hey everyone it's nurse Sarah with registered nurse rn.com and in this video I'm going to go over patient positioning so let's get started the first position is the Supine position and notice our patient is lying on their back with the back of the head resting flat and those legs are extended so if you're having trouble remembering this position remember the phrase put the patient on their spine to be supined now what does this position used for well it's a very popular position for sleeping so chances are you probably slept in the Supine position or maybe you start out there but you end up on your sides like me in the lateral position which we're going to talk a little bit later about it's also used after procedures for instance after a lumbar puncture sometimes this may help decrease a headache that you can get after you have that procedure and it can be used after heart procedures for instance a heart cath you got to keep that patient flat for several hours afterwards you can also use this procedure for abdominal surgery for instance a C-section you'll have the patient in the Supine position and it's really helpful for those head to toe assessments especially whenever you're assessing the anterior part of the body you can really check a lot of different systems in this position now with this position unfortunately there are problems that can arise especially if your patient can't move around and shift their weight and the problem is pressure injuries also known as pressure ulcers so here you see our skeleton he's in the Supine position and notice everywhere there's a bony prominence there's a risk for a pressure injury the breakdown of that skin that's because that bony prominence is putting pressure on that skin and then that surface that the patient's laying on is putting pressure and we can really break down the Skin's Integrity so some big areas you have to watch out for as a nurse are those Hills and the ankles in addition to the sacral and coccyx area the elbow the scapula and the back of the head plus with this position again if your patient can't move they are at risk for developing a condition called foot drop the next we have the prone position and with this position notice that our patient is lying flat on the abdomen with the leg extended and the head can be to either side the right or the left now if you're having problems remembering this position look at that word prone in that word we have the word on and then we have the letter e so remember that the patient is lying on their esophagus and entrails so what does this position used for it can be used for spinal surgery and it can be helpful for patients with certain respiratory problems such as ards and coven 19. so we've always had the prone position but it seems like over the recent years since we went through the pandemic this position has started gaining a lot of attention because coveted patients they have found that it's actually improved their lung status because this position pronine can actually move those lungs secretes it can improve gas exchange and ease that workload on the heart however there are some problems with this position that you definitely have to monitor for so if your patient is proning and they have mechanical ventilation they have a tube in you got to make sure you're monitoring that Airway because that tube could come out or it could become blocked plus we have their head turned certain ways where we're putting a lot of pressure on the ears it could break down the ear leading it to a pressure injury and the eyes we've got to be really careful about the eyes that we don't put too much pressure on them and damage them plus up here on this area you can develop a brachial plexus injury because those nerves can become damaged so it's very important we're making sure we're not putting too much pressure on that area next is the dorsal recumbent position so here we have our patient lying on their back but their knees are flexed so if you need help remembering this position look at the name of the position dorsal means of back think of a a dolphin they have a dorsal fin where on their back and recumbent means lying down so this is a lot like that Supine position but huge difference is that we have bent knees and looking again at that word recumbent we have the word bent in there so we have something bent and it's particularly the knees this position is used for many procedures with one procedure being fully catheter insertion on the female patient in addition this is a great position to provide pericarian now there are problems with this position and again it deals with those bony promises putting pressure on that skin so with this we can have breakdown on our heels our shoulder our elbow the coccyx sacral area and the back of the head the next we have the lithotomy position and this position is similar to the dorsal recumbent position with the patient lying on the back but the legs are flexed at a 90 degree angle at at the hips and the calf part of the legs are usually placed in stirrups now why do we call it the lithotomy position well let's look at lithotomy lith means Stone and otomy deals with an incision cutting into a body part so we're talking about surgery so this position is actually a position that's used during a procedure to remove stones from the urinary system now it's also used during vaginal procedures such as childbirth and vaginal exams and then any type of surgery related to the genital urinary system now with this position there are problems just like with the dorsal recombinant so those pressure injuries that can happen with that position can also happen with this one plus whenever we have the legs in the stirrups we have to be very careful that we're not putting pressure on those nerves in those legs the next is the Sims position this is also called semi-prone so the patient is somewhat prone but not completely Prime where they're laying on that abdomen so here you can see our patient the patient is lying on their left side that is the key with the Sims position we're talking about being on the left side and notice that that right hip and that knee are flexed while that left hip and knee are slightly extended and the arm the right arm can be at the side and the left arm can be slightly behind the patient now this position can be used for Foley catheter insertion on the female patient so if your patient wasn't able to get in that dorsal recumbent position because they have mobility issues this is a great alternative plus it's a great position to give enemas in and for sleeping some problems that can arise from this position is that pressure injuries can occur on The Ear The Great trochanter and the side of the heel and Ankle the next is the lateral position this is also sometimes referred to as either right or left lateral recumbent so if you hear that term it's also talking about this position now the word lateral means to the side of so this position either deals with being on the left side or the right side so with this position we want to put a person in a lateral position if they are having a seizure or if they're unconscious or they've had some type of surgery where they're going to be having a lot of drainage for instance like throat surgery because we want to prevent them from aspirating so this position can help with that in addition it can help with keeping that airway open which is really important on that unconscious patient and the patient who's having a seizure in addition it can be used during surgery of the hip and the kidneys problems with this position arise from pressure injury so because we're on our side think of those bony prominences that hang out on our lateral side so we have ears that can be affected the shoulder the elbow the hip the knees the ankle and because we have those nerves up there in the shoulder we could damage the brachial plexus now let's talk about the Fowler's position so there are about out four of them and the name of these positions comes from a surgeon so with these positions it's all about the angle of the head of the bed so make sure you're paying attention to those angles because that's where you're going to be tested at so with this your patient is going to be in the bed they're going to be lying on their back and their knees can be flexed or extended and again what we're paying attention to is the head the bed that angle so first we have low Fowlers and with low Fowlers that head the bed is about 15 to 30 degrees so it's almost supine but they have a little slight elevation to it then we have semi-fowlers and semi-fowlers is higher than low Fowlers low Fowlers is the lowest of all of them but with semi the head of the bed is at an angle of 30 to 45 degrees now it's important to note that some sources will actually just group low Fowlers and semi-fowlers together and just say semi-fowlers ahead the bed at 30 up to 30 degree three so just keep that in mind while you're studying now these positions are used for sleeping especially they're beneficial for patients who have breathing problems like heart failure because there's so much fluid backing up putting pressure on the heart and the lungs it actually makes it easier for the patient to breathe at an angle when they're resting it can also be beneficial during that post-op period to prevent upper body swelling if surgery was let's say on the neck it helps decrease the swelling and when we're talking about that 30 degree position we want a patient at at least 30 degrees if they have increased intracranial pressure because this had the bed elevation is going to help decrease that intracranial pressure and maintain perfusion to the brain and then when we're talking about the 30 to 45 degree angle it's beneficial in patients who are getting GI feedings those enteral feedings because it can help prevent aspirations so you know sometimes there's a sign on the bed or you have these protocols that say if a patient is getting a tube feeding their head of the bed cannot go any lower than like 30 or 45 degrees plus if the patient needs suctioning this is a good position and if there are critical care patient because they're at risk for aspiration and we want to prevent ventilator Associated pneumonia and problems associated with these Fowler positions would be pressure injuries like pressure injuries to the sacral area the coccyx area shoulder spine and heels and the next we have the Fowler's position and with this it's just called Fowler's position there's no low semi or high in front of it and this is where the patient's head the bed is between 45 to 60 degrees so they're resting on their back their knees could be Flex or extended so it's a lot like low and semi-fowlers but the head of the bed is just a little bit higher and this position is used for many of the same things that low and semi-fowlers was used for like eating and drinking and easing breathing with certain respiratory problems plus the problems associated with this position are the same as what it was for low and semi and then lastly we have high Fowler's position and this is the highest position of all the Fowler's positions with that head to bed being at about a 60 to 90 degree angle so the patient is setting straight up in the bed as you can see here now if this position has the same usages as the other Fowler's positions but it's very helpful for nasogastric tube insertion and if your patient is experiencing autonomic dysreflexia now this only happens in patients who have a spinal cord injury at T6 or higher and when a patient is experiencing this condition you want to put them up at 90 degrees because this is going to drop their blood pressure and if you forgot what autonomic dysreflexia is I have a whole comprehensive review that can help you review this now with this position there is a risk for pressure injuries because you have your patient setting straight up in bed so there's a lot of pressure being placed on that bottom so there's the risk of pressure injuries to that sacral and coccyx area the shoulders the spine and the heels now let's take a look at the Trendelenburg positions so just like with the Fowler's position these positions come from the last name of a surgeon so our very first one is just Trendelenburg and with this position as you can see with our patient the patient is supine but their head is lowered and their feet are elevated and this position is useful whenever a patient is getting a central venous catheter line placement or it's getting removed like internal jugular or subclavian because it can help decrease the risk of an air embolism in addition it's helpful for pelvic surgeries and in the past it was one of those positions that you put your patient in whenever they're experiencing hypotension but does it really help with hypotension the jury is out on that one evidence is showing that possibly this Trendelenburg position doesn't it help increase the blood pressure instead it could actually harm cardiac function and lung function plus it could increase the intracranial pressure so always check with your Hospital's protocols before you place a patient in the trendola Berg position if they're having hypotension the next is reverse Trendelenburg and it is the opposite of Trendelenburg so if you can understand trendelenberg you got reverse Trendelenburg down this is where the patient again is supine but the head is going to be elevated and the feet are lowered and this position is useful for whenever patients are having surgery of their head and neck because whenever they're in this position it's going to decrease blood flow and hence hopefully decrease the amount of blood loss it's also helpful for closed cervical traction and then lastly is modified Trendelenburg position so with this position you can see that our patient is flat in the supine position their head is level with their upper body but their feet are elevated so that the bed angle is increased and this position can be helpful with hemodynamic problems because it could potentially increase that venous return which is why we're elevating those legs so there was a case study done in 2023 that showed Improvement of hemodynamic status of a patient who actually had a grade 3 hemorrhagic shock okay so that wraps up this video and don't forget to check out the other videos in this series