بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم

2. POSITION CHANGE AS A NURSING MANEUVER

3. INTRODUCTION

4. The critical care nurse plays a crucial role in the assessment, diagnosis, and management of patients with respiratory problems who develop hypoxemia. Body positioning is one of the general kinds of nursing actions during care of patients. Critically ill patients positioning maximizes ventilation to improve oxygenation which in turn would affect the individual’s ability to maintain an internal environment that allows normal cellular function

5. The importance of the effect of body position on ventilatory function and gas exchange has been appreciated Less information is available concerning the effect of position change on gas exchange in human body Studies related to the adequate duration in each position and the frequency of turning patients for maimizing ventilation to improve systemic oxygenation has not been attempted

6. AIM OF THE STUDY

7. To determine the effect of position change on oxygenation and respiratory mechanics in mechanically ventilated patients

8. MATERIAL &METHODS

9. Setting Critical care units of the Main University Hospital in Alexandria. MATERIAL

10. Adult patients with respiratory problems receiving mechanical ventilatory support were studied. They were aged from 16 to 70 years. Intern nurses were trained to help the researcher in turning patients, four at a time Subjects 48 30

11. Patients were classified to four groups Normal lungs left lung disease Bilateral lung disease Right lung disease

12. Low hemoglobin Arrhythmia Patients excluded from the study Carbon monoxide poisoning, pulmonary hemorrhage, pulmonary abscess. Skeletal deformity Head or spine injury obesity Facial surgery Abdominal distension hyperthermia

13. *HD, ABG, RM were evaluated immediately before and every half-hour after turning patient for a total of 6 hours for each patient *Patients were turned to left, prone, right, supine position respectively *Researcher trained nurses to help in patient turning * Instructions were given about how to turn the ventilated patients in the proper way METHODS Patients positioning Nurses’ instructions

14. RESULTS

15. #Effects of turning on Respiratory mechanics Oxygenation Results were #General characteristics of the study sample

16. Distribution of patients by age

17. Distribution of patients by sex

18. Position change and hemodynamic B.L.P=Base line position L.L.P=Left lateral position P.P= Prone position R.L.P=Right lateral position S.P= Supine position

19. Position change and respiratory mechanics B.L.P=Base line position L..L.P= Left lateral position P.P= Prone position R.L.P= Right lateral position S.P= Supine position

20. Position change and arterial blood gases B.L.P=base line position L.L.P=Left lateral position P.P=Prone position R.L.P=Right lateral position S.P=Supine position

21. CONCLUSION

22. position changes had a significant effect on oxygenation in mechanically ventilated patients

23. Normal lungs Bilateral disease The improvement in arterial blood gases depends on site and extent of lung pathology ABG are improved in all positions The best position is prone The subsequent are right and then left The same improvement in duration and frequency but less than in normal lung Are improved with the good lung down Are worsened with the affected lung down Unilateral disease

24. Healthy lungs Diseased lungs In both Prone and side lying positions enhance the efficiency of O2 transport and thereby minimize or avoid use of high concentration of supplemental oxygen and positive end expiratory pressure.

25. Recommendations

26. For any critically ill patient body positioning is a 24-hours concern

27. Turn Patients with normal lungs and patients with bilateral lung disease Left 1.5 hr Prone 1.5 hr Right 1.5 hr Supine 1.5 hr

28. Turn Patients with right lung disease Left 1.5 hr Supine 1.5 hr Prone 1.5 hr Right 0.5hr

29. Turn patients with left lung disease Prone 1.5 hr Right 1.5 hr Supine 1.5 hr No left

30. Position change is asimple way to reduce shunting and improve oxygenation It allows reduction in FIO2 and PEEP and reducing their complications *do your patients a good turn *Try the position changes early in the course of illness Turning a critically ill patients is not difficult. It requires four trained nurses

31. More studies are needed to evaluate Frequent cycles using different duration Steep position Other range of positions Using larger sample

32. Books and scientific magazines The care of critically ill patients in their programs *pre-service training programs (for newly critical care nurses)*in-service training programs (for already critical care nurses) Hospital administration Schools of nursing Critical care units

33. Turn Turn Turn Turn

34. THANK YOU