Thanks so much! I don't have a link or anything, but in my skills book and my skills instructors, always talks about putting the patient on the right side if they can't sit in a semi-fowers or fowers position because it helps promote stomach emptying or something.
I am still alittle confused about the IS..I mean I kinda get what you are saying, but maybe I just need to read more pathio on PNA because I don't understand how atelectasis leads to PNA; my pathio/med-surg book doesn't really go into detail on it...it just says that atelectasis can lead to PNA.
These fluid-filled and/or collapsed alveoli are not only unavailable for gas exchange, but fluid/secretions in these regions are stagnant and become a favorable environment for bacteria.
This is the best explanation I've got. Secretions and fluids don't circulate well in poorly ventilated sections of lung. Anwhere there is stasis of fluids, be it lung or urinary tract, you lose that mechanical flushing mechnism that helps to prevent bacteria from forming a stronghold.
I think their reasoning for this is actually that if you have a patient with an NG tube they may vomit, and keeping them on their side will make them less likely to aspirate the vomitus (like you'd do with a drunk friend...).
Lol, drunk friend. That line of reasoning crossed my mind, BUT, here's the thing, if your patient is actively vomiting, then it is appropriate to turn the patient to the lateral position (doesn't matter which) to facilitate the removal of vomitus from the oral cavity. Being johnny on the spot with the Yankauer helps. In this situation, I still would not lower the head of the bed any further than needed to get this person onto their side. The next step (or if someone can give you a hand) is to disconnect the tube feeding and hook it up to suction. Tube feeding shouldn't be resumed until cause of vomiting is identified and corrected.
If a patient only has an NG tube and for whatever reason, must be flat, it isn't appropriate to give TF via the NG, even if they are on their side because that person is at high risk for reflux and aspiration (gross and micro). If that person is expected to require such position limitations for a prolonged time, TF should be held until there is a relatively safer route (percutaneous J-tube for ex). We also put the bed in rev T-burg if appropriate.
One real life example that I can offer is a patient we had in the Rotorest bed for weeks. We used a combination of TPN, enteral feeding through the J-tube and LWS via NGT.
Doing some quickie internet googling, I tried to find some evidence that gastric emptying was more rapid on the right side. I found this. It's pretty old, though. Most of the other stuff had to do with babies and reflux. Maybe someone else has some better references.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282856/pdf/jphysiol00723-0397.pdf
