Positioning Clients

Question 1

Positions to ensure safety and comfort:

Integumentary System

Answer 1

• Autograft: site is immobilized usually for 3 to 7 days (provide time for graft to adhere).
• Burns (face and head): elevate head of the bed to prevent edema.
• Circumferential burns of extremities: elevate the extremities above level of the heart to prevent or reduce edema.
• Skin graft: Elevate and immobilize the graft site to prevent disruption of tissue.

Question 2

Positions to ensure safety and comfort:

Reproductive System

Answer 2

• Mastectomy: Semi-fowler’s position with affected arm elevated to promote lymphatic fluid return. Turn only to back and unaffected side.
• Perineal and vaginal procedures: Lithotomy.

Question 3

Positions to ensure safety and comfort:

Endocrine System

Answer 3

• Hypophysectomy: elevate head of bed to prevent increased intracranial pressure.
• Thyroidectomy: semi-f to fowler’s to reduce neck swelling and edema. Devices may be used to support the head and neck. Avoid neck extension.

Question 4

Positions to ensure safety and comfort:

Gastrointestinal System

Answer 4

• Hemorrhoidectomy: lateral (side-lying) position to prevent pain and bleeding.
• Gastroesophageal reflux: reverse trendelenburg’s to promote gastric emptying.
• Liver biopsy: position client in supine with upper abdomen exposed and right arm raised and extended behind the head. After procedure, assist to lateral (side-lying) position and place small pillow under the puncture site.
• Paracentesis: semi-fowler or sitting upright on the side of bed or in chair with the feet supported.
• Nasogastric tube: during insertion position in high-fowler with head tilted forward. Irrigation and feedings, use fowler to semi-f.
• Rectal enema and irrigation: LEFT sims’ position.
• Sengstaken-Blakemore and Minnesota: elevation of the head of bed.

Question 5

Positions to ensure safety and comfort:

Respiratory System

Answer 5

• COPD (DPOC): sitting position, leaning forward, and arms above several pillows.
• Laryngectomy: Semi-f to fowler.
• Bronchoscopy post procedure: semi-fowler.
• Postural drainage: lung segment to be drained should be in the uppermost position. Trendelemburg’s may be used.
• Thoracentesis: during procedure, position sitting on edge of the bed leaning over a bedside table, with feet supported. OR lying on the unaffected side in fowler’s.

Question 6

Positions to ensure safety and comfort:

Cardiovascular System

Answer 6

• Abdominal aneurysm resection: after surgery, limit elevation of head of bed to 45 degrees to avoid flexion of graft. Client may turn to side.
• Amputation of lower extremity: first 24 hours elevate foot of bed and support residual limb with pillows to reduce edema. Consult PHCP, and if prescribed, use prone position twice a day for 20 to 30 min.
• Arterial vascular grafting of extremity: bed rest for approx 24 hours and affected extremity is kept straight. Limit movement and avoid flexion of the hip and knee.
• Cardiac catheterization: if femoral vessel was accessed maintain bed rest for 4 to 6 hours. May turn from side to side. Affected extremity is kept straight and head is elevated no more than 30 degrees.
• Heart failure and pulmonary edema: client upright, preferably with the legs dangling over the side of bed to decrease venous return.
• Peripheral arterial disease: elevate feet at rest, but not above heart.
• Deep vein thrombosis: if extremity is red, edematous, and painful, heparin may be initiated and bed rest with leg elevation may also be prescribed. Clients with low-molecular-weight heparin usually can be out of bed in 24 hrs if pain level permits.
• Varicose veins: leg elevation above heart. Advised to minimize prolonged sitting and standing.
• Venous insufficiency: leg elevation.

Question 7

Positions to ensure safety and comfort:

Sensory System

Answer 7

• Cataract surgery: post-op semi-f to fowler’s, client on back or nonoperative side to prevent edema.
• Retinal detachment: if large, bed rest and bilateral eye patching may be prescribed to minimize eye movement.

Question 8

Positions to ensure safety and comfort:

Neurological System

Answer 8

• Autonomic dysreflexia: high-fowler to prevent hypertensive stroke.
• Cerebral aneurysm: 30 to 45 degrees to prevent pressure on site.
• Cerebral angiography: bed rest as prescribed and extremity in which the contrast was injected is kept straight and immobilized for 6 to 8 hrs.
• Stroke: hemorrhagic elevate to 30 degrees to reduce intracranial pressure. Ischemic, usually flat. Maintain head in midline, neutral position to facilitate venous drainage. Avoid extreme hip and neck flexion.
• Craniotomy: should not be positioned to the side that was operated. Elevate 30 to 45 degrees, maintain head in midline and neutral position. Avoid extreme hip and neck flexion.
• Laminectomy and other vertebral surgery: often out of bed post-op with back brace. Back is kept straight with feet resting on floor.
• Increased intracranial pressure: elevate 30 to 45 degrees, head in midline and neutral, and avoid hip and neck flexion.
• Lumbar puncture: side lying, knees flexed up and neck flexed down. After procedure, supine for 4 to 12 hours AP.
• Spinal cord injury: immobilize spinal and head, logroll.

Question 9

Positions to ensure safety and comfort:

Musculoskeletal System

Answer 9

• Total hip replacement: positioning depends on surgical technique, method of implantation, prosthesis and surgeon’s preference. Avoid extreme internal and external rotation. Avoid ADDUCTION. Maintain ABDUCTION when supine position or nonoperative side.