Patient Positioning Nursing Care | Nursing Fundamentals Next Generation NCLEX Review

Summary

In this video, Nurse Sarah explains various patient positions used in nursing care, such as supine, prone, dorsal recumbent, lithotomy, Sims, lateral, Fowler’s, and Trendelenburg. Each position is discussed in terms of its clinical uses, such as post-surgery recovery, respiratory support, and catheter insertion, while also highlighting potential complications like pressure injuries and nerve damage. The video provides a comprehensive overview of these key positions, offering insights into their benefits and precautions to enhance patient care in diverse medical settings.

Takeaways

• 😀 Supine position: The patient lies on their back with legs extended. Commonly used for sleeping, post-procedure recovery (e.g., lumbar puncture, C-section), and head-to-toe assessments.
• 😀 Prone position: The patient lies flat on their abdomen, useful for spinal surgery and respiratory problems (e.g., ARDS, COVID-19). Can improve lung function and gas exchange.
• 😀 Dorsal Recumbent position: The patient lies on their back with flexed knees, commonly used for procedures like catheter insertion and peri-care.
• 😀 Lithotomy position: Used for surgeries related to the urinary or genital system, such as childbirth or vaginal exams. Requires care to prevent nerve damage from stirrups.
• 😀 Sims position: The patient lies on their left side with one knee flexed, used for Foley catheter insertion or enemas. Pressure injuries can occur at bony prominences.
• 😀 Lateral position: The patient lies on either side, often used during seizures or unconsciousness to maintain an open airway and prevent aspiration.
• 😀 Fowler's position: There are several variations (low, semi, high), and it involves elevating the head of the bed. It is used to ease breathing in patients with heart failure or respiratory issues.
• 😀 High Fowler's position: The head of the bed is raised to 60-90 degrees, useful for NG tube insertion, and managing autonomic dysreflexia in spinal cord injury patients.
• 😀 Trendelenburg position: The patient lies flat with head lowered and feet elevated. It was traditionally used to treat hypotension, but it may not be effective and can worsen intracranial pressure.
• 😀 Reverse Trendelenburg position: The head is elevated and feet lowered, useful during head and neck surgeries to minimize blood loss and improve surgical visibility.
• 😀 Modified Trendelenburg position: The patient is flat with feet elevated, used to improve venous return in cases of hemorrhagic shock or hemodynamic instability.

Q & A

What is the Supine position, and what are its common uses?

The Supine position involves the patient lying flat on their back with their legs extended. It is commonly used for sleeping, post-procedure recovery (such as after lumbar puncture or heart surgeries), abdominal surgeries like C-sections, and head-to-toe assessments. It is also useful for patients who need to remain flat after certain procedures to prevent complications like headaches.

What are the main risks associated with the Supine position?

The main risks associated with the Supine position include pressure injuries (pressure ulcers), particularly on bony prominences like the heels, ankles, sacrum, elbows, scapula, and back of the head. Additionally, patients who cannot shift their weight are at risk for developing foot drop.

How does the Prone position help with respiratory issues?

The Prone position, where the patient lies on their abdomen with the head turned to either side, is used for conditions like ARDS (acute respiratory distress syndrome) and COVID-19. It helps improve lung function by redistributing lung fluids and improving gas exchange, which eases the heart's workload and improves overall respiratory function.

What are some complications associated with the Prone position?

Complications from the Prone position include airway management issues, particularly with mechanical ventilation, risk of pressure injuries on the ears and eyes, and the potential for brachial plexus injury due to excessive pressure on the shoulder area. Close monitoring is required to prevent these issues.

What distinguishes the Dorsal Recumbent position from the Supine position?

The Dorsal Recumbent position is similar to the Supine position, but with the patient's knees flexed. This position is commonly used for procedures like Foley catheter insertion and for providing perineal care. Like the Supine position, it carries risks for pressure injuries on the heels, shoulders, and sacral area.

Why is the Lithotomy position used, and what are its key risks?

The Lithotomy position involves the patient lying on their back with their legs flexed at a 90-degree angle at the hips, with the legs placed in stirrups. It is commonly used during vaginal or urinary surgeries, including childbirth. Risks include pressure injuries, especially to the legs, and potential nerve compression due to the positioning of the legs in stirrups.

What is the purpose of the Sims (semi-prone) position?

The Sims position involves the patient lying on their left side with the right knee and hip flexed. It is commonly used for procedures like Foley catheter insertion (when the dorsal recumbent position is not possible) and for administering enemas. Risks include pressure injuries to the ear, trochanter, and side of the heel.

What are the benefits of the Lateral position, and when is it used?

The Lateral position, where the patient is placed on their left or right side, is used to prevent aspiration in unconscious or seizure patients, as well as during hip and kidney surgeries. It helps maintain an open airway. However, pressure injuries are a concern, particularly on the ear, shoulder, elbow, hip, and knees.

What is the difference between the various Fowler's positions?

The Fowler's positions involve different degrees of head elevation in the bed. Low Fowler's (15-30 degrees) and Semi-Fowler's (30-45 degrees) are commonly used for breathing difficulties, post-operative care, or enteral feedings. High Fowler's (45-60 degrees) is used for patients with respiratory issues or during procedures like NG tube insertion. The higher the angle, the more pressure on the sacral and coccyx areas, increasing the risk for pressure injuries.

What is the Trendelenburg position used for, and why is it controversial for hypotension?

The Trendelenburg position involves placing the patient in a supine position with the head lowered and feet elevated. It has traditionally been used for central venous catheter placement and pelvic surgeries, as well as to treat hypotension. However, evidence suggests it may not effectively raise blood pressure and could harm cardiac and lung function, as well as increase intracranial pressure.