PRELIMS

• Patient positioning involves maintaining a patient's neutral body alignment to prevent complications of immobility and injury
• It is an essential aspect of nursing practice and a responsibility of the registered nurse
• In surgery or treatments, positioning provides optimal exposure to the surgical/treatment site and maintains the patient's dignity
• Goals of patient positioning:

  • Provide patient comfort and safety
  • Maintain patient dignity and privacy
  • Allow maximum visibility and access
• Supine or Dorsal Recumbent Position:

  • Patient lies flat on the back with head and shoulders slightly elevated
  • Legs may be extended or slightly bent with arms up or down
  • Most commonly used for general examination or physical assessment
  • Watch out for skin breakdown and provide support with pillows
• Fowler's Position:

  • Bed position with the head elevated 45 to 60 degrees
  • Promotes lung expansion and useful for patients with difficulty breathing
  • Prepare for walking and watch out for poor neck alignment
  • Used in surgeries involving neurosurgery or shoulders, use a footboard for proper alignment
• Orthopneic or Tripod Position:

  • Patient sits or leans on the side of the bed with pillows for support
  • Allows maximum lung expansion and helps in exhaling for patients with breathing difficulties
• Prone Position:

  • Patient lies on the abdomen with head turned to one side
  • Allows full extension of hip and knee joints, contraindicated for spine problems
  • Promotes drainage and support with pillows under the head and abdomen
• Lateral Position:

  • Patient lies on one side with top leg in front of the bottom leg
  • Relieves pressure on the sacrum and heels, distributes body weight laterally
  • Support pillows are needed for comfort and proper positioning
• Sims' Position:

  • Posture between lateral and prone positions with upper arm flexed
  • Prevents aspiration of fluids and reduces lower body pressure
  • Used for perineal area visualization and treatment, pregnant women comfort
  • Support body alignment with pillows under the head, upper arm, and between the legs
• Lithotomy Position:

  • Patient lies on their back with hips and knees flexed and thighs apart
  • Commonly used for vaginal examinations and childbirth
  • Modifications include low, standard, high, hemi, and exaggerated positions based on procedure requirements
• Low Lithotomy Position:

  • Hips flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 40 to 60 degrees
  • Lower legs parallel with the O.R. bed
• Standard Lithotomy Position:

  • Hips flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 80 to 100 degrees
  • Lower legs parallel with the O.R. bed
• Hemilithotomy Position:

  • Non-operative leg in standard lithotomy
  • Operative leg may be placed in traction
• High Lithotomy Position:

  • Hips flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 110 to 120 degrees
  • Lower legs flexed
• Exaggerated Lithotomy Position:

  • Hips flexed until the angle between the posterior surface of the patient’s thighs and the O.R. bed surface is 130 to 150 degrees
  • Lower legs almost vertical
• Trendelenburg’s Position:

  • Involves lowering the head of the bed and raising the foot of the bed of the patient
  • Arms tucked at their sides
  • Promotes venous return and postural drainage
• Reverse Trendelenburg’s Position:

  • Head of the bed elevated with the foot of the bed down
  • Used for patients with gastrointestinal problems to minimize esophageal reflux
  • Prevents rapid change of position for patients with decreased cardiac output
• Knee-Chest Position:

  • Can be lateral or prone
  • Used for sigmoidoscopy without anesthesia
  • Embarrassing for some patients
  • Assumed for gynecologic or rectal examinations
• Jackknife Position:

  • Abdomen lies flat on the bed
  • Used for surgeries involving the anus, rectum, coccyx, certain back surgeries, and adrenal surgery
  • Compression of the inferior vena cava decreases venous return to the heart
  • Requires team effort and support paddings
• Kidney Position:

  • Modified lateral position with the abdomen over a lift in the operating table
  • Allows access to the retroperitoneal area
  • Risk for falls until the position is secured
  • Padding and stabilization support required
• Support Devices for Patient Positioning:

  • Bed boards for back support and body alignment
  • Foot boots to keep the foot flexed
  • Hand rolls for finger and thumb alignment
• Hand-Wrist Splints:

  • Maintain proper alignment of the thumb and wrist
• Pillows:

  • Provide support, elevate body parts, and reduce postoperative pain
  • Should be of appropriate size for body positioning
• Sandbags:

  • Shape or contour the body's shape and provide support
  • Immobilize extremities and maintain specific body alignment
• Side Rails:

  • Ensure client safety and assist in mobility
  • Useful for rolling from side to side or sitting in bed
• Trochanter Rolls:

  • Prevent external rotation of the legs in the supine position
• Wedge Pillows:

  • Maintain legs in abduction following total hip replacement surgery