Health II
Unit 203
Position and Move Patients
Principles of Proper
Body Alignment
 good body alignment is essential for the
well being of a patient, regardless of
whether they are sitting or lying
Principles of Proper
Body Alignment
 when someone is in good alignment, they
“look comfortable”



spine should be straight
shoulders/hips/knees parallel to one
another and parallel to the sides of bed or
chair
no slumping, twisting, bending or
unnatural positions
Complications Related to Poor
Body Alignment
 contractures

if position of body is not changed regularly
and detailed attention is not given to
proper body alignment of the patient,
contractures may develop

REMINDER, a contracture is a permanent
shortening/tightening of a muscle
Complications Related to Poor
Body Alignment
 pressure areas

areas of pressure are increased when the
body is in poor alignment and not changed
regularly that may cause pressure ulcers

REMINDER: pressure ulcers begin with a
redness of the skin and may continue to large
open and deep sores
Common Alignment Problems
 Neck flexion
 may cause strain
on the neck
muscles
 may restrict the
act of breathing,
leading to shallow
breathing or
possibly an
airway
obstruction and
death
Common Alignment Problems
 Shoulder internal
rotation

may cause contracture
at shoulder and loss of
the ability to externally
rotate shoulder
 Adduction of shoulder
 will lead to loss of
ability to abduct
shoulder
Common Alignment Problems
 Wrist flexion
 may cause wrist
drop and weak
grasp
Wrist drop
due to hanging
over edge of pillow
in flexed position
Common Alignment Problems
 Lumbar spine
convexity

causes low back
pain , due to lack
of support to the
spine
direction of
spine curvature
Common Alignment Problems
 Lumbar spine
convexity

to reduce the convex
curve of the back, the
patient’s knees must be
flexed to flatten the
spine against the bed
and gain support or
sometimes a small
pillow under the “small
of the back” may be
necessary
spine flattened
& supported
by bed
Common Alignment Problems
 Hip external
rotation

causes hip pain,
decreased range
of motion or
contracture of
the hip
Common Alignment Problems
 Knee
hyperextension
(beyond normal
extended position)

causes a painful
stretch of nerves &
blood vessels in
back of knee. This
position may lead
to loss of normal
ROM of the knee
flexed knee
hyperextended
knee with foot
on blanket
Common Alignment Problems
 Ankles
 may lead to plantar
flexion (“foot
drop”) if the ankle
is not maintained
@ 90 degrees
toes pointed
forward & down
Common Pressure Areas
Common Pressure Areas
Grsaphic:www.info.gov/hk
Common Pressure Areas
 Ears/Head
 the ears & head may experience pressure
from the pillow or bed when the patient is
placed in prone, side lying and supine
positions
 Shoulder/Scapula
 shoulder blades will experience pressure
from the bed when patient is placed in the
supine position
Common Pressure Areas
 Elbows

the olecranon process of proximal ulna (tip
of elbow) will experience pressure when
the patient is in supine or prone positions
Common Pressure Areas
 Sacrum/Coccyx/Hips
 the ischial bones that
supports the weight
of the patient while
sitting & the tailbone
may feel pressure
while sitting or lying
 greater trochanter
may feel pressure
while patient is
sitting or sidelying
Graphic: www.dinf.ne.jp
Common Pressure Areas
 Ankle
 medial and lateral malleoli
when the patient is lying in
the side lying position
 Heel
 while patient is in the
supine, or any of the
Fowler’s positions
 Toes
 when lying in the prone
position, or heavy bedding
over toes when lying
supine
Graphic: z.about.com
Purpose of Supports
 provide comfort
 reduce stress and strain on joint
structures and muscles
 reduce risk of pressure ulcers
 provide elevation of body parts to reduce
edema
 support used to reduce effects of
immobility and provide patient comfort
Types of Supports
 pillows
Types of Supports
 rolled bath
blankets
Bath blanket
 rolled towels
 rolled
washcloths
Washcloth roll
Towel roll
Types of Supports
 splints (upper &
lower extremities)
 hand cones
bar prevents
rotation of
lower extremity
ankle splint
Hand
cone
Wrist &
hand splint
Criteria for Selecting Supports
 will vary
 each patient unique
 review chart
 communicate with patient about areas of
discomfort
 visually inspect body for support needs
Support(s) for Specific
Health Conditions
 Paralysis

requires support to the affected area(s)
 Fractures

will require support(s) to prevent rotation
of the fractured part, and elevation of the
fractured part to minimize swelling of soft
tissue
Support(s) for Specific
Health Conditions
 Diabetic Patients



have diminished circulation that causes
decrease of skin’s ability to recover from
an injury
diabetics are prone to pressure ulcers and
must be monitored carefully
complications from pressure ulcers in a
diabetic patient can result in the
amputation of a lower extremity
Key Factors
Support Devices
 the longer the length of immobility, the
more sensitive the skin due to decreased
circulation
 protect pressure points the thinner the
patient the more supports that are needed
 too much support may limit movement
and have a reverse effect
 keep bedding loose
 bed linens should be clean dry and
wrinkle free
Supine Position

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
lying on back, face up
spine straight & parallel
to sides of bed
shoulders, hips, knees
aligned with one another
hips extended, legs are
apart so that skin is not
rubbing against skin of
opposite leg
ankle in a 90 degree angle
with toes up
Consider These Support(s)
for Supine Position



pillow of suitable thickness under head
and shoulders (avoid hyperextension and
hyper-flexion of the neck)
small pillow under lumbar spine to prevent
convex curve
blanket rolls (trochanter roll) to prevent
external rotation of lower extremities
centered at the greater trochanter of each
femur
Consider These Support(s)
for Supine Position

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small pillow under thighs for knee flexion
foot splints, foot board, pillows or high top
shoes to keep feet in 90 degree position
towel roll just superior to heels to keep
heels off bed
pillows under elbows with hands above
heart to promote good venous blood return
cone to an affected hand to prevent
contractures
Prone Position

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

lying face down on
abdomen
spine straight &
parallel w/ bed rails
shoulders, hips &
knees aligned with
one another
arms, position of
comfort, elbows
flexed
hips extended, legs
slightly separated
Consider These Support(s)
for Prone Position


small pillow under head (avoid lateral neck
flexion, select appropriate pillow
thickness)
small pillow under abdomen just below
diaphragm to prevent:



hyper extension of the lumbar spine
reduce pressure of women’s breast
reduce pressure on genitals of men
Consider These Support(s)
for Prone Position


allow feet to fall
naturally over end of
mattress or support
lower legs on pillow so
toes hang over edge of
pillow and not touch
bed to prevent
pressure ulcers
hand cone in affected
hand to prevent
contractures
Toes over
edge of mattress
Advantages of
Prone Position
 promotes drainage from the mouth
 only position that allows full extension of
the hip and knee that may prevent
contractures of these joints
Disadvantages of
Prone Position
 gravity produces lordosis of the spine
(exaggerates the sway back)
 should not be used with neck/spine
problems
 inhibits chest expansion so should not be
used for patients with cardiac and
respiratory disorders
Fowler’s Position





head of bed elevated 90
degrees, patient sitting
upright
no pillow under head and
shoulders
upper torso supported by
arms on a pillow placed
on an over the bed table
shoulders, hips, knees
aligned with one another
spine parallel to the
sides of bed
Semi-Fowler’s Position



reclining, semisitting position
head of the bed
elevated 15-45
degrees
lower end of bed
elevated to full
potential or pillows
placed under distal
thigh area to cause
knee flexion
Semi-Fowler’s Position



shoulders, hips
and knees
aligned with one
another
spine parallel to
the sides of bed
shoulders and
hips in neutral
position
Consider These Support(s) for
Semi-Fowler’s Position
 pillow to support
head, neck & upper
shoulders to prevent
flexion of the neck
 small pillows under
distal femur if b
knees to prevent
hyperextension of
knees
Consider These Support(s) for
Semi-Fowler’s Position
 “trochanter roll”
lateral side of femur
centered at the
greater trochanter
to prevent lateral
(external) rotation of
femur
Consider These Support(s) for
Semi-Fowler’s Position
 towel roll under
ankles to lift heels
off bed
Consider These Support(s) for
Semi-Fowler’s Position
 foot board, rolled
pillows, foot/ankle
splints to prevent 90 degree ankle
plantar flexion by angle w/pillow
keeping ankle in a
90 degree
position
90 degree ankle
angle
w/professional
splint
Consider These Support(s) for
Semi-Fowler’s Position
 pillow under each elbow
with hand supported
above the elbow to
promote good venous
blood return & prevent
pressure ulcers
 hand cone or splint in
affected hand to prevent
contractures
Note: do not let the wrist drop
over the edge of the pillow,
as this may lead to “wrist drop”
Side-lying Position
 patient lying on side
 spine parallel to sides of bed
 hips & shoulders aligned w/
themselves & each other
 weight of upper torso
supported on lateral border
of scapula, not directly on
shoulder joint
 top leg, top arm, head &
back supported
Note: the greater the flexion of top hip
& knee, the more stable & balanced
the position
Consider These Support(s) for
Sidelying Position
 the top leg should be supported with a firm pillow
first, have it near or on bed when patient is turned

use pillow as a catcher’s mitt, and place knee in center
of pillow

this support relieves stress on the back muscles
 pillow under head that will not cause lateral
flexion of the neck (size of support will vary per
individual)
Consider These Support(s) for
Sidelying Position
 pillow under top arm to prevent internal rotation
of the shoulder that could lead to limited shoulder
movement and may impair chest expansion
during breathing. Do not allow wrist to hang over
edge of pillow
 pillow rolled behind back to prevent patient from
falling backwards
 pillow or blanket roll to plantar surface of foot to
prevent plantar flexion
 hand cone in affected hand to prevent
contractures
SIM’S Position




combination of
sidelying & prone
posture
bottom arm
positioned behind
the patient
upper arm flexed at
shoulder & elbow
near the head
legs flexed, top leg
more flexed than
bottom
SIM’S Position
 SIM’S
 this position promotes drainage from mouth &
prevents aspiration & may be used with the
unconscious patient
 position may be used when administering
rectal medications/enemas or examinations of
the perineal area
 used for paralyzed patients to reduce pressure
over sacrum & greater trochanter
 pregnant women often prefer this position for
sleeping
Consider These Support(s) for
SIM’S Position
 pillow or folded towel (optional) under head. The
wider the patient’s shoulders, the more likely this
will be necessary. Avoid lateral flexion of the
neck
 pillow under top arm to prevent internal rotation
of shoulder and arm, reduces pressure on chest
 pillow under top knee to prevent internal rotation
and adduction of the hip and leg
Consider These Support(s) for
SIM’S Position
 blanket roll or ankle splint to keep ankle in an
extended position (90 degree angle) to prevent
plantar flexion of the top foot
 toes of bottom foot should hang over the edge of
the mattress, or washcloth roll placed proximal to
the toes under dorsal aspect of foot to lift toes off
bed & prevent pressure ulcers
 hand cone in affected hand to prevent contractures
Clients needing maximum assistance
 Bariatrics is the branch of medicine that
deals with prevention, control and
treatment of obesity (Taber’s Dictionary,
6th edition)
 Employers want caregivers to move them
safely, but without injury to caregivers
Lift/Draw sheets
 A sturdy folded piece of linen that is
placed under a client to assist lifting, so
shearing forces are lessened, yet client
can be made comfortable.
Slide boards
 A sturdy, flexible, yet smooth, synthetic
board used to move a client from bed to
cart, or vice versa, with less shearing
force on client’s skin and less stress on
muscles and joints of caregivers.