NEWBORN NURSES POLICY AND PROCEDURES. PURPOSE: Varying positions helps to stimulate physiological functioning and provides rest.

Transcription

1 NEWBORN NURSES POLICY AND PROCEDURES SUBJECT: POSITIONING EFFECTIVE DATE: 6/91 PURPOSE: Varying positions helps to stimulate physiological functioning and provides rest. POLICY: 1. The nurse will vary the position of the patient to improve physical and psychological well being. 2. The nurse will change the patient's position every two hours or as ordered. EQUIPMENT: 1. The following are the various positions to place the patient: a. Supine position b. Prone position c. Side-lying position d. Fowler's position 2. The nurse will individualize the patient positioning as tolerated by the patient. 3. Positioning will be carried out whenever there is physical inactivity and the patient is restricted to bedrest. 4. The patient will be positioned using pillows or blanket rolls. 5. The nurse may follow the attached position schematic drawing for positioning the patient.

2 Figure This diagram illustrates the patient in a protective supine position as viewed from above. Note support of the head, neck, arms, hands and feet. Figure This diagram illustrates the patient in a protective supine position as viewed from the side. The Protective Supine Position Exaggerated curvature of the spine and Provide a firm supportive mattress. Use a flexion of the hips. bed board, if necessary. Flexion contracture of the neck. Internal rotation of the shoulders and extension of the elbows (hunch shoulders). Extension of the fingers and abduction of the thumbs (claw hand deformities), External rotation of the femurs. Hyperextension of the knees Foot drop Place pillow(s) under the upper shoulders, the neck, and the head so that the head and neck are held in the correct position. Place pillows or arm supports under the forearms so that the upper arms are alongside the body and the forearms are pronated slightly. Use head rolls or small rolled towels for hands to grasp. If the patient is paralyzed, use thumb guides to hold the thumbs in the adducted position. Place sandbags or a trochanter roll alongside the hips and upper half of the thighs. Place a small soft roll or sponge rubber under the knees, sufficient to fill the popliteal space, but do not create pressure and not to exceed 5 degrees of flexion. Use a footboard or make an improvised firm foot support to hold the feet in dorsal position.

3 Figure This diagram illustrates the patient in the protective side-lying position. Figure This diagram illustrates the patient in the protective side-lying position as viewed anteriorly. The Protective Side-lying Position COMPLICATION TO BE PREVENTED SUGGESTED PREVENTIVE MEASURE Lateral flexion of the neck Place a pillow under the head and the neck Inward rotation of the arm and interference with respiration. Extension of the fingers and abduction of the thumbs. Internal rotation and adduction of the femur. Place a pillow under the upper arms Provide a hand roll for the fingers and the thumbs. Use one or two pillows as needed to support the leg from the groin to the foot.

4 Figure This diagram illustrates the patient in the correct protective position Figure This diagram illustrates the patient improperly placed in a corrective prone position. The head is elevated too high which causes hyperextension of the neck, and the feet are not supported to prevent foot drop. The Protective Prone Position Foot drop Move the patient down in bed so that his. feet are over the mattress; or support his lower legs on a pillow just high enough. to keep the toes from touching the bed. Flexion of the cervical spine. Hyperextension of the spine. Impaired respirations. Place a small pillow under the head. Place some suitable support under the patient between the end of the rib cage and the upper abdomen if this facilitates breathing and there is space there.

5 Figure This diagram illustrates the patient in the Fowler's position. Note how the elbow and wrist joints are supported as the shoulder is flexed. The Fowler s Position Flexion contracture of the neck Allow the head to rest against the mattress Exaggerated curvature of the spine or be supported by a small pillow only. Exaggerated curvature of the spine Dislocation of the shoulder Flexion contracture of the wrist. Edema of the hand Flexion contractures of the fingers and abduction of the thumbs. Use a firm support for back. Position the patient so the angle of elevation at the hips. Support the forearms on pillows in order to elevate them sufficiently so that no pull is exerted on the shoulders. Support the hand so it is slightly elevated in relation to the elbow. Provide hand rolls for grasping and thumb supports if necessary. Elevate the knees for only brief periods of time. Avoid pressure on the popliteal vessels. Impaired lower extremity circulation and knee contractive. Support the feet in dorsal flexion.