Positioning the Client for Specific Surgical Conditions

Surgical Condition	Key Points	Rationale
Amputation: lower extremity	No pillows under stump after first 24 hr; turn client 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
Burns (extensive)	Usually flat for first 24 hr	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	Reduces 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 repair)	Head of bed elevated on shock blocks	Prevents esophageal irritation from gastric regurgitation
Hip prosthesis	Keep affected leg in abduction (splint or pillow between legs) Avoid adduction and flexion of the hip 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	Do not abduct arm first few days 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	Gives unaffected lung room for full expansion Prevents mediastinal shift In case of bleeding, there will be no drainage into the unaffected bronchi
Pneumothorax	Semi-Fowler’s	Gives optimal chest expansion
Radium implantation in cervix	Bedrest—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	Affected area toward bed—complete bedrest No sudden movements of head Face down if gas bubble in place	Gravity may help retina fall in place; prevents further tearing 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 client more freedom to move about than in straight traction	In balanced suspension, additional weights supply countertraction
Client who is unconscious	Turn on side with head slightly lowered—“coma” position	Important to let secretions drain out by gravity Must prevent aspiration
Vascular
Iliofemoral bypass; arterial insufficiency	Do not elevate legs Avoid hip flexion—walk or stand, but do not sit	Arterial flow is helped by gravity Flexion of the hip compresses the vessels of the extremity
Vein strippings; vein ligations	Keep legs elevated Do not stand or sit for long periods	Prevents venous stasis Prevents venous pooling

Source: Jane Vincent Corbett, RN, MS, EdD, Professor Emerita, School of Nursing, University of San Francisco.

Used with permission.

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Table 11-4