Positioning, Moving, and Transferring Clients PDF

Positioning, Moving, and Transferring Clients Positioning a client in good body alignment and changing the position regularly (every 2 hours) and systematically are essential aspects of nursing practice. Clients who can move easily reposition themselves automatically for comfo...

Positioning, Moving, and Transferring Clients Positioning a client in good body alignment and changing the position regularly (every 2 hours) and systematically are essential aspects of nursing practice. Clients who can move easily reposition themselves automatically for comfort. They generally require minimal positioning assistance from nurses, as well as guidance about ways to maintain body alignment and to exercise their joints. However, people who are weak, frail, in pain, paralyzed, or unconscious rely on nurses to provide or assist with position changes. For all clients, it is important to assess the skin and provide skin care before and after a position change. Purposes of patients positioning Promote comfort to the patient. Provide proper body alignment. prevent muscle discomfort, contractures and body deformities. Stimulate circulation. Remove pressure on various parts and decrease the risk for bed sores. Carry out nursing interventions. Perform medical and surgical procedures. Prevent complications of immobility Promote normal physiological functions. Point to be consider when positioning patient: Follow the principles of proper body mechanics. Make sure the mattress is firm and support natural body curvatures. Ensure that the bed is clean and dry. Wrinkled or damp sheets increase the risk for pressure ulcer formation. Place supportive devices in specified areas according to the position. If the client is capable of movement, too many devices limit mobility and increase the potential for muscle weakness and atrophy. Plan a systematic 24-hour schedule for position changes. Avoid placing one body part, particularly with bony prominences, directly on top of another body part. Supportive devices used for assisting and maintaining position: Pillow Different sizes are available. Used for support or elevation of head, arm or leg Mattresses 56 There are two types of mattresses: ones that fit on the bed frame (e.g., standard bed mattress) and mattresses that fit on the standard bed mattress (e.g., egg-crate mattress, waterbed mattress). Mattresses should be evenly supportive. Suspension or heel guard boot These are made of a variety of substances. They usually have a firm exterior and padding of foam to protect the skin. They prevent foot drop and relieve pressure on heels. Footboard A flat panel often made of plastic or wood. It keeps the feet in dorsiflexion to prevent plantar flexion or foot drop. Hand roll This can be made by rolling a washcloth. It is useful to keep hand in a functional position and prevent finger contractures. Hand and wrist splints They May be manufactured from rolled washcloths. Often splints are custom made for patients. The purpose of splints is to hold the wrist and hand in natural position and prevent claw- hand deformities. Heel or elbow protectors They reduce mattress pressure on heels or elbows and alleviate elbow friction when patient moves in bed. Abduction pillow A triangular-shaped foam pillow that maintains hip abduction to prevent hip dislocation following total hip replacement. Side rails Bars attached to the sides of the bed. Assist with mobility and prevents falls Trapeze Bar A trapeze bar is a triangular-shaped device that is attached to an overhead bed frame. It is used for self-help or with minimal help from nurse to change positions in bed. 57  Bed Loops They are attached to bed sides, and help patients to reposition themselves and move into a safe sitting position on the edge of a bed. Bed cradle Metal or plastic devices that are secured at the foot of the bed to hold bedding up off the toes and feet, allowing for free movement and minimize friction and pressure on toes. Bed board Plywood board placed under entire mattress; it improves spinal alignment by providing support. Trochanter roll Made from tightly rolled towels, bath blankets, or foam pads. They are placed snugly adjacent to the hips and thighs to prevent external rotation of the hips. High-top sneakers They prevent heel drop, but they do not reduce heel pressure. They do help in positioning hips and pelvis to prevent hip rotation. Sandbags Small fabric bags filled with sand. They are used in the same manner as pillows, foot board and trochanter rolls; however, they provide firmer support. Over Bed Table “Cardiac table” In addition to be used for daily activities like eating, it arranged in such a way to keep the patient in a sitting position on the bed with the help of pillows, it relieves problem caused by heart disease and respiratory distress. Types of positioning: There are many positions that are used in medical practices, some of them are used for a short period of time to carry out a specific procedure “examination positions” while the others are used for longer time (2 hours) which are called “comfort positions”. 58  Examination positions: Jackknife Position Jackknife position, also known as Kraske, is similar to Knee-Chest or Kneeling positions and is often used for colorectal surgeries Kidney Position The kidney position resembles lateral position, except the patient's abdomen is placed over a lift in the operating table that bends the body to allow access to the retroperitoneal space. Lithotomy Position This position is typically used for gynecology, colorectal, urology, perineal, or pelvis procedures. Trendelenburg Position typically used for lower abdominal, colorectal, gynecology, and genitourinary surgeries, cardioversion, and central venous catheter placement. Reverse Trendelenburg Position typically used for laparoscopic, gallbladder, stomach, prostrate, gynecology, bariatric and head and neck surgeries. Sitting Position This position can be used to assess head, neck, posterior and anterior thorax, lungs, breasts, axillae, heart, vital signs, upper and lower extremities, reflexes Dorsal Recumbent Position This position can be used to assess female genitals, rectum, and female reproductive tract Knee Chest Position This position often used for spine surgery. 59 Comfort positioning: ❖ Orthopneic position: The head of the bed is elevated 90° and an overbed table with a pillow on top is positioned in front of the patient. Have the patient lean forward, resting his arms and head on the pillow. This position facilitates respiration by allowing maximum chest expansion. It is particularly helpful to clients who have problems exhaling, because they can press the lower part of the chest against the edge of the overbed table.  Position Description Indications Potential Complications Corrective Measures Horizontal recumbent Back-lying ❖ Promote comfort Cervical hyperextension Maintain correct alignment with (supine) position position. NOTE: Head and shoulders pillows under upper shoulders, are kept flat after procedures neck, and head. Head and involving spinal anesthetics Internal rotation of the Position the upper arms next to the shoulders may be ❖ commonly used for the shoulders and extension body. Place pillows under the slightly raised of the elbows forearms, and position the wrists in following procedures: slight pronation. intracranial, cardiac, Flexion of fingers and Use hand splints if appropriate, or abdominal, endovascular, abduction of the thumbs provide a large roll in the palm of laparoscopic, lower “claw hand” the hand. extremity procedures, Flexion of the lumbar Provide a firm mattress. 61 curvature and hips Place a small pillow under the and ENT, neck and face. lumbar curvature. ❖ can be used to assess; External rotation of the Place sandbags or rolls alongside head, neck, axillae, legs the trochanters and upper thighs. anterior thorax, lungs, Hyperextension of the Place a small pillow under the breasts, heart, vital signs, knees lower legs from the ankles to below Pressure on heels the knees. abdomen, extremities, Foot drop Use a footboard or high-top peripheral pulses sneakers to hold the feet in dorsiflexion.  Position Description Indications Potential Complications Corrective Measures Fowler’s Semi-sitting ❖ Promote comfort Hyperextension of the Use a small pillow under the head position. ❖ Improve respiratory neck and neck. Head of bed problems (i.e., dyspnea, Posterior flexion of the Use a firm mattress. elevated to 45–60 pneumonia) lumbar curvature Position the patient so that the angle degrees. Knees ❖ Encourage slightly elevated. postoperative drainage of elevation begins at the hip. ❖ Typically used for Dislocation of the Position a pillow under the forearms neurosurgery and shoulders to prevent pull on the shoulders. Low Fowler’s shoulder surgeries. Flexion contracture of the Support the hands-on pillows in and typically wrist and edema of the alignment with the forearms. means 15° to 30° hands of elevation. Flexion contracture of the Use hand splints if appropriate, or Semi-Fowler’s fingers and abduction of provide a large roll in the palm of 62 position is when the thumbs the hand. the head and trunk External rotation of the Place sandbags or rolls alongside are raised to 30° legs the trochanters and upper thighs. to 45°. Hyperextension of the Place a small pillow under the Fowler’s position knees lower legs from the ankles to below refers to a 45° to the knees. Do this for short periods 60o angle of only; avoid pressure on the popliteal elevation of the area. upper body. Foot drop (plantar Use a footboard or high-top flexion) sneakers to hold the feet in In high-Fowler’s position, the head dorsiflexion. and trunk are raised 60° to 90°  Position Description Indications Potential Complications Corrective Measures Lateral Side-lying ❖ Promote comfort Lateral flexion of the Place a pillow under the head and position. ❖ Relieves pressure on neck neck to provide alignment. Lateral aspects of sacrum and heels lower scapula and ❖ A patient may be Internal rotation and Place a pillow under the upper arm, lower ilium positioned in Lateral adduction of the upper and comfortably flex the lower arm. support most of position during back, shoulder and limited body weight. colorectal, kidney, and hip surgeries. respirations 63 ❖ It's also commonly Internal rotation and Support the upper leg from groin to used during thoracic adduction of the femur foot with pillows. and ENT surgeries, and neurosurgery. Twisting of the spine Align the shoulders with the hips. Flexion of the cervical Place a pillow under the head and spine neck to provide alignment, unless drainage from the mouth is desired.  Position Description Indications Potential Complications Corrective Measures Sims’ Semi-prone ❖ Promotes drainage Lateral flexion of neck Place a pillow under the head and position from mouth neck to provide alignment. Upper arm is ❖ Prevents aspiration Internal rotation and Place a pillow under the upper arm, flexed at shoulder ❖ Reduces pressure on and elbow; lower sacrum and greater adduction of the upper and comfortably flex the arm at the arm is positioned trochanter of hip shoulder and limited elbow. behind client. ❖ This type of position respirations Both legs flexed allows access to the in front of client anus. Pressure on the shoulder Position the lower arm behind and 64 with more flexion and axilla of the inferior away from the back. in upper leg. arm Promotes comfort especially in Internal rotation and Support the upper leg from groin to pregnant clients adduction of the femur foot with pillows. Twisting of the spine Align the shoulders with the hips. Foot drop Support the feet in dorsiflexion with sandbags.  Position Description Indications Potential Complications Corrective Measures Prone Face-down ❖ Helps prevent Hyperextension of the Place a small pillow under the position. contractures of hips lumbar curvature, abdomen. Head is turned to and knees pressure on the breasts in one side ❖ Promotes drainage from mouth women or genitals in ❖ Prone position is often men, impaired used for spine and neck respirations surgeries, neurosurgery, Foot drop Move the patient down in bed so the 65 colorectal surgeries, feet extend over the edge of the vascular surgeries, and mattress, or place a small pillow tendon repairs. under the lower legs so that the toes do not touch the bed. Lateral flexion of the Place a pillow under the head and neck neck to provide alignment, unless drainage from the mouth is desired.