Fowlers

* Reduces ICP by promoting venous return and drainage from head * * Relaxes abdominal muscle tension * * Prevents aspiration by promoting gastric emptying; also, theres a slight gravitational pull when swallowing * Abdominal aneurysm surgery: prevents pressure on the graft (Ruptured) Appendicitis: semi fowler if ruptured. If not, then any position ok Bronchoscopy: Semi fowlers post op to prevent aspiration Cataract surgery: Prevents edema at the operative site. Cerebral aneurysm: Semi fowler Craniotomy: Semi fowler if supratentorial, and Flat if infratentorial that can promote drainage from the head. Cerebro vascular accident: Reduce ICP. Hypophysectomy: Prevents increase ICP Laryngectomy: Maintains airway and reduces edema. Lobectomy (lung/thyroid/brain): Semi fowler Myelogram: Elevate HOB if water based dye was used, and flat if oil based dye was used. Pulmonary edema: Fowlers Thoracentesis: (aka pleural tap) If unable to sit, Fowlers during procedure; any position after. Thyroidectomy: Avoid hyperflexion/extension of neck.

High Fowlers
* Concepts from Fowlers applies * Autonomic dysreflexia: Prevents hypertension stroke. Congestive heart failure (CHF): Improves oxygenation. Hiatal hernia: Upright position after meals to prevent reflux of stomach contents.

Elevate Extremities
Cast: elevation prevents edema. Thrombophlebitis: Bed rest and elevate the affected leg to promote circulation Varicose veins: elevate leg above heart Mastectomy: Elevate extremity of the affected side (on pillow) to prevent edema. Vein stripping and ligation (removal of vein): Legs are elevated to prevent venous stasis

Trendelenburg
* Increases CPP * * Adverse effects with breathing; used in waterboarding torture * * Reverse trendelenburg is used in abdominal/gynecological surgery, when gravity pulls intestines down, allowing better access to pelvic organs * * Contraindicated in those w/ ICP, head injuries, spinal cord injuries, and those w/ certain respiratory d/o (so if see pt with dyspnea, dont put in T* Shock: Modified trendelenburg to promote venous return. CVC Insertion: Distends the upper, central veins (subclavian and jugular, not femoral). Trendelenburg during CVC insertion to prevent air embolism (big adverse event during CVC insertion)air will float to highest point of heart Cord Prolapse: take pressure off the cord to oxygenate fetus

Prone
Cleft palate repair: Lets blood from procedure drain out of mouth. Tonsillectomy: Side-lying or prone to let blood drain out mouth. ** Modified sims is prone with 1 leg straight and 1 out flexed and to the side- for colonoscopy and rectal procedures.

Supine

Cleft lip: Prevents pressure on the suture line post-op Dumping syndrome: Prevents rapid emptying or the stomach after meals. Radium implant in the cervix: Flat to prevent dislodge of the implant. Tracheoesophagel Fistula (TEF): Supine with low fowlers (~30 degrees) Esophagus in back; trachea in front Craniotomy: Flat if infratentorial; promotes drainage from head.

Side-lying position

* side facilitates gastric emptying * Air embolism: Left side position and lower HOB to trap air in apex of the right ventricle and prevents it from going into the lung circulation Flail chest: Keep patient on affected side to promote expansion of the unaffected lung. Hemorroidectomy: remove pressure from rectum Liver biopsy: Right side position post procedure to prevent patient from bleeding. Lumbar puncture: Lateral side lying during procedure and flat after procedure. Pyloric stenosis: Right side lying position after meal, to facilitate entry of stomach contents into the intestines. Seizure: Side lying position post-ictal Tonsillectomy: Side-lying or prone Post salpingo/oophorectomy: take pain off stomach and prevent pooling

Sitting/Tripod

* Promotes patient breathing; pt is usually in resp distress * Bronchiolitis: Tripod position. Epistaxis: Leaning forward to prevent blood aspiration. Asthma: Sitting position, leaning forward, to promote patient breathing Placenta previa: Sitting position that can minimize bleeding. Thoracentesis: (aka pleural tap) sit up and lean forward (on table)

Special

Hip surgery: Legs in abduction position- prevents dislodge of femur head from acetabulum.

Laminectomy: keeping back as straight as possible- prevents twisting of spine Spinal cord injury: Immobilize the patient Retinal detachment: The affected side toward the bed to help the detached retina to fall back in place. Prolapse cord: Knee-chest Position to prevent pressure on the cord. Tetralogy of Fallot: squatting or knee-chest position- increases pressure on left side of heart, decreasing the Right-to-Left shunting, which decreases the amount of deoxygenated blood entering into the circulation.