The following different positions are used in nursing of women in gynaecology situations so as to create appropriate body posture in caring for the patient. In some positions there might be need for supportive aid in order to maintain correct alignment and ensure comfort.
- LITHOTOMY POSITION
Client lies on her back with thighs flexed on the abdomen and knees flexed to the abdomen, with the legs spread apart and the hips laterally located. The client’s feet are placed on stirrups to achieve this position.
USES OF LITHOTOMY POSITION:
- During a Pelvic examination.
- During surgery on the pelvis, reproductive or urinary systems.
KNEE – CHEST POSITION
The client kneels forward on the knees with head and upper chest resting on the bed, the hips are sharply bent. The rest on the bed above the shoulders and head and provide support for maintaining the position.
USESOF KNEE – CHEST POSITION:
- During a rectal or perineal examination or during protoscopy.
- For certain types of postural drainage form the lungs.
- It is also used in management of a pregnant mother in cases of cord prolapsed.
POSITIONING OF CLIENT ON THE BED BY THE NURSE
Before the nurse positions a client, should asses the client on the following ground:
- Ability to move without assistant.
- Check for adequate joint movement.
- Evaluate the client’s muscle strength.
- Confirm presence of pain, weakness or dyspnea (difficulty in breathing).
- Check for any contra indication for movement.
- Observe for any skin excoriation, pressure or friction against the skin, edema or body excretion.
- Confirm if need be for changing the position.
PLACING OF CLIENT IN SPINE OR DORSAL RECUMBENT POSITION
- Arrange the bed in a flat position.
- Remove the top bedclothes.
- Assist the client by keeping the clients head, cervical, thoracic and lumbar spine in a straight line.
- Bend the client’s arms and position them in a resting position on the abdomen.
- Straighten the client’s legs and slightly separate them.
- Place a roller towel in between the two legs so to avoid friction.
- Place a footboard against the feet so that the ankle remains in its functional angle.
- Confirm comfort of the patient.
- Finally, replace the top bedclothes and if necessary raise the side-rails.
PLACING IN PRONE POSITION
- Place the client on his or her abdomen and turn head to one side.
- Place a flat soft pillow under the head.
- Position the client’s arms so that they are resting next to his or her sides slightly bent and fingers pointing up. Position them arm that is opposite the direction of the face above the shoulders with elbow bent and resting on the bed above the head.
- Straighten and separate the client’s legs so that the feet drop over the bed. Place as well a flat pillow under the ankles.
PLACING IN FOWLERS POSITION
- Raise the head of the bed to the required height.
- Place the pillow beneath the client head and supper shoulders.
- Place the client’s arms in a bent or relaxed position at the side or on the lap. If muscular control is lacking, place the arms on a pillow.
- Move the legs slightly apart and tuck a roller towel next to each lateral thigh in case the client’s hip and knees tend to rotate away from the body. Maintain a functional angle.
PLACING CLIENT IN LEFT SIMS POSITION
- Roll the client to the left side then place a pillow under the head.
- Assist the client on raising upper body on its side and pull the left arm under the body on its side the bed beside his or her back while the upper chest and right shoulder lean towards the bed.
- Place the right arm on a pillow in front of the head, upper chest, elbow bent and fingers pointing towards the pillow.
- Place the leg on a pillow in front of the body, bent at the knee with the ankle resting in a natural angle.
- Confirm the comfort of the client and change the position if required.
LIFTING THE CLIENT ALONE
MOVING SUPINE POSITION TOWARDS THE HIP
- Raise the bed to a convenient height, to avoid much bending.
- If clients conscious, inform him/her
- Position the client’s arms on chest, one arm folded on the other.
- Stand at the side of the bed with the feet apart.
- The nurse bends her knees and hips. Instruct the client to bend the knees and place the feet flat against the bed surface. If client is unable to move the leg but can move the arm, instruct him to hold on the side rail so as to push himself against it on the rail opposite the nurse.
- Place the hand and arm under the clients almost, at the level of the scapular.
- Place the other hand below the client’s hip under the thigh.
- Instruct him to breathe out.
- Move back toward the foot of the bed and simultaneously tell the client to push off with leg or arm.
- Quickly move towards the foot of the bed pushing the client’s body towards the head of the bed as far as possible.
- Repeat the move until the desired site to the head of bed is reached.
BASIC POINTS WITH LIFTING
- Preparation for lifting:
It is important that lifters prepare to lift and are not tense when the lift is made.
- Position of feet:
This is very important in all lifting. The feet must be far enough apart to allow for good weight transference and one foot facing the direction of the move. The position of the other foot will vary according to the type of lift and stability required.
The grasp must be comfortable and firm with the elbows flexed and are near the body as possible, and the full surface of the hand used, not only with the fingers.
The position of one lifter must be such that the load is held opposite the center of the body, equidistant between lifters and as near to them as possible.
- Lifting together:
Both lifters must be ready to lift together. This is essential as it is easy for one person to take a major part of the load.
- During the lift:
The lifters heads and backs are carried in a normal straight position and should remain so during the lift. This position must be held without tension, extending the hip and knees, lift the load.