THERAPEUTIC POSITIONING

• Therapeutic Positioning


  Correct positioning is crucial for maintaining body alignment and comfort, preventing injury to the musculoskeletal and integumentary systems, and providing sensory, motor and cognitive stimulation
• Position changes maintain muscle tone and stimulate postural reflexes
• Purposes of therapeutic positioning

  • Maintain body alignment
  • Maintain skin integrity (facilitates pressure distribution, prevents friction and shear on tissue)
  • Prevent injury and deformities of the musculoskeletal system
  • Promote comfort
  • Promote optimal lung expansion
  • Position client for a variety of clinical procedures
• Equipment for therapeutic positioning

  • Supportive devices required by the client (e.g. draw sheet, trochanter roll, foot board, heel protectors, rolled blankets or towels, hand rolls)
  • Pillow for head, plus extra pillows for proper alignment and support
  • Gloves (if contact with body fluids is likely to occur)
• Assessment for therapeutic positioning

  • Assesses the client's ability to move independently
  • Assesses the client's flexibility
  • Assess the client's age, medical diagnosis, cognitive status, skin integrity, nutritional status, continence, altered sensation, as well as the overall condition of the musculoskeletal system
  • Assesses for presence of tubes, incisions, and equipment
  • Assesses the physician's orders for specific restrictions regarding client positioning
• Planning for therapeutic positioning

  1. Raise level of bed to a comfortable working height

  2. Remove all pillows and devices used in previous position

  3. Get extra help as needed
• Implementation of therapeutic positioning

  1. Perform hand hygiene and put on PPE, if indicated

  2. Introduce self to client

  3. Verify the client using at least two identifiers

  4. Explain the procedure to the client and encourage to participate as appropriate

  5. Close the room door and/or curtains around the bed if possible. Assemble equipment at bedside

  6. Raise level of bed to comfortable working height. Lower the side rail on the side of the bed from which you are assisting client

  7. Remove all pillows and devices used in previous positions. Plan the moving technique

  8. Obtain any needed supportive devices or assistance

  9. Follow proper body mechanics guidelines
• Placing Client in Supine position

  1. Place client on back with head of bed flat and spine in straight alignment

  2. Place pillow under shoulders, neck or head

  3. Place pillow under pronated forearms, keeping upper arms parallel to client's body

  4. Place hand rolls in client's hands

  5. Place small rolled towel under lumbar area of back

  6. Place trochanter rolls parallel to lateral surface of the client's thighs

  7. Place foot board to prevent plantar flexion (foot drop)

  8. Position feet with toes pointed upwards
• Placing Client In Fowler's Position

  Places the patient in supine position. Elevate the head of the bed to an angle of: Fowler's: approximately 45 degrees. The head and trunk are raised 45° to 60° relative to the bed and the knees may or may not be flexed. Semi-Fowler's: approximately an angle of less than 45 degrees (often 20-30 degrees). High-Fowler's position: the head and trunk are raised 60° to 90°, and most often means the client is sitting upright at a right angle to the bed
• Placing Client in Orthopneic Position

  1. Have the client sits either in bed or on the side of the bed with an over bed table across his lap

  2. Pad table with pillow and elevate to a height that is comfortable to the client

  3. Have the client bend with head and arms resting on the table
• Placing Client in Lateral (Side Lying) Position


  1. Position the patient on the side with the head supported on a low pillow

  2. Tuck a pillow along the patient's back

  3. Bring the underlying arm forward and flex it onto the pillow used for the head

  4. Bring the top arm forward, flex it and rest it on a pillow in front of the body. Put hand rolls in place if needed

  5. Flex the top leg and bring it slightly forward

  6. Place the pillow lengthwise under the top leg

  7. Support the feet at right angles
• Placing Client in Sim's Position

  1. Place the patient in a side-lying position using only a single supporting pillow under the head

  2. Turn the patient far enough onto the abdomen so that the lower arm is extended behind the back and both knees are slightly flexed. Flex upper leg farther forward than the lower leg

  3. Turn the head to one side. Be sure the spine is straight

  4. Place a folded towel under each shoulder

  5. Place arms flat on the patient's side or flexed at the elbow with the hands near the patient's head. Place hand roll, if needed

  6. Position client's feet beyond the end of the mattress or between the mattress and footboard. Use a trochanter roll under ankles or pillows under the legs
• Placing Client on Prone Position

  1. Positions the client by turning him or her onto the abdomen

  2. Turns the head to one side
• Both knees are slightly flexed


  • Flex upper leg farther forward than the lower leg
• This position


  • Prevents damage to nerves and blood vessels in the axilla
  • Hinders internal rotation and adduction of hip and leg
• Turn the head to one side


  Be sure the spine is straight
• 
  

  • Prevents flexion of the head or hyperextension of the neck
  • Supports the natural curvature of the spine
• Fowler's Position

  
• Semi Fowler's Position

  
• Orthopneic Position

  
• Dorsal Recumbent

  
• Prone


  Position

  
• Lateral Position 


  Position

  
• Sim's position 


  Position:

  
• Knee-chest

  Position:

  
• Lithotomy 


  Position:

  
• Trendelenburg 


  Position:

  
• Reverse Trendelenburg 


  Position:

  
• Jacknife (Kraske)


  Position:

  
• a semi-sitting position, typically, refers to a 45° angle of elevation of the upper body. This position prevents posterior flexion of lumbar curvature

  Fowler's Position
• This position is sometimes called low Fowlers and typically means 30 degrees of elevation.


  Semi-fowler's Position
• the position of choice for people who have difficulty breathing and for some people with heart problems. When the client is in this position, gravity pulls the diaphragm downward, allowing greater chest expansion and lung ventilation.

  Fowler's Position
• This position facilitates respiration by allowing maximum chest expansion. It is particularly helpful to clients who have problems exhaling.

  Orthopneic Position
• The client's head and shoulders are slightly elevated on a small pillow and the legs are slightly flexed. This position is used to provide comfort and facilitates healing following certain surgeries or anesthetics.

  Dorsal Recumbent Position
• The client lies on the abdomen with the head turned to one side and hips are not flexed. This position also promotes drainage from the mouth and is useful for unconscious clients or those clients recovering from surgery of the mouth or throat. It also helps to prevent flexion contractures of the hips and knees

  Prone Position
• The client lies on one side of the body with the top leg in front of the bottom leg and the hip and knees 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. The greater the flexion of the top hip and knee, the greater the stability and balance in this position.

  Lateral (side-lying) Position
• The client 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. This position is use when there is multiple pressure ulcers and to improve respiratory function by promoting drainage.

  Sims (semi-prone) position
• This can be in lateral or prone position. In lateral knee-chest position, the patient lies on their side, torso lies diagonally across the table, hips and knees are flexed. In prone knee chest position (genupectoral), the patient kneels on the table and lower shoulders on to the table so chest and face rests on the table. This is a position assumed for gynecologic or rectal examination

  Knee-chest position (genupectoral)
• This can be in lateral or prone position. In lateral knee-chest position, the patient lies on their side, torso lies diagonally across the table, hips and knees are flexed. In prone knee chest position (genupectoral), the patient kneels on the table and lower shoulders on to the table so chest and face rests on the table. This is a position assumed for gynecologic or rectal examination

  Knee-chest position (genupectoral)
• This position is which the patient is on her back with hips and knees flexed and thighs apart and legs are supported by stirrups. It is often used for vaginal examinations and childbirth

  Lithotomy Position