The most important action when assisting a patient to move around in bed is
In this guide for patient positioning, learn about the common bed positions such as Fowler’s, dorsal recumbent, supine, prone, lateral, lithotomy, Sims’, Trendelenburg’s, and other surgical positions commonly used. Learn about the different patient positioning guidelines, how to properly position the patient, and the nursing considerations and interventions you need to know. Show
What is Patient Positioning?Patient positioning involves properly maintaining a patient’s neutral body alignment by preventing hyperextension and extreme lateral rotation to prevent complications of immobility and injury. Positioning patients is an essential aspect of nursing practice and a responsibility of the registered nurse. In surgery, specimen collection, or other treatments, proper patient positioning provides optimal exposure to the surgical/treatment site and maintenance of the patient’s dignity by controlling unnecessary exposure. In most settings, proper positioning of patients provides airway management and ventilation, maintains body alignment, and provides physiologic safety. Goals of Patient PositioningThe ultimate goal of proper patient positioning is to safeguard the patient from immobility injury and physiological complications. Specifically, patient positioning goals include:
Guidelines for Patient PositioningProper execution is needed during patient positioning to prevent injury for both the patient and the nurse. Remember these principles and guidelines when positioning clients:
Common Patient PositionsThe following are the commonly used patient positions, including a description of how they are performed and the rationale: Supine or Dorsal Recumbent PositionSupine position, or dorsal recumbent, is wherein the patient lies flat on the back with head and shoulders slightly elevated using a pillow unless contraindicated (e.g., spinal anesthesia, spinal surgery). Supine (Dorsal Recumbent) Position
Fowler’s PositionFowler’s position, also known as semi-sitting position, is a bed position wherein the head of the bed is elevated 45 to 60 degrees. Variations of Fowler’s position include low Fowler’s (15 to 30 degrees), semi-Fowler’s (30 to 45 degrees), and high Fowler’s (nearly vertical). Fowler’s position has different variations.
Orthopneic or Tripod PositionOrthopneic or tripod position places the patient in a sitting position or on the side of the bed with an overbed table in front to lean on and several pillows on the table to rest on. Orthopneic or tripod position is useful for maximum lung expansion.
Prone PositionIn prone position, the patient lies on the abdomen with their head turned to one side and the hips are not flexed. Prone position is comfortable for some patients.
Lateral PositionIn lateral or side-lying position, the patient lies on one side of the body with the top leg in front of the bottom leg and the hip and knee flexed. Flexing the top hip and knee and placing this leg in front of the body creates a wider, triangular base of support and achieves greater stability. An increase in flexion of the top hip and knee provides greater stability and balance. This flexion reduces lordosis and promotes good back alignment. Lateral position.
Sims’ PositionSims’ position or semi-prone position is when the patient assumes a posture halfway between the lateral and the prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. The upper leg is more acutely flexed at both the hip and the knee than is the lower one. Sims’ position
Lithotomy PositionLithotomy is a patient position in which the patient is on their back with hips and knees flexed and thighs apart. ADVERTISEMENTS Lithotomy position
Trendelenburg’s PositionTrendelenburg’s position involves lowering the head of the bed and raising the foot of the bed of the patient. The patient’s arms should be tucked at their sides
Reverse Trendelenburg’s PositionReverse Trendelenburg’s is a patient position wherein the head of the bed is elevated with the foot of the bed down. It is the opposite of Trendelenburg’s position.
Knee-Chest PositionKnee-chest position can be in a lateral or prone position. In lateral knee-chest position, the patient lies on their side, the torso lies diagonally across the table, and the hips and knees are flexed. In prone knee-chest position, the patient kneels on the table and lowers their shoulders onto the table, so their chest and face rest on the table. Lateral knee-chest position. Can also be done prone.
Jackknife PositionJackknife position, also known as Kraske, is wherein the patient’s abdomen lies flat on the bed. The bed is scissored, so the hip is lifted, and the legs and head are low.
Kidney PositionIn the kidney position, the patient assumes a modified lateral position wherein the abdomen is placed over a lift in the operating table that bends the body. The patient is turned on their contralateral side with their back placed on the edge of the table. The contralateral kidney is placed over the break in the table or over the kidney body elevator (if an attachment is available). The uppermost arm is placed in a gutter rest at no more than 90º abduction or flexion. Right lateral kidney position
Support Devices for Patient PositioningThe following are the devices or apparatus that can be used to help position the patient properly.
Documenting Patient PositioningDocumenting change of patient position in the patient’s chart. Note the following:
Cheat Sheet for Patient PositionsThe section below is a nursing cheat sheet for different conditions or procedures and their appropriate patient position with rationale, including a downloadable copy of the different positions above. Patient positioning cheat sheet Click on the image to enlargeClick on the image to enlargePatient positioning cheat sheet for different conditions and procedures Condition/ProcedurePatient PositionRationale & Additional InfoBronchoscopyAfter: Semi-Fowler’sTo reduce aspiration risk from difficulty of swallowingCerebral angiographyDuring: Flat on bed with arms at sides; kept still.After: Extremity in which contrast was injected is kept straight for 6 to 8 hours. Flat, if femoral artery was used. Apply firm pressure on site for 15 minutes after the procedure.Myelogram (air contrast)Pre-op: surgical table will be moved to various positions during test.Post-op: Head of bed (HOB) is lower than trunk. To disperse dye.Myelogram (oil-based dye)Pre-op: surgical table will be moved to various positions during test.Post-op: Flat on bed for 6 to 8 hours To disperse dye.To prevent CSF leakage.Myelogram (water-based dye)Pre-op: surgical table will be moved to various positions during test.Post-op: HOB elevated for 8 hours. To prevent dye from irritating the meninges.Liver biopsyDuring: Supine with RIGHT side of upper abdomen exposed; RIGHT arm raised and extended behind and and overhead and shoulder.After: RIGHT side-lying with pillow under puncture site. To expose the area.To apply pressure and minimize bleeding. Lung biopsyFlat supine with arms raised above head and hands health together; head and arms on pillow.To expose and provide easy access to the area.Renal biopsyPRONE with pillow under the abdomen and shoulders.To expose the area.Arteriovenous fistulaPost-op: Elevate extremityDon’t sleep on affected side; encourage exercise by squeezing a rubber ball.Don’t use AV arm for BP reading and venipuncture. Peritoneal DialysisWhen outflow is inadequate: turn patient from side to side.Turning facilitates drainage; check for kinks in the tubing.Possible to have abdominal cramps and blood-tinged outflow if catheter was placed in the last 1-2 weeks. What are the steps taken to assist a patient in moving from a lying position to a sitting position?Put one of your arms under the patient's shoulders and one behind the knees. Bend your knees. Swing the patient's feet off the edge of the bed and use the momentum to help the patient into a sitting position. Move the patient to the edge of the bed and lower the bed so the patient's feet are touching the ground.
Which method is used for patients that are not able to assist with repositioning?If a patient is unable to assist with repositioning in bed, follow agency policy regarding “no patient lifts” and the use of mechanical lifts for complex and bariatric patients.
When lifting and moving a patient up in bed a lift sheet should be used where is the best place for the lift sheet?The goal is to pull, not lift, the patient toward the head of the bed. The 2 people moving the patient should stand on opposite sides of the bed. To pull the person up both people should: Grab the slide sheet or draw sheet at the patient's upper back and hips on the side of the bed closest to you.
When transferring a client from a bed into a wheelchair where should the wheelchair be placed?Position and lock the wheelchair close to the bed. Remove the armrest nearest to the bed, and swing away both leg rests. Help the patient turn onto his or her side, facing the wheelchair. Put an arm under the patient's neck with your hand supporting the shoulder blade; put your other hand under the knees.
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