CHANGING POSITION OF HELPLESS PATIENT

Sushmita Kaldan B.Sc Nursing 4th yr 2009 Batch BPKIHS

CONTENTS
1. 2. 3. 4. 5. 6. 7. Introduction Definition of position Different types of positions Reasons for changing the position of a patient Basic principles in positioning of patient Protective positioning Nurses responsibility while changing the position of patient 8. Procedure for turning a client in bed
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1.INTRODUCTION

One of the basic procedures that nurses perform most frequently is that of changing the patients position. Any position , even the most comfortable one, will become unbearable after a period of time.

 Whereas the healthy person has the ability to move at will , a sick persons movements may be limited by disease , injury or helplessness.

It is often the responsibility of the practical nurse to position the patient and change his position frequently.

DEFINITION

The manner in which body is arranged is called position.

DIFFERENT TYPES OF POSITIONS FOR PATIENTS

TYPES OF POSITION

1. SUPINE POSITION: This is the most common position used during examination of chest and abdomen.
The patient lies on the back with one pillow under the head. Arm lies on side, knees are slightly flexed. The head is turned to one side.
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2. PRONE POSITION

The patient lies flat on bed with face downwards and backwards and hands folded over pillow. One pillow is given under head for resting of chin and hands, another is given below abdomen and one under legs.
This position is useful in postoperative cases, tonsillectomy, fistula operation, operation over spine, injury over back, to prevent bedsore, to relieve abdominal distension and for good postural drainage.
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3. LITHOTOMY POSITION
This is usually used for gynecological purpose for adequate exposure of pelvis and vagina. Like dorsal position the patient lies flat facing upwards. But the legs are held or fixed in position by lifting from table and hanged by steps or attachments especially fixed on the table.

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LITHOTOMY POSITION

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4. DORSAL RECUMBENT POSITION

The patient lies on her back, knees fully flexed, thighs flexed and externally rotated. Feet flat on the bed. It is used for catheterization, vulval, vaginal and rectal examination.
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5. SIMS POSITION
This is also known as prone position. This is used for examination of rectum or vagina.

The patient lies on left lateral position slightly prone with buttocks drawn slightly backwards to the edge of the bed. The right arm remains in front of the patient, the right knee is flexed against the abdomen. The left leg lies straight on the bed. For better comfort a small pillow may be given under abdomen.

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SIMS POSITION

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6. LATERAL POSITION
This can be left or right lateral position. This is used for giving back care, enemas, colonic irrigation, for gynecological examination and for rectal examination.
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LATERAL POSITION
Patient lies in left or right lateral position with legs flexed at thigh and knees. Buttocks are brought to the edge of the bed.

The upper leg is flexed more than the lower leg. It is better to put one pillow for resting of upper leg behind the lower leg.
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7. KNEE CHEST POSITION

This is absolutely used for gynecological purpose like examination of vagina and rectum and for first aid treatment for cord prolapse and retroverted uterus.
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KNEE CHEST POSITION

The patient lies with chest downwards facing down on the bed. Knees and thighs are flexed with buttocks high up in air. The thighs remain at right angle to bed and knees take weight of hip or lower position of abdomen. The head remains on the side with one side of cheek on pillow.
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 The hands are flexed at elbow and rests on either side to give support to keep body in stable position. A small pillow can be given under chest. Abdomen remains above bed in air.

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8. TRENDELENBURG POSITION
This position is used while doing operation over pelvic organs to displace intestine into upper abdomen. Used for patient of shock. Also used to check bleeding from lower limbs.
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TRENDELENBURG POSITION
In this position the patient lies on back with head lowered and body on inclined plane with hips higher than the bed. Good padding is given over shoulder to keep the patient from sliding towards lower end of table.
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9. FOWLERS POSITION
The semi sitting position or fowlers position, calls for the bed to be elevated45- 60 degrees. This position is often used to promote cardiac and respiratory functioning because abdominal organs drop in this position, thereby providing maximal space in the thoracic cavity.
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FOWLERS POSITION
This is also a position of choice for eating, conversation, vision and during urinary and bowel elimination. High Fowler- 90 degree Semi Fowler- 45-60 degree Low Fowler- 30 degree
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10. SITTING POSITION

Patients should be positioned in a comfortable, wellconstructed chair, so that the head and the spine are erect.

The back and buttocks should be up against the chair back. The feet should be flat on the floor.
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SITTING POSITION
1. Pillows or postural supports may be needed to maintain the position. 2. A small pillow may be folded and placed at the small of the back to add comfort and support.
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REASONS FOR CHANGING THE POSITION OF A PATIENT

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REASONS FOR CHANGING THE POSITION OF A PATIENT

To promote comfort and relaxation. To restore body function. To prevent deformities. To prevent bed sore.

To stimulate circulation. To facilitate range of motion exercises. To carry out any nursing efficiently and effectively. procedure

To maintain correct body alignment and to facilitate physiological and physical wellbeing.

BASIC PRINCIPLES IN POSITIONING OF PATIENTS

Maintain good patient body alignment. Maintain the patients safety. Reassure the patient to promote comfort and cooperation. Elevate the height of the bed as necessary so that it becomes less strenuous to work for the nurse herself.

 Properly handle the patients body to prevent pain or injury. Keep in mind proper body mechanics as a nurse. Be aware of the patients limitations and restrictions. Obtain assistance to move heavy or helpless patients. Follow physicians orders.

PROTECTIVE POSITIONING
Correct positioning technique

The need to change position frequently, at least every 2 hours.

Exercising the extremities and massaging the pressure areas.

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NURSES RESPONSIBILITY
1.
2. 3. 4. 5. 6.

Help the patient assume the desired or required bed position. The nurse assists the patient to achieve proper body positioning and alignment. Support patients body in correct alignment using pillows or splints. Assure the proper use of supportive devices. Frequently monitor and evaluate the position selected. Provide skin care. Ensure proper body mechanics.

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HOW TO TURN A CLIENT IN BED?

The procedure is: 1. Explain the procedure to the patient. 2. Wash hands 3. Raise the bed to your waist level. Adjust to flat position or as low as the client can tolerate. Lower side rail nearest to you and raise the opposite side.
4. Position the client closer to the far side of the bed in the supine position.
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CONT

5. Place the clients arm across the chest, cross the clients far leg over the near one. 6. Stand opposite the clients centre with your feet spread and one foot ahead of the other. Tighten your gluteal and flex your knees.
7. Position your hand on the clients far shoulder and hip and roll the client towards you.
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CONT

8. Make the client comfortable and positioning proper alignment. 9. Readjust the bed height and position and raise side rail if appropriate. 10. Wash your hands.

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LETS REVISE

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SUMMARY

SAQs: 1. What are the various purposes of positioning? 2. Enlist various types of positions.
MCQs: 1. The common position required for back care is: a. Supine position b. prone position c. Lateral position d. fowlers position
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cont

2.

The head of bed is elevated to. degree in high fowlers position. a. 30 degree b. 45 degree c. 60 degree d. 90 degree
3. Appropriate position for the patient having difficulty in breathing is: a. Supine position b. Fowler position c. Lithotomy position d. Lateral position
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REFERENCES

1.
2. 3. 4. 5.

Textbook of adult nursing. Health learning materials centre.2008.Page no:336-339 Gupta LC, Practical nursing procedure, 3rd edition, page no: 184-191 Mehta RS, Mandal GN,Nursing Concept, Makalu publication house, 2nd editioj. Page no: 206-211 Taylor Carol, Lillis Carol, Fundamental of nursing, 6th edition, page no: 1214-1221 www.google.com (positioning of patient)

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