Amputation: lower extremity

No pillows under stump after first 24 hours; turn patient prone several times a day

Prevents flexion deformity of the limb

Appendicitis: ruptured

Keep in Fowler's position—not flat in bed

Keeps infection from spreading upward in the peritoneal cavity

Bums (extensive)

Usually flat for first 24 hours

Potential problem is hypovolemia, which will be more symptomatic in a sitting position

Cast, extremity

Keep extremity elevated

Prevents edema

Craniotomy

Head elevated with supratentorial incision; flat with cerebellar or brainstem incision

Reduce cerebral edema, which contributes to increased intracranial pressure

Flail chest

Position on affected side

Reduces the instability of the chest wall that is causing the paradoxical respiratory movements

Gastric resection

Lie down after meals

May be useful in preventing dumping syndrome

Hiatal hernia (before repaired)

Head of bed elevated on shock blocks

Prevents esophageal irritation from gastric regurgitation

Hip prosthesis

1. Keep affected leg in abduction (splint or pillow between legs)
2. Avoid adduction and flexion of the hip
3. Use trochanter roll along outside of femur anterior joint capsule incision to keep affected leg turned slightly inward; no trochanter roll with posterior joint capsule incision as leg is turned slightly outward

If affected hip is flexed and allowed to adduct and internally rotate, the head of the femur may be displaced from the socket

Laminectomy; fusion

Avoid twisting motion when getting out of bed, ambulating

Prevents any shearing force on the spine

Liver biopsy

Place on right side, and position pillow for pressure

Prevents bleeding

Lobectomy

Do not put in Trendelenburg position. Position of comfort-sides, back

Pushes abdominal contents against diaphragm; may cause respiratory embarrassment

Mastectomy

1. Do not abduct arm first few days
2. Elevate hand and arm higher than shoulder if lymph glands removed

Puts tension on suture line Prevents lymphedema

Pneumonectomy

Turn only toward operative side for short periods; no extreme lateral positioning

1. Gives unaffected lung room for full expansion
2. Prevents mediastinal shift
3. In case of bleeding there will be no drainage into the unaffected bronchi

Radium Implantation in cervix

Bed rest-usually may elevate head to 30 degrees

Must keep radium insert positioned correctly

Respiratory distress

Orthopnea position usually desirable

Allows for maximum expansion of lungs

Retinal detachment

1. Affected area toward bed-complete bed rest
2. No sudden movements of head
3. Face down if gas bubble in place

1. Gravity may help retina fall in place; prevents further tearing
2. Any sudden increase in intraocular pressure may further dislodge retina

Traction Straight traction

Check specific orders about how much head may be elevated

Body is used as the countertraction-this must not be less than the pull of the traction

Balanced suspension

May give patient more freedom to move about than in straight traction

In balanced suspension additional weights supply countertraction

Unconscious patient

Turn on side with head slightly lowered—"coma” position

1. Important to let secretions drain out by gravity
2. Must prevent aspiration

Vascular Ileofemoral bypass; arterial insufficiency

1. Do not elevate legs
2. Avoid hip flexion—walk or stand, but do not sit

1. Arterial flow is helped by gravity
2. Flexion of the hip compresses the vessels of the extremity

Vein strippings; vein ligations

1. Keep legs elevated
2. Do not stand or sit for long periods

1. Prevents venous stasis
2. Prevents venous pooling