POSITIONS USED IN NURSING PATIENTSCLIENTS POSITIONS USED IN

POSITIONS USED IN NURSING PATIENTS/CLIENTS

POSITIONS USED IN NURSING � Good body posture or normal body alignment is very vital to the proper functioning of the body. Body alignment refers to the condition of the joints, tendons, ligaments and muscles in various body positions-whether standing, sitting or lying. When the body is in good alignment, undue strain is not exerted on the musculoskeletal system. � A healthy person assumes the position that is most comfortable without even thinking about the constant changes. However, in sickness, patients are not always able to independently move and position themselves hence need the assistance of the nurse.

POSITIONS USED IN NURSING Position changes alleviate pressure on pressure areas and enhance circulation, facilitates drainage from the lungs as well as bowel movement. Proper positioning also allows the health worker to: 1. Make patients as comfortable as possible 2. Prevent complications such as contractures and pressure sores. 3. Make parts of the client’s body available for treatment or procedures 4. Facilitate client’s recovery e. g. postural drainage Whatever the reason for positioning or changing of position, good body alignment is the watch word. �

POSITIONS USED IN NURSING Guidelines for Positioning Patients in Bed 1. Supportive devices should be used according to the individual’s body and physical ability. E. g. a patient who is muscular and have adequate adipose tissue in the lumber regions may not require support in this area but an emaciated patient does. 2. Frequently change the position of the helpless patient every 2 -4 hours to enhance blood circulation and also to prevent skin breakdown

POSITIONS USED IN NURSING 3. Provide skin care for pressure areas created in the previous positions; treat pressure areas that bear the body’s weight. 4. Ensure that the foundation of the bed is firm, clean and the mattress is dry always. 5. When not contra-indicated, encourage or provide range of motion exercises for the patient’s major joints each time his/position is changed.

POSITIONS USED IN NURSING � The positions used in nursing patients are: 1. Fowler’s position i. High Fowler’s position ii. Semi-Fowler’s position 2. Supine/Recumbent position 3. dorsal positions 4. Lateral/Side-lying position 5. Semi-prone position 6. Prone position 7. Lithotomy position 8. Knee-chest (genu-pectoral) position 9. Tredelenberg position 10. Reverse tredelenberg position

Fowler’s Position – is assumed both for comfort and for therapeutic purposes. There are two adaptations of the fowler’s position: High Fowler’s/Sitting/cardiac/ orthopnoeic Position. bed is elevated and inclined at an angle of between 60° and 90° to the bed like sitting in a chair. A heart/cardiac table on which is a pillow, a call bell and at times a sputum mug is placed in front of the patient to ensure support when the patient leans forward to rest on it.

Fowler’s Position bed ridden patients usually find it easier to eat, watch television and chat in this position.

POSITIONS USED IN NURSING � This position allows for maximum expansion of the chest and also helps patients with exhalation difficulty as they can press their chest against the table during exhalation. Also, bed ridden patients usually find it easier to eat, watch television and chat in this position. � Semi-Fowler’s position: in this position, the head of the bed is inclined at an angle of 30°-45° It allows for chest expansion and is used for cardiac and respiratory conditions as well. In these two positions, the main weight of the body is exerted on the buttocks, then the sacrum, heels and the scapulae.

POSITIONS USED IN NURSING � To assume these position, pillows are placed under the lumber region, the upper back, the head, the thigh and the also a small pillow under the heels. A trochanter roll is placed lateral to each femur. A foot board on the bed supports the feet to prevent plantar flexion and then later foot drop.

POSITIONS USED IN NURSING � Supine position: The supine position is assumed without a pillow after lumber puncture and also in spinal injuries. This position is also use when examining the anterior part of the body.

POSITIONS USED IN NURSING � The semi-recumbent position, the patient lies on his back with two or more pillows; the bed rest may be used in a reclining position. It is used in nursing surgical and medical conditions such as abdominal surgeries, abdominal distension and in convalescents

POSITIONS USED IN NURSING � Prone position: the patient lies flat on the abdomen with the legs extended and the face turned to the side and the arms flexed at the sides. A small pillow is put under the ankle to lift the toes in order not to press them into the mattress. The feet are also supported with a foot board. The prone position is used � to dry P. O. P, � to relieve pressure on areas of the back in preventing pressure sores, � for nursing clients with fractured spines � For patients with burns and other injuries at the back � For comfort and during sleep in some patients

Prone position

POSITIONS USED IN NURSING The Lateral or Side Lying Position: the client lies on his side with the upper leg flexed and the arms in front. It is used � For comfort during rest and sleep � To relief pressure from the back of the head, scapulae, sacrum and the heel � To promote drainage of saliva or secretions in unconscious patients to prevent aspiration � For examination of the rectal, vaginal and perineal regions � Used when giving enema � For insertion of suppository and flatus tube

POSITIONS USED IN NURSING Dorsal position: the client lies flat on the back with legs flexed and feet flat on the bed. It is used � For gyanaecological examinations � Insertion of urethral catheters � Semi – Prone/Sim’s/Recovery Position: to assume this position, the client lies half way between the lateral and the prone position. The lower knee is slightly flexed and also the hip at 90°. It can be used � For vaginal and rectal and vaginal examinations � To facilitate drainage in from the mouth of unconscious patients � To provide comfort for the pregnant woman in the last trimester of pregnancy

Lateral position

� Lithotomy Position: a client in the lithotomy position lies on her back with the legs flexed at 90° at the hip and the knees; the feet are placed in stirrup. It is used for gyanaecological operation and in the labour ward for delivery and the evacuation of the uterus.

� The Tredelenburg Position: the patient lies on the operation table in the recumbent position with the arms by the sides. The foot section of the table is dropped down and the legs are strapped on it to secure them. This position can be used on the ward to treat shock for gynaecological, pelvic and rectal examinations. In the reverse Tredelenburg, the head end of the bed is raised.

The Knee-chest/Genu-pectoral position; the client kneels on the bed with thighs vertical and chest resting on a firm pillow. The head is turned to one side and the hands are flexed around the head or on the bed. Used for vaginal and rectal examination, high colonic irrigation and in replacing dropped organ in visceroptosis.

BED MAKING � This is the art and science using beddings and bed accessories to make beds for comfort and also to facilitate/aid patients’ recovery. Some principles that guide bed making are: Ø All requirements for bed making should be collected before starting the procedure Ø Two nurses are usually required and they should work in harmony, avoiding jerky movements and jarring of the bed. Ø The patient’s face must never be covered with sheets or blankets

BED MAKING � The patient must never be exposed � Extra assistance should be available and, if necessary, should be called upon to help lift the patient. � When pillows are being shaken, the nurse should turn away from the patient � Any conversation during bed making should included the patient and should not be on personal matters between the nurses.

BED MAKING Types of Beds Made to Nurse Patients � Simple unoccupied bed, � Simple occupied bed � Admission bed � Operation bed � Fracture bed � Cardiac bed � Amputation bed � Divided bed � Bed for drying of plaster of Paris � Tent bed