Positioning

Overview

1. Positioning
   1. Reasons for positioning
   2. Common types
   3. Other types

Nursing Points

General

1. Reasons for positioning
   1. Identify Needs
   2. Response to a need
   3. Think “form and function”
2. Common Types
   1. Fowlers
      1. Elevation of the head of bed
         1. Degree dependent on the problem or complaint
         2. Higher degree indicates better thoracic expansion
         3. Decreases likelihood of aspiration
      2. Low Fowler’s
         1. 15°-30°
      3. Semi-Fowler’s
         1. 30°-45°
      4. Fowler’s
         1. 45°-60°
         2. Most common position
      5. High Fowler’s
         1. 60°-90°
         2. Promotes best chest expansion
   2. Flat types
      1. Supine
         1. Face up
         2. Most common
      2. Prone
         1. Face down
         2. Used commonly in surgery
         3. Also used with specialty beds like the Roto-Prone for respiratory disease
      3. Flat
         1. Used for spinal precautions
      4. Trendelenburg
      5. Trendelenburg
         1. Used for certain procedures
      6. Reverse Trendelenburg
         1. Used to promote gastric emptying
3. Others
   1. Sims position
      1. Used for pregnant patients or ideal for suppository administration
   2. Dorsal recumbent
      1. Lying flat, but with arms overhead
      2. Used most commonly for abdominal exams
   3. Lithotomy
      1. Used in pelvic exams
      2. More commonly used by providers, but still used by nurses for dilation exams

Assessment

1. Needs of patient may change ordered position.
   1. Use nursing judgment
   2. Promote prioritization
   3. Discern patient’s primary ABC needs in patient positioning
      1. Don’t sacrifice airway because of an order
2. Take heed of any cervical or spinal precautions
3. Assess patient’s pain and comfort needs
   1. Consider this when using interventions like traction

Therapeutic Management

1. All positioning can be implemented unless there is a strict order
2. Use additional resources such as UAPs or other RNs to properly position a patient
3. Promote airways, breathing, circulation priority
   1. Consider aspiration risks

Nursing Concepts

1. Safety
2. Patient-Centered Care
3. Comfort
4. Clinical Judgment

Patient Education

1. Educate patient on need for turning to offset pressure if capable
2. Explain to patient that certain positions are needed
3. Walk through with your patient the different maneuvers for patient positioning

Study Tools