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SECTION II. Positioning and Ambulating the Adult Patient
4-13.
COMMON POSITIONS
UTILIZED FOR THE ADULT PATIENT
Placing the Adult
Patient in the Supine Position (see
figure 4-2).
-
Collect equipment.
-
Wash your hands.
-
Approach and identify the patient (by
checking the identification band) and explain the procedure (using simple
terms and pointing out the benefits).
-
Provide privacy throughout the procedure.
-
Position the bed.
-
Place the bed in a flat or level position
at working height, unless contraindicated.
-
Lower the side rails on the proximal side
(as necessary).
-
Move the patient from a lateral (side)
position to a supine position.
-
For the patient on his side, remove
supportive pillows.
-
Fold top bedding back to the hips, being
careful to avoid any undue exposure of the patient's body.
-
With one hand on the patient's shoulder
and one on the hip, roll his body in one piece (like a log) over onto
his back.
-
Align the patient's body in good position.
-
Head, neck, and spine are in a straight
line.
-
Arms are at the patient's sides (parallel
to the body) with hands prone.
-
Legs are parallel to his body.
-
Hips, knees, and feet should be in good
alignment.
-
Support the body parts in good alignment
for comfort.
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Place a pillow under the head and
shoulders to prevent strain on neck muscles and hyperextension and
flexion of the neck.
-
Support the small of the back with a
folded bath towel or small pillow.
-
Put a footboard at the foot of the bed
and place the feet flat against it (at right angles to the legs) to
prevent plantar flexion ("foot drop").
-
Arrange a sandbag along the outer portion
of the right foot to keep the foot upright.
-
Make a trochanter roll and arrange it
along the right hip and thigh to keep the hip joint from rotating
outward.
-
Place a pillow under each forearm so the
arm is at least six inches from the body.
-
Provide for the patient's comfort and
safety.
-
Replace the bedding neatly and raise the
side rails, if used.
-
Place the call light within reach.
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Position the bedside stand or overbed
table so that the patient will be within easy reach of drinking water
and personal items.
-
Leave the bed in the low position.
-
Report significant nursing observations to
the charge nurse.
Placing the Adult
Patient in the Fowler's and Semi-Fowler's Position
(see figures 4-5
and 4-6).
-
Collect equipment.
-
Wash your hands.
-
Approach and identify the patient (checking
the ID band) and explain the procedure (in simple terms and pointing out
benefits).
-
Provide for privacy throughout the
procedure.
-
Be sure the patient is in a supine position
with his head near the top of the bed.
-
Elevate the head of the bed.
Figure 4-5. Fowler’s position.
Figure 4-6. Semi-Fowler’s position.
-
Raise the knee gatch (knee rest) of the bed
approximately 15 degrees unless contraindicated.
-
Use a footboard to maintain the feet at
right angles to the legs.
-
Use pillows for support as needed.
-
Behind the shoulders and head to prevent
flexion and hyperextension of the neck.
-
Behind the lower back to prevent
posterior convexity of the lumbar spine region.
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Under the thighs to prevent
hyperextension of the knees.
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Place the patient in good body alignment.
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Head, neck, and back are straight.
-
The weight of the body is supported where
the hips are flexed in the sitting position.
-
Feet are straight.
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Toes are pointing up.
-
Provide for the patient's comfort and
safety.
-
Replace bedding neatly.
-
Raise and secure the side rails.
-
Place the call light within reach.
-
Position the bedside stand or overbed
table so that the patient will be within easy reach of drinking water
and personal items.
-
Leave the bed in a low position.
-
Report significant nursing observations to
the charge nurse.
Prone Position
(see figure 4-1).
-
Collect the equipment.
-
Wash your hands.
-
Approach and identify the patient and
explain the procedure.
-
Provide for privacy.
-
Adjust the bed.
-
Lower the headrest and knee rest so that
the bed is in a flat position.
-
Raise the bed to working height.
-
Lower the side rails on the side where
you are working.
-
Fold the top bedding down to the level of
the patient's hips, but avoid
undue exposure of the patient's body, which may cause embarrassment.
-
Position the patient in bed.
-
If there is room between the end of the
mattress and the foot of the bed, the patient should be moved down in
the bed so that his feet extend over the edge of the mattress.
-
Remove the footboard if one is present.
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Turn the patient onto his side and then
onto his stomach.
-
Align the patient in good position.
-
Head is turned to one side.
-
Neck and back are in a straight line.
-
Arms are parallel to the body in a
slightly flexed position; or arm on the same side toward which the head
is turned can be flexed sharply at the elbow so the hand is near the
head.
-
Support the patient's body and keep it in
good alignment.
-
Provide for the patient's comfort and
safety.
-
Replace bedding neatly.
-
Raise and secure the side rails.
-
Place the call light within reach.
-
Position the bedside stand or
over-the-bed table within reach so the patient can get drinking water
and personal items.
-
Leave the bed in a low position.
-
Report significant nursing observations
to the Charge Nurse.
Lateral
(see figure 4-7) and Sim's (see
figure 4-3)
Positions.
-
Collect equipment.
-
Wash hands.
-
Approach and identify the patient by checking
identification band.
-
Explain the procedure and gain patient's
cooperation.
-
Use simple terms.
-
Point out benefits.
Figure 4-7. Lateral position.
-
Provide for privacy.
-
Position the bed.
-
Turn the patient onto the side.
-
Obtain assistance, if needed.
-
Fold the top bedding back to the level of the
patient's hips, but avoid undue exposure of the patient's body
which may cause embarrassment.
-
Flex the distal knee and place the distal arm
across the chest.
-
"Log-roll" the patient toward you by placing
one hand on the shoulder and the other on the distal hip and
pulling without twisting the patient's torso.
-
Reach behind the patient's back with both
hands, placing one on the proximal hip and lift slightly outward
and roll the body toward yourself.
-
Alternative method: turn the patient onto the
side away from self.
-
"Log-roll" the patient's body away from self
by putting one hand on the proximal shoulder and the other on the
hip and rolling the patient to the distal side.
-
Lower hands to the distal shoulder and hip
and pull them toward self to stabilize the patient in the lateral
position.
-
Align the patient's body in good position.
-
Ensure the patient is not lying on his/her
arm.
-
Head, neck, and back are in a straight line.
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Legs are parallel with knees slightly flexed.
-
Uppermost arm may be flexed across patient's
abdomen or supported on his/her body and hip.
-
Support the body in good alignment for
comfort.
-
Place a pillow under the patient's head and
neck to prevent muscle strain and maintain alignment.
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Put a pillow under the uppermost leg so that
it is supported from the knee to the foot.
-
Place another pillow firmly against the
patient's abdomen to support the back and hips in better alignment, if
necessary.
-
You may want to use a pillow to support the
back.
-
Place a pillow lengthwise along the back.
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Tuck one edge under the side.
-
Roll the remainder of the pillow under
(toward the bed surface).
-
Tuck the pillow firmly against the back.
-
Provide for the patient's comfort and safety.
-
Replace the bedding neatly.
-
Raise and secure the side rails.
-
Place the call light within reach.
-
Position the bedside stand and over-the-bed
table so that the patient is within easy reach of drinking
water and personal items.
-
Leave the bed in a low position.
-
Report significant nursing observations to
the charge nurse.
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