to which position would the nurse assist the patient who is experiencing difficulty with breathing? This is a topic that many people are looking for. newyorkcityvoices.org is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, newyorkcityvoices.org would like to introduce to you Patient Positioning. Following along are instructions in the video below:
Guys this is our ketchup chapter here its called the physical exam. However what what were really gonna be talking about with this particular chapter is how to a patient properly. And what is the name of the different positions all right so we have talked about objective versus subjective already and just as a recap right objective are things you can see measure right physically prove or a subjective are all those things that the patient says that you have no way of proving.
We ought to refer to objective things when we talk about diseases as signs and subjective things as symptoms right so a symptom of a disease is the subjective okay component and the signs of a disease is the objective components. Um lab for us were not going to get super detailed into this because we have a whole course in this however of course lab. Tells tests.
Help us to confirm diagnosis determine what we call our differential diagnosis. Which is really a fancy term for you know what are the potential things that are wrong with the patient and of course our prognosis. What is our long term outcome for our patients all right so lets say youve got a patient is coming in theyre getting examined today.
What are some of the things you need to do of course. Were gonna bring them back to the room offer the bathroom. I want to caution you that of course if you need to get a urine sample from them dont let them go to the bathroom without a urine cup.
Although you can certainly collect it early. We will talk about proper ways to gown and drape a patient be aware that some folks again are more modest as we talked about and some a little bit less concerned. So do look to your patient.
If they need an extra gown an extra sheet to cover up let them be comfortable all right. Some of the things youre going to do is to observe or to inspect. Which of course just requires your eyes youre just looking at some general health.
What is their posture. What is their movement. What does their skin look like you know is there anything obvious at the surface okay that would be evidence one of their mannerisms right do they look like theyre in pain.
You know withdrawn okay are they groomed do they have body symmetry in contour. Right. If theyre complaining.
Especially about a musculoskeletal complaint. Okay um. Say a sprained ankle.
Right. Is one look. Relatively normal.
And the other one is twice the size red right has edema certainly that wouldnt be symmetrical skin rashes and certainly obvious deformities like we talked about with first aid alright. The health care provider is then going to palpate and palpate of course means to touch okay. When touching you can feel for masses lumps.
What does the skin feel like what is its temperature right is it warm indicating infection or swelling and of course. Theyre going to use fingertips. Perhaps one hand both hands okay.
And that is something that is taught in medical schools or upper level.
Health care programs. The health care provider. May perk.
Us and perk us really means to tap right. So. What they will do and they often use fingers to do.
This is that they will tap particularly over places like the chest and the abdomen. They do sound different right when you tap over something that should be full of air saying. The lung space.
Okay they sound relatively hollow. Certainly if a patient has got pneumonia and youre tapping its gonna sound okay much more consolidated right dull its not gonna have that same sort of echo like its an empty space. But to perk us for you guys is to tap.
And then auscultation you guys have done some of this right with blood pressure. Assessing heart rates in different ways other than radial. But to auscultate requires listening right and of course that generally requires a stethoscope if were going to listen inside the body alright.
We have done a term. We call mensuration all right weve talked about height in weights. But some of the stuff.
We havent talked about and we will see in some future chapters is to measure lengths of limbs right if one side is uneven from the other we can certainly create some mechanical problems you could measure range of motion. Which is how much does a patient flex. Extend rotate and of course.
Theres a lot of pediatric measurements. That were going to do with the pediatric unit unit and of course use a tape measure for all of these measurements. If you do not use a tape measure or something to physically measure these numbers that you are placing into your soap notes.
Okay. Insurance companies will not accept that all right the doctor may do what we call manipulation again were gonna look at this a lot with our physical therapy. Chapter.
But essentially what this is is looking at you know how much do the joints move. Okay compared right and left and we often refer to this as our o and witches range of motion. Okay the bulk of this chapter.
Really is this stuff positioning and draping all right as were doing different types of exams. The patient may have to take clothes off not necessarily always but may have to be unclothed for parts of the exam. And we do want to consider the modesty embarrassment.
Plus temperature right. I mean it can get very cold. If youre waiting for an hour for a doctor okay inside that room and youve got nothing to cover you.
But a flimsy sheet.
So do consider what youre giving the doctor or giving the patient while waiting for the doctor different types of positions are also going to be used for different types of exams and itll be fairly obvious once you see the different positions. Why that is all right so our first position here is this top right hand picture. We refer to this position as supine or dorsal recumbent or sorry horizontal recumbent okay so supine is generally the way we go and supine really refers to one of two things.
It is either palms up in this case or it is entire body up so face up lie on your back all right this of course is a good position for a patient if were going to be looking at something on the anterior side the patient right so if we need to see something on the front side this is a great position all right of course. Were gonna count our patients right and oftentimes do consider that the opening may have to be towards the front. If we have to look at something on the anterior side of our patient and drapes or gowns or toweling.
Were sheets that are going over our patients are generally going shoulders all the way down to feet alright our second one here is this bottom right here a picture. Which we refer to as dorsal recumbent. Which is essentially the same as the above picture.
However with one minor difference and of course. That is to bring the knees up feet flat on the floor. Okay draping would be exactly the same way right shoulders down two feet.
If youre gonna do an ob gyn exam. In this position. You may do it in a diamond shape okay with the point in between the knees.
The reason for bringing the knees up is it actually reduces pressure on the lumbar spine right so if somebodys got lower back issues. And is finding it very difficult to be just regular old supine. Okay you can simply have them draw their knees up or the other method is to simply place a rolled towel sheet pillow or if youve got something as fancy as a roll underneath the knee.
When the knees pop up it reduces pressure on that low back. So does for patient comfort. All right.
This top right hand side is lithotomy and of course. You should recognize this as being for your ob gyn. Pay type exams and of course.
We start in supine generally gowns are going to be open towards the front. Because were going to have to do a breast exam at some point in this position. You will break out these stirrups.
Okay help the patient get their heals properly into the stirrups and then they need to move down okay. Until their buttocks is all the way at the end and it may feel like theyre gonna fall off a little bit im so just if youre assisting the healthcare provider or the doctor certainly stay by their shoulders and just reassure them and that they in fact are going to remain on the table to get out of this position of course you want to make sure that their body is pushed up and securely on the table before they remove their legs from the stirrups. All right the next two are related.
Okay. The one at the bottom right hand side is a semi fowlers and essentially all youre doing here is going supine. But raising the head to about 45 degrees.
And then the next will be full fowlers which means youre gonna see at a full 90 degrees with the head raised and essentially these are folks for respiratory or hurt issues right when they go fully flat. It does become much more difficult to breathe so if theyre complaining of having difficulty breathing okay in a full supine or dorsal recumbent position this semi fowlers is a much more comfortable position for lots of folks. Okay and of course.
Here is high fowlers which is or full fowlers.
Which is 90 degrees. Okay the only difference is just the amount of tilt all right now were going to go the other direction on the bottom right hand side. Which is prone.
Ok. The prone position is face down. Okay patients back side up and of course.
The gown should be open to the back. When its placed on the patient drapes should go all the way down from shoulders. All the way down to ankles all right knee chest.
Position. Rarely used this is mostly for proctology or sigmoidoscopy. But youre going to see that there are better positions for this they had proctological tables okay and lets talk some fenestrated drapes.
I know weve mentioned this before in the surgical unit. Okay. But a fenestrated drape has any drape with a hole in it okay.
And lets take a peek at what knee chest position looks like okay. So this is a me chest position. You can see why we dont often use this.
It would be a relatively uncomfortable position for most things so again uncommonly use. But be aware that this one does exist alright now. Lets talk about our simmons position.
Which is a much more common position for these types of exams. And this one is sideline generally left side lying if you can but obviously if you need to see something okay on the left side you would go right side lying the arm at the bottom is going to come underneath and behind the patient. The knees.
Are the bottom leg is going to be straight the top leg will be bent okay. Ma. Pillow will be placed in between the knees.
And that top knee is going to come over okay that bottom leg. So again bottom straight top bent. And youre actually going to see a slight rotation in the patient.
When you stick this arm behind. And you straighten the bottom leg bend. The top leg.
So it should present the backside a little bit up which is good for rectal exams. Okay and its a comfortable position for the patient okay. This is easy to maintain trendelenburg.
We did talk about when we talked first aid and trendelenburg is essentially head down legs up position and of course. This was really good for somebody in shock right low blood pressure lightheadedness all right we will finish up this rest of this lecture in class. But please review your positions okay i come and prepare to practice those have a good day .
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