POSITIONING TIPS FOR NCLEX EXAM
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing,
tachycardia, pale/cyanotic, sense of impending doom) --> turn pt to left
side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased
variability, fetal bradycardia, etc) --> turn on left side (and give
O2, stop Pitocin, increase IV fluids)
3. Tube Feeding w/ Decreased LOC --> position pt on right side
(promotes emptying of the stomach) with the HOB elevated (to prevent
aspiration)
4. During Epidural Puncture --> side-lying
5. After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in
flat supine (to prevent headache and leaking of CSF)
6. Pt w/ Heat Stroke --> lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) --> catheter is taped
to thigh so leg should be kept straight. No other positioning restrictions.
8. After Myringotomy --> position on side of affected ear
after surgery (allows drainage of secretions)
9. After Cataract Surgery --> pt will sleep on unaffected side
with a night shield for 1-4 weeks.
10. After Thyroidectomy --> low or semi-Fowler's, support head, neck
and shoulders.
11. Infant w/ Spina Bifida --> position prone (on abdomen) so
that sac does not rupture
12. Buck's Traction (skin traction) --> elevate foot of bed for
counter-traction
13. After Total Hip Replacement --> don't sleep on operated side,
don't flex hip more than 45-60 degrees, don't elevate HOB more than 45 degrees.
Maintain hip abduction by separating thighs with pillows.
14. Prolapsed Cord --> knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip --> position on back or in infant seat to
prevent trauma to suture line. While feeding, hold in upright position.
16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries)
--> eat in reclining position, lie down after meals for 20-30 minutes (also
restrict fluids during meals, low CHO and fiber diet, small frequent meals)
17. Above Knee Amputation --> elevate for first 24 hours on pillow,
position prone daily to provide for hip extension.
18. Below Knee Amputation --> foot of bed elevated for first 24
hours, position prone daily to provide for hip extension.
19. Detached Retina --> area of detachment should be in the dependent
position
20. Administration of Enema --> position pt in left side-lying
(Sim's) with knee flexed
21. After Supratentorial Surgery (incision behind hairline) -->
elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck)-->
position pt flat and lateral on either side.
23. During Internal Radiation --> on bedrest while implant in
place
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache,
profuse sweating, nasal congestion, goose flesh, bradycardia, hypertension)
--> place client in sitting position (elevate HOB) first before any other
implementation.
25. Shock --> bedrest with extremities elevated 20 degrees, knees
straight, head slightly elevated (modified Trendelenburg)
26. Head Injury --> elevate HOB 30 degrees to decrease intracranial
pressure
liver biopsy
appendectomy (with legs flexed)
28. Position Patients on the Left Side if or after:
Pregnant with risk of cord compression
29. Position Left side:
with HOB elevated with GERD
30. Position on the Affected Side:
-pneumonia (to splint and reduce the pain)
You can watch the video here Master NCLEX Exam Essential Positioning 2024 05 25
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