[Fundamentals] Positioning

Semi-Fowler position: 30-45degree

1. Cirrhosis of the liver
2. Ascites
3. Restraints
4. Postoperative. (thyroidectomy, mastectomy) 

Fowler position: 45~60 degree : improving oxygenation

 

High-fowler posion: 60~90 degree: 

1. Allows for maximum lung expansion
2. promotes oxygenation
3. indications (Dyspnea, Chronic respiratory conditions)

Tripod position

1. Facilitates lung expansion
2. decreasing diaphragmatic pressure produced by the viscera
3. Indications: COPD and asthma exacerbation

Orthopneic position

 

Trendelenburg position : 수술할 때 펠빅에 있는 장기들이 밀려 내려와서 더 접근이 수월. 근데 이것때문에 neurological conditions->increases intracranial pressure 생길 수 있어서 뇌에 문제가 있거나, 뇌부종 있거나 하면 이 자세 금지. 

Clients with acites 또한 exacerbates dyspnea로 추천하지 않음.

 

Reverse Trendelenburg position

<->파울러랑 다른 점은 파울러 포지션은 환자가 bending하고 있지만 reverse trendelen은 환자가 stay flat 함.

척추 수술하신 분, Femoral access- artery approach, cardiac catheterization -> Don't bend!

 

circulatory conditions like venous... 

 

 

 

 

Shock position (modified trendelenburg)

1. indication:  hypovolemic shock -> increases blood flow to the brain

 

Left Lateral Trendelenburg position

Indication: suspected air embolism

we can trap the little bubble of the air against heart wall.

 

Air embolism is a rare but life-threatening complication of central venous catheter (CVC) placement in which air enters the bloodstream.

CVC placement 에서 공기가 혈류로 들어가면 Air embolism으로 진짜 큰일날 수 있음.

This air displaces blood in the pulmonary vessels, which prevents oxygenation of blood by the lungs.

폐혈관으로 들어가면 폐에서 산소교환을 막음 ㅜㅜ

Air embolism may occur after CVC removal, as air can enter the bloodstream via the open, large-bore insertion site.

특히 CVC 뺄때, 큰 직경의 오픈된 인셜선 사이트로 들어간다.

Clients with air embolism can rapidly develop respiratory distress leading to cardiopulmonary collapse. (appears cyanotic and tachypneic, diaphoretic.)

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Cyanotic (청색증)

• 정의: 피부나 점막이 파랗게 변하는 상태를 의미합니다. 이는 혈액 내 산소가 부족하여 발생합니다.
• 원인: 저산소증(산소 부족), 호흡기 질환, 심장 질환 등.
• 예시: 산소가 부족한 환자의 입술이나 손가락 끝이 파랗게 변하는 경우.

Tachypneic (빈호흡, 빠른 호흡)

• 정의: 비정상적으로 빠른 호흡을 의미합니다. 성인의 경우 분당 20회 이상의 호흡이 해당됩니다.
• 원인: 호흡기 질환, 심장 문제, 운동 후, 스트레스 등.
• 예시: 폐렴 환자가 호흡 곤란으로 인해 호흡이 빨라지는 경우.

Diaphoretic (발한, 땀 흘림)

• 정의: 비정상적으로 많은 땀을 흘리는 상태를 의미합니다.
• 원인: 고열, 저혈당, 심장 문제, 통증, 스트레스 등.
• 예시: 심장마비를 겪는 환자가 땀을 많이 흘리는 경우.

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Nurses caring for clients with symptoms of air embolism (eg. hypoxemia, dyspnea, sense of impending doom) after CVC removal or dislodgement should perform these actions

1) Apply an occlusive dressing to the insertion site to prevent entry of additional air into the bloodstream

2) Administer 100% oxygen via non-rebreather mask to improve oxygenation

3) position the client in left lateral Trendelenburg position to promote venous air pooling in the heart apex rather than the lung capillary beds

4) Continuously monitor vital signs and client respiratory effort to identify changes in client status.

5) Notify the health care provider immediately

 

 

Supine position:

 flat- spinal surgury(after lumbar puncture), femoral artery cardiac catheterization(if, pts in Fowler position after this procedure, pts will experience hemorrhage. )

 

Prone position

indication:

following lower limb amputation -. prevent hip contractures

Acute respiratory distress syndrome -> improve oxygenation

 

Sims position

Enema administration

Alleviate referred shoulder pain after laparoscopic abdominal procedures (eg. cholecystectomy)

 

Lithotomy position

Pelvic exams 

Cervial dilation

cystoscopy

 

 

Right side-lying position for >2hours to promote direct internal pressure to the liver, which minimizes bleeding.

After liver biopsy, the client should lie on the right side for a minimum of 2 hours (to apply pressure and splint the puncture site) and then supine for an additional 12-14 hours.

 

Side-lying with the head, back, knees flexed for clients undergoing lumbar puncture. A small pillow may be placed between the legs and under the head for comfort and to maintain the spine in a horizontal position. 

 

Chest tube placement: the arm should be raised above the head on the afected side for clients undergoing chest tube insertion. If possible, the head of the bed should be raised 30-45 degrees to reduce risk of injury to the diaphragm.

Position client with the arm raised above the head for chest tube placement.

 

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A client with dehiscence and evisceration of the surgical incision. 

-> immediately place the client in the low Fowler position with the knees bent!!

Wound dehiscence occurs when the edges of the surgical incision separate and can be further complicated by evisceration (ie. protrusion of underlying abdominal organs). These complications are more common afer procedures with lrge incisions, in the presence of client risk factors for poor wound healing (eg. malnutrition, DM), or as a result of increased intraabdominal pressure (eg. forceful coughing, obesity)

 

the client should immediately be placed in the low Fowler position with the knee bent to decrease intraadominal pressure and avoid further evisceration. Clients with evisceration require emergency surgery b/c the eciscerated organ (eg. bowel) is at risk for strangulation. While the client waits for surgery, the area should be covered with sterile, saline-moistened gauze to protect the exposed organs and reduce the risk for infection.

 

What if... Prone positioning?? would put excessive pressure on an open incision and protruding bowel and could contaminate the open wound. 

What if... The supine position with the head of the bed flat ?? may increase the tension placed on the open wound. 

What if... A side-lying position (recovery position) - following emergencies such as cardiac arrest or seizure but will not lessen the tension placed on the open wound. 

 

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A client with an anxiety and SOB, HR:110/min, RR: 24/min, 

-> Elevating the head of the bed to Fowler or high Fowler position is the priority to help relieve SOB, facilitate O2, and promote lung expansion.

-> Reassure the client that it is okay.. thing is the second.