined at a downward angle �Cont…

Draping for jackknife �One large drape or sheet can be used to cover patient �For surgical procedure, use a large sheet with a hole at the surgical site �Two small sheets can also be used and positioned to meet at the surgical or treatment area �Do not tuck in sheet at sides or bottom �Drape is left loose on all sides to facilitate examination or treatment �Special safety precautions: remain with patient at all times, watch for signs of dizziness, pain, or discomfort

Basic principle for positioning patients �Determine the examination, treatment, or procedure to be performed �Determine which position or positions will be required �Prepare the examination table by wiping it with disinfectant and covering it with table paper �Prepare patient correctly: follow agency policy for procedure or treatment �Ask patient to remove all clothes including underwear �Tell patient to put on exam gown �Instruct the patient to leave the opening in the front or back depending on the exam �Ask patient to void to prevent bladder discomfort during the exam or treatment

�Assist patient onto table �Position patient in correct position �Drape patient correctly for position �To change positions �Hold up drape while patient turns �Always ask patient to turn toward you � Brace your body against side of table � Be alert so patient does not roll off table �Observe all safety precautions �Watch patient for signs of dizziness, pain, or discomfort

�When examination or treatment is complete, assist patient to a sitting position slowly �Assist patient off table �Clean and replace all equipment �Wash hands �Record all required information