POSITIONING AND ITS IMPORTANCE

INTRODUCTION-

Therapeutic positioning are used to promote comfort of the client. Proper turning and
positioning allows the health care provider to make client as comfortable as possible, prevent
contracture s and pressure sores ,and facilitate diagnostic tests or surgical interventions.
While positioning a client ,three factors must be remembered: pressure ,friction & force.

Problems of contractures and deformities can often be prevented by proper positioning of the
patient. Regardless of the position selected it is essential that the patient maintains a correct
body alignment while in bed and it is very important for the nurse to evaluate patient position
during each contact throughout the shift. To achieve proper body positioning and alignment,
it is imperative for the nurse to suggest and assist ways and methods of preventing
deformities and contractures.

The nurse uses a variety of interventions to bring comfort and relief to her patients. positions
used for clients in many settings and situations can adopt varies comfortable positions to
provide them a comfortable stay. Any part of the client that comes in contact with the surface
in which the client is lying is a pressure site. To relive the pressure ,turn the client to new
position every two hours. Always assess the blood flow to the skin and tissue areas under
pressure.

DEFINITION-

Positioning define as moving moving a patient into a specific position or posture to facilitate
examination ,surgery or for therapeutic purposes.

Positioning is defined as deliberative placement of the patients or a body part to promote

physiologic & psychological well being.

COMMON POSITIONING POSTURES

 Prone Position
 Standing Position
 Sitting Position
 Prone Position
 Supine Position
 Fowler’s Position
 Dorsal Recumbent Position
 Knee Chest Position
 Sim’s Lateral Position
 Trendelenburg Position
 Lateral Position
 lithotomy position
PURPOSES OF POSITIONS

 To promote comfort & safety.

 To protect from pressure, abrasion ,injuries etc.
 To prevent muscle stretch & muscle strains.
 To provide adequate circulatory & respiratory functions.

STANDING POSITION/ ERECT POSITION

The client stands erect .

IMPORTANCE

 To assess posture ,balance & gait.

 Assessment of neurological disorders.

CONTRAINDICATION

Not use for clients who are weak dizzy or prone to fall.

SITTING POSITION

The client sit on a chair or on the side of the bed or examining table.

IMPORTANCE

 It Allows Visualization of the upper body

 Facilitate full lung expansion.
 It is used to assess the vital sings.
 It is used to assess the head , neck ,anterior & posterior thorax ,lungs, heart ,breast and
upper extremities’.

PRONE POSITIONING –

 Laterally turn the head to either side. Keep in mind that the head should be in
alignment with the rest of the body. The spines should be straight and the legs
extended.
 Abduct the arms and position it externally rotated at the shoulder joint. Elbows can be
flexed or extended, depending on the patient’s preference for his or her comfort.
Pillows can be placed under the arms.
 To reduce pressure against female breast’s a rolled towed can be placed under the
shoulder or a small pillow can be placed under the abdomen. This method also
relieves pressure on the back.
 A small flat support is placed under the pelvis. The length of this support should
extend from the level of the umbilicus to the upper third of the thigh.
 Lower extremities should be maintained at a neutral position.
 The toes are suspended over the edge of the mattress.
 IMPORTANCE
 Assess The Hip Joints .
 Assess The Posterior Thorax.
 Give Comfort
 Position The Client With Injuries ,Burns And Surgeries Of The Back.
 Relieve Pressure From Pressure Sore Prone Areas By Providing A Change Of
Position.
 For The Client After Anaesthesia To Prevent Aspiration Of Saliva ,Mucous &
Blood.

CONTRAINDICATION

1. Client with respiratory disease

2. Spinal problem .

SUPINE /DORSAL /HORIZONTAL RECUMBENT POSITION

In this position patient lies on his back with one pillow at

 The head should be positioned in line with the spine. Patient’s head should be about 2
to 3 inches from the head of the bed. A pillow should be placed under the patient’s
head. It should be extended about two inches below the patient’s pillow while
maintaining the head in line with the spine.
 Hip flexion should be minimized by positioning the trunk well. To do so, a trochanter
roll can be placed along the greater trochanter of affected hip or along both hips to
prevent external rotation if the patient has little control over the legs. Trochanter roll
is a supportive device that can be bought or can be manually devised by simply
rolling a bath blanket to a rolled shaped with a length of about 12 to 14 inches. It is
essential to keep in mind that trochanter rolls should be long enough to reach the areas
above the hip and above the knee from each edge. With the use of this supportive
device, external hip rotation is prevented.
 Flex the arms of the patient at the elbow and let the hands rest against the lateral side
of the abdomen.
  Legs are extended with a small and firm support under the popliteal area. Pillows can
be used in these instances.
 To prevent footdrop and if care plan indicates, the toes should be pointed straight up
and supported by a foot board. If foot board is not available for use, placing a folded
pillow to support the patient’s feet will produce the same effect. The ankles should be
at 90 degree angle.

LATERAL POSITION

Lateral position in this the patient lies on his side with knees slightly flexed toward the
abdomen, one knee more acutely than other . pillow can be placed at the head ,back , & at the
sides for support.one pillow can be placed between the knees to take the weight off the upper
leg & prevent friction.

o Make sure that body alignment is correct – spines are straight, and not twisted.
o Flex the shoulders and the elbow and support the upper arm with a pillow. If right
lateral position is desired right shoulder and elbow should be flexed while the palm is
positioned facing up. The left arm is slightly flexed and supported with a pillow.
o Slightly forward the uppermost hip joint and slightly abduct the leg by supporting it
with a pillow. The hip, knee and ankle of the patient should be at approximately the
same height.
o To help maintain or support the position, a pillow may be place behind the patient or
at his or her back.
o The feet should be placed and supported in neutral dorsiflexion.

Right Lateral Recumbent

    The Right lateral recumbent, or RLR, means that the patient is lying on their right side.

Left Lateral Recumbent

    The left lateral recumbent, or LLR, means that the patient is lying on their left side.
IMPORTANCE

 Use for giving enema or suppositories.

 For taking rectal temperature.
 For doing rectal examination.
 To relieve pressure on bony prominences of the back & sacral region .

FOWLER’S POSITION

FOWLER’S POSITION IS A SEMI –Setting position with head elevated to 30 degree with the
support to back rest & pillow . fowler’s bed can also be giving this position .the arms should
be supported on pillow so that client sits with arms supported in an arm chair fashion.

    A person in the Fowler's position is sitting straight up or leaning slightly back. Their legs
may either be straight or bent.  A ‘high fowlers’ position is somewhat who is sitting upright. 
A ‘low fowlers’ position is someone whose head is only slightly elevated.

High Fowler’s Position

low fowler’s position.

IMPORTANCE

 To relieve breathing difficulty .

 To relieve tension on the abdominal sutures.
 To help in the drainage of the abdominal cavity.
 To relax the large muscles of the back & thighs.
CONTRAINDICATION

Not to used after brain or spine surgery.

DORSAL ELEVATED OR SEMI RECUMBENT POSITION

Client lies in the bed with two or more pillow which may be arranged in armchair fashion to
support the shoulder ,arms & elbows . additional comfort may be provided by means of
pillow under the knees & foot support.

IMPORTANCE

 Client in convalescence period.

 Client with minor respiratory diseases.

KNEE CHEST POSITIONING

The client lies prone on the knees & chest .the head is turned to one side ,with the check on a
pillow . a small pillow may be placed under the chest . the arms are above the head or they
may be flexed at the elbows & rest along the sides of the head ,so as to support the client
partially. the weight of the client should rest on the chest & knees.

IMPORTANCE

 For examination of the rectum & vagina.

 For sigmoidoscopy.
 As an exercise for postpartum client.
CARDIAC POSITION

The client is propped up in a sitting position by means of back rest & pillows. place an over
bed table in front with a pillow on it ,on which the client can lean forward & take rest. client
has an air cushion to sit and a small pillow under the knees.

IMPORTANCE

 This is the most comfortable for clients with cardiac asthma.

 This position is used for clients with cardiac diseases who can not breath easily
inlying down position.

LITHOTOMY POSITION

The client lies with supine with hip flexed & calves & heels ,parallel to the floor. the buttocks
are brought to the edge of the examining table & the heels in stirrups. one pillow placed
under the head .the legs are well separated & the thighs are well flexed on the abdomen and
legs on the thighs.

IMPORTANCE

 For gynaecological examination & treatment.

 Surgical procedures involving genitourinary system
 Assessment of female genitalia & rectum.
SIM’S LATERAL OR LEFT LATERAL PRONE POSITION

In this position , the client lies on the left side with one pillow placed under the head ,& the left cheek
resting on it . the left arm is drown behind the back & the right arm may be in a position comfortable
for the client. the right thigh is flexed against the abdomen.

IMPORTANCE

 Use for vaginal and rectal examination

TRENDELENBURG POSITION

Trendelenburg position the body is laid flat on the back (supine position) with the feet higher than
the head by 15-30 degrees, in contrast to the reverse Trendelenburg position, where the body is
tilted in the opposite direction. This is a standard position used in abdominal and gynecological
surgery. It allows better access to the pelvic organs as gravity pulls the intestines away from the
pelvis. It was named after the German surgeon Friedrich Trendelenburg.[1] It is not recommended for
the treatment of hypovolemic shock People with hypotension (low blood pressure) have
historically been placed in the Trendelenburg position in hopes of increasing their cerebral
perfusion pressure (the blood pressure to the brain). A 2005 literature review found the
"Literature on the position was scarce, lacked strength, and seemed to be guided by 'expert
opinion.'"[3] A 2008 meta-analysis found adverse consequences to the use of the
Trendelenburg position and recommended it be avoided.[4] However, the passive leg raising
test is a useful clinical guide to fluid resuscitation and can be used for effective
autotransfusion.[5]

IMPORTANCE

 The Trendelenburg position used to be the standard first aid position for shock.
 The Trendelenburg position is used in waterboarding to prevent water entering the
lungs.
 Trendelenburg position is helpful in surgical reduction of an abdominal hernia.
 The Trendelenburg position is also used when placing a Central Venous Line.
 Trendelenburg position uses gravity to assist in the filling and distension of the upper
central veins when placing a central line in the internal jugular or subclavian veins.
  It is also used in the placement of an external jugular peripheral line for the same
reason. It plays no role in the placement of a femoral central venous line.
 The Trendelenburg position is also used in respiratory patients to create better
perfusion.

Nursing Responsibilities of the Nurse in Patient Positioning:

1. Help the patient assume the desired or required bed position.

2. The nurse assists the patient to achieve proper body positioning and alignment.
3. Support patient’s body in correct alignment using pillows or splints.
4. Assure the proper use of supportive devices.
5. Frequently monitor and evaluate the position selected.
6. Provide skin care.

CONCLUSION

The nurse uses a variety of interventions to bring comfort and relief to her patients. positions
used for clients in many settings and situations can adopt varies comfortable positions to
provide them a comfortable stay. To relive the pressure ,turn the client to new position every
two hours. Always assess the blood flow to the skin and tissue areas under pressure.
Child assuming tripod position. (Illustration by Jason M. McAlexander, MFA. Copyright ©
2007 Wild Iris Medical Education.)

One position that the (quite wonderful) medtrng.com site does not mention is the ‘tripod’
position.

When people sit like this - with their hands on their knees and their elbows out, leaning
forward - it's because they are very short of breath and struggling to get enough air. 

There's a big difference between someone who is just 'sitting', which we will often describe
as 'sitting comfortably', and someone who is 'tripoding'.

Any patient who is tripoding is struggling to breath, and that should worry you.

Incidentally, here's a clinical pearl for you.  If you find a patient sitting high fowlers with
their legs crossed it's a pretty good sign that they are not in any distress.  Don't take that as an
unbreakable law or anything - but many clinicians have noticed over the years that folks who
are really in trouble don't lie back with their legs crossed.  Usually, only people who are
relaxed do that.

http://www.medtrng.com/posturesdirection.htm in April 2008.

 
 POSITIONING & ITS IMPORTANCE
INTRODUCTION-

Therapeutic positioning are used to promote comfort of the client. Proper turning and
positioning allows the health care provider to make client as comfortable as possible, prevent
contracture s and pressure sores ,and facilitate diagnostic tests or surgical interventions.
While positioning a client ,three factors must be remembered: pressure ,friction & force.

DEFINITION-

Positioning define as moving moving a patient into a specific position or posture to facilitate
examination ,surgery or for therapeutic purposes.

Positioning is defined as deliberative placement of the patients or a body part to promote

physiologic & psychological well being.

COMMON POSITIONING POSTURES

 Prone Position
 Standing Position
 Sitting Position
 Prone Position
 Supine Position
 Fowler’s Position
 Dorsal Recumbent Position
 Knee Chest Position
 Sim’s Lateral Position
 Trendelenburg Position
 Lateral Position
 lithotomy position