Nursing foundation
Topic: Positioning
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 of
the surgical/treatment site and maintenance of the
patient’s dignity by controlling unnecessary exposure.
• In most settings, positioning patients provide airway
management and ventilation, maintaining body
alignment, and provide physiologic safety.
Goals of Patient Positioning :
•The ultimate goal of proper patient positioning
is to safeguard the patient from injury and
physiological complications of immobility.
•Provide patient comfort and safety.
• Maintaining patient dignity and privacy.
• Allows maximum visibility and access.
Guidelines for Patient Positioning :
• Proper execution is needed during patient positioning to prevent injury for
both the patient and the nurse.
• Remember these principles and guidelines when positioning clients:
• Explain the procedure.
• Encourage client to assist as much as possible.
• Get adequate help.
• Use mechanical aids.
• Raise client’s bed.
• Frequent position changes.
• Avoid friction and shearing.
• Proper body mechanics.
Common Patient Positions:
• Supine or Dorsal Recumbent Position
• Fowler’s Position
• Orthopneic or Tripod Position
• Prone Position
• Lateral Position
• Sims’ Position
• Lithotomy Position
• Trendelenburg’s Position
• Reverse Trendelenburg’s Position
• Knee-Chest Position
• Jackknife Position
Supine position :
•Supine 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).
• Most commonly used position. Supine position is used for
general examination or physical assessment.
• Support for supine position. Small pillows may be placed
under the head to and lumbar curvature. Heels must be
protected from pressure by using a pillow or ankle roll.
Prevent prolonged plantar flexion and stretch injury of the
feet by placing a padded footboard.
• Variation in position. In supine position, legs may be
extended or slightly bent with arms up or down. It provides
comfort in general for patients under recovery after some
types of surgery.
Fowler’s Position
• Fowler’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).
• Use a footboard. Using a footboard is recommended to
keep the patient’s feet in proper alignment and to help
prevent foot drop.
• Promotes lung expansion. Fowler’s position is used for
patients who have difficulty breathing because in this
position, gravity pulls the diaphragm downward allowing
greater chest and lung expansion.
• Fowler’s position is useful for patients who have cardiac,
respiratory, or neurological problems and is often
optimal for patients who have nasogastric tube in place.
Orthopneic or Tripod Position:
•Orthopneic 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 position is particularly helpful to
patients who have problems exhaling because
they can press the lower part of the chest
against the edge of the overbed table.
• . Patients who are having difficulty breathing
are often placed in this position because it
allows maximum expansion of the chest.
Prone Position:
•In prone position, the patient lies on the
abdomen with head turned to one side
and the hips are not flexed.
• support in prone. To support a patient lying in prone, place a
pillow under the head and a small pillow or a towel roll under
the abdomen.
• Prone position is the only bed position that allows full
extension of the hip and knee joints. It also helps to prevent
flexion contractures of the hips and knees.
• Prone position should only be used when the client’s back is
correctly aligned.
• Prone position also promotes drainage from the mouth and
useful for clients who are unconscious or those recover from
surgery of the mouth or throat.
Lateral Position:
• In 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. Increase in flexion of the
top hip and knee provides greater stability and balance.
This flexion reduces lordosis and promotes good back
alignment.
• Support pillows needed. To correctly position the
patient in lateral position, use of support pillows are
needed.
• Lateral position helps relieve pressure on the sacrum
and heels especially for people who sit or are confined to
bed rest in supine or Fowler’s position.
• In this position, most of the body weight is distributed to
the lateral aspect of the lower scapula, the lateral aspect
of the ilium, and the greater trochanter of the femur.
Sims’ Position:
•Sims’ position or semiprone 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.
• Support proper body alignment in Sims’ position by placing a
pillow underneath the patient’s head and under the upper arm
to prevent internal rotation. Place another pillow between legs.
• It is often used for clients receiving enemas and occasionally
for clients undergoing examinations or treatments of the
perineal area.
• Sims’ may be used for unconscious clients because it facilitates
drainage from the mouth and prevents aspiration of fluids.
• It is also used for paralyzed clients because it reduces pressure
over the sacrum and greater trochanter of the hip.
to be continued…
