PATIENT POSITIONING – NURSING PROCEDURE

PATIENT POSITIONING – Purpose, Principles, Factors Involved, Types, General Instructions, Preliminary Assessment, Equipment and Procedure

Updated 2024

Positioning
defined as placing the person in such a way to perform therapeutic
interventions to promote the health of an individual.

Positioning
defined as placing the person in a proper body alignment for the purpose of
preventive, promotive, curative, and rehabilitative aspects of health.

PURPOSE

To provide comfort to the patient
To relieve pressure on various parts
To improve circulation
To prevent formation of deformity
To carry out investigations
To perform surgical and medical
investigations
To prevent pressure sores
To provide proper body alignment
To conduct delivery/labor
To carryout nursing interventions

PRINCIPLES OF POSITIONING

Systemic and orderly way of doing
Cooperation between two
Follow safety measure to prevent
accidents
Active participation
Using a right technique at right time

FACTORS INVOLVED INN POSITIONING

Need of an individual
Self care ability
Extend of disability
Nature of disease condition
Level of consciousness
Protocol of the hospital

TYPES OF POSITION

Dorsal position
Dorsal recumbent position
Lithotomy position
Lateral position
Prone position
Slim’s position
Knee-chest position
Trendelenburg’s position
Fowler’s position

SUPINE POSITION

Supine position,
the patient lies on his back with his head and shoulders are slightly elevated.
One pillow is given under the head. His legs should be slightly flexed. A small
pillow is placed under his knees.

LATERAL POSITION

Patient lies
on left side with legs flexed at thighs. The upper leg is flexed more than the
lower. A pillow is kept in front of the abdomen and at the back and one under
the upper leg.

PRONE POSITION

A patient
lies flat on abdomen. Head turned to sideways. One soft pillow is given under
head. An extra pillow is given under the ankles to keep toes from touching the
bed.

DORSAL RECOMBENT POSITION

Patient lies
on back, knees fully flexed, thighs flexed and externally rotated feet flat on
the bed

SEMI-FOWLER’S POSITION

The
semi-fowler’s position is the position of a patient who is lying in bed in a supine
position with the head of the bed at approximately 30 to 45 degrees.

FOWLER’S POSITION

Fowler’s
position is a sitting position in which the head is elevated, at least, a 45
degree angle. Back rest and two pillows are used for the back and head.
Fowler’s position the main weight bearing areas of the patient are the heels,
sacrum and the posterior aspects of the ileum.

LITHOTOMY POSITION

The patient
lies on her back. The legs are separated and thighs are flexed on the abdomen
and the legs are on the thighs. The patient’s buttocks are kept the edge of the
table and legs are supported by stirrups.

ASSISTING THE PATIENT IN KNEE-CHEST POSITION

A prone
position in which the individual rests on the knees and upper part of the
chest, assumed for gynecologic or rectal examination. It is also called
genupectoral position.

KNEE CHEST POSITION

Patient
rests on the knees and the chest. The head is turned to one side with one check
on a pillow. A pillow is placed under the chest. The weight is on the chest and
knees.

CARDIAC POSITION

The client
is propped-up in a sitting position by means of back rest and pillows. Place an
over bed table in front with a pillow on it. The client has an aircushion to
sit and a small pillow under the knees.

TRENDELENBURG’S POSITION

The patient
lies on his back. The patient’s head is low. The foot of the bed is elevated at
45 degree angle. The body is on an inclined place and the legs hang downward
over the end of the table.

TYPES OF PATIENTS NEED SPECIAL CARE

Unconscious patient
Infant and children
Hemiplegic and paraplegic position
Immediate postoperative patients
Orthopedic patients
Cardiac patients

GENERAL INSTRUCTIONS

Maintain good body alignment of the
patient at all times
Support body parts in good alignment
by using supportive devices to promote comfort and prevent undue muscle strain
Avoid prolonged flexion of any one
body segment by changing the position at least every two hours
Reduce the pressure caused by body
weight of his or her body or object by changing the position and using
protective devices

PRELIMINARY ASSESSSMENT

Check the patient’s general condition
Check the physician’s order for any
limited movements
Assess the self-care ability of an
individual
Arrange the comfort devices near the
bedside
Identify the deformed extremity
Support the immobilize area during
positioning
Identify the rationale before
positioning

EQUIPMENT

Extra man power if needed
Extra pillows
Sheets and sheet rolls
Comfort devices such as back rest, cardiac table, sand bag, etc

PROCEDURE

Explain the procedure to the patient
Provide privacy
Arrange the articles and manpower (if
needed)
Untie the bed sheets
Turn/lift/ambulate gently
Place and support with extra pillows
under pressure points
Special care taken at pressure areas
Cover the patient with top sheet
Hand wash
Record the time, position and
condition of the skin
Positioning a patient in bed is
important for maintaining alignment and for preventing bed sores (pressure
ulcers), foot drop, and contractures. Proper positioning is also vital for
providing comfort for patients who are bedridden or have decreased mobility
related to a medical condition or treatment. When positioning a patient in bed,
supportive devices such as pillows, rolls, and blankets, along with
repositioning, can aid in providing comfort and safety.

Good body
alignment can be achieved in any of the bed rest positions. The following
points should be checked.

Head should be in midline with the
trunk
Back should be straight, with normal
body curves (cervical, thoracic, and lumbar) maintained
Ribs should be elevated to prevent
constriction of the chest
Arms and legs should be in a position
of function (the position for maximum usefulness of the joints, feet and hands)

Position of function of leg and feet. This position favors
standing upright and walking. In general, if the toes point to the ceiling when
in a back-lying position and point to the floor when in a front-lying position,
the feet, legs, and hips are in good alignment.

Position of function of arms and hands. This position favors raising arms and grasping things with the fingers. The hand should not droop at the wrist, be clenched in a fist, or be flat. The position of function for the hand is dorsiflexion (at a slight upward angle) at the wrist, with the fingers and thumb in position to write with a pencil.