Nursing - Positioning Clients

Front 1

Positioning Client Post-op:
Autograft
Burns to Face and Head
Circumferential Burns of Extremities
Skin Graft

Back 1

Autograft: Immobilize site for 3-7 days to provide time for the graft to adhere and attach to the wound bed.

Burns to face/head: elevate HOB to prevent or reduce facial or tracheal edema.

Circumferential burns of extremities: Elevate extremities above level of heart of prevent or reduce dependent edema.

Front 2

Positioning Client Post-op:
Mastecomy
Cataract Surgery
Retinal Reattachment

Back 2

Skin graft: elevate and immobilize graft site to prevent movement and shearing.
Mastectomy: HOB elevated at least 30 degrees with affected arm elevated on pillow to promote lymphatic fluid return. Turn client only to the back or unaffected side.

Perineal and vaginal procedures: lithotomy position

Cataract surgery: elevate HOB 30-45 degrees. Turn client on back or non-operative side to prevent edema of site.

Retinal reattachment: obtain dr’s order re: positioning.
If gas is used as tamponade, client may have to be specially positioned. Some must lie face down or on the side as prescribed.

Front 3

Positioning Client Post-op:
Hypophysectomy
Thyroidectomy

Back 3

Hypophysectomy: Elevate the bed to prevent increased intracranial pressure (ICP)

Thyroidectomy: Place in semi-Fowler’s position to reduce swelling and edema in the neck area. Sandbags or pillows may be used to support head or neck.

Front 4

Positioning Client Post-op:
Hemorrhoidectomy
Liver biopsy
Instestinal tubes
Nasogastric tubes
Rectal enemas/irrigations

Back 4

Hemorrhoidectomy: Assist to lateral position

Liver biopsy: Right side-lying with pillow or small towel under puncture site for at least 3 hours.

Intestinal tubes: Place client on right side to facilitate passage into duodenum.
NG tubes: Elevate HOB 30 degrees to prevent aspiration. Maintain elevation for continuous feeding or 1 hour after intermittent feedings.
Rectal enemas/irrigations: Left Sims’ position to allow gravity to work in the natural direction of the colon.

Front 5

Positioning Client:
COPD
Laryngectomy
Bronchoscopy
Postural Drainage
Thoracentesis

Back 5

COPD: Sitting position, leaning forward, arms raised on table or pillows
Laryngectomy: semi-Fowler’s or Fowler’s to maintain patent airway and minimize edema
Bronchoscopy: semi-Fowler’s to prevent choking
Postural drainage: Lung segment to be drained should be in uppermost position.
Thoracentesis: During procedure, position client sitting on edge of bed leaning over bedside table, with feet supported OR lying in bed on unaffected side with HOB elevated 45 degrees.

Front 6

Positioning Client Post-op:
Abdominal Aneurysm Resection
Amputation of Lower Extremity
Arterial vascular grafting of extremity

Back 6

Abdominal Aneurysm Resection: limit HOB elevation to 45 degrees to avoid flexion of graft.
Amputation of Lower Extremity: During first 24h, elevate foot of bed, not the stump to reduce edema; then keep bed flat to prevent hip flexion contractures. Consult with MD, then position client prone every 3-4 hours for 20-30 min to stretch muscles. When client is prone, keep legs close together to prevent abduction. Teach client to contract gluteal muscles.
Arterial grafting: Bed rest 24h. Affected extremity kept straight. Limit movement and avoid flexion of hip and knee.

Front 7

Positioning Client Post-op:
Abdominal Aneurysm Resection
Amputation of Lower Extremity
Arterial vascular grafting of extremity

Back 7

Cardiac cath: Keep affected extremity straight 4-6h. If femoral artery was used, strict bed rest enforced 6-12h. Client may turn side to side. HOB elevated no more than 30 degrees until hemostasis is adequate.
CHF/Pulmonary edema: upright, pref. with legs dangling over side of bed to decrease venous return/lung congestion.
PAD: Obtain MD order. May elevate legs, but not above heart.
Thrombophlebitis: Bed rest with elevation of affected extremity. No pillow under knees.
Vein ligation: Elevate feet above heart and avoid leg dangling/chair sitting.

Front 8

Positioning Client Post-op:
Autonomic dysreflexia
Cerebral aneurysm
Cerebral angioplasty
Craniotomy

Back 8

Autonomic dysreflexia: High Fowler’s to assist c ventilation and prevent hypertensive stroke
Cerebral aneurysm: Complete bed rest with HOB elevated 30 to 45 degrees to prevent pressure on aneurysm site.
Cerebral angiography: Bed rest as prescribed, keep injected extremity straight and immobilized.
Craniotomy: Not on operative site. Elevated HOB 30-45. Maintain head in midline, neutral position to facilitate venous drainage from head.

Front 9

Positioning Client Post-op:
CVA:
Hemorrhagic strokes
Ischemic stokes

Back 9

Hemorrhagic stroke: HOB elevated 30 degrees to reduce ICP and facilitate venous drainage.
Ischemic stroke: HOB flat

Both: Maintain head in midline, neutral position. Avoid extreme hip and neck flexion. Hip flexion may increase intrathoracic pressure, neck flexion may impede drainage.

Front 10

Positioning Client Post-op:
Laminectomy
ICP (intracranial pressure)
Lumbar puncture
Myelogram

Back 10

Laminectomy: log roll client, keeping back straight as can.
ICP: Elevate HOB 30-45, maintain head in midline, neutral position. Avoid extreme hip and neck flexion.
Lumbar puncture: during, assist to lateral position with back bowed at the edge of exam table, knees flexed up to abdomen, and head bent so chin is resting on chest.
After: supine position 4-12 hours (dorsal recumbent)
Myelogram: Water-soluble dye – HOB elevated for at least 8 hours to avoid dye irritating meninges.
Oil-based dye: flat in bed for 6-8 hours to prevent leakage of CSP.

Front 11

Positioning Client Post-op:
Hip surgery
Spinal cord injury

Back 11

Spinal cord injury: immobilize on spine board, with head in neutral position. Immobilize head with firm padded c-collar. Maintain traction and alignment of head manually. Logroll client. Do not allow client to twist or bend.

Hip surgery: avoid extreme positions and acute flexion of operative hip. Keep affected leg abducted. Place pillow between legs to maintain abduction. Do not cross legs. Prevent external rotation of leg using trochanter roll beside outer thigh and elevating heels. Check with MD about HOB elevation. Turn only after checking MD orders.