Therapeutic Positioning in Clinical Settings

therapeutic positioningTherapeutic positioning may be defined as moving a patient into a specific position or posture to facilitate medical examination, surgery or for therapeutic purposes.

Therapeutic Positioning for Competitive Staff Nurse Exams

We have seen that in many staff nurse/registered nurse exams, various positions during and after surgery or some other procedure is  repeatedly asked.  Here we are giving a good theory for the topic to prepare for the upcoming exam.

Before going to study positions, you should understand the basic terminologies while stating a position which is given below

Common terminology

Abduction – Moving away from the median line
Adduction – Moving towards the median line
Biomechanics – Looks at effects of movement and normal patterns of movements
Circumduction – Moving through a circle, in combination
Contraction – Shortening or drawing together
Contractures – Deformity caused by shortening of muscles, tendons and ligaments
Dorsal – Relating to the back
Dorsiflexion – Bending of the foot and toes upwards
Ergonomics – Looks at effective use of energy in relation to efficient movement
Eversion – Turning outwards
Extension – Straightening
External rotation – Rolling outwards
Flexion – Bending
Hemiparesis – Weakness/paralysis on one side of the body
Hemiplegia – Paralysis on one side of the body
Internal rotation – Rolling inwards
Inversion – Turning inwards
Plantar – Related to the sole of the foot, as in plantar reflex
Pronation – Turning the palm of the hand downwards
Prone – Lying face downwards
Quadriplegia – Paralysis of all four limbs
Recumbent – Lying down in the dorsal position, i.e. on the back
Semi-prone – Lying on one side
Semi-recumbent – Lying down in the dorsal position with a pillow under the head
Supination – Turning upwards
Supine – Lying on the back with the face upwards

Common Positions used during patient care by registered nurses

Fowler’s
• Fowler’s position, is a bed position wherein the head and trunk are raised 40 to 90 degrees.
• Fowler’s position is used for people who have difficulty breathing because in this position, gravity pulls the diaphragm downward allowing greater chest and lung expansion.
• In low Fowler’s or semi-Fowler’s position, the head and trunk are raised to 15 to 45 degrees; in high Fowler’s, the head and trunk are raised 90 degrees.
• This position is useful for patients who have cardiac, respiratory, or neurological problems and is often optimal for patients who have nasogastric tube in place.
• Using a footboard is recommended to keep the patient’s feet in proper alignment and to help prevent foot drop.

Orthopneic or Tripod
• Orthopneic or tripod position places the patients in a sitting position or on the side of the bed with an overbed table in front to lean on and several pillows on the table to rest on.
• Patients who are having difficulty breathing are often placed in this position since it allows maximum expansion of the chest.

Dorsal Recumbent
• In dorsal recumbent or back-lying position, the client’s head and shoulders are slightly elevated on a small pillow.
• This position provides comfort and facilitates healing following certain surgeries and anesthetics.

Supine or Dorsal position
• Supine is a back-lying position similar to dorsal recumbent but the head and shoulders are not elevated.
• Just like dorsal recumbent, supine position provides comfort in general for patients recover after some types of surgery.

Prone
• In prone position, the patient lies on the abdomen with head turned to one side; the hips are not flexed.
• This is the only bed position that allows full extension of the hip and knee joints.
• Prone position also promotes drainage from the mouth and useful for clients who are unconscious or those recover from surgery of the mouth or throat.
• Prone position should only be used when the client’s back is correctly aligned, and only for people with no evidence of spinal abnormalities.
• To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen.

Lateral position
• In lateral or side-lying position, the patient lies on one side of the body with the top leg in front of the bottom leg and the hip and knee flexed.
• Flexing the top hip and knee and placing this leg in front of the body creates a wider, triangular base of support and achieves greater stability.
• The greater the flexion of the top hip and knee, the greater the stability and balance in this position. This flexion reduces lordosis and promotes good back alignment.
• Lateral position helps relieve pressure on the sacrum and heels in people who sit for much of the day or confined to bed rest in Fowler’s or dorsal recumbent.
• In this position, most of the body weight is distributed to the lateral aspect of the lower scapula, the lateral aspect of the ilium, and the greater trochanter of the femur.

Sims’ Position
• Sims’ is a semi-prone position where the patient assumes a posture halfway between the lateral and prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. Both legs are flexed in front of the client. The upper leg is more acutely flexed at both the hip and the knee, than is the lower one.
• Sims’ may be used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids.
• It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip.
• It is often used for clients receiving enemas and occasionally for clients undergoing examinations or treatments of the perineal area.
• Pregnant women may find the Sims position comfortable for sleeping.
• Support proper body alignment in Sims’s position by placing a pillow underneath the patient’s head and under the upper arm to prevent internal rotation. Place another pillow between legs.

Trendelenburg’s
• Trendelenburg’s position involves lowering the head of the bed and raising the foot of the bed of the patient.
• Patient’s who have hypotension can benefit from this position because it promotes venous return.

Reverse Trendelenburg
• Reverse Trendelenburg is the opposite of Trendelenburg’s position.
• Here the HOB is elevated with the foot of bed down.
• This is often a position of choice for patients with gastrointestinal problems as it can help minimize esophageal reflux.

Along with above said therapeutic positions we are hereby giving positions administered to patients before and after many procedures. Rationals are also given along with the positions mentioned.

 

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