How to Put A Patient Into The Orthopneic Position
Once the nurse or doctor witnesses signs of orthopnea in the patient, such as swollen feet and breathlessness, it’s crucial to put the patient in an orthopneic position to help with circulation.
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Positioning
You can do this in the following steps:
Step 1: Explain the Procedure to The Patient
Explaining to the patient why you’re changing their position is the most crucial step. It helps the patient becomes more receptive to the procedure and helps reduce any resistance.
The easiest way to understand this is to put yourself in the patient’s shoes. Imagine a nurse comes into the room and puts you in this weird posture without uttering a word. I’d be confused too.
Before you put your patient in the orthopneic position, ensure you:
- Inform them that you’re putting them in the orthopneic position
- Why you’re putting them in the orthopneic position
Step 2: Encourage the patient to assist as much as possible
Making your patient take part in the procedure is the second step of the orthopneic position. Encouraging your patient to take part helps with:
- It can be a form of exercise
- It helps reduce patient resistance to the position
- It enables you to bond with your patient
Step 3: Elevate the head of the bed to about 90 degrees
It’s essential to have the head of the bed at 90 degrees. It offers support because the patient will either be propped on a chair or sit with their legs off the edge of the bed.
Step 4:Place a pillow between the patient’s back and the mattress
With the orthopneic position, many nurses (me included) focus on the over-bed pillows forgetting the backrest pillows.
Always remember that one of the primary aims of the orthopneic position is to offer patient comfort.
That said, a backrest pillow goes a long way in supporting your patient’s back and making them more comfortable.
Step 5: Place a Pillow on the overbed table and assist the patient to lean over
Doing this puts your patient in the orthopneic position. This position encourages maximum chest and lung expansion and breathing.
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02.03 Respiratory Terminology
Why Is Patient Positioning Crucial
This is the most crucial question, the “why.” Before you embrace the orthopneic position, you have to embrace the origins of patient positioning and its subsequent goals.
Positions like the orthopneic positions help with:
- Access and exposure to the patient’s body
- Preventing both internal and external injuries to the patient
- Maintaining the patient’s dignity
- Help the patient with recovery
The orthopneic position caters to a patient’s comfort and wellbeing by ensuring that their airway, breathing, and circulation are conducive.
What Is Orthopnea
For more perspective of the orthopneic position, it’s essential to make a brief detour to orthopnea, the condition that causes it.
The name orthopnea originates from two Greek words, ortho, which means straight or vertical, and pnea, which means breathe.
Orthopnea is a sensation of breathlessness in the recumbent position. This is just another way of saying a condition that causes shortness of breath when lying down that is relieved by sitting or standing.
Everyone, both you and I included, is bound to experience breathlessness at some point in time. If you’re yet to do so, spoiler alert, it’s surreal.
However, for orthopnea, you only get a sensation of breathlessness when you’re lying down, which is relieved every time you sit or stand.
What Causes Orthopnea
Oblivious to most people, whenever you lie down, there’s a redistribution of blood. When you’re sitting and standing, gravity concentrates most of your blood is towards the lower parts of your body, such as the legs.
As you lie down, these gravity forces become neutral. Hence the blood redistributes towards the chest area.
For healthy people, the more muscular left ventricle kicks in, helping to pump this increase of blood out of the heart.
The same can’t be said for a patient with heart complications, however. Their heart struggles to handle this increase in pressure. As such, their heart and may struggle with pumping all this blood out of the heart.
This leads to feelings of breathlessness which most patients control by taking deeper, faster breaths.
Some probable underlying conditions that cause orthopnea include:
- Excess fluid in the lungs
- The buildup of fluids around the lung or abdomen area
- Chronic Pneumonia
- Obesity
- Diaphragm paralysis
Diagnosis of Orthopnea
If you don’t get caught up in the jargon and respiratory terminology, Orthopnea is less complicated than it seems. It’s hard to miss (to a keen eye), and you can diagnose orthopnea in your patients through observation or interrogation.
1. Asking patients if they are able to breathe when lying down
The best way to know if a patient has breathing problems is to ask them. It never fails. In fact, some patients will be generous enough to tell you beforehand and save you the trouble.
2. Asking patients how many pillows they use
Many patients suffering from orthopnea will unknowingly embrace positions that make breathing easier for them.
An excellent example of this phenomenon in action is sleeping using multiple pillows to reduce the rate of flow of blood to the chest area. The more pillows your patient sleeps with, the worse the progression of orthopnea.
3. Asking Patients if Their Breathlessness Gets Better When They Stand
One unique characteristic of orthopnea that sets it aside from other types of dyspnea is that it is instantly relieved by standing or sitting down.
Asking your patients whether their breathlessness gets better when they stand is an excellent method of diagnosing orthopnea.
4. Observe the patient’s posture
Like with the pillows, a patient with orthopnea will adjust their posture such that it resembles the orthopneic position.
Such patients will sit upright with their shoulders hunched up to try and increase the volume of their chest and lung cavity.
Positions Where Shortness Of Breath Is Considered Orthopneic
Most nurses, me included, find trouble differentiating between orthopnea and dyspnea. If you struggle with this, too, you’re not alone.
Dyspnea is the medical term for shortness of breath. Orthopnea is a type of dyspnea (shortness of breath) that occurs when a patient is lying down.
That said, “lying down” alone is not descriptive enough. Bear with me through the jargon as we go over the positions where shortness of breath in your patients will be considered orthopnea.
- Supine position– This is where your patient feels breathlessness when lying on their back
- Prone position- This is where your patient feels breathlessness when lying facing downwards
- Left Lateral Recumbent and Right Lateral Recumbent-This is where your patient feels breathlessness when lying facing down with their heads either on the right or left.
If your patient has dyspnea in either of these three positions, that’s a sign of orthopnea which means you can proceed to put them in an orthopneic position.
What is an Orthopneic Position
An orthopneic position is a position you put a patient to reverse the effects of orthopnea.
In the orthopneic position, your patient sits at the side of the bed with their head resting on an overbed table on top of several pillows
Alternatively, your patient can get in an orthopneic position by sitting upright in a chair with their back to the backrest.
What Orthopnea Feels Like
As a nurse, I often find myself looking at patients and wondering what they feel like. Sometimes, asking the patient is not enough; they may not know the words to describe it.
Many patients describe breathlessness as a tightening in the chest and breath being something they’re chasing but can’t touch.
Knowing what the patient feels is crucial in diagnosis. Above that, knowing what they’re going through it also helps create a connection; that’s how you become “that nurse.”
Some of the words that describe breathlessness your patients may use to describe orthopnea include:
- “I feel like I’m suffocating.”
- “It feels like I’m taking my last breaths.”
- “It feels like I’m holding my breath and running out of air.”
- “It feels like I can’t get enough air in”
Signs Of Orthopnea in Patients
Apart from the feeling of shortness of breath, you’re probably wondering if there are any other signs of orthopnea that you can read in your patient.
Shortness of breath, which is alleviated by standing or sitting, is a pretty solid sign. However, some patients also show other signs. You can be on the lookout for the following symptoms of orthopnea in patients:
- Swollen feet and ankles
- Wheezing
- Unusual fatigue
- Paroxysmal Nocturnal Dyspnea
- Frequent and unusual coughing
- Intermittent chest pain
Paroxysmal Nocturnal Dyspnea is a condition where the patient feels shortness of breath whenever they wake up from sleep.
Although it’s a different type of dyspnea altogether, signs of paroxysmal nocturnal dyspnea may also indicate the presence of orthopnea.
Why The Orthopneic Position Is Used
In practice, you’ll use the orthopneic position to help with the aeration, breathing, and circulation (ABC) of patients with orthopnea.
The orthopneic position helps expand the chest and lung cavity of your patients, which helps them breathe better.
One thing I only came to appreciate once I entered practice was the impact of positioning on a patient’s circulation and breathing.
With the right positioning, you can move from a patient frantically struggling to breathe to one who’s breathing almost normally within a few minutes.
An effective orthopneic position can help your patient with:
- Avoid further damage to their lungs
- Increase overall comfort
- Reduce mortality and deterioration due to acute respiratory disease syndrome (ARDS)
- Help your patient recover fast
Acute Respiratory Disease Syndrome (ARDS) is a respiratory syndrome that occurs when fluid builds up in the patient’s lung cavity, making breathing extremely difficult. People who die from Covid 19 often develop ARDS.
1. The Bent Position
By having your patient bend over the overbed, you lower his diaphragm. This together with the maximum expansion of the chest and lung cavity of your patients makes oxygenation through inhalation and exhalation easier.
2. The Pillow Support
The supporting pillows play several roles in the orthopneic position. These include:
- Ensuring the comfort of the patient
- Keeping the patient in the orthopneic position
- Avoiding strain and internal or external injuries for patients who’ve had procedures
3. The Overbed
In practice, the edge of the overbed where the patient bends overplays a crucial role in the orthopneic position.
It comes in handy where a patient has difficulties with exhaling. Such a patient can press the lower part of their chest against the edge of the overbed table, which helps with exhalation.
Making Patients Comfortable While Administering the Orthopneic Position
For some patients you will encounter in practice, breathlessness can be a frightening experience. Often, it leads to panic, which together with anxiety can then lead to more breathlessness.
Some of the techniques I’ve used to make patients comfortable during this procedure include:
1. Communication
Talking my patients through the procedure always goes a long way to alleviating panic during the process.
Always be in communication with the patient when giving instructions and watch their reactions or replies.
Consider using words like:
- · “I’m gonna put this pillow behind your back.”
- · “Breathe in, Breathe out.”
- · “You’re doing great.”
- · “You’re gonna be fine.”
2. Distraction
Distraction is another technique that you can use to alleviate anxiety while putting a patient in the orthopneic position.
Often, for distraction to work, you have to have been close enough with the patient to come up with a distraction from something they shared with you, i.e., a particular book or movie.
A few examples of distractions that can help with anxiety include:
- “The Patriots won last night’s game.”
- “Marvel announced the release of the next Avenger movie.”
- “How did you like the food today.”
3. Touch
An element of touch can help some patients calm down and deal with their anxiety. That said, I’ve learned in my practice that all patients are not the same; you’ll never go wrong with asking.
Some of the touch techniques that I’ve used a few times when putting patients in the Orthopneic position include:
- Gentle rubbing of the back
- Stroking of the arm
- Holding of the shoulder
What Are the Nursing Concerns That Come With the Orthopneic Position
The orthopneic position is crucial in helping patients with their aeration, breathing, and circulation.
Nonetheless, the orthopneic position also comes with its fair share of concerns that all nurses should be aware of. These concerns include:
1. The Lack Of Communication
During orthopnea and other types of dyspnea, a patient who’s short for breath may have trouble with communication.
The orthopneic position, which pushes the patient’s posterior into a pillow, may also hamper non-verbal communication from your patient.
This means that it may be difficult for your patient to give verbal feedback.
As a nurse, you can prevent this scenario from occurring by:
- Asking the patient to nod or squeeze your arm if uncomfortable
- Using close-ended questions with options such as “Yes “and “No” instead of open-ended ones
- Availing papers and flashcards to help the patient with communication
2. Fall risk
Like any other patient positioning, leaving a patient in the orthopneic position exposes them to the risk of falling.
This fall risk is further worsened by the fact that your patient is experiencing breathing difficulties, which come with its fair share of involuntary movements.
To counter this fall risk, you should ensure that:
- Your patient is not left unattended
- Ensure the patient can safely sit back in the bed
3. Fatigue
Despite its proven efficacy in helping patients with breathing, the orthopneic position is not a natural position. This means that your patient may become fatigued after some period, which may lead to discomfort and stress.
To avoid fatigue, ensure that:
- Reposition your patient every two hours to prevent conditions like pressure ulcers and skin breakdown
- You are in frequent communication with your patient throughout the procedure
- You don’t leave the patient unattended
- Ensure that your patient takes frequent breaks within the procedure
4. Previous Surgery in The Area
For patients who’ve had previous surgery in the chest area, you have to take more precautions when putting them in an orthopneic position.
For a patient who’d recently had surgery, putting them in an orthopneic position without consideration can lead to internal injury, pain, and even hamper recovery.
Some of the procedures of concern before putting a patient in the orthopneic position include:
- Coronary artery bypass grafting
- Heart valve repair or replacement
- Aneurysm repair
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