Professional Documents
Culture Documents
If the legs are supported on leg rests and are straight, keep the ankles flexed
at a 90 degree angle.
Assisting clients to comfortable therapeutic positions requires much skill. Often the
client is unable to assist in repositioning; in such cases, it is best to use two or more
staff members to reposition the client in order to prevent injury.
Maintaining Proper Position: Assistive Devices (Specialized equipment used
for client positioning)
Bed board Plywood board placed under entire mattress; improves spinal
alignment by providing support
Footboard Board placed at end of bed to provide support for feet to
maintain dorsiflexion
Hand-wrist splint Individually contoured for each client; maintains thumb
adduction and opposition to fingers
Pillow Available in various thicknesses; provides support; elevates body
parts
Restraint Variety of types available (jacket or vest, wrist belt, ankle belt,
waist belt); provides immobilization
Side rails Bars attached to the sides of the bed. Assist with mobility and
prevents falls.
Trochanter roll Folded blanket placed under clients buttocks and rolled
inward toward client to place thigh in a neutral position; used when client is
supine to avoid external rotation of hips and legs.
Traction Used for immobilization and to promote healing of fractures
Trapeze bar Triangular device hanging from above-bed bar that is secured to bed
frame; used by clients with upper extremity function to assist in repositioning and
transferring.
Hand-wrist splints can facilitate extension of the wrist hand-fingers, prevent
contracture, and reduce spasticity. The goal for splint use is to maintain a functional
hand for the client.
Clients must be taught the correct way to put on the device, as incorrect use of a
splint or brace can cause joint damage, stiffness, or pain.
Falls are common types of injuries in hospitals and long-term care facilities.
Side rails, which are placed on the sides of beds and stretchers to prevent falls,
can be raised, lowered, and locked into place.
For clients who are at risk for falls, the following should be checked:
Side rails should always be used; however, they should not give caregivers a
sense of security.
Beds must still be place in the lowest position to reduce the force of a
possible fall, should one occur.
Clients identified as being at-risk for falls should be closely monitored.
Some clients resist the use of side rails because they feel their independence
is altered.
It is important that the caregiver teach clients and families the purpose of
side rails, focusing on safety promotion. Note that some health care agencies
require signed notification consenting to the use of raised side rails.
Restraints are protective devices used to limit physical activity or to immobilize a
client or body part. Restraints are used for the following purposes:
To protect the client from falls
To protect a body part
To prevent the client from interfering with therapies (i.e., pulling out tubes or
catheters)
RATIONALE
1. Reduces anxiety; helps increase
comprehension and cooperation;
promotes client autonomy.
2. Avoids strain on caregivers back
muscles.
3. Decreases shearing, which can lead to
formation of pressure ulcers.
POSITION
4. The height of the head of the bed is
determined by physicians order, client
preference, client tolerance, or clients
activity (e.g., eating).
5. Promotes client comfort. Pillows under
ankles elevate heels to help prevent
pressure ulcer formation.
Pillows under the arms can assist with
lung expansion.
6. Assists in maintaining correct client
positioning.
INDICATIONS:
FOWLERS:
Promote comfort
Improve respiratory problems
Encourage post-operative drainage
DORSAL RECUMBENT (SUPINE):
Promote comfort
NOTE: Head and shoulders are kept flat after procedures involving spinal
anesthetics
PRONE:
Helps prevent contractures of hips and knees
Promotes drainage from mouth
SIDE-LYING POSITION/LATERAL:
Promote comfort
Relieves pressure on sacrum and heels
SIMS POSITION
Promotes drainage from mouth
Prevents aspiration
Reduces pressure on sacrum and greater trochanter of hip
NAME:
SCORE SHEET
POSITIONING A CLIENT IN BED
DATE:
ACTION
1. Inform client of reason for the move and how to assist (if able).
2. Elevate bed to highest position.
3. Using two caregivers, place turn (or draw) sheet under clients
back and head.
FOWLERS POSITION
4. Place bed in a 15 to 30 angle for low-Fowlers position, 45 to
60 angle for Fowlers position, or 70 to 90 angle for highFowlers position.
5. Place pillows at small of back, under ankles, under the arms,
and under head of client.
6. Slightly elevate the gatch of the lower portion of the bed.
7. Assess client for comfort.
8. Lower height of bed and elevate side rails.
SUPINE/DORSAL RECUMBENT POSITION
9. Repeat steps 13.
10. Place bed in a flat position.
11. Place small pillows at the slender part of the back, under head,
and under ankles.
12. Assess clients comfort level.
13. Lower height of bed and elevate side rails.
SIDE-LYING POSITION