Patient Positioning

• Patient positioning is important for physical assessment.
• Supine position allows abdominal muscles to relax and provides easy access to peripheral pulse sites.
• Areas that can be assessed in the supine position include the head and neck, chest and lungs, breast and axillae, heart, and abdomen.
• Semi-Fowler’s position is a semi-sitting position with knees flexed and supported by pillows, used for respiratory, cardiac, and breast exams.
• Perform the examination as quickly as possible during lithotomy.
• Keep the client well-draped during lithotomy.
• Lithotomy may require assistance to get into this position.
• Lithotomy may not be well-tolerated by elderly clients.
• Lithotomy is an exposed position, which can lead to embarrassment.
• Lithotomy involves the examination of the female genitalia, reproductive tracts, and rectum.
• Prone position is a position where the client lies down on the abdomen with the head to the side, primarily used to assess the hip joint.
• The prone position is not tolerated by patients with problems in the cardiac and respiratory systems.
• Sitting position allows evaluation of the areas: head and neck, chest and lungs, back, breast and axillae, heart, and extremities.
• Sitting position permits full expansion of the lungs, allowing assessment of symmetry of upper body parts.
• Dorsal recumbent position is a position where the client lies down on an examination table with knees bent and legs separated, more comfortable for some patients with back or abdominal pain.
• Areas that can be assessed in the dorsal recumbent position include the head and neck, chest and lungs, heart, breast and axillae, and extremities and peripheral pulses.
• The Lithotomy position involves the client leaning on the back with the hips at the edge of the examination table, feet supported by stirrups.
• The knee-chest position is the best position for examining the male rectal and prostate areas.
• The left lateral position involves the client kneeling on the examination table with the weight of the body supported by the chest and knees.
• The standing position is the best position for assessing spine and joints (ROM).
• Dorsal Recumbent According to Dillon involves lying on the back with knees slightly flexed to relax abdominal muscles.
• The Sim’s lateral position involves the client lying on the right or left side with the lower arm behind and the upper arm flexed at the shoulder and elbow.
• The Sim’s lateral position may be difficult to assume if the client has arthritis.
• The knee-chest position may be uncomfortable and embarrassing, limiting the time as much as possible.
• The Sim’s lateral position is contraindicated if the client has had a total hip replacement.
• The standing position is a normal, comfortable, resting posture that allows assessment of posture, balance, gait, and male genitalia.
• In the knee-chest position, the client kneels on the examination table with the arms placed above the head which is turned to one side.
• In the Sim’s lateral position, the lower leg is slightly flexed at the knee and the upper leg is flexed at a sharper angle and pulled forward.
• Body Mechanics - the coordinated use of the body parts to produce motion & maintain their equilibrium in relation to the skeletal, muscular, and visceral systems and their neurological association
• Purposes of Body Mechanics

  • maintain good body posture
  • promote good physiological functions of the body
  • use the body correctly and to maintain its effectiveness
  • prevent injury or limitation of the movement of the musculoskeletal system
• Principles of Body Mechanics

  • the wider the base of support = greater stability
  • the lower the center of gravity = greater stability
  • the equilibrium of an object is maintained as long as the line of gravity passes through its base of support
  • facing the direction of movement prevents abnormal twisting of the spine
  • dividing balanced activity between arms and legs reduces the risk of back injury
• Principles of Body Mechanics

  • leverage, rolling, turning, or pivoting requires less work than lifting
  • when friction is reduced between the object to be moved and the surface on which it is moved, less force is required to move it
  • reducing the force of work reduces the risk of injury
  • maintaining good body mechanics reduces fatigue of the muscle groups
  • alternating periods of rest and activity helps reduce fatigue
  • get help whenever possible
  • ask the patient to help if able
  • pulling action requires less effort than pushing or lifting
• Areas of Application

  • Standing
  • Sitting
  • Body movement
  • Assist the patient to move up in bed
  • Logrolling the patient
  • Transferring a patient from bed to chair/wheelchair
  • Transferring a patient from bed to stretcher
• Mobility - ability to move freely, easily, rhythmically and purposely in the environment; vital to independence
• Alignment and posture - promotes balance and maximal body function
• How to maintain BALANCE?

  The line of gravity passes through the center of gravity and base of support
• Joint Mobility

  • joints are functional units of the musculoskeletal system
  • most of the skeletal muscles attach to the two bones at the joint
  • muscles are categorized according to the type of joint movement they produce
• Balance - ability to maintain postural equilibrium

  SENSORY RECEPTORS

  • labyrinth
  • vision
  • stretch receptors
• Coordinated movement - pertains to a BALANCED, SMOOTH, & PURPOSEFUL MOVEMENT

  • cerebral cortex
  • cerebellum
  • basal ganglia
• Standing - keep feet 3-4 inches apart for a wider base; equal weight distribution