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Proper Patient Positioning Guidelines

مشاركةمرسل: الجمعة نوفمبر 23, 2018 7:22 pm
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Proper Patient Positioning Guidelines : Fowler's Position
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The sitting position is a common surgical position, also known as the Fowler's position, and was named for George Ryerson Fowler. While used during some ear and nose procedures it is primarily used for shoulder surgery. A beach-chair table attachment is often used that allows for half of the backrest to be removed for improved access to the surgical site. Although the sitting position has been used for some craniotomies and cervical laminectomies; however, this is rare because negative venous pressure in the head and neck places patients at risk for potentially fatal air embolism.

The patient is initially positioned supine with the head supported with a secure headrest. The patient’s head, neck, and torso elevated 20 degrees to 90 degrees. The feet are supported on a padded foot rest and the foot of the table is slowly lowered, flexing the hips to 45 degrees to 60 degrees and the knees to 30 degrees.1 The upper portion of the table is then raised to become the backrest until the patient’s torso reaches an upright position. The patient’s arms can be at rest on a pillow on their lap or on an adjustable padded platform like the Versa-Board in front of them but never left to hang at their sides. Pressure points are similar to the supine position; and the AliGel Head Donut can be used to support the back of the head, however, the OR table should have well-constructed pressure-reducing pads like AliMed’s Deluxe Support Surface designed to give a higher degree of pressure redistribution, because the weight of the patient’s body rests on the ischial tuberosities and sacral nerve.

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The supine position means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities.

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The Sims' position, named after the gynaecologist James Marion Sims, is usually used for rectal examination, treatments and enemas. It is performed by having a patient lie on their left side, left hip and lower extremity straight, and right hip and knee bent. It is also called lateral recumbent position.

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Fowler's position is a standard patient position in which the patient is seated in a semi-upright sitting position (45-60 degrees) and may have knees either bent or straight . It is an intervention used to promote oxygenation via maximum chest expansion and is implemented during events of respiratory distress. Fowler's position facilitates the relaxing of tension of the abdominal muscles, allowing for improved breathing.
In immobile patients and infants, the Fowler's position alleviates compression of the chest that occurs due to gravity.
Fowler's position increases comfort during eating and other activities, is used in postpartum women to improve uterine drainage, and in infants when signs of respiratory distress present.
Fowler's position is also used when oral or nasal gastric feeding tubes have been implemented as it minimizes the risk of aspiration.
Peristalsis and swallowing are aided by the effect of gravitational pull.

There are several types of Fowler's positions : Low, Semi, Standard, and High Fowler's.
Low Fowler's position is when the head of bed is elevated 15-30 degrees, Semi-Fowler's position is 30-45 degrees, Standard Fowler's is 45-60 degrees, and High Fowler's position is 60-90 degrees.

It is named for George Ryerson Fowler, who saw it as a way to decrease the mortality of peritonitis : Accumulation of purulent material under the diaphragm led to rapid systemic sepsis and septic shock, whereas pelvic abscesses could be drained through the rectum.
https://en.wikipedia.org/wiki/Fowler%27s_position

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