Positioning 1
- 2. Purpose Protect functional ability Avoid injury Prevent Cx of immobility Treatments or Dx studies Promote oxygenation Conserve patient’s energy
- 3. Conserving Energy Changing position in bed requires SIGNIFICANT effort Increases oxygen consumption Healthy patients require > ½ liter more of O 2 /min when turning from side to back or side to side Women consume less oxygen with activities than men
- 4. Nursing Considerations Know client restrictions Use supports Personal items in reach Leave bed in safe position Alter position- minimally q 2 hours OR requires specialized positioning and protecting of bony prominences
- 5. Positioning for “Hip” “ total hip”- head of the femur has been replaced and a cup has been placed in the acetabulum Simple hip replacement- head of the femur replaced How surgeon accomplishes this Hip is adducted Then flexed Then internally rotated POST-OP- What motions must nurse avoid and teach client to avoid?
- 6. More HIP POST-OPERATIVELY Hip is never flexed past 90 o Kept in external rotation Naturally occurs
- 7. Pictures
- 8. Positions Nurse’s expertise As you study these, focus on prevention of complications Look at pictures in books and think of George!
- 9. Fowler’s Position 45 o to 60 o Injury prevention Assess and protect sacrum, heels, and cervical spine Advantages Decreases pooling of respiratory secretions and urinary stasis Promotes lung expansion Used for feeding, respiratory therapy, NG tube insertion, nasotracheal suctioning,
- 10. Semi-Fowler’s (Low Fowler’s 30 o Minimal elevation needed for tube feeding EBC strongly supports use with a ventilated client to prevent gaastroesophageal reflux and aspiration
- 11. High-Fowler’s When to use Severe respiratory distress, swallowing problems Disadvantages Heart rate may be increased significantly Uncomfortable for legs and lower back Orthopneic position
- 12. Protected Supine Most common position Assess for and prevent Pressure sores- coccyx and heels Foot drop Disadvantages Compromises respiratory and renal function Advantages Supports cardiac function Allows elevation of extremities
- 13. Side-lying or Lateral DO NOT use full lateral position USE MODIFIED lateral Advantages Reduces pressure on the greater trochanter Enhances respiratory function Surgery positioning Lateral jackknife- lateral nephrectomy
- 14. SIM’s or semi-prone When to use Multiple pressure sores particularly- sacrum, trochanter, and heels Improves respiratory function when it promotes drainage Used to administer enemas or rectal meds “ Safe” position for clients who are unconscious
- 15. Prone Least used Some research shows improves respiratory function in some clients Great effort to maintain alignment Arms require special protection Vollman Prone Positioner invented by a nurse http://www.vollman.com/prone_positioner.cfm
- 16. Dorsal Lithotomy Used for pelvic diagnostic procedures Privacy issues
- 17. Trendelenburg NO LONGER recommended for hemorrhagic shock Used for postural drainage Facilitates venous return in clients with poor peripheral perfusion
- 18. Reverse Trendelenburg REVERSE trendelenburg decreases respiratory rate and increases tidal volume in clients with large abdomens who were intubated but spontaneously breathing Promotes gastric emtying Prevents esophageal reflux
- 19. EQUIPMENT Pillows Foot boards Adjustable beds Turning beds Sandbags Trochanter rolls Slings Splints Trapezes
Editor's Notes
- #5: Old terminology is turning now we talk about repositioning b/c even slight changes in position help relieve pressure. We use pillows, wedges etc to help us