وضعيات المريض
Which position for which condition — and why.
أساسيات التمريض والإجراءات
Positions by condition or procedure
| Condition / procedure | Position | Why |
|---|---|---|
| Raised ICP, supratentorial craniotomy, head injury | Head of bed 30°, head midline, neck not flexed | Promotes venous drainage from the brain |
| Asthma, COPD, dyspnea | High Fowler or orthopneic (sitting, leaning forward) | Maximises lung expansion |
| Heart failure, pulmonary edema, distended neck veins | High Fowler with legs dependent | Reduces venous return and lung congestion |
| Hypovolemic shock | Supine with legs elevated | Improves venous return; never high Fowler |
| Hip replacement | Hip abducted (pillow between legs); no flexion > 90°, no crossing legs | Prevents dislocation |
| Cast or injured limb | Elevate above heart level (first 24–48 h) | Reduces edema |
| After above-knee amputation | Stump elevated on a pillow for the first 24 h only; then flat and prone periods | Edema first; then prevent hip flexion contracture |
| Enema | Left Sims (left lateral, right knee flexed) | Follows the sigmoid colon |
| Colonoscopy / upper endoscopy | Left lateral | Anatomical access; drainage of secretions |
| NG tube insertion | High Fowler, head slightly flexed | Eases passage, reduces aspiration |
| Tube feeding or NG irrigation | Head of bed 30–45° during and 30–60 min after | Prevents aspiration |
| Central line insertion or removal | Trendelenburg (head down) | Distends neck veins, prevents air embolism |
| Suspected air embolism | Left side, head down (Durant maneuver) | Traps air in the right atrium |
| Seizure | Side-lying (recovery position) after the jerking stops | Drains secretions, protects the airway |
| Unconscious / post-anesthesia | Lateral (recovery) position | Airway protection |
| After cardiac catheterisation (femoral) | Flat or head ≤ 30°, affected leg straight for 2–6 h | Prevents bleeding at the puncture site |
| Thyroidectomy | Semi-Fowler to Fowler, neck supported | Reduces swelling; check behind the neck for bleeding |
| Mastectomy | Head up; affected arm elevated on a pillow | Promotes lymph drainage |
| Appendicitis (comfort) | Semi-Fowler with right hip and knee flexed | Relaxes abdominal muscles |
| Liver biopsy — during | Supine, right arm above head; exhale and hold the breath | Opens the intercostal spaces |
| Liver biopsy — after | Right side-lying for 1–2 h | Compresses the puncture site |
| Lumbar puncture | Side-lying fetal position (or sitting, leaning forward); flat afterwards as ordered | Opens vertebral spaces; reduces headache |
| Thoracentesis | Sitting upright, leaning over a bedside table | Spreads the ribs, pools fluid at the base |
| Perineal or vaginal procedures | Lithotomy | Access |
| Hemorrhoidectomy | Intra-op: prone jackknife or left anterolateral; post-op: side-lying | Exposure; comfort |
| Autonomic dysreflexia | Sit upright, lower the legs | Lowers blood pressure while the trigger is found |
| Late pregnancy, preeclampsia, fetal distress | Left lateral | Relieves aortocaval compression |
| Prolapsed cord | Knee–chest or Trendelenburg; lift the presenting part off the cord | Relieves cord compression |
| Tetralogy of Fallot 'tet spell' | Knee–chest (squatting) | Increases systemic resistance and pulmonary flow |
| Myelomeningocele (before repair) | Prone | Protects the sac |
| Cleft lip repair | Supine or side — never prone; elbow restraints | Protects the lip suture line |
| Cleft palate repair | Prone or side-lying | Drains oral secretions |
| Tonsillectomy | Prone or side-lying until awake | Drains blood and secretions |
| Vitrectomy with gas bubble | Face-down as ordered | Bubble presses the retina in place |
Exam tip: when a position question involves the airway, choose the option that keeps secretions draining (side-lying) or lungs expanding (upright). For bleeding sites, choose the position that compresses the site.
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