Lead: Different posture and lying position is one of the reasons for physical discomfort. Proper placement of patients and keeping correct posture and lying position can not only help patients feel comfortable, but also prevent complications caused by long-term bed rest.

First, lie down.

(a) the nature of the recumbent position

According to the patient's activity ability, lying position is usually divided into:

1. Patients with active decubitus independently adopt decubitus.

2. Patients with passive decubitus have no ability to change their decubitus, and lie in the placed decubitus, such as coma, extreme weakness and paralysis.

3. Patients who are forced to lie flat have a clear consciousness and the ability to change their lying position. They were forced to lie down because of illness and treatment. For example, when patients with bronchial asthma have an attack, they take an upright position because they have difficulty breathing.

(2) Common prone position

1. supine position

(1) supine position without pillow

1) Requirements: The patient lies on his back, the pillow stands across the bed surface, his head leans to one side, his arms are placed at his sides, and his legs are naturally flat.

2) Scope of application: ① Used for patients in coma or general anesthesia to prevent vomit from flowing into trachea and causing suffocation or pulmonary complications; ② For patients with spinal anesthesia or lumbar puncture 6-8 hours later, it is used to prevent headache caused by intracranial pressure reduction. Because after puncture, cerebrospinal fluid can leak out of the spinal cavity from the puncture point, causing intracranial pressure to decrease, pulling intracranial venous sinus and meninges and other tissues, causing headache.

(2) concave prone position

1) Requirements: The patient's head and chest should be raised 10? ~20? Angle, lower limbs raised by 20? ~30? Horn.

2) Scope of application: shock patients. Raising the head and chest is beneficial to keep the respiratory tract unobstructed and improve hypoxia; Elevated lower limbs are beneficial to venous return, increase cardiac output and relieve shock symptoms.

(3) Kneeling supine position

1) Requirements: The patient lies on his back, with his arms at his sides, his knees bent and slightly apart.

2) Scope of application: ① For patients undergoing abdominal examination, abdominal muscles are relaxed, which is beneficial to the examination; ② Patients with urethral catheterization are beneficial to expose the surgical site.

2. Lateral position

(1) Requirements: The patient lies on his side, with his arms bent, one hand on the pillow and the other hand on his chest, with his legs straight and his thighs bent, and a soft pillow placed if necessary.

(2) Scope of application

1) enema and anal examination, combined with gastroscopy and colonoscopy.

2) gluteal muscle injection (leg bending, thigh straight).

3) Prevention of pressure ulcers: alternate with supine position to reduce local compression time.

3. Half-sitting and lying position

(1) Requirements: shaking table. When shaking, shake the bedside bracket to 30? ~50? Angle, and then shake the knee brace to prevent the patient's body from slipping; When laying flat, put the knee bracket flat first, and then put the bedside bracket.

(2) Scope of application

1) Patients with dyspnea caused by heart and lung diseases. Reasons: ① Under the action of gravity, the diaphragm descends, the chest volume increases, the pressure of organs in abdominal cavity on the heart and lungs decreases, and the vital capacity increases; ② Part of the blood stays in the lower limbs and pelvic cavity, which reduces the amount of blood flowing back to the heart, reduces the congestion in the lungs and the burden on the heart, and improves the dyspnea.

2) Patients with inflammation after thoracic, abdominal and pelvic surgery. Causes: ① Peritoneal exudate can flow into pelvic cavity, which limits the infection; ② To prevent infection from spreading upward and causing subphrenic abscess.

3) Patients after abdominal surgery. Reason: It can reduce the tension of abdominal incision suture, relieve pain and be beneficial to wound healing.

4) Some patients after face and neck surgery. Cause: Reduce local bleeding.

5) Patients with weak constitution in recovery period. Reason: Make the patient adapt to the change of posture gradually, which is beneficial to the transition to standing.

Step 4 sit in a supine position

(1) Requirements: The patient should be seated, lean forward slightly, put a small table horizontally on the bed, and put a soft pillow on the table, so that the patient can rest on the table.

Shake the head support to 70? ~80? Angle, below-knee bracket is 15? ~20? Angle, the patient can also lean back.

(2) Scope of application: Patients with acute pulmonary edema, pericardial effusion and acute attack of bronchial asthma are forced to sit up due to extreme dyspnea.

Step 5 lie prone

(1) Requirements: The patient is prone, with elbows bent at both sides of his head, legs straight, soft pillows placed in the stables under his chest, abdomen, buttocks and ankles, and his head tilted to one side (for comfort and breathing).

(2) Scope of application

1) low back examination, with pancreatography, cholangiography, etc.

2) Patients with wounds in the waist, back and buttocks or after spinal surgery cannot lie on their back or side.

3) Abdominal pain caused by flatulence. Reason: It can increase the volume of abdominal cavity and relieve flatulence.

6. Head low and feet high

(1) Requirements: The patient lies on his back, the pillow stands across the bed surface (to protect his head), and the cushion height at the end of the bed is 15 ~ 30cm.

(2) Scope of application

1) Drainage of pulmonary secretions makes sputum easy to cough up.

2) Duodenal drainage to facilitate bile drainage.

3) Premature rupture of membranes during pregnancy to prevent umbilical cord prolapse.

4) When the calcaneus and tibial tubercle are traction, human gravity is used as back traction.

7. Head high and feet low

(1) Requirements: The patient lies on his back, the pillow stands horizontally at the end of the bed, and the height of the bedside cushion is 15 ~ 30cm.

(2) Scope of application

1) When patients with cervical fracture are traction on the skull, they use human gravity as back traction.

2) Reduce intracranial pressure and prevent brain edema.

3) Patients after craniotomy.

8. Knee-chest position

(1) Requirements: The patient kneels on the bed, with his legs flat, his thighs perpendicular to the bed surface, his legs slightly separated, his chest attached to the bed surface, his abdomen suspended, his hips raised, his arms bent at both sides and his head turned to one side.

(2) Scope of application

1) Examination and treatment of anus, rectum and sigmoid colon.

2) Correct the backward inclination and dislocation of uterus.

3) Promote postpartum uterine recovery.

9. Stone cutting position

(1) Requirements: The patient lies on his back on the examination table, with his legs spread out on the leg rest, his hips flush with the edge of the bed, and his hands on his sides or chest. Pay attention to avoid rain and keep warm.

(2) Scope of application

1) Examination, treatment and operation of perineum and anus.

2) When the parturient gives birth.

(3) the method of changing the lying position

1. Help the patient turn over and lie on his side.

(1) Purpose

1) Help patients who can't get up to change their lying position to make them comfortable.

2) Prevent complications such as pressure sore and falling pneumonia.

3) Meet the needs of examination, treatment and nursing.

(2) Operation method

Method 1: One person assists the patient to turn over and lie on his side. Suitable for patients with light weight.

1) to examine the patients, and explain the purpose, method and matters needing attention of the operation to the patients, so as to obtain the cooperation of the patients.

2) Fix the bed wheel.

3) The patient lies on his back with his hands on his abdomen and his legs flexed; All kinds of catheters are properly placed.

4) Move the patient's shoulders and hips to the nurse's side first, and then move the lower limbs. The nurse held her shoulders and knees with one hand and pushed the patient across from the nurse.

5) According to the requirements of lying position, place a soft pillow between the back, chest and knees to make it comfortable.

6) Record the rotation time and skin condition.

Method 2: Two people help the patient turn over and lie on his side. It is suitable for patients with heavy weight or serious illness.

1) is the same as the method 1 1) ~ 3).

2) Two nurses stand on the same side of the bed, one holds the patient's neck, shoulders and waist, the other holds the buttocks and fossa, and both of them carry the patient to the proximal side at the same time; The two nurses held the patient's shoulders, waist, hips and knees respectively and gently turned the patient to the opposite side.

3) According to the requirements of lying position, place a soft pillow between the back, chest and knees to make it comfortable.

4) Record the rotation time and skin condition.

2. Help the patient move to the bedside

(1) Objective: To help patients who have slipped to the end of the bed but can't move by themselves move to the bedside, so as to make them safe and comfortable.

(2) Operation method

Method 1: One person assists the patient to move to the bedside. Suitable for patients with light weight.

1) to examine the patients, and explain the purpose, method and matters needing attention of the operation to the patients, so as to obtain the cooperation of the patients.

2) Put the bedside bracket flat, and put the pillow across the bedside, so as not to hurt the patient; All kinds of catheters are properly placed.

3) The patient lies on his back, kneeling on his knees and holding the bedside railing with both hands.

4) The nurse holds the patient's shoulder with one hand and the patient's hip with the other, and at the same time guides the patient to push the bed surface and move up to the head of the bed.

5) Move the pillow back to a comfortable position.

Method 2: Two people assist the patient to move to the bedside. It is suitable for patients with heavy weight or serious illness.

1) is the same as methods 1 1) and 2).

2) Patients lie on their backs and bend their knees. Two nurses stood on both sides of the sickbed, holding the patient's neck, shoulders and buttocks cross, and carrying the patient to the bedside. Two nurses can also stand on the same side of the bed, one holding the neck, shoulders and waist, and the other holding the hip fossa, and move to the bed in the same way.

3) Move the pillow back to a comfortable position.

(3) Precautions

1) Determine the turning interval according to the condition and skin pressure. If the skin is found to be red, swollen and damaged, it should be handled in time, and the number of turns should be increased, and records should be made and handed over.

2) When assisting the patient to turn over, don't drag to avoid scratching the skin. When two people turn over the patient, the movements should be coordinated and the force should be steady.

3) When patients have a variety of catheters, they should be properly placed before turning over. After overturning, check whether they fall off, deform, shift, compress, etc. Keep the catheter unobstructed.

4) Special patients: ① Before helping the patient turn over after operation, check the wound dressing, change the dressing first and then turn over; ② After brain surgery, excessive rotation of the patient's head can cause cerebral hernia and lead to sudden death, so generally only the healthy side or supine position is taken; ③ Patients with bone traction should not relax traction when turning over; (4) Patients with plaster fixation and large wounds should pay attention to putting the affected part in a proper position after turning over to prevent oppression.

5) Pay attention to the principle of labor saving: when turning over, the nurse should let the patient get close to herself as much as possible, make the gravity line pass through the support surface to maintain balance, and shorten the gravity arm to achieve the purpose of labor saving and safety.

Second, the use of protective gear.

(1) Purpose

1. Ensure safety and prevent children from accidents such as high fever, delirium, coma, restlessness and critically ill patients due to unconsciousness or weakness.

2. Ensure the smooth progress of treatment and nursing.

(2) Method

1. Bed stall is mainly used to protect patients and prevent them from falling out of bed.

(1) Multifunctional bed stall: it is inserted at the end of the bed when not in use and at both sides of the bed when in use; If necessary, the mattress can also be removed and placed on the patient's back for chest compression.

(2) Semi-automatic bed stall: it can be lifted as required.

(3) Wooden bed rail: When in use, put the bed rail on both sides of the bed and fix it at the head of the bed and the end of the bed; There is a movable door in the middle of the bed stall, which can be opened during operation and closed after operation.

2. Restraint band is mainly used for restless or mental patients to restrict physical activity.

(1) Wide bandage: mainly used for fixing wrists and ankles. First, wrap the part with a cotton pad, then tie the wide bandage into a double knot, put it on the cotton pad, and tie the belt slightly on the edge of the bed to prevent the part from coming out and not affect the blood circulation.

(2) Shoulder restraint belt: it is mainly used to fix shoulders and restrict patients from sitting up. The shoulder restraint belt is made of cloth, with a length of 120cm and a width of 8cm. One end of the shoulder restraint belt is made into a sleeve shape with a thin belt. When in use, firstly, the sleeves are sleeved on the shoulders on both sides, and cotton pads are placed under the armpits. The thin band on the sleeve is tied to the chest, and the ends of the two wide bands are tied to the bedside for fixation. If necessary, put the pillow across the bed.

(3) Knee restraint belt: it is mainly used to fix the knee to limit the activity of the patient's lower limbs. The knee restraint belt is 250cm long and 1Ocm wide, and there are two at the middle ends. When in use, first put the cotton pad on the knee, then fix one knee joint with two straps respectively, and tie the broadband to the edge of the bed on both sides.

(4) Velcro strap: suitable for fixing wrists, upper arms, ankles and knees. When in use, the pad is partially padded, the velcro is closed, and the belt is tied on the edge of the bed; Pay attention to the tightness.

3. Support the quilt frame

Mainly used for patients with limb paralysis and extreme weakness, which can avoid discomfort or other complications caused by covering and pressing limbs; It can also be used to keep warm when burn patients are treated. When in use, the supporting quilt frame is covered at the required position first, and then the quilt cover is covered.

(3) Precautions

1. Strictly grasp the application indications of protective equipment, introduce the necessity of using protective equipment to patients and their families, gain their understanding, eliminate their psychological barriers and protect patients' self-esteem.

2. The brake protector can only be used for a short time, and the binding belt must be loosened regularly (usually every 2 hours); At the same time, pay attention to the patient's limbs should be in a functional position.

3. When using the restraint belt, the local area must be properly padded, and the local skin color should be observed frequently (usually once every 15 ~ 30 minutes), and the local area should be massaged if necessary to promote blood circulation.

4. Record the reasons for using protective equipment, the use time, the observation results, the nursing measures taken, and the time to stop using it.