Positio

Positioning & draping

ning &
 Patient Positioning
drapin
– Involves properly maintaining a patient’s neutral body alignment by preventing hyperextension &
extreme lateral rotation to prevent complications of immobility & injury.
– Proper positioning provides optimal exposure of the surgical/treatment site & maintenance of the
patient’s dignity by controlling unnecessary exposure.
– The ultimate goal of proper patient positioning is to safeguard the patient from injury &
physiological complications of immobility.
– Provide patient comfort & safety.
– Maintaining patient dignity & privacy.
– Allows maximum visibility & access.

COMMON PATIENT POSITIONS

 SUPINE
 The patient lies flat on the back with head & shoulders slightly elevated using a pillow unless
contraindicated (spinal anesthesia, spinal surgery)
 Examination of abdomen, heart & breasts.
 Patient lie flat on table facing upwards, pull extension for support.
 Provides excellent surgical access for intracranial procedures, most otorhinolaryngology
procedures, & surgery on the anterior cervical spine.
 Used also during cardiac & abdominal surgery as well as procedures on the lower extremity
including hip, knee, ankle & foot.
 Patient lies flat on back Arms at side legs extended examination of front of body, breasts
 Palpation of internal organs
 Draping: extends from under the armpits to the toes
 FOWLER’S POSITION
 Examination of head, neck, chest or patients with difficulty in breathing while lying flat.
 Facilitates the relaxing of tension of the abdominal muscles, allowing for improved breathing.
 In immobile patients & infants, the Fowler’s position alleviates compression of the client that
occurs due to gravity.
 Sitting with backrest elevated at 90º angle
 Legs extended flat on table

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  Examination of lower extremities / feet
 May be position of comfort for respiratory patients
 Drape should cover legs
 Drape is over the thighs and legs at first then it's placed lengthwise
 SEMI – FOWLER’S POSITION
 Used for post – operative patients, if patients have fever, head injury or pain, supports patients
with difficulty in breathing.
 Elevation is less than that of the fowler’s position & may include the foot of the bed being
raised at the knee to bend the legs.
 Useful in promoting lung expansion as gravity pulls the diaphragm downward, allowing for
expansion & ventilation.
 Semi-Fowler's - 45º angle
 DORSAL RECUMBENT
 Examination of rectal, vagina & perineal areas of the body.
 Can be used at home delivery of the baby.
 Patient lies on the back with the lower extremities moderately flexed & rotated outward.
 Employed in the application of obstetrical forceps, repair of lesions following parturition,
vaginal examination & bimanual palpation.
 Allow for examination of the head, neck, anterior thorax, lungs, breasts, axillae & heart.
 Position: Flat on back with knees bent and feet flat on exam table
 Examination of the rectum, vagina or both
 Drape: placed in diamond-shaped
 fashion: Cover chest and pubic area cover / wrap each leg with the c
 LITHOTOMY
 Mostly for vaginal/pelvic exams, pap smears.
 Used at hospital delivery.
 Often used during childbirth & surgery in the pelvic area.
 It involves lying on your back with your legs flexed 90 degrees at your hips.
 Knees will be bent at 70-90 degrees, & padded foot rests attached to the table will support the
legs.
 Pelvic examination Pap smears Position patient in dorsal recumbent position with feet on
corners of table
 Assist to end of table with buttocks even with edge of table

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  Assist positioning of feet into stirrups - both feet / legs at same time
 Drape is diagonally over patient
 TRENDELENBERG’S POSITION
 Rare in physician office, for patients with severe hypertension or going into shock.
 Only used on a table that separates, so the patient’s head is tilted lower than the legs.
 To assist in the filling & distension of the upper central veins, as well as the external jugular
vein.
 Can also be used in respiratory patients to create better perfusion.
 PRONE POSITION
 Examination of the back & surgical procedures.
 Patient lay on flat stomach, pull out extension of examination table for patient to be
comfortable.
 Decreases the pressure in the lungs from the heart, gravity & abdomen.
 Prone positioning is generally used for patients who require a ventilator (breathing machine).
 Patient lies on abdomen with hands at side, head turned to side
 Examination of the spine and legs
 Drape extends from shoulders to knees
 SIM’S POSITION
 Examination of the rectum, instilling medications into the rectum, perineal & some pelvic
exams.
 Patient lays on their left side, patient should place left arm/shoulder drawn back behind the
body, flex right arm upward, flex left leg slightly & sharply flex right leg up towards chest.
 Usually used for rectal examination, treatments, enemas & examining women for vaginal wall
prolapse.
 Position on side with top leg bent sharply and lower leg bent slightly
 Examination of the rectum
 Administration of enema
 Drape is lengthwise over the patient and adjusted as needed
 KNEE – CHEST POSITION
 Examination of the back/rectum, & some surgical procedures.
 Patient lays in prone position & then moves onto knees, with knees spread apart, leans forward
onto the head so that the buttocks is raised in the air. Patient should put weight on
chest/shoulders.

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 May be used for rectal (proctologic) examination

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  Patient kneels on exam table
 Buttocks raised while head and chest remain flat on table
 Arms extended above the head with elbows bent
 Pillow under chest may provide comfort
 Drape: covers back and legs
 drape diagonally over patient
 PROCTOLOGIC/JACK – KNIFE POSITION
 Examination of the rectum/anus & related surgical procedures
 Patient lies of prone on table, resembling Jack – Knife
 STANDING POSITION
 Typical position for examination of male patient's genitals & assessment for inguinal hernia.
 Screening test for scoliosis
 SITTING POSITION
 Auscultation of: Heart & lungs Examination of: Head, eyes, ears, nose & throat
 Parts of the neurological exam
 Drape sheet: extended on lap & leg

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1. What must be considered before, during, and after treatment when a patient is at risk? Proper patient
positioning
2. How often should you change a dependent patient’s position? At least every 2 hours to relieve pressure
and prevent contractures
3. How should a patient be draped? With clean linen and only the area/body part to be treated should be
exposed
4. What are the bony prominences that should be protected for a seated position?
o ischial tuberosity
o scapula/vertebral spinous processes
o olecranon processes
o medial epicondlyes of humerus
o back of knees
o heels and feet
5. What are the bony promininces that should be protected for a supine position?
o occipital tuberosity
o spine and inferior angle of scapula
o spinous processes of the vertebrae
o olecranon processes
o posterior illiac crests
o sacrum
o posterior calcaneous
6. What are the bony promininces that should be protected for a prone position?
o Forehead
o lateral ear
o tip of acromion process
o anterior head of humerus
o sternum
o ASIS anterior superior illiac crest
o Patella
o crest of tibia
o dorsum of foot
7. What are the bony promininces that should be protected for a sidelying position?

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 o lateral ears
o lateral ribs
o lateral acromion process
o lateral head of humerus
o greater trochanter of femur
o lateral condyle of femur
o malleolus of fibula
o medial condyle of femur
8. Describe the use of patient restraints. Used to protect the patient from falling out of bed. recommended for
short time usage. examples are straps, constraints, body garments and bed rails
9. How often should a persons body position be changed and why? Every 2 hours to relieve pressure and
prevent contractures on skin
10. What do you use to protect a patients bony landmarks to prevent pressure ulcers?
o pillows
o rolled towels
o bolsters
o foam wedges
11. What is the time periods allotted for patient restraints?
o Adults- 4 hours
o 9-17 age- 2 hours
o 9 years and younger- 1 hour
o orders expire after 24 hours
12. After a patient goes into restraints, what must occur? Patient must be evaluated within 1 hour by
physician/ licensed practioner
13. What should be avoided for a patient with a transfemoral amputation? prolonged hip flexion, hip
abduction, lying prone is recommended
14. What should be avoided for a patient with a transibital amputation? prolonged hip/ knee flexion, lying
prone reccomended
15. What should be avoided for a patient with hemiplasia in the upper extremities?
o shoulder abduction/ IR
o elbow flexion
o forearm sup/pro

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 o wrist, finger, thumb, flexion and adduction
16. What should be avoided for a patient with hemiplasia in the lower extremities? hip/ knee flexion/ ER or
ankle plantar flexion/ Inversion
17. What should be avoided for a patient with rhemautoid arthritis? prolonged immobilization of affected
extremity joints, flexion should be avoided
18. What should be avoided for a patient with burns? prolonged flexion/ adduction
19. What are the orthopedic surgical conditions for a patient with total knee replacement? keep knee in
extension
20. What are the orthopedic surgical conditions for a patient with total hip replacement? avoid hip adduction,
rotation and flexion
21. What is the primary reason to drape? to only expose / free the area to be treated, address modesty,
maintain comfortability and body temp and protect skin and clothing
22. What affects the caregivers ability to drape a patient?
o cultural
o religious
o personal preferences

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