What are contractures and what causes them?
Joint and muscle rigidity caused by muliple reasons:
- from staying in the same position for too long
- nerve damage
- muscular dystrophy
What are pressure injuries and what causes them?
Injuries of the skin and tissue due to prolonged pressure on the skin.
Why do we change the client’s position by turning them at least every 2 hours?
It helps to:
- Prevent pressure ulcers (decubitus ulcers/bed sores)
- Prevent pneumonia by breaking up mucus secretions in lungs
- Prevent contractures
What does HOB mean?
Head of Bed
HOB refers to the position that the head of the bed is in.
Example: “HOB elevated” or “HOB flat”.
What is the most common position to place a client?
Fowler’s position
Fowler’s position: HOB is elevated. This position prevents pressure of the diaphragm on the lungs and heart to promote breathing. It is common with cardiac and respiratory diseases.
Describe the HOB elevation in degrees for each Fowler position:
- low-Fowler’s
- semi-Fowler’s
- standard Fowler’s
- high-Fowler’s
- low-Fowler: HOB elevated 15 - 30 degrees
- semi-Fowler’s: HOB elevated 30 - 45 degrees
- standard Fowler’s: HOB elevated 45 - 60 degrees
- high-Fowler’s: HOB elevated 60 - 90 degrees
What position is supine?
On the back.
What position is prone?
On the stomach.
What position is semi-prone or sim’s?
Forward side-lying.
What position is right lateral recumbent?
On the right side.
What position is left lateral recumbent?
On the left side.
What position is lithotomy?
On the back with legs apart.
What position is Trendelenburg?
Supine with head lower than the feet.
What position is reverse Trendelenburg?
Supine with head higher than the feet.
What position is best after a cardiac catheterization?
Supine with legs straight for 2-6 hours afterwards.
This prevents bleeding and promotes good circulation. If a closing device is used may only need to be supine for 1-2 hours.
What position is best during and after tube feedings?
Semi-Fowler’s: Head of Bed (HOB) elevated at least 30 degrees.
This prevents aspiration.
What position is best after a liver biopsy?
On right side with pillow splint for 2 hours.
This is to prevent bleeding since the liver is vascular and on the right side.
What position is best during a thoracentesis?
There are two positions:
- Leaning over the bedside table
- In bed with the affected side up
This is to promote separation of the ribs in order to reach the pleural space better and to get the excess fluid out.
What position is best with most neurological problems?
Semi-Fowlers: Head of Bed (HOB) elevated and head midline.
This is to prevent increased intracranial pressure and promote blood flow to the brain.
How should a client with spinal cord injuries be moved?
Logroll
Keep the head in midline with the rest of the body when moving.
This is to prevent additional spinal injuries.
What position is best for varicose veins?
Keep veins elevated by having the legs up to prevent swelling.
Varicose veins: elevate veins - keep legs up to prevent swelling. This is to promote blood circulation because the valves of the veins are not strong enough to move the blood back to the heart (remember the V in eleVate and Veins).
What position for the legs is best for peripheral arterial disease?
Dangle arteries by keeping the legs down.
This is to promote blood circulation because the arteries are hardening making them stiff and unable to dilate well (remember the A in dAngle and Arteries).
What is the best position after a hip replacement?
Legs abducted (apart) using a wedge pillow avoid hip flexion > 90 degrees.
Prevents hip from dislocating.
Remind the patient: no bending over, no sitting on a low toilet.
What is the best position after an amputation?
Elevate extremity for 24 hours post-op.
This is to prevent edema.
What is the best position 24 hours after a leg amputation?
Help client get into the prone position for 20-30 minutes daily.
This is to prevent a contracture.
What is the best position for an enema?
left sim’s position
This position will allow gravity to help fluid come back out.
What are foot boots for?
Help to keep the foot flexed at the proper angle and to prevent foot drop.
Remove once per shift to assess for skin breakdown and joint mobility.
What are hand rolls for?
Help to keep the fingers slightly flexed to prevent contractures.
What are pillows for?
To prevent contractures and pressure ulcers.
Pillows help to support and elevate body parts to prevent contractures and pressure ulcers. Make sure the pillow is not too big or too small for the area being supported.
What are trochanter rolls for?
To prevent external rotation of the legs when in the supine position.
What is a trapeze bar for?
Hangs over the bed so the client can:
- Reach it and reposition themselves in bed.
- Perform exercises.
What is a bed board for?
Placed under or on top of the entire mattress to provide body support and alignment.
Frequently used with CPR or transferring clients from one bed to another.
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What is the best position for dumping syndrome?
Supine or flat to slow the absorption of food.
What is the best position for GERD or a hiatal hernia?
Fowler’s position to prevent gastric reflux.
What is the best position for a lumbar puncture?
The “C” position or left lateral for easier needle insertion.
What is the best position for a suspected air embolism?
Left trendelenburg to trap the air bubble in the heart and to prevent it from going into the lungs.
