Put patient in supine position

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Procedure 0
Steps
Purposes
Change the client position into comfortable
position. Facilitate healing following certain
surgeries.
Equipment
Disposable gloves. At least 4 small Pillows
□ Linens (pull sheets).  Large pillows.
□ Sandbag (optional).
1. Assess the client’s physical abilities (e.g., muscle strength, presence
of paralysis) and ability to assist with the move, ability to understand
instructions, degree of comfort or discomfort when moving, and
client’s weight.
2.Use pain relief medication prior to moving the client as doctor order.
3.Plan around encumbrances to movement such as an IV or urinary
catheter.
4.Make sure the mattress is firm and level yet has enough give to fill in
and
support natural body curvatures.
5. Ensure that the bed is clean and dry.
6. Obtain required assistance from other individuals.
7. Raise the height of the bed
8. Lock the wheels on the bed, and raise the rail on the side of the bed
opposite you
9. Face in the direction of the movement
10. Loosen the side rails at your side.
11. Assume a broad stance and lean your trunk forward, and flex your
hips,
knees, and ankles
12. Rock from the front leg to the back leg when pulling or from the
back
leg to the front leg when pushing
13. Move the client to the center of the bed using pull sheet.
Use the pillows to support the pressure areas while the patient is
lying on his back.
□ Pillow of suitable thickness under head and shoulders if
necessary for alignment
 □ small pillow under lumbar curvature
□ sandbag placed laterally to trochanter of femur (optional)
□ Small pillow under thigh to flex knee slightly
□ Footboard or rolled pillow to support feet in dorsiflexion
□ Pillow under lower legs
14. Secure the side rails.
15. Ensure patient comfort.
Documentation
Use nursing note form in the appendix (A).
Knowledge
Identify the major assessment points before
positioning. Identify indication to put patient in
supine position.

Turning patient to the lateral position (side lying ) with support

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Procedure Steps 0
Purposes
Movement to the lateral (side-lying) position may be necessary:
□ When placing a bedpan beneath the client
□ When changing the client’s bed linen
□ When repositioning the client.
Equipments:
Disposable gloves. At least four small Pillows
□ Linens (pull sheets).  Large pillows.
1. Determine assistive devices that will be required
2. Encumbrances to movement such as an IV or an indwelling urinary
catheter
3. Medications the client is receiving, because certain medications
may hamper movement or alertness of the client
4. Ask for assistance required from other health care personnel.
5. Adjust the head of the bed to a flat position or as low as the client
can tolerate.
6. Raise the bed to a height appropriate for personnel safety
7. Lock the wheels on the bed.
8. Move the client closer to the side of the bed opposite the side the
client will face when turned.
9. Loosen the side rails at your side.
10. While standing on the side of the bed nearest the client, place the
client’s near arm across the chest. Abduct the client’s far shoulder
slightly from the side of the body and externally rotate the
shoulder.
 11. Place the client’s near ankle and foot across the far ankle and foot.
12. The person on the side of the bed toward which the client will turn
should be positioned directly in line with the client’s waistline and
as close to the bed as possible.
13. Roll the client to the lateral position.
□ The second person(s) standing on the opposite side of
the bed helps roll the client from the other side.
□ Place one hand on the client’s far hip and the other hand
on the client’s far shoulder.
□ Position the client on his or her side with arms
and legs positioned and supported properly.
Support patient position by using pillows to comfort patient and
ensure good alignment:
Put large pillow under head and neck.
Put small pillow under upper arm while flex the lower arm.
Put a small pillow under leg and thigh.
14. Secure the side rails.
15. Ensure patient comfort.
16. documentation

Put patient in prone position with support

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Procedure Steps 0
 Purposes:
To reposition patient from other bed positions.
To prevent flexion contracture of the hips and knees.
To promote drainage from the mouth for unconscious patient,
and post operative throat and mouth surgery.
Equipments:
Disposable gloves. Four small Pillows
□ Linens (pull sheets).  Large pillows.
1. Position yourself and the client appropriately.
2. rise the bed to a height appropriate to you , lock the wheels of
the bed then Loosen the side rails at your side
3. Move the client closer to the side of bed by using pull sheet.
4. Place the patient arms along side the body prevent pinned under
the client when the client is rolled
5. Keep the client’s one arm alongside the body the other
externally rotated from the shoulder .
6. Place the clients near foot and ankle Cross the far ankle and
foot.
7. Raise side rail next to the client.
8. Position yourself on side of the bed toward which the client will
turn.
9. Use the proper body mechanics while changing client’s position.
10. position of nurse when rolling Rolling the client on to prone
position.
If one nurses :
Place one hand beneath the patient far shoulder and the other
hand beneath patient far hips.
Roll the patient completely on the abdomen.
If two nurses :
Position the second person to the opposite side of the bed.
The second nurse helps to roll the client completely onto the
abdomen and toward you.
11. Turn head to side and keep neck slightly flex.
12. Support patient position by using pillows to comfort patient
and ensure good alignment:
Put large pillow under head and neck.
Put small pillow under the abdomen just below
the diaphragm.
Put a small pillow between leg and thigh.
 13. Support the lower feet by a small pillows.
14.Allow the feet to fall naturally over end of matters while toes
rest on the bed surface.
15.Assess the patient general skin condition and the existence of
pressure ulcer & Clark the time of position change
Documentation
Use nursing note form in the appendix (A).
Knowledge:
□ List contraindication of prone position. (Patient with cardiac
, respiratory problem, spinal abnormalities.
□ Identify the recommended duration and interval for
prone position.
□ List the Disadvantages of prone position. (Cause planter
flexion, and marked Lordosis, inhabits chest expansions).
Identify if there is encumbrance to movement such as I,V
or indwelling urine catheter .
□ Demonstrate sites of pressure ulcer result from keeping
patient in prone position.

Helping patient to setting position in bed

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Procedure Steps 0
Purposes
□ To facilitate other nursing care intervention. (Feeding
and mouth care).
□ To change the client position into comfortable position.
 Equipments
□ Overhead Trapeze.
□ Four small pillows.
□ Footboard (optional).
1. Secure the side rails and raise the bed at the waist level.
2. Slide the client in the center of the bed by.
3. Ask the client to grasp with the side rails or the over head trapeze.
4. Put your close arm under the client shoulders and the other hand
grasping the client arm.
5. Ask the client to sit while raising the trunk.
6. Make the angle of the bed between 45 to 90 degree.
7. Keep the clients leg and hip flat on the lower bed surface.
8. Support patient position by using pillows to comfort patient
and ensure good alignment:
Put large pillow to support head, neck and upper back.
Put small pillow under forearms, elbow, while flex the lower
arm.
Put small pillow under the thighs to flex knees
Place trochanter roll lateral to femur.
9. Place a small pillow under feet to keep it in dorsal flexion position.
10. Keep the heels rest on bed surface.
11. Keep feet in dorsal flexion position by using small pillow or
footboard if available.
12. Ensure clients safety before leaving.
Documentation
Use nursing note form in the appendix (A).
Knowledge:
Identify the most important information should be documented.
Identify the major assessment points before put patient in sitting
position.
□ Demonstrate sites of pressure ulcer result from keeping
patient in sitting position.
□ Differentiate between angle of semi sitting position and
sitting position angels.

Transferring patient from bed to the chair

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Procedure Steps 0
Purposes:
To transferred the patient between the bed and wheelchair as he
need , chair and commode or wheel chair to toilet .
Equipments
Wheelchair, chair ,commode Walking transfer /gait belt
□ Sliding board (optional).  Non skid slipper or shoes.
1. Lower the bed to the lowest level so that clients feet will rest on
floor.
2. Lock the wheels of bed and the wheelchair.
3. Positioning the wheelchair
□ Place the wheelchair parallel and as close to the bed as possible.
□ If the clients have difficulty walking; place the wheelchair at 45C
angel to the bed .
□ If the client can’t stand but can use the upper extremity, use sliding
board without using nurses assistance.
4. Preparing and assess the client
□ Assist the client to a sitting position at the side edge of the bed.
□ Allow for period of reset to prevent orthostatic hypotension before
moving the client.
□ Assist the client to put the nonskid slipper or shoes.
□ Place gait /transfer belt snugly and securely around the
client's waist avoid placing in axillaries if needed .
□ Place the client hands on the bed or on your shoulders.
5. Positioning yourself
□ Lean your trunk from the hips, Flex hips, knees and ankles.
□ Place one foot forward and the other strongest one back beneath the
edge of the bed.
□ Support the client's feet with your feet to prevent client from sliding
laterally.
□ Make sure that the placement of nurse's feet mirrors that of the
client's feet.
6. Assisting client to stand and move together toward the wheel
chair.
If one nurse:
□ Grasp the client tightly from the belt or encircle the client’s waist
with your arms.
 Instruct the patient to push against the matters and stand when
hearing the word "stand".
Transfer your weight from one foot to other keeping your back
straight while transfer the patient.
Stand upright moving client forward into a standing position.

If two nurses
□ Position yourselves on both side of the patient, using the proper body
mechanics.
□ Grasp the client belt with hand closest to the client and the
other hand support the elbow.
7. Assisting client to sit
□ Ask the clients to place both hands on the wheelchair arms or on
your shoulders.
□ Ask the client to back up to the wheel chair.
□ Stand in front of the client placing one foot forward and one back.

□ Have the client sit down on the wheelchair while you bend your
knee, hips.
8. Ensure the client safety (sitting well and lower the footplates).
Documentation
Use nursing note form in the appendix (A).
Knowledge:
Identify the most important information should be documented.
□ Identify the major assessment points before transferring patient
from bed to chair and from chair to bed.

Moving patient up to bed

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Procedure Steps 0
Purposes
□ To move up clients slide down from Fowler’s position or
pulled down traction.
Equipments
□ Disposable gloves. Pull or turn sheet.
□ Overhead trapeze. Sliding bar (friction –reducing
device).
1. Adjust the bed in flat position.
2. Raise the level of bed to the waist level.
 3. Lock the wheels on the bed and raise the side rails on the side of the
bed opposite you.
4. Assist the client to a sitting position.
5. Remove all pillows .and place one against the head of the bed to
protect patient head injury
6. Ask the client to flex his hips and knees so it can be used in pushing
to prevent friction during movement
7. For patient who is able to reposition without assistance.
□ First method: Ask the client to grasp the head of bed with both
hands and pull during the move.
□ Second method: raise the upper part of the body on the elbows
or grasp the overhead trapeze.
8. For an average size client who is partially able to assist:
If One nurse :
□ Place your arm under the client thigh
□ Push down the mattress with the other arm .
□ For client with limited strength put the other arm under the
client shoulders.
9. For an overweighed size client who is partially able to assist:
Two nurses are required.
□ Both nurse work together as one person.
□ First method: both nurses interlock their forearm under the
client thigh and shoulders.
□ Second method: The two nurses use a turn sheet placed under
the client extended from shoulders to thighs.
10. The two nurses grasp the sheet close to the shoulders and
buttocks.
11. Lean your trunk from the hips, Flex hips, knees and ankles.
12. Assume a board posture with foot nearest the bed behind the
forward foot.
13. Follow the direction of the movement.
14. Shift your weight to the front legs as the client pushes with heels
moving toward the head of the bed.
15. Elevate the head of the bed and provide appropriate support for the
client's new position.
15. Documentation