Online Nursing Classes
I. Positions for clients with Respiratory Disorders
After lung Biopsy:
- To apply pressure in the site and prevent bleeding
Upright or Sitting Position at the edge of the bed, arms on overbed table, leaning forward, and feet supported on a foot stool
- For easy access to the site of insertion of aspiration needle. It also promotes comfort.
Unaffected side for 1 hour to prevent leakage of fluid into the thoracic cavity.
Client on Oxygen Therapy:
- For lung expansion and ventilation.
During Tracheostomy or Endotracheal Tube Suctioning:
- To facilitate suction catheter insertion and enhance removal of mucous membrane.
After Bronchosgraphy and Bronchoscopy:
Side-lying/lateral or semi-fowler’s position
- To promote drainage of secretions from the mouth and prevent aspiration.
Sitting Upright, leaning forward position, with arms on overbed table at shoulder level (orthopneic position)
- To allow lung expansion.
Sitting/Upright position, leaning forward with head tipped
- To prevent aspiration of blood.
Side lying/lateral or prone position with pillow under the chest
- To promote drainage of mouth secretions and prevent aspiration. If client is awake, maybe placed in semi-fowler’s position.
Pulmonary Edema:High-Fowler’s position with legs slightly dependent (lowered)
- To relieve dyspnea. Lowering the legs reduces venous return thereby reduces cardiac workload.
Slightly towards affected side, with head elevated or Semi-Fowler’s position for lung expansion
- To prevent flooding of blood coming from the affected side to the remaining lung. Slight turning prevents mediastinal shift.
Semi-fowler’s position, turned towards the affected side or the affected side be supported
- To control paradoxical breathing and prevent hypercapnea.
Child with Epiglottitis, laryngotracheobronchitis, bronchiolitis:
Tripod position (sitting upright, leaning forward with hands on the bed or floor) – to facilitate breathing.
SIDS (Sudden Infant Death Syndrome):
Supine or Side-lying position in a firm bed during sleep. Do not place the infant in prone position during sleep. Do not place infant in soft bed or over a pillow or comforter.
II. Positions for clients with Cardiovascular and Hematologic Disorders
Myocardial Infarction (MI):
– for maximum lung expansion and improves myocardial oxygenation.
Congestive Heart Failure (CHF):
– it relieves dyspnea and reduces cardiac workload.
When taking Nitroglycerin:
Sitting or Supine position
– to prevent orthostatic hypotension
Lower extremities slightly lower than the level of the heart (dependent position)
– it promotes arterial flow
Lower extremities elevated
– it promotes venous return and relieves edema of the legs.
Tetralogy of Fallot in “tet spell” (hypoxic episode):
Knee-to-Chest position or Squatting position
– to improve venous return, increases cardiac output and improve tissue oxygenation.
Left Side-lying position, Trendelenburg position
– it allows the air to be absorbed in the right side of the heart thus prevents pulmonary embolism.
III. Positions for clients with Gastrointenstinal, hepato-Biliary and Pancreatic Disorders
During Abdominal Examination:
Dorsal recumbent position
– to relax the abdominal muscles and facilitate abdominal examination.
During Rectal Examination:
– to facilitate examination of the area.
During Nasogastric tube (NGT) insertion:
High-fowler’s position, with the neck hyperextended, initially. Flex the neck slightly once the tube reaches the oropharynx.
During and after NGT feeding (gastric gavage) and Gastrostomy feeding:
– to prevent reflux and aspiration of feeding.
After insertion of Intestinal/Nasogastric Tube:
Right Side-lying position
– it helps advance the tube into the duodenum.
During insertion of Parenteral Nutrition (TPN) Catheter:
– to engorge the vein and facilitate insertion of the catheter to the subclavian vein. It also prevent air embolism.
During Enema Administration:
Left lateral position for adult. Dorsal Recumbent position for infant and children.
Upright/Sitting position during and after eating
– to prevent gastroesophageal reflux.
After Gastric and Biliary Surgery:
– to promote lung expansion and ventilation and also prevents atelectasis.
Left side-lying position
– to slow down emptying of gastric content into the jejunum.
– to localize the inflammatory process in the pelvic area.
Semi-fowler’s position, then sitting on a bowl once ambulatory.
– it prevents pressure in the operated area and promote comfort.
After Infant Feeding:
Right side-lying position
– it prevents gastroesophageal reflux and aspiration.
After Cleft Lip Repair:
– to promote drainage and prevent aspiration. No to Prone position to prevent tension on the suture line. Restraint the elbow to prevent trauma in the suture line.
After Cleft Palate Repair:
Side-lying and Prone position
– to promote drainage and prevents aspiration.
After repair of Imperforate Anus:
Side-lying position or Supine with the legs suspended at the right angle
– to prevent pressure in the area and minimize discomfort.
During Liver Biopsy:
– to facilitate approach to the liver
After Liver Biopsy:
Right Side with rolled towel under the puncture site
– it helps apply pressure at the puncture site and prevent bleeding.
– it facilitates aspiration of abdominal fluid.
IV. Positions for clients with Fluid-Electrolyte, Acid-Base Imbalances, Genito-Urinary Disorders, Shock, Burns
During insertion of Urinary Catheter:
Supine with legs extended and abducted for male. Dorsal Recumbent for female.
During Cyctoscopy: Lithotomy position– to promote easy insertion of cystoscope.
During Renal Biopsy:
– it is because the kidneys location is retroperitoneally.
After Renal Biopsy:
Supine position with small pillow or rolled towel under the posterior lumbar area to apply pressure and prevent bleeding.
During insertion of Peritoneal Catheter:
Dorsal Recumbent or Semi-fowler’s position with the knees flexed
– to relax abdominal muscles and facilitates the insertion of the catheter.
During Vaginal Examination:
Dorsal Recumbent if she is in bed. Lithotomy position if the examination is done in the table.
Modified Trendelenburg position
– to increase venous return and increased force of cardiac contractility thus increases cardiac output and tissue perfusion.
– to promote position of extension and prevent contractures.
V. Positions for clients with Neurologic Disorder
During Lumbar Puncture: Lateral, Knee-chest position (fetal/flexed/C-position/shrimp position)
– to widen intervetebral spaces and facilitate insertion of spinal needle.
After Pantopaque (oil-based dye) myelogram:
Lie Flat for 6 to 8 hours
– to prevent spinal headache.
After Metrizamide (water-based dye) myelogram:
Semi-fowler’s position for 8 hours
– to prevent meningeal irritation.
Lateral, Semi-fowler’s position
– to reduce the pressure, promote adequate lung expansion and improve cerebral tissue perfusion.
Spinal Cord Injury:
Flat/Supine position on a firm space
– to maintain alignment of spine.
VI. Positions for clients with Eye and Ear Disorders
After Eye Surgery: Supine position turned to the Unoperated Side
– to prevent trauma to the affected eye. If the client is fully awake: Semi-fowler’s position.
Preoperative: Dependent position (lower)
– to prevent further detachment of the retina.
Postoperative: Dependent position (upper)
– to lower the sclera and choroids by gravity and allow attachment of the area of retinal detachment.
After Ear Surgery:
– to prevent trauma to operated side.