Comfort measures- different positions for therapeutic procedures

                              Comfort positions for patient

Positions are used to promote comfort of the client. The comfort position helps patients to relieve pressure sore, ulcers, discomforts etc.

The major therapeutic positions are

Prone position:

The patient lies flat on the abdomen with head turned to one side. The head rests on a pillow.

The main uses of this position are

Ø To assess the hip joint

Ø To give better comfort

Ø To assess the posterior thorax

Ø To provide comfort to the patient with injuries, burns and surgeries of the back

Ø To the patients after giving anesthesia to prevent aspiration of saliva, mucus and blood

The major contraindications are

Ø The client with respiratory or spinal surgery

Ø The client after abdominal surgery

SUPINE/DORSAL/HORIZONTAL RECUMBENT POSITION

The client lies flat on back with legs extended and knees slightly flexed. Keep pillows under the head, knees and calves to raise heels off the mattress. Aircushion under the buttocks to takeoff the pressure and thereby prevent pressure sore.

The main uses of this position are

Ø To check the vital signs

Ø To take head to foot physical examination

Ø For comfort of the patient

Ø After surgeries involving the anterior portion of the body

The major contraindications are

Ø client with aspiration or convulsion

Ø surgeries on the back

DORSAL ELEVATED OR SEMI RECUMBENT POSITION

Patient lies in the bed with two or more pillows which may be arranged in armchair fashion to support the shoulders, elbows and arms.

Uses of this positions are

Ø Client in convulsion

Ø Client with minor respiratory diseases

LEFT LATERAL POSITION

With one pillow under the head, patient is placed to lie on the left side

The uses of this positions are:

 Ø For giving Enema

 Ø For inserting suppositories

Ø To take rectal examination

Ø To take rectal temperature

LATERAL OR SIDE LYING POSITION

The client lies on the side with weight on his hips and shoulder. Keep pillows under leg arm head and back. The trunk should be at right angle to the bed.

The major uses of this position are:

Ø To  relieve pressure on bony prominences of the back and sacral region

Contra indications of this position are

Ø After hip surgery

Ø After orthopedic surgery

FOWLER’S POSITION

  Client‘s head is raised to 80° - 90°. Back rest and additional pillows are necessary to keep this position more comfortable. An aircushion under the buttocks prevents the pressure over sacral areas. The knees may be raised over a knee pillow or a bolster to prevent the client from slipping

The uses of this position are

Ø To improve cardiac output

Ø To relieve breathing difficulty

Ø To relieve tension

Ø To help in the drainage of the abdominal cavity

Ø To relax the large muscles of the back and thighs

Contraindication

Ø After brain surgery and spine surgery

CARDIAC POSITION

The client is propped-up  in a sitting position by means of back rest and pillows. Place an overbed table in front with a pillow on it. The client has an aircushion to sit and a small pillow under the knees

Uses of this position are

Ø For cardiac asthma patient

Ø Cardiac disease  patient who cannot breath easily in lying down position

POSITION USED FOR PHYSICAL EXAMINATION

STANDING POSITION/ERECT POSITION

    

The client should stand keeping both hands in sides and close the legs together.

The main uses of this position are

Ø To assess posture, balance and gait

Ø Orthopedic examination

Ø Assessment of neurologic disorders

SITTING POSITION

  The client sits on a chair or on the side of the bed or examine table. Keep both hand aside and chin up and spin straight. The angle between thigh and chest should be 90 degree angle.

Uses of this positions are

Ø  It allows visualization of the upper body

Ø Facilitates full lung expansion

Ø To assess vital signs

Ø It is used to assess the head, neck, anterior and posterior thorax, lungs,heart,breast and upper extremities.

DORSAL RECUMBENT POSITION

     With leg separate, client lies on back. Knees flexed and soles of the feet flat on the bed or table. One pillow should keep under the head for comfort.

The main uses of this dorsal recumbent position are

Ø Assessment of head ,neck ,anterior thorax and lungs

Ø Vaginal and Vulval examination

Ø To exam rectum

Ø For urinary catheterization

 SIM’S LATERAL /LEFT LATERAL PORN POSITION

Client lies on the left side with one pillow under the head,and the left cheek resting on it. Keep left arm behind the back and the right arm may be in a position  comfortable for the client. The right thigh is flexed against the abdomen

The main use of this position  is to examination of vagina and rectum

LITHOTOMY POSITION

The client lies supine position with his or her hips flexed and calves and heels parallel to the floor. The buttocks should place at the edge of the exam table and heels in the stirrups. One pillow is placed under the head

This position is useful for

Ø Gynecological examination and treatment

Ø Genitourinary surgery

Ø Assessment of genitalia and rectum

Contraindication of this positions are

Ø Immobilizing arthiritis

Ø Joint deformity

KNEECHEST POSITION

 The client lies prone on the knees and chest. The head is turned to one side with the cheek on the pillow. The arms are above the head or they may be flexed at the elbows and rest  along  the sides of the head. So as to support the client. The weight of the client should  rest on the chest and knees. The thighs are at the right angles to the legs

The uses of this position are

Ø To examine the rectum and vagina

Ø For sigmoidoscopy

Ø Exercise for postpartum clients

Contraindiactions of this positions are

Ø Joint deformity

Ø Arthritis

TRENDLENBURG POSITION

The client lies supine with the head 30 to 40 degree lower than the feet or the foot of the bed may be elevated at 45 degree angle. The operation table can adjust to this position

The uses of this position are

Ø Examination of the pelvic organs

Ø Operations on the pelvic organs

Ø To treat shock

Ø For postural drainage

Ø Promote venous return

Ø To decrease blood pressure

These are the comfort measures which we are giving to the patients to get a better therapeutic effects

Hope this article is helpful for you. Please ask doubt and suggestion on the comment box below.

Read More

Blood pressure

Blood pressure:   It is the force exerted by the blood against the walls of the blood vessels as the blood flows through them. There are 2 types of blood pressure. Systolic and Diastolic pressure. Systolic pressure is the highest degree of pressure exerted by the blood against the walls of the blood vessels during the ventricular systole when the ventricle is forcing the blood into the Aorta. Normal systolic pressure in adult is 120 mm of Hg.

Diastolic pressure is the lowest pressure that occurs when the heart is in its resting period just before the contraction of the left ventricle. Normal diastolic pressure is 80mm of Hg.

       Normal Blood pressure – 120/80 mm of Hg

Instructions before checking blood pressure

Do not take blood pressure reading on a patient’s arm if;

·        The arm has an intravenous infusion  on it

·        The arm is injured or diseased.

·        The arm has a shunt or fistula for the renal dialysis

Articles needed for  checking blood pressure

Articles	Quantity	Purpose
Sphygmomanometer	1	To check Blood pressure
Stethoscope	1	To listen the brachial pulse

Procedure of blood pressure

·         Wash hand neatly and keep the equipment near bedside

·         Tie deflated cuff over the brachial artery.( the lower edge being 2 inch above the knee joint. The two rubber tubes turning towards the palm.

·         Place the bell of the stethoscope on the brachial artery.

·         Close the valve on the pump by turning the knob clockwise. Pump the cuff to 140 to 160 mm of Hg.

·         Open the valve slowly. Note the number on the manometer where the sound first starts. This pressure is systolic pressure.

·         Continue to release the valve until the sounds stops. Note that reading and that is called diastolic pressure.

·         Open the valve fully and untie the cuff from the arms. Deflate the cuff and keep it in shelf.

Read More

WHAT ARE VITAL SIGNS? HOW TO CHECK VITAL SIGNS?

     VITAL SIGNS:

                                   Body temperature (T), Pulse (P), Respiration ® and Blood Pressure (BP) are the basic signs of Life. Vital Signs are the assessment of physiological, Psychological health of a client. The Vital signs is also called as “Cardinal Signs”.  If we say simply, TPR BP is the vital signs. We can assess a client diagnosis with the help of TPR BP.

Let us see what T P R & BP are

·         Body Temperature:    Body Temperature is defined as the degree or heat maintained by    

the body or it is the balance between heat produced and the heat lost in the body.

             

              Instrument used to check body Temperature- Clinical thermometer

            Normal Body temperature - 37˚C    or 98.6˚F

            Temperature can check from Oral(Mouth),Axilla and Rectum.

·         Pulse:  It is defined as the alternate expansion and recoil of an artery as the wave of blood is    

            forced through it during the contraction of the left ventricle.

             Instrument used to check Pulse- Index and Middle fingers of Hand

             Normal Pulse – 70 to 80 beats /minute

·        Respiration :  It is a process of taking oxygen and Giving out carbon dioxide

                            Instrument used to check respiration- palms or by eyes

                             Normal Body temperature – 16-20 breaths /min

·        Blood pressure :   It is the force exerted by the blood against the  walls of the blood vessels as the blood flows through them. There are 2 types of blood pressure. Systolic and Diastolic pressure. Systolic pressure is the highest  degree of pressure  exerted by the blood against the walls of the blood vessels during the ventricular systole  when the ventricle is forcing the blood  into the Aorta. Normal systolic pressure in adult is 120 mm of Hg.

Diastolic pressure is the lowest pressure that occurs when the heart is in its resting period just before the contraction of the left ventricle. Normal diastolic pressure is 80mm of Hg.

Instrument used to check blood pressure - Sphygmomanometer

       Normal Blood pressure – 120/80 mm of Hg

Let us see how to check Vital signs (TPR BP)

Instructions before doing Vital Signs procedure

1. Do hand washing neatly with soap.

2. Conform that the thermometers are properly disinfected

3. Give an explanation of procedure to the patients.

4. Tell the patients what to do and what do not

5. Instruct the client not to bite on the thermometer while doing Oral temperature procedure.

6. Never leave the patient alone with a thermometer in position.

7. Never hold the thermometer by touching the bulb.

8. Lubricate the bulb of the rectal thermometer before placing thermometer into the rectum.

9. Do not count the pulse if the patient is nervous or immediately after exercise.

10. Never make the  patient conscious that you are counting the respiration.

11. Never use thumb for counting the pulse because there is a pulse in the thumb.

Articles needed for taking TPR :

Articles	Quantity	Purpose
Tray	1	To keep articles
thermometer	2-3	To check the temperature
Disinfectant bottle	2-3	To keep the thermometer
Jar with clean water	1	To rinse the thermometer
A  bowl  with cotton swab	1	To wipe the thermometer
Kidney tray or paper bag	1	To discard the waste swabs
Wrist watch with sec needle	1	To check the time of procedure

parts of thermometer

Procedure of taking temperature from mouth (oral temperature

• Do a hand washing  first to prevent the cross infections

·         Take thermometer from disinfectant  bottle
·         Rinse it in water to clean the disinfectant lotion           
·         Take a cotton swab and wipe the thermometer from the bulb to stem of the thermometer.
·         Check the mercury level and shake it to minimum level.
·         Place the thermometer under the tongue of the patient and note the time. 2 minute is enough for checking oral temperature.

·         Check the pulse for first minute and respiration for 2^nd minute. For checking pulse, place the client’s hand over his chest with the wrist extended and palm downwards. Place the finger tips over the pulse point. Count the pulse beat for one minute.
·         Keep your hand is on same position. So that you can check the respiration easily. Count the rise and fall of chest without the knowledge of the client. Count the respiration for 1 minute.
·         Remove the thermometer .wipe the thermometer with a cotton swab from stem to bulb.
·         Read the level of mercury. Note it in a paper.
·         Keep the thermometer in disinfectant bottle
·         Wash hands and keep the soiled articles in place to clean them.
Procedure for Axillary temperature
·         Keep the thermometer in dry axilla
·         The procedures are same. But the main difference is in oral temperature 2 minute is enough for checking the temperature. But in axillary 5 minutes is necessary.
Procedure for Rectal temperature
·         Keep the thermometer in rectum .
·         The procedures are same. But the main difference is in oral temperature 2 minute is enough for checking the temperature. But in rectal temperature 5 minutes is necessary. Use any lubricant for lubricating the thermometer for inserting the thermometer to rectum.


                             

Read More