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DESCRIPTION
After you have turned and moved the patient into proper body alignment, you can place pillows and other supportive devices to help the patient maintain the position. Directions are given here for the basic positions and their variations.
SUPINE POSITION
1. Start with the bed flat and the patient lying on the back. The patient's head should be about two to three inches from the head of the bed.
2. Place a pillow under the patient's head. It should extend about two inches below the patient's shoulders, with the head in the middle of the pillow.
3. Place a trochanter roll along the affected hip or along the both hips if the patient has little control over the legs. A trochanter roll is devised by rolling a bath blanket into a shape about 12-14 inches in length. The roll should be just long enough to reach from above the hip to above the knee. The trochanter roll prevents external rotation of the hip.
4. Place pillows under the legs to reach from above the back of the knee to the ankle so that the ankles and heels do not rub on the sheets.
5. If care plan so indicates, position the footboard or place a folded pillow to support the patient's feet. The ankles should be at 90° angles.
6. Extend the patient's arms and place small pillows to reach from the elbow to below the wrist. The hand should be in alignment with the wrist.
SEMI-SUPINE POSITION
Start with the patient in supine position. Roll the patient's trunk and shoulder away from you so that there is a 45° angle between the patient's back and the bed.
1. Place a pillow behind the patient's back for support.
2. Bring the patient's left shoulder forward. Flex the elbow of the left arm and place the lower left arm, palm up, on a pillow.
3. Flex the elbow of the right arm and bring the forearm across the chest with palm down.
4. Extend both legs. Place right leg a little behind left leg. Support right leg with two pillows folded in half that extend from groin to ankle.
PRONE POSITION
Start with the bed flat and the patient lying on the abdomen with head turned to either side, spine straight and legs extended.
1. Place a small pillow under the head so that it extends to the patient's shoulders and five to six inches beyond the face.
2. Place a small pillow under the abdomen. This relieves pressure on the back and reduces pressure against a female patient's breasts. An alternate method is to roll a towel and place it under the shoulders.
3. Place a pillow under the arms to reach from the elbow to below the wrists. The shoulders and elbows may be flexed or extended, whichever is more comfortable for the patient.
4. Place a pillow under the lower legs to prevent pressure on the toes. The patient may be moved down in the bed before starting the procedure, so that the feet extend over the end of the mattress. This allows the foot to assume a normal standing position.
SEMI-PRONE POSITION
This position relieves pressure on the hips. Breathing is easier in this position than in the full prone position. Directions given here are for the patient lying on the left side. These can be easily adapted for the right side.
1. Extend the patient's left arm and tuck it slightly beneath the patient's body.
2. Place a pillow in front of and at right angles to the patient's chest.
3. Flex the patient's right knee and hip. Support with pillows that are parallel to the leg.
4. Grasp the patient's left arm from the back of the patient. Turn the patient onto his chest facing away from you. Gently pull his left arm toward you and push on his hip.
5. Extend the right arm upward and toward the head of the bed. Place it on the head pillow with the fingers and palm against the bed.
6. Flex the upper arm on a pillow.
7. Lift up the sheepskin and place a foam block under the sheepskin above the iliac crest (hip bone).
8. Place another foam block under the sheepskin just below the iliac crest. You should be able to slide your hand between the hip and the bed.
RIGHT LATERAL POSITION
1. Start with the bed flat and the patient turned to the left side, with spine straight. Remember before turning to move the patient to the right side of the bed.
2. Place a pillow under the head so it extends five to six inches beyond the patient's face and down to the shoulders.
3. Position patient's right arm so shoulder and elbow are flexed and palm of hand is facing up.
4. Place patient's left arm so it is extended or only slightly flexed and rest it on patient's hip or bring it forward and place it on a pillow. The patient's shoulder, elbow, and wrist should be at approximately the same height.
5. Place a pillow between the patient's legs so that it extends from above the knee to below the ankle. The patient's hip, knee, and ankle should be at approximately the same height.
6. A pillow may be placed behind the patient to help maintain the position.
SIM'S POSITION
This position is a variation of lateral position with the patient on the left side, left leg extended and right leg flexed. This position is often used for rectal examination and treatments and enemas.
1. Place a pillow under the patient's head as for lateral position.
2. Start with the bed flat and the patient moved and turned onto the left side.
3. Extend the patient's left arm and position it behind the patient's back.
4. Flex the right arm and bring it forward. Support arm with a pillow.
FOWLER'S POSITION
This position, or a variation of it, is used for feeding patient's in bed, for certain treatments and procedures, for the patient's comfort while visiting or watching television, and for those who have trouble breathing.
1. Start with the patient on the back, in the middle of the bed and in good alignment. The patient's hips should be at the place where the bend bends when the bed head is rolled up. Place the head of the bed at 30° for semi-Fowler's, 45° to 60° for Fowler's, and 90° for high Fowler's.
2. Place one or two pillows behind the patient's head to extend four to five inches below the patient's shoulders.
3. Flex elbows and place a pillow under each arm to prevent pull on the shoulders.
4. Place a pillow under each leg to extend from above the knee and to the ankle, to prevent pressure on heels.
5. Place footboard or folded pillow to keep feet in position, if necessary.
ORTHOPNEIC POSITION
This is a variation of high Fowler's position and is used for patients who have difficulty breathing.
1. The position of the bed remain the same as high fowler's (90° angle).
2. Bring the bedside table across the bed and place one or two pillows on top of the table.
3. Have the patient lean forward across the table with her arms on or beside the pillows. Have her rest her head on the pillows.
4. Place another pillow low behind the patient's back for support.
SITTING POSITION
Patients should be positioned in a comfortable, well-constructed chair, so that the head and the spine are erect. The back and buttocks should be up against the chair back. The feet should be flat on the floor.
1. Pillows or postural supports may be needed to maintain the position.
2. A small pillow may be folded and placed at the small of the back to add comfort and support.
3. Do not permit the back of the patient's knees to rest against the chair.
POSITIONING DEVICES
Several types of devices called orthoses, are used to maintain position of an extremity. The correct use of these devices prevents contractive formation. Orthoses are also called splints. The graphic above are examples of orthoses for the upper extremities.
A health care provider may also order splints or orthoses for the lower extremities. A common type is called the ankle foot orthosis (AF0). The AFO provides support for an unstable ankle and helps reduce extensor spasticity. The AFO is applied to the lower leg before the shoe is put on.
Guidelines For The Use of Splints
- The splint must be applied correctly. Follow the manufacturer's directions for each splint.
- Follow the care plan for the patient's wearing schedule.
- Keep the extremely under the splint clean and dry.
- Keep the splint clean. If it becomes soiled, check with health care provider or supplier to see how it should be cleaned.
MoonDragon's Health & Wellness - Bedsores Guidelines, Nutrition, Herbal, & Holistic Recommendations
