Fundamentals of Nursing Q 518
Which is the best position for a client with autonomic dysreflexia?
A. Sim's Position.
B. Fowler's Position.
C. Semi-Fowler's Position.
D. High Fowler's Position.
Correct Answer: D. High Fowler’s Position.
Autonomic dysreflexia is a condition in which there is a sudden onset of excessively high blood pressure. If it occurs, immediately place the client in a high Fowler’s position to promote adequate ventilation and assist in the prevention of a hypertensive stroke.
Option A: The Sims position is a standard position in which the patient lies on their left side, with right hip and knees bent. The lower arm is behind the back, the thighs flexed. The left knee is slightly tilted. The right arm is positioned comfortably in front of the body, the right arm is rested behind the body. This is also known as “lateral” position. This position is often used for rectal or vaginal examination, and treatments.
Option B: In Fowler’s position, the patient is at an increased risk for air embolism, skin injury from shearing and sliding, and DVT forming in the patient’s lower extremities. In this position, a patient has an increased pressure risk in their scapulae, sacrum, coccyx, ischium, back of knees, and heels.
Option C: When positioning a patient in Fowler’s position, the surgical staff should minimize the degree of the patient’s head elevation as much as possible and always maintain the head in a neutral position. The patient’s arms should be flexed and secured across the body, the buttocks should be padded, and the knees flexed 30 degrees.