Patient Positioning Nursing Care | Nursing Fundamentals Next Generation NCLEX Review

Patient Positioning in Nursing

Supine Position

• Nurse Sarah introduces the topic of patient positioning, starting with the supine position where the patient lies flat on their back.

• The phrase "put the patient on their spine" is suggested as a mnemonic to remember this position.

• Common uses include post-operative care after procedures like lumbar punctures and heart surgeries, as well as for abdominal surgeries such as C-sections.

• Important for head-to-toe assessments; however, it poses risks for pressure injuries at bony prominences like heels, elbows, and sacral areas.

• Patients unable to shift may also develop foot drop due to prolonged immobility.

Prone Position

• In this position, patients lie flat on their abdomen with legs extended and head turned to either side.

• A mnemonic involves associating "prone" with lying on one's esophagus and entrails.

• Used in spinal surgeries and has gained attention during COVID-19 for improving lung function by enhancing gas exchange.

• Risks include airway obstruction if intubated, potential pressure injuries on ears and eyes, and brachial plexus injury from excessive pressure.

Dorsal Recumbent Position

• This position features the patient lying on their back with knees flexed. The term "dorsal" relates to the back while "recumbent" means lying down.

• It is similar to supine but allows for bent knees; useful for procedures like Foley catheter insertion in females.

• Risks mirror those of supine: potential skin breakdown at heels, shoulders, elbows, coccyx area.

Lithotomy Position

• Similar to dorsal recumbent but with legs flexed at 90 degrees in stirrups; named from 'lith' (stone) and 'otomy' (cutting).

• Primarily used during urinary system stone removal procedures or vaginal exams/childbirth.

• Like previous positions, it carries risks of pressure injuries especially when legs are placed in stirrups.

Sims Position

Patient Positioning Techniques

Sims Position

• The patient lies on their left side in the Sims position, with the right hip and knee flexed while the left hip and knee are slightly extended. The left arm is positioned behind the patient.

• This position is beneficial for Foley catheter insertion in female patients who cannot assume a dorsal recumbent position due to mobility issues. It is also suitable for administering enemas and for sleeping.

• Potential complications include pressure injuries on the ear, greater trochanter, heel, and ankle.

Lateral Position

• The lateral position can be either right or left lateral recumbent. It is used when a patient has seizures, is unconscious, or post-surgery to prevent aspiration by keeping the airway open.

• Risks associated with this position include pressure injuries on bony prominences such as ears, shoulders, elbows, hips, knees, and ankles. Damage to the brachial plexus may occur due to nerve compression.

Fowler's Positions Overview

• Fowler's positions vary based on head elevation angles: low (15-30 degrees), semi (30-45 degrees), standard (45-60 degrees), and high (60-90 degrees). These positions are named after a surgeon.

Low Fowler's Position

• In low Fowler's position, the head of the bed is elevated 15 to 30 degrees. This slight elevation aids in comfort during sleep and assists patients with breathing difficulties like heart failure.

Semi-Fowler's Position

• Semi-Fowler’s involves an elevation of 30 to 45 degrees. Some sources group it with low Fowler’s but note that it helps reduce upper body swelling post-neck surgery and manage increased intracranial pressure.

Standard Fowler's Position

• Standard Fowler’s has an angle between 45 to 60 degrees; it's useful for eating/drinking and easing respiratory problems similar to lower angles but at a higher elevation.

High Fowler's Position

• High Fowler’s elevates the head of the bed at about 60 to 90 degrees. It's particularly helpful for nasogastric tube insertion and managing autonomic dysreflexia in spinal cord injury patients at T6 or higher.

Understanding Patient Positions in Medical Settings

Trendelenburg Position

• The Trendelenburg position involves the patient being supine with their head lowered and feet elevated. This position is beneficial for procedures like central venous catheter line placement or removal, as it reduces the risk of air embolism.

• Historically, this position was used for patients experiencing hypotension; however, current evidence suggests it may not effectively increase blood pressure and could potentially harm cardiac and lung function while increasing intracranial pressure.

• It is crucial to consult hospital protocols before using the Trendelenburg position for hypotensive patients due to its potential risks.

Reverse Trendelenburg Position

• The reverse Trendelenburg position is the opposite of the standard Trendelenburg: the patient remains supine but with their head elevated and feet lowered. This positioning is particularly useful during head and neck surgeries to minimize blood flow and reduce blood loss.

Modified Trendelenburg Position

• In the modified Trendelenburg position, the patient lies flat with their head level with their upper body while their feet are elevated. This adjustment aims to enhance venous return, which can be beneficial in managing hemodynamic problems.