Placing the Patient in Different Positions for Examination
February 10, 2010 | In: Fundamentals of Nursing
I. Horizontal Recumbent
- Place patient flat on back with legs extended or slightly flexed.
- Place bath blanket over patient lengthwise. Fan bedding to foot of bed
- General examination.
- Abdominal surgery.
- Surgery on head and extremities.
II. Dorsal Recumbent
- Place patient flat on back with one pillow under head; have knees flexed and separated and feet flat on bed.
- Fold blanket in half lengthwise. Lay center of blanket over abdomen and ends over each foot. Fan leading to foot on bed. Arrange blanket to cover extremities and expose perineum.
- Rectal, vaginal and pelvic examinations and treatments.
III. Sims or Left Lateral
- Place patient on left side somewhat obliquely across the bed with buttocks to edge of mattress. Incline the body forward, draw the left arm back under patient and place the right arm free in front. The thighs should be flexed upon the body—the right more than the left.
- Place lengthwise bath blanket over patient, fanfold topsheet to foot of bed. Fold blanket back exposing the area to be examined.
IV. Knee-Chest or Genu-Pectoral
- Place patient in the prone position, then assist her to kneel so that her weight rests on her chest and knees. Turn head to one side and flex her arms at the elbows extending, then to the bed in front of her. Be sure the thighs are perpendicular to the level of the head. Watch pulse and general condition of the patient.
- To obtain better exposure of the vagina, cervix, and rectum.
- To examine the bladder.
- To help correct retroversion of the uterus.
- To administer caudal and sacral anesthesia.
- Vaginal and rectal examinations.
- Operative procedures on the vagina, rectum and perineum. Operative deliveries
V. Dorsal Lithotomy or Dorso-sacral:
- Place the patient on her back across bed with the buttocks slightly beyond the edge of the mattress, then flex knees over the abdomen and separate the knees. Support the knees by means of long sheet folded diagonally and passed under the knees and around the neck.
- Draw up gown over abdomen. Drape as for dorsal recumbent.
- Vaginal and rectal examination.
- Operative procedures on the vagina, rectum and perineum.
- Deliveries and operative deliveries
On Examining Tables: Place patient on dorsal position with the knees flexed and feet in still-ups. Buttocks are brought down to edge of examining table.
VI. Standing or Erect
When used for vaginal examination:
- Have the patient standing with the knees separated about ten inches with one foot on a low stool. Instruct her to place one hand on the buck of the chair for support and the other hand on her hip.
- Either remove skirts or fold about waist. Wrap a folded sheet about the lower part of the body stimulating skirt, with the sides overlapping in front. Pin it to hold in place.
When use for examination of spine and backs:
- Remove patient’s slippers and have patient stand on towel.
- Loosen gown, place bath blanket around shoulders with opening at the back. Pin at nape.
1. Vaginal examination for determining the degree of prolapse of the uterus.
2. Examination of hernia
- Let patient lie on his abdomen. Turn hand to one side. Allow pillow under the head and another under the lower chest.
- Draping same as in dorsal.
- For treatment on the back.
- To facilities drainage from wound.
- To secure drainage of pus to front of abdomen.
- To keep pus away from the spine.
VIII. Jack knife or Kroaske or Bozeman
- Place patient on a prone position with the hips directly over the band of the examining table. Tip the table with the head lower than the hips. Lower the foot part of the table so that the patients feet are below the level of his head. Place pillow under the pelvis and abdomen to relieve the strain.
Purpose: Operation on the rectum and coccyx
IX. Walchers Position
- Place patient flat on her back with the sacrum resting on the edge of the table. Lower the legs slowly toward the floor. Elevate the buttocks slightly if the table permits.
- Draping is similar to that of the lithotomy position.
- To increase the diagonal conjugate of the pelvis in high forcep delivery and in breach presentation.
- Relax the perineum
X. Fowlers and Semi-Fowler’s Position
Method I: Elevate head part of the bed by means of head elevator 8-24 inches high. Elevate knee to about 6 in.
Method II: Place patient in semi-sitting position by backrest. Flex knees and support with pillows.
- To obtain good drainage in the pelvis.
- To localize infection in the pelvis and prevent it’s spread to the peritoneum.
- To prevent strain of abdominal muscles.
- To facilitate breathing in patients with cardiac or respiratory embarrassment fur post-operative nasal cases and/or thyroidectomy cases.
XI. Trendelenburg Position
- Place patient in the horizontal recumbent position. Well-padded shoulder braces and knees and arms restraints are adjusted. If on the operating table. Adjust the table so that the patient’s head is low the body on an inclined phone and the knees flexed over the adjustable lower section of the table, which is lowered.
- If no bed, rise the foot part of the bed by means of bed elevator blocks also known as shock blocks.
- Gynecological surgery and suprapubic prostatectomy cases.
- To prevent shocks.
- To prevent or relieve post-partum hemorrhage.
Role the Nurse in Physical Examination
1. Nurse plays an important role in the program of prevention of disease not only by encouraging the individual to have such as examination but also by her tact and a kill in assisting in such a way as to minimize embarrassment to the patient.
2. Explanation as to what is to be done and why usually facilitate the procedure both for the doctor and the patient and will make the patient more relaxed and more cooperative.
3. Nurse can render invaluable assistance in expanding the examiner’s work and in conserving the patient’s strength. Most thorough examination is lengthy and tiring.
4. When patient is a woman, the presence of nurse prevents embarrassment to the patient and it protects the physician from any court action in case patient complains.
5. Nurse is held responsible in having all equipment and articles ready for the examination, preparing the patient accordingly, anticipating the physician’s needs and taking care of the used articles after the examination.