Positions

Elevate Extremity

High fowlers

• Position on the  right to promote gastric emptying
• Elevate HOB to prevent aspiration.

Elevated HOB

• Sim’s position (forward side-lying with knees flexed)

Sitting leaning forward

Client’s arms over pillows on table

Orthopneic position

Semi-fowlers

• During the procedure: Lateral/side lying
• Post procedure: FLAT supine for 4-12 hours to prevent headache and CSF leakage
• This position is also for Oil-Based Myelogram

• Side Lying

• Semi-Fowlers
• Affected arm elevated on pillow
• Turning ⇒ back or unaffected side

• Low or semi-fowler’s, support head, neck, and shoulders.
• Prevent neck flexion/hyperextension
• Have trach at the bedside
• Be concerned if client has stridor (noisy breathing) since airway may be closing.

• Upright w / legs dangling over side of the bed (decreases venous return and lung congestion)

• During procedure- supine w/arms raised above head.
• Post-procedure- right lateral (side-lying) with small pillow under puncture site to apply pressure
• Deferred shoulder pain is EXPECTED
• Abdomen rigid and distended = hemorrhage

Lateral (Side-Lying)

• Semi-fowler’s or high-fowler’s (30 degrees)
• Head midline
• Goal is to decrease intracranial pressure

Semi-Fowlers

• EMPTY BLADDER
• Semi-fowlers
• or sitting upright w/ feet supported
• Obtain BP after procedure since fluid is removed (ascites) and blood pressure may drop.

• Removes fluid from thoracic cavity
• Sitting at the edge of the bed leaning over w/feet supported
• or lying in bed on unaffected side HOB elevated 45 degrees
• Shave around needle insertion

• Keep abduction pillow between legs 
• Avoid ADDUCTION or sleeping on operated side
• Don’t flex hip more than 45 to 60 degrees
• Don’t elevate HOB more than 45 degrees
• Trapeze bar can help client move in bed
• Side-lying ok but wedge pillow must be between legs.

• 1st 24 hours ⇒ foot of bed elevated
• Prone 20-30 minutes BID (stretches muscles and prevents hip contractures and promotes hip extension)

• 1st 24 hours ⇒ elevate on pillow
• Prone 20-30 minutes BID to promote hip extension (stretches muscles and prevents hip contractures and promotes hip extension) 

• Sleep on Back or on non-operative side with a night shield for 1-4 weeks

• Immediate post-op ⇒ face down
• Dependent position. For example if left retinal detatchment, lay on left side, which will place retina on a dependent position.
• that is, area of detachment should be in dependent position.

• Turn client to the left side and lower the head of the bed. Left Trendelenberg

• Non-reassuring = late decelerations, decreased variability, fetal bradycardia
• Turn on the left side, give Oxygen, STOP pitocin, and ↑ IV fluids.
• LION: Left-lying, IV Fluids, Oxygen and d/c Oxytocin, Notify provider.

• A myelogram is an imaging test that takes detailed pictures of the spine.  An oil-based contrast can be used.
• Client lies flat supine to prevent headache and CSF leakage.
• Also flat supine after lumbar puncture!

• Catheter must be taped to thigh and leg should be straight. It should also be in a dependent position.  

• Position on side of affected ear after surgery to allow drainage of secretions
•  Myringotomy involves making a small opening in the eardrum to drain fluid and relieve pressure from the middle ear

• Position prone to protect sac from rupture

• Knee-chest postion or Trendelenburg

• This is skin traction.
• Elevate foot of bed for counter-traction.

• Position on back or in infant car seat to prevent trauma to suture line. While feeding, hold in upright position.

• After gastric surgery, eat in reclining position, lie down for meals 20-30 minutes
• Restrict fluids with meals
• Low carbohydrates and low fiber diet
• Give small frequent meals.

• Incision is behind the hairline. 
• Elevate HOB 30-45 Degrees

• Incision on the nape of the neck (Infra-below)
• Position flat and lateral on either side

• Position left side-lying or Sim’s position with knee flexed

• Bedrest with implant in place

• Sitting position with HOB elevated (decreases blood pressure).  This is the priority intervention.  Remember that! Then check for impaction, bladder distension, anything bothering the client. 
• Signs and symptoms: headache, sweating, nasal congestion, goose flesh, bradycardia and hypertension.

• Bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified trendelenburg). Goal is to increase blood flow to the upper body while preventing aspiration.

• Turn from side to side and then check for kinks in tubing to promote outflow.