Questions on Positioning

Many graduate nurses are not comfortable answering these questions because:
They dont understand the whys of positioning
They dont know the terminology
They have diculty imaging the various positions
!ince many illnesses a"ect body alignment and mobility# you must be able to safely
care for these clients in order to be an e"ective nurse$ %orrespondingly# these topics
are also important on the &%'()*+&, e-am$ The successful test taker must
correctly answer questions about impaired mobility and positioning$
.mmobility occurs when a client is unable to move about freely and independently$
To answer questions on positioning# you need to know the ha/ards of immobility#
normal anatomy and physiology# and the terminology for positioning$
.f you have diculty answering positioning questions# the following strategy will
assist you in selecting the correct answer$
Step 1. 0ecide if the position for the client is designed to prevent something or
promote something$
Step 2. .dentify what it is that you are trying to prevent or promote$
Step 3. Think about anatomy# physiology# and pathophysiology$
Step 4. 1hich position best accomplishes what you are trying to prevent or
promote2
0oes this sound a little confusing2 3ang in there$ 'ets walk through a question
using this strategy$
Immediately after a percutaneous liver biopsy, the nurse should place the client in which of the following
positions?
1. Supine.
2. Right side-lying.
3. Left side-lying.
4. Semi-Fowlers.
4efore you read the answers# lets go through the four steps outlined above$
Step 1. 4y positioning the client after a liver biopsy# are you trying to prevent
something or promote something2 5nswer: 6ou position a client after this
procedure to prevent something$
Step 2. 1hat are you trying to prevent2 5nswer: The most serious and
important complication after a percutaneous liver biopsy is hemorrhage$ 3ow
did you know that you are trying to prevent hemorrhage2 6ou accessed what
you know about a liver biopsy$
Step 3. Think about principles of anatomy# physiology# and pathophysiology$
1hat do you do to prevent hemorrhage2 5nswer: 6ou apply pressure$ 1here
would you apply pressure2 7n the liver$ 1here is the liver2 7n the right side of
the abdomen under the ribs$
Step 4. 3ow should the client be positioned to prevent hemorrhage from the
liver# which is on the right side of the body2
&ow look at your answer choices$
89: !upine$ .f you lay the client ;at on his back# no pressure will be applied to
the right side$ (liminate$
8<: +ight side*lying$ .f you lay the client in a right side*lying position# will
pressure be applied to the right side2 6es$ =eep it in for consideration$
8>: 'eft side*lying$ &o pressure is applied to the right side$ (liminate$
8?: !emi*@owlers$ .f you lay the client on his back with head partially
elevated# no pressure is applied to the right side$ (liminate$
The correct answer is 8<:$ !ome students select 8>: because they dont know
normal anatomy and physiology$ !ome students select 8?: because semi*
@owlers position is used for a lot of reasons$
Things to +emember
(ven if you didnt memori/e what position to use before# during# and
after a procedure# think about the question for a moment$ 6ou can Agure
out what position is needed$
6ou cannot Agure out the correct position if you do not know what the
terms mean 8supine# Trendelenburg# Fowlers:$
6ou cannot Agure out a correct position if you do not know anatomy and
physiology$ .f you think the liver is on the left side of the body# you are in
troubleB
6ou cannot Agure out a correct position if you do not know what you are
trying to accomplish$ .f you couldnt remember that a complication after
a liver biopsy is hemorrhage# your best hope of selecting the correct
answer would be to throw a dart$
To those students who think in images# you should form a mental image
of each position$ Cicture yourself placing the client in each position# and
then see if the position makes sense$
(ssential Cositions to =now for the &%'()*+&, (-am
Position Therapeutic Function
@lat 8supine: 5voids hip ;e-ion# which can compress arterial ;ow$
0orsal recumbent !upine with knees ;e-edD more comfort* able$
!ide lateral 5llows drainage of oral secretions$
!ide with leg bent 8!imss: 5llows drainage of oral secretionsD decreases
abdominal tension$
3ead elevated 8@owlers: .ncreases venous returnD allows ma-imal lung
e-pansion$
3igh @owlers: EF to GF degrees @owlers: ?H to EF degrees !emi*@owlers: >F to
?H degrees 'ow @owlers: 9H to >F degrees
@eet and legs elevated .ncreases blood return to heartD relieves pressure on
lumbrosacral area$
@eet elevated and head Ised to insert %JC line# or for treatment
lowered 8Trendelenburgs: of umbilical cord compression$
@eet elevated <F degrees# .ncreases venous returnD used for shock$knees
straight# trunk ;at#and head slightly elevated8modiAed Trendelenburgs:
(levation of e-tremity .ncreases venous return$ .ncreases blood volume to
e-tremity$
@lat on back# thighs ;e-ed# .ncreases vaginal opening for legs abducted
8lithotomy: e-amination$
Crone Cromotes e-tension of hip Koint$ &ot well tolerated by persons with
respiratory or cardiovascular diculties$
=nee*chest Crovides ma-imal visuali/ation of rectal area
Positioning Facts:
1. Air/Pulmonary Embolism (S&S: chest pain, diiculty breathing, tachycardia,
pale/cyanotic, sense o impending doom! ""# turn pt to let side and lo$er the head o the
bed.
%. &oman in 'abor $/ (n"reassuring F)* (late decels, decreased +ariability, etal
bradycardia, etc! ""# turn on let side (and gi+e ,%, stop Pitocin, increase -. luids!
/. 0ube Feeding $/ 1ecreased ',2 ""# position pt on right side (promotes emptying o the
stomach! $ith the ),3 ele+ated (to pre+ent aspiration!
4. 1uring Epidural Puncture ""# side"lying
5. Ater 'umbar Puncture (and also oil"based 6yelogram!""# pt lies in lat supine (to
pre+ent headache and lea7ing o 2SF!
8. Pt $/ )eat Stro7e ""# lie lat $/ legs ele+ated
9. 1uring 2ontinuous 3ladder -rrigation (23-! ""# catheter is taped to thigh so leg should be
7ept straight. :o other positioning restrictions.
;. Ater 6yringotomy ""# position on side o aected ear ater surgery (allo$s drainage o
secretions!
<. Ater 2ataract Surgery ""# pt $ill sleep on unaected side $ith a night shield or 1"4
$ee7s.
1=. Ater 0hyroidectomy ""# lo$ or semi"Fo$ler>s, support head, nec7 and shoulders.
11. -nant $/ Spina 3iida ""# position prone (on abdomen! so that sac does not rupture
1%. 3uc7>s 0raction (s7in traction! ""# ele+ate oot o bed or counter"traction
1/. Ater 0otal )ip *eplacement ""# don>t sleep on operated side, don>t le? hip more than
45"8= degrees, don>t ele+ate ),3 more than 45 degrees. 6aintain hip abduction by
separating thighs $ith pillo$s.
14. Prolapsed 2ord ""# 7nee"chest position or 0rendelenburg
15. -nant $/ 2let 'ip ""# position on bac7 or in inant seat to pre+ent trauma to suture
line. &hile eeding, hold in upright position.
18. 0o Pre+ent 1umping Syndrome (post"operati+e ulcer/stomach surgeries! ""# eat in
reclining position, lie do$n ater meals or %="/= minutes (also restrict luids during meals,
lo$ 2), and iber diet, small re@uent meals!
19. Abo+e Anee Amputation ""# ele+ate or irst %4 hours on pillo$, position prone daily to
pro+ide or hip e?tension.
1;. 3elo$ Anee Amputation ""# oot o bed ele+ated or irst %4 hours, position prone daily
to pro+ide or hip e?tension.
1<. 1etached *etina ""# area o detachment should be in the dependent position
%=. Administration o Enema ""# position pt in let side"lying (Sim>s! $ith 7nee le?ed
%1. Ater Supratentorial Surgery (incision behind hairline! ""# ele+ate ),3 /="45 degrees
%%. Ater -nratentorial Surgery (incision at nape o nec7!""# position pt lat and lateral on
either side.
%/. 1uring -nternal *adiation ""# on bedrest $hile implant in place
%4. Autonomic 1ysrele?ia/)yperrele?ia (S&S: pounding headache, prouse s$eating, nasal
congestion, goose lesh, bradycardia, hypertension! ""# place client in sitting position
(ele+ate ),3! irst beore any other implementation.
%5. Shoc7 ""# bedrest $ith e?tremities ele+ated %= degrees, 7nees straight, head slightly
ele+ated (modiied 0rendelenburg!
%8. )ead -nBury ""# ele+ate ),3 /= degrees to decrease intracranial pressure
%9. P,S-0-,:-:C: PE*-0,:EA' 1-A'DS-S ($hen outlo$ is inade@uate!
0urn patient rom S-1E 0, S-1E beore chec7ing or 7in7s in tubing (according to Aaplan!.
%;. P,S-0-,:-:C: P*,'APSE1 2,*1 A:EE"2)ES0 or 0*E:1E'E:3(*C