Patient Positioning

Patient Positioning




SUPINE POSITION







Start
with the bed flat and the patient lying on the back. The patient's head
should be about two to three inches from the head of the bed


Place
a pillow under the patient's head. It should extend about two inches
below the patient's shoulders, with the head in the middle of the
pillow








Place
a trochanter roll along the affected hip or along the both hips if the
patient has little control over the legs. A trochanter roll is devised
by rolling a bath blanket into a shape about 12-14 inches in length.
The roll should be just long enough to reach from above the hip to
above the knee. The trochanter roll prevents external rotation of the
hip






Place
pillows under the legs to reach from above the back of the knee to the
ankle so that the ankles and heels do not rub on the sheets


If
care plan so indicates, position the footboard or place a folded pillow
to support the patient's feet. The ankles should be at 90° angle


Extend
the patient's arms and place small pillows to reach from the elbow to
below the wrist. The hand should be in alignment with the wrist









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SUPINE POSITION







Start
with the patient in supine position. Roll the patient's trunk and
shoulder away from you so that there is a 45° angle between the
patient's back and the bed


Place a pillow behind the patient's back for support


Bring the patient's left shoulder forward. Flex the elbow of the left arm and place the lower left arm, palm up, on a pillow


Flex the elbow of the right arm and bring the forearm across the chest with palm down.


Extend
both legs. Place right leg a little behind left leg. Support right leg
with two pillows folded in half that extend from groin to ankle





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PRONE POSITION








Start with the bed flat and the patient lying on the abdomen with head turned to either side, spine straight and legs extended


Place a small pillow under the head so that it extends to the patient's shoulders and five to six inches beyond the face


Place
a small pillow under the abdomen. This relieves pressure on the back
and reduces pressure against a female patient's breasts. An alternate
method is to roll a towel and place it under the shoulders









Place
a pillow under the arms to reach from the elbow to below the wrists.
The shoulders and elbows may be flexed or extended, whichever is more
comfortable for the patient








.
Place a pillow under the lower legs to prevent pressure on the toes.
The patient may be moved down in the bed before starting the procedure,
so that the feet extend over the end of the mattress. This allows the
foot to assume a normal standing position




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SEMI-PRONE POSITION









This
position relieves pressure on the hips. Breathing is easier in this
position than in the full prone position. Directions given here are for
the patient lying on the left side. These can be easily adapted for the
right side


Extend the patient's left arm and tuck it slightly beneath the patient's body


. Place a pillow in front of and at right angles to the patient's chest


.Flex the patient's right knee and hip. Support with pillows that are parallel to the leg


Grasp the
patient's left arm from the back of the patient. Turn the patient onto
his chest facing away from you. Gently pull his left arm toward you and
push on his hip


. Extend
the right arm upward and toward the head of the bed. Place it on the
head pillow with the fingers and palm against the bed


Flex the upper arm on a pillow


Lift up the sheepskin and place a foam block under the sheepskin above the iliac crest (hip bone


Place
another foam block under the sheepskin just below the iliac crest. You
should be able to slide your hand between the hip and the bed

RIGHT LATERAL POSITION



Start
with the bed flat and the patient turned to the left side, with spine
straight Remember before turning to move the patient to the right side
of the bed

Place a pillow under the head so it extends five to six inches beyond the patient's face and down to the shoulders

Position patient's right arm so shoulder and elbow are flexed and palm of hand is facing up.

Place
patient's left arm so it is extended or only slightly flexed and rest
it on patient's hip or bring it forward and place it on a pillow. The
patient's shoulder, elbow, and wrist should be at approximately the
same height

Place
a pillow between the patient's legs so that it extends from above the
knee to below the ankle. The patient's hip, knee, and ankle should be
at approximately the same height

A pillow may be placed behind the patient to help maintain the position

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SIM'S POSITION

This
position is a variation of lateral position with the patient on the
left side, left leg extended and right leg flexed. This position is
often used for rectal examination and treatments and enemas

Place a pillow under the patient's head as for lateral position

Start with the bed flat and the patient moved and turned onto the left side

. Extend the patient's left arm and position it behind the patient's back

Flex the right arm and bring it forward. Support arm with a pillow

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FOWLER'S POSITION




This
position, or a variation of it, is used for feeding patient's in bed,
for certain treatments and procedures, for the patient's comfort while
visiting or watching television, and for those who have trouble
breathing

Start
with the patient on the back, in the middle of the bed and in good
alignment. The patient's hips should be at the place where the bend
bends when the bed head is rolled up. Place the head of the bed at 30°
for semi-Fowler's, 45° to 60° for Fowler's, and 90° for high Fowler's

Place one or two pillows behind the patient's head to extend four to five inches below the patient's shoulders

Flex elbows and place a pillow under each arm to prevent pull on the shoulders

Place a pillow under each leg to extend from above the knee and to the ankle, to prevent pressure on heels

. Place footboard or folded pillow to keep feet in position, if necessary

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ORTHOPNEIC POSITION



This is a variation of high Fowler's position and is used for patients who have difficulty breathing.

. The position of the bed remain the same as high fowler's 90° angle

. Bring the bedside table across the bed and place one or two pillows on top of the table

Have the patient lean forward across the table with her arms on or beside the pillows Have her rest her head on the pillows

Place another pillow low behind the patient's back for support

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SITTING POSITION



Patients
should be positioned in a comfortable, well-constructed 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

Pillows or postural supports may be needed to maintain the position

A small pillow may be folded and placed at the small of the back to add comfort and support

Do not permit the back of the patient's knees to rest against the chair

POSITIONING DEVICES



Several types of devices
called orthoses, are used to maintain position of an extremity. The
correct use of these devices prevents contractive formation. Orthoses
are also called splints. The graphic above are examples of orthoses for
the upper extremities

A health care provider may
also order splints or orthoses for the lower extremities. A common type
is called the ankle foot orthosis (AF0). The AFO provides support for
an unstable ankle and helps reduce extensor spasticity. The AFO is
applied to the lower leg before the shoe is put on



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