Changing a patient's position in bed every 2 hours helps keep blood flowing. This helps the skin stay healthy and prevents bedsores.
Turning a patient is a good time to check the skin for redness and sores.
The following steps should be followed when turning a patient from their back to their side or stomach:
- Explain to the patient what you are planning to do so the person knows what to expect. Encourage the person to help you if possible.
- Stand on the opposite side of the bed the patient will be turning towards, and lower the bed rail. Move the patient towards you, then put the side rail back up.
- Step around to the other side of the bed and lower the side rail. Ask the patient to look towards you. This will be the direction in which the person is turning.
- The patient's bottom arm should be stretched towards you. Place the person's top arm across the chest.
- Cross the patient's upper ankle over the bottom ankle.
If you are turning the patient onto the stomach, make sure the person's bottom hand is above the head first.
The following steps should be followed when turning a patient:
- If you can, raise the bed to a level that reduces back strain for you. Make the bed flat.
- Get as close to the person as you can. You may need to put a knee on the bed to get close enough to the patient.
- Place one of your hands on the patient's shoulder and your other hand on the hip.
- Standing with one foot ahead of the other, shift your weight to your front foot (or knee if you put your knee on the bed) as you gently pull the patient's shoulder toward you.
- Then shift your weight to your back foot as you gently pull the person's hip toward you.
You may need to repeat steps 4 and 5 until the patient is in the right position.
The following steps should be followed to make sure the patient is in the right position:
- Make sure the patient's ankles, knees, and elbows are not resting on top of each other.
- Make sure the head and neck are in line with the spine, not stretched forward, back, or to the side.
- Return the bed to a comfortable position with the side rails up. Check with the patient to make sure the patient is comfortable. Use pillows as needed.
American Red Cross. Assisting with positioning and transferring. In: American Red Cross. American Red Cross Nurse Assistant Training Textbook. 4th ed. American National Red Cross; 2018:chap.11.
Qaseem A, Mir TP, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):359-369. PMID: 25732278 pubmed.ncbi.nlm.nih.gov/25732278/.
Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Body mechanics and positioning. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 12.
Updated by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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Nutrition & Body Mechanics
| A nurse is repositioning a patient to the left lateral position. What action should the nurse implement when positioning this patient? | Left shoulder protracted |
| Which newly admitted patient would be at the greatest risk for an injury? | A patient who has a history of falls |
| Which stage pressure ulcer requires the nurse to measure the extent of undermining? | Stage 3 |
| A patient is diagnosed with a vitamin A deficiency. Which type of pie should the nurse encourage the patient to ingest? | Pumpkin |
| A patient with a diagnosis of CVA, which has caused right-sided paralysis and limited mobility, has been admitted to the nursing unit. What should be used to prevent the complication of external hip rotation in caring for this patient? | A trochanter roll |
| The patient asks the nurse to explain what a kilocalorie is. What is the nurse's best response to this patient's question? | :A kilocalorie is a measurement of energy." |
| A common complication of patients with limited mobility is a thrombus or emboli. Which nursing intervention assists in the prevention of a thrombus? | Applying TED stockings |
| A nurse places a patient in the orthopneic position. What is the primary reason for the use of this position? | Facilitate respirations |
| Food is divided into several essential nutrients. Which nutrient does the bulk of the body's lean tissues and organs contain? | Proteins |
| A patient has had a wrist safety reminder device on for the last 2 hours. What is the nurse's highest priority intervention? | Remove the safety reminder device and assess circulation and skin integrity. |
| You have an immobile patient on the unit. How often should the staff change the position of this immobile patient? | Every 2 hours |
| A patient is diagnosed with iron deficiency anemia. Which major cause of iron deficiency will influence a focused assessment by the nurse? | Inadequate diet |
| Food is divided into several essential nutrients. Which nutrient does the bulk of the body's lean tissues and organs contain? | Proteins |
| Which is the earliest nursing assessment that indicates damage to tissues because of compression of soft tissue between a bony prominence and a mattress? | Nonblanchable erythema |
| A nurse identifies that a vegetarian understands the importance of eating kidney beans when the patient says, "Kidney beans are essential because they are a great source of: | Protein |
| A pt has multiple fractures from a skiing accident. To best facilitate bone growth the nurse should encourage the patient to eat more foods high in calcium. Which food selected by the patient indicates an understanding of foods that are high in calcium? | Cottage cheese |
| Which is the most important nursing action when assisting a patient to move from a bed to wheelchair? | Letting the patient help as much as possible when permitted |
| A nurse identifies that a patient's pressure ulcer has just partial-thickness skin loss involving the epidermis and dermis. What stage pressure ulcer should the nurse document based on this assessment? | Stage 2 |
| A patient has been on bed rest for a few days and is getting up for the first time. What is the best nursing intervention for this patient? | Assist the patient to a sitting position on the edge of the bed. |
| A school nurse is preparing to teach a health class about vitamins. Which information about vitamins that is based on scientific principle should the nurse include? | Eating a variety of foods prevents the need for supplements. |
| A nurse plans to use a trochanter roll when repositioning a patient. Where should the nurse place the trochanter roll? | Alongside the ilium to mid-thigh |
| A nurse is counseling a patient with the diagnosis of osteoporosis. Based on the practitioner's prescription, which vitamin should the nurse instruct the patient to include in a daily health regimen? | D |
| A nurse is working in a long-term care facility caring for older adults. What type of accident is most often experienced by an older adult? | Falls |
| A nurse places a patient with a sacral pressure ulcer in the left Sims position. How should the nurse position the patient's right arm? | On a pillow |
| Which option should the nurse encourage a patient to include in the diet to provide vitamin D? | Fortified Milk |
| A patient has hemiplegia as a result of a brain attack (cerebrovascular accident). Which complication of immobility is of most concern to the nurse? | Contractures |
| A nurse is transferring a patient from a bed to wheelchair. What should the nurse do to quickly assess this patient's tolerance to the change in position? | Determine if the patient feels dizzy |
| A nurse plans to teach a patient with hemiparesis to use a cane. What should the nurse teach the patient to do? | Hold the cane in the strong hand when walking |
| An immobilized bed-bound patient is place on a 2-hour turning and positioning program. What should the nurse explain to the patient as to why this program is important? | Maintain skin integrity |
| What would a patient, who is unable to move about freely, need assistance from the staff and a mechanical device for to prevent complications related to immobility? | Passive ROM exercises |
| A newly admitted patient appears to be disoriented and the nurse is considering using a safety reminder device (SRD). What is the nurse's next intervention for this patient? | Obtain a physician's order |
| A patient has returned to the surgical floor following hip replacement surgery. What assistive device is used for proper body alignment? | Wedge pillow |
| When lifting and moving a patient up in bed, a lift sheet may be used. Where is the best place for a lift sheet under the patient? | Between the upper back and the thighs |
| A nurse teaches a post-operative patient about foods high in protein that will promote wound healing. Which food selection by the patient indicates that the teaching was effective? | Meat |
| A patient has a decreased hemoglobin level because of a low intake of dietary iron. Which food should the nurse teach the patient is the best source of iron? | Meat |
| The practitioner identifies that a patient may have a fluoride deficiency. What physical characteristic supports this conclusion? | Dental caries |
| A patient ambulating in the hallway complains of severe dizziness and begins to fall. What should the nurse do first? | Gently lower the patient to the floor. |
| A patient is scheduled for surgery and the nurse is teaching the patient about the importance of vitamin C in wound healing. Which source of vitamin C should the nurse include in the teaching plan? | Potatoes |
Which method is used for patients that are not able to assist with repositioning?
If a patient is unable to assist with repositioning in bed, follow agency policy regarding “no patient lifts” and the use of mechanical lifts for complex and bariatric patients.
Which item would the nurse use when helping an immobile patient move up in bed?
To decrease the surface area and to reduce the friction when the patients are unable to assist with moving up in bed, the nurse uses an ergonomic assistive device such as a full-body sling to help lift the patient off the surface of the bed.
What action should the nurse take when transferring a client from bed to wheelchair?
Position and lock the wheelchair close to the bed. Remove the armrest nearest to the bed, and swing away both leg rests. Help the patient turn onto his or her side, facing the wheelchair. Put an arm under the patient's neck with your hand supporting the shoulder blade; put your other hand under the knees.
When preparing to move a client up in the bed which action should the nurse take?
Preparing to Move the Patient
Tell the patient what you are doing. If you can, raise the bed to a level that reduces the strain on your back. Make the bed flat. Roll the patient to one side, then place a half rolled-up slide sheet or draw sheet against the person's back.