Patient Positioning: Complete Guide for Nurses

By
 Matt Vera, BSN, R.N.
 What is Patient Positioning?

Patient positioning involves properly maintaining a patient’s neutral body

alignment by preventing hyperextension and extreme lateral rotation to prevent
complications of immobility and injury. Positioning patients is an essential aspect of
nursing practice and a responsibility of the registered nurse. In surgery, specimen
collection, or other treatments, proper patient positioning provides optimal
exposure of the surgical/treatment site and maintenance of the patient’s dignity by
controlling unnecessary exposure. In most settings, positioning patients provide
airway management and ventilation, maintaining body alignment, and provide
physiologic safety.

Goals of Patient Positioning

The ultimate goal of proper patient positioning is to safeguard the patient from
injury and physiological complications of immobility. Specifically, patient positioning
goals include:

 Provide patient comfort and safety. Support the patient’s airway and

maintain the circulation throughout the procedure (e.g., in surgery, in
examination, specimen collection, and treatment). Impaired venous return to
the heart, and ventilation-to-perfusion mismatching are common
complications. Proper positioning promotes comfort by preventing nerve
damage and by preventing unnecessary extension or rotation of the body.

 Maintaining patient dignity and privacy. In surgery, proper positioning is a

way to respect the patient’s dignity by minimizing exposure of the patient
who often feels vulnerable perioperatively.

 Allows maximum visibility and access. Proper positioning allows ease of

surgical access as well as for anesthetic administration during perioperative
phase.
Guidelines for Patient Positioning

 Explain the procedure. Provide explanation to the client on why his or her

position is being changed and how it will be done. Rapport with the patient
will make them more likely to maintain the new position.

 Encourage client to assist as much as possible. Determine if the client can

fully or partially assist. Clients that can assist will save strain on the nurse. It
will also be a form exercise, increase independence, and self-esteem for the
client.

 Get adequate help. When planning to move or reposition the client, ask help
from other caregivers. Positioning may not be a one-person task.

 Use mechanical aids. Bed boards, slide boards, pillows, patient lifts and
slings can facilitate ease of changing positions.

 Raise client’s bed. Adjust or reposition the client’s bed so that the weight is
at the level of the nurse’s center of gravity.

 Frequent position changes. Note that any position, correct or incorrect, can

be detrimental to the patient if maintained for a long period. Repositioning
the patient every 2 hours helps prevent complications like pressure ulcers
and skin breakdown.

 Avoid friction and shearing. When moving patients, lift rather than slide to
prevent friction that can abrade the skin making it more prone to skin
breakdown.

 Proper body mechanics. Observe good body mechanics for you and your
patient’s safety.
o Position self close to the client.

o Avoid twisting your back, neck, and pelvis by keeping them aligned.

o Flex your knees and keep feet wide apart.

o Use your arms and legs and not your back.

o Tighten abdominal muscles and gluteal muscles in preparation for

the move.

o Person with the heaviest load coordinates efforts of the nurse and
initiates the count to 3.
Common Patient Positions

1. Supine or Dorsal Recumbent Position

Supine position, or dorsal recumbent, is wherein the patient lies flat on the back with head and
shoulders slightly elevated using a pillow unless contraindicated (e.g., spinal anesthesia, spinal
surgery).

Supine position

 Variation in position. In supine position, legs may be extended or slightly

bent with arms up or down. It provides comfort in general for patients under
recovery after some types of surgery.

 Most commonly used position. Supine position is used for general

examination or physical assessment.

 Watch out for skin breakdown. Supine position may put patients at risk for
pressure ulcers and nerve damage. Assess for skin breakdown and pad bony
prominences.

 Support for supine position. Small pillows may be placed under the head to
and lumbar curvature. Heels must be protected from pressure by using a
pillow or ankle roll. Prevent prolonged plantar flexion and stretch injury of
the feet by placing a padded footboard.

 Supine position in surgery. Supine is frequently used on procedures

involving the anterior surface of the body (e.g., abdominal area, cardiac,
thoracic area). A small pillow or donut should be used to stabilize the head, as
extreme rotation of the head during surgery can lead to occlusion of the
vertebral artery.
 2. Fowler’s Position

Fowler’s position, also known as semi-sitting position, is a bed position wherein the head of the
bed is elevated 45 to 60 degrees. Variations of Fowler’s position include: low Fowler’s (15 to 30
degrees), semi-Fowler’s (30 to 45 degrees), and high Fowler’s (nearly vertical).

Fowler’s position has different variations.

 Promotes lung expansion. Fowler’s position is used for patients who have

difficulty breathing because in this position, gravity pulls the diaphragm
downward allowing greater chest and lung expansion.

 Useful for NGT. Fowler’s position is useful for patients who have cardiac,
respiratory, or neurological problems and is often optimal for patients who
have nasogastric tube in place.

 Prepare for walking. Fowler’s is also used to prepare the patient for

dangling or walking. Nurses should watch out for dizziness or faintness
during change of position.

 Poor neck alignment. Placing an overly large pillow behind the patient’s

head may promote the development of neck flexion contractures. Encourage
patient to rest without pillows for a few hours each day to extend the neck
fully.

 Used in some surgeries. Fowler’s position is usually used in surgeries that

involve neurosurgery or the shoulders

 Use a footboard. Using a footboard is recommended to keep the patient’s

feet in proper alignment and to help prevent foot drop.

 Etymology. Fowler’s position is named after George Ryerson Fowler who saw

it as a way to decrease mortality of peritonitis.
 3. Orthopneic or Tripod Position

Orthopneic or tripod position places the patient in a sitting position or on the side of the bed
with an overbed table in front to lean on and several pillows on the table to rest on.

Orthopneic or tripod position is useful for maximum lung expansion.

 Maximum lung expansion. Patients who are having difficulty breathing are

often placed in this position because it allows maximum expansion of the
chest.

 Helps in exhaling. Orthopneic position is particularly helpful to patients who

have problems exhaling because they can press the lower part of the chest
against the edge of the overbed table.

4. Prone Position

In prone position, the patient lies on the abdomen with head turned to one side and the hips
are not flexed.
Prone position is comfortable for some patients.

 Extension of hips and knee joints. Prone position is the only bed position
that allows full extension of the hip and knee joints. It also helps to prevent
flexion contractures of the hips and knees.

 Contraindicated for spine problems. The pull of gravity on the trunk when

the patient lies prone produces marked lordosis or forward curvature of the
spine thus contraindicated for patients with spinal problems. Prone position
should only be used when the client’s back is correctly aligned.

 Drainage of secretions. Prone position also promotes drainage from the

mouth and useful for clients who are unconscious or those recover from
surgery of the mouth or throat.

 Placing support in prone. To support a patient lying in prone, place a pillow

under the head and a small pillow or a towel roll under the abdomen.

 In surgery. Prone position is often used for neurosurgery, in most neck and

spine surgeries.

5. Lateral Position

In lateral or side-lying position, the patient lies on one side of the body with the top leg in front
of the bottom leg and the hip and knee flexed. Flexing the top hip and knee and placing this leg
in front of the body creates a wider, triangular base of support and achieves greater stability.
Increase in flexion of the top hip and knee provides greater stability and balance. This flexion
reduces lordosis and promotes good back alignment.
Lateral position.

 Relieves pressure on the sacrum and heels. Lateral position helps relieve

pressure on the sacrum and heels especially for people who sit or are
confined to bed rest in supine or Fowler’s position.

 Body weight distribution. In this position, most of the body weight is

distributed to the lateral aspect of the lower scapula, the lateral aspect of the
ilium, and the greater trochanter of the femur.

 Support pillows needed. To correctly position the patient in lateral position,

use of support pillows are needed.

6. Sims’ Position

Sims’ position or semiprone position is when the patient assumes

a posture halfway between the lateral and the prone positions. The lower arm is
positioned behind the client, and the upper arm is flexed at the shoulder and the
elbow. The upper leg is more acutely flexed at both the hip and the knee, than is
the lower one.

Sims’ position

 Prevents aspiration of fluids. Sims’ may be used for unconscious clients

because it facilitates drainage from the mouth and prevents aspiration of
fluids.

 Reduces lower body pressure. It is also used for paralyzed clients because it
reduces pressure over the sacrum and greater trochanter of the hip.
  Perineal area visualization and treatment. It is often used for clients
receiving enemas and occasionally for clients undergoing examinations or
treatments of the perineal area.

 Pregnant women comfort. Pregnant women may find the Sims position

comfortable for sleeping.

 Promote body alignment with pillows. Support proper body alignment in

Sims’ position by placing a pillow underneath the patient’s head and under
the upper arm to prevent internal rotation. Place another pillow between
legs.

7. Lithotomy Position

Lithotomy is a patient position in which the patient is on their back with hips and knees flexed
and thighs apart.

Lithotomy position

 Lithotomy position is commonly used for vaginal examinations and childbirth.

 Modifications of the lithotomy position include low, standard, high, hemi, and
exaggerated based on how high the lower body is raised or elevated for the
procedure. Please check with your facility’s guidelines but typically:
o Low Lithotomy Position: The patient’s hips are flexed until the
angle between the posterior surface of the patient’s thighs and the
O.R. bed surface is 40 degrees to 60 degrees. The patient’s lower
legs are parallel with the O.R. bed.2

o Standard Lithotomy Position: The patient’s hips are flexed until

the angle between the posterior surface of the patient’s thighs and
the O.R. bed surface is 80 degrees to 100 degrees. The patient’s
lower legs are parallel with the O.R. bed.
 o Hemilithotomy Position: The patient’s non-operative leg is
positioned in standard lithotomy. The patient’s operative leg may be
placed in traction.

o High Lithotomy Position: The patient’s hips are flexed until the

angle between the posterior surface of the patient’s thighs and the
O.R. bed surface is 110 degrees to 120 degrees. The patient’s lower
legs are flexed.

o Exaggerated Lithotomy Position: The patient’s hips are flexed

until the angle between the posterior surface of the patient’s thighs
and the O.R. bed surface is 130 degrees to 150 degrees. The
patient’s lower legs are almost vertical.

8. Trendelenburg’s Position

Trendelenburg’s position involves lowering the head of the bed and raising the foot of the bed
of the patient. The patient’s arms should be tucked at their sides

 Promotes venous return. Hypotensive patients can benefit from this

position because it promotes venous return.

 Postural drainage. Trendelenburg’s position is used to provide postural

drainage of the basal lung lobes. Watch out for dyspnea, some patients may
require only a moderate tilt or a shorter time in this position during postural
drainage. Adjust as tolerated.

9. Reverse Trendelenburg’s Position

Reverse Trendelenburg’s is a patient position wherein the the head of the bed is elevated with
the foot of the bed down. It is the opposite of Trendelenburg’s position.
  Gastrointestinal problems. Reverse trendelenburg is often used for
patients with gastrointestinal problems as it helps minimize esophageal
reflux.

 Prevent rapid change of position. Patients with decreased cardiac output

may not tolerate rapid movement or change from a supine to a more erect
position. Watch out for rapid hypotension. It can be minimized by gradually
changing the patient’s position.

 Prevent esophageal reflux. Promotes stomach emptying and prevents

reflux for clients with hiatal hernia.

10.Knee-Chest Position

Knee-chest position, can be in lateral or prone position. In lateral knee-chest position, the
patient lies on their side, torso lies diagonally across the table, hips and knees are flexed.
In prone knee-chest position, the patient kneels on the table and lower shoulders on to the
table so chest and face rests on the table.

Lateral knee-chest position. Can also be done prone.

 Two ways. Knee-chest position can be lateral or prone.

  Sigmoidoscopy. Usual position adopted for sigmoidoscopy without
anesthesia.

 Patient dignity. Prone knee-chest position can be embarrassing for some

patients.

 Gynecologic and rectal examinations. Knee-chest position is assumed for a

gynecologic or rectal examination.

11.Jackknife Position

Jackknife position, also known as Kraske, is wherein the patient’s abdomen lies flat on the bed.
The bed is scissored so the hip is lifted and the legs and head are low.

 In surgery. Jackknife position is frequently used for surgeries involving the

anus, rectum, coccyx, certain back surgeries, and adrenal surgery.

 Requires team effort. At least four people are required to perform the
transfer and position the patient in the operating table.

 Cardiovascular effects. In jackknife position, compression of the inferior

vena cava from abdominal compression also occurs, which decreases venous
return to the heart. This could increase the risk for deep vein thrombosis.

 Support paddings. Many pillow sare required on the operating table to

support the body and reduce pressure on the pelvis, back, and the abdomen.
Jackknife position also puts excessive pressure on the knees. While
positioning, surgical staff should put extra padding for the knee area.

12.Kidney Position
In kidney position, the patient assumes a modified lateral position wherein the abdomen is
placed over a lift in the operating table that bends the body. Patient is turned on their
contralateral side with their back placed on the edge of the table. Contralateral kidney is placed
over the break in the table or over the kidney body elevator (if attachment is available). The
uppermost arm is placed in a gutter rest at no more than 90º abduction or flexion.

Right lateral kidney position

 Access to retroperitoneal area. Kidney positions allows access and

visualization of the retroperitoneal area. A kidney rest is placed under the
patient at the location of the lift.

 Risk for falls. Patient may fall off the table at anytime until the position is
secured.

 Padding and stabilization support. Contralateral arm underneath the body

is protected with padding. Contralateral knee is flexed and the uppermost leg
is left straight to improve stability. A large soft pillow is placed in between the
legs. Kidney strap and tape are placed over the hip to stabilize the patient.

Support Devices for Patient Positioning

The following are the devices or apparatus that can be used to help position the
patient properly.

 Bed Boards. Bed boards are plywood boards that are placed under the entire
surface area of the mattress and are useful for increasing back support and
body alignment.

 Foot Boots. Foot boots are shoes made of rigid plastic or heavy foam and
keep the foot flexed at the proper angle. It is recommended that they should
be removed 2 to 3 times a day to assess the skin integrity and joint mobility.
  Hand Rolls. Hand rolls maintain the fingers in a slightly flexed and functional
position and keep the thumb slightly adducted in opposition to the fingers.

 Hand-Wrist Splints. These splints are individually molded for the client to

maintain proper alignment of the thumb in a slight adduction and the wrist in
slight dorsiflexion.

 Pillows. Pillows provide support, elevate body parts, splint incision areas, and
reduce postoperative pain during activity, coughing or deep breathing. They
should be of the appropriate size for the body to be positioned.

 Sandbags. Sandbags are soft devices filled with substance that can be used
to shape or contour to the body’s shape and provide support. They
immobilize extremities and maintain specific body alignment.

 Side Rails. Side rails are bars along the sides of the length of the bed. They
ensure client safety and are useful for increasing mobility. They also provide
assistance in rolling from side to side or sitting up in bed. Check with your
agencies policies regarding the use of side rails as they vary state to state.

 Trochanter Rolls. These rolls prevent external rotation of the legs when the
client is in the supine position. To form a roll, use a cotton bath blanket or a
sheet folded lengthwise to a width extending from the greater trochanter of
the femur to the lowest border of the popliteal space.

 Wedge Pillows. Are triangular pillows made of heavy foam and are used to
maintain legs in abduction following total hip replacement surgery.

Documenting Patient Positioning

Documenting change of patient position in the patient’s chart. Note the following:

 Date and time of the procedure.

 Explanation of the procedure to the patient.

 Notation of the position the patient was placed in including rationale.

 Pertinent teaching given.

 Patient’s response to the procedure.

 Cheat Sheet for Patient Positions

The section below is a nursing cheat sheet for different conditions or procedures
and their appropriate patient position with rationale:

Condition/Proced Rationale &

Patient Position
ure Additional Info

To reduce
aspiration risk
Bronchoscopy After: Semi-Fowler’s
from difficulty
of swallowing

During: Flat on bed
with arms at sides;
kept still.

After: Extremity in Apply firm

Cerebral which contrast was pressure on site
angiography injected is kept for 15 minutes
straight for 6 to 8 after the
procedure.
hours. Flat, if
femoral artery was
used.

Pre-op: surgical table

will be moved to
various positions
Myelogram (air during test. To disperse dye.
contrast) Post-op: HOB is
lower than trunk.

Myelogram (oil- Pre-op: surgical table To disperse

based dye) will be moved to dye.To prevent
various positions CSF leakage.
during test.
Condition/Proced Rationale &
Patient Position
ure Additional Info

Post-op: Flat on
bed for 6 to 8 hours

Pre-op: surgical table

will be moved to
various positions
during test. To prevent dye
Myelogram
(water-based dye) Post-op: HOB from irritating
elevated for 8 the meninges.
hours.

During: Supine with
RIGHT side of upper
abdomen exposed;
To expose the
RIGHT arm raised and
area.
extended behind and
and overhead and To apply
Liver biopsy shoulder. pressure and
After: RIGHT side- minimize
lying with pillow bleeding.
under puncture
site.

Flat supine with arms

To expose and
raised above head and
provide easy
Lung biopsy hands health together;
access to the
head and arms on
area.
pillow.
PRONE with pillow
To expose the
Renal biopsy under the abdomen and
area.
shoulders.
Arteriovenous Post-op: Elevate Don’t sleep on
fistula extremity affected side;
encourage
exercise by
squeezing a
rubber ball.
Condition/Proced Rationale &
Patient Position
ure Additional Info

Don’t use AV
arm for BP
reading and
venipuncture.

Turning
facilitates
drainage; check
for kinks in the
tubing.
Possible to
have
abdominal
When outflow is cramps and
inadequate: turn blood-tinged
Peritoneal Dialysis
patient from side to outflow if
side. catheter was
placed in the
last 1-2 weeks.

Cloudy
outflow is
never normal.

Change position Provide

Meniere’s Disease slowly; bedrest during protection when
acute phase ambulating
To promote
Immobilize site for 3 healing and
Autografting
to 7 days. maximal
adhesion.
Internal radiation, Strict bedrest while To prevent
during treatment implant is in place dislodgement of
the implant
device.
Provide own
urinal or
Condition/Proced Rationale &
Patient Position
ure Additional Info

bedpan to
patient.

To decrease
venous return
and reduce
Heart failure with Sitting up, with legs congestion;
pulmonary edema dangling promotes
ventilation and
relieves
dyspnea.
To help lessen
Myocardial chest pain and
Semi-Fowler’s
infarction promote
respiration.
High-Fowlers, upright To help lessen
Pericarditis
leaning forward. pain.
Depending on desired
outcome.
Slight elevation of
legs but not above
the heart or slightly To slow or
Peripheral artery
dependent. increase arterial
disease
return

Dangle legs on side

of the bed.

To improve or
increase
circulation.
Trendelenbur
Shock Flat on bed. g is no longer
a
recommende
d position.

Sickle Cell HOB elevated 30 To promote

Anemia degrees, avoid knee maximum lung
Condition/Proced Rationale &
Patient Position
ure Additional Info

expansion and
gatch and putting
assist in
strain on painful joints
breathing.
To prevent
pooling of blood
Varicose veins, leg in the legs and
Elevate extremities
ulcers, and venous facilitate venous
above heart level.
insufficiency return; avoid
prolonged
standing.
Bed rest with affected
limb elevated.
After 24 hours after
Deep vein heparin therapy, To promote
thrombosis patient can circulation.
ambulate if pain
level permits.

Tracheoesophageal HOB elevated 30-45 To prevent

fistula (TEF) degrees. reflux.
After shunt placement:
Place on non-operative
side in flat position.
HOB raised 15-30
Ventriculoperitone degrees if ICP is
al shunt (for Avoid rapid
Hydrocephalus increased. fluid drainage.
treatment)
Do not hold infant
with head elevated.

To allow the
hyphema to
settle out
HyphemaBlood in HOB elevated 30-45 inferiorly and
anterior chamber degrees, with night avoid
of eye shield. obstruction of
vision and to
facilitate
resolution
Condition/Proced Rationale &
Patient Position
ure Additional Info

Abdominal Post-op: HOB no To avoid flexion

aneurysm more than 45 degrees of the graft.
Place in low-Fowler’s
position then raise To decrease
Dehiscence knees or instruct knees tension on the
and support them with abdomen.
a pillow.
To delay gastric
emptying time.
Restrict fluids
Take meals in during meals,
Dumping
reclining position, lie low carb, low
Syndrome,
down for 20-30 fiber diet in
prevention of
minutes after.
small frequent
meals.

Instruct not to
cough; place on
NPO; keep
intestines moist
Place in low-Fowler’s
Evisceration and covered
position.
with sterile
saline until
patient can be
wheeled to OR.
Reverse
Trendelenburg, slanted To promote
Gastroesophageal bed with head higher. gastric emptying
reflux disease Pediatric: prone and reduce
(GERD) with HOB elevated. reflux.

To prevent
Upright position after
Hiatal hernia gastric content
meals.
reflux.
To facilitate
RIGHT side-lying entry of stomach
Pyloric stenosis
position after meals. contents into the
intestines.
Extremity burns Elevate extremity. To reduce
Condition/Proced Rationale &
Patient Position
ure Additional Info

dependent
edema and
pressure.
Facial burns or To reduce
Head elevated
trauma edema
To reduce blood
Initially place in sitting pressures below
Autonomic position or high dangerous levels
dysreflexia Fowler’s position with and provide
legs dangling. partial symptom
relief.
To prevent
HOB elevated 30-45
Cerebral aneurysm pressure on
degrees; bed rest
aneurysm site
To promote
venous return
Supine, flat with legs
Heat stroke and maintain
elevated.
blood flow to
the head.
To reduce ICP
and encourage
blood
Hemorrhagic HOB elevated 30 drainage.Avoid
stroke degrees. hip and neck
flexion which
inhibits
drainage.
To promote
venous drainage.
Avoid flexion
of the neck,
Elevate HOB 30-45 head rotation,
Increased
degrees, maintain head hip flexion,
intracranial
midline and in neutral coughing,
pressure (ICP)
position.
sneezing and
bending
forward.

Ischemic stroke HOB flat in midline, To facilitate

Condition/Proced Rationale &
Patient Position
ure Additional Info

venous drainage
and encourage
arterial blood
flow.
Avoid hip and
neutral position.
neck flexion
which inhibits
drainage

To drain
Side-lying or recovery secretions and
Seizure
position. prevent
aspiration.
Immobilize on spinal
backboard, head in
neutral position and
immobilized with a
firm, padded cervical
collar. To prevent any
Spinal cord injury Must be log rolled movement and
without allowing further injury.
any twisting or
bending
movements

To decrease
intracranial
pressure
(ICP).Keep head
Elevate HOB 30
from flexing or
degrees, head should
Head injury rotating.
be kept in neutral
position. Avoid
frequent
suctioning.

Buck’s Traction Elevate FOB for Ask patient to

counter-traction; use dorsiflex foot of
trapeze for moving; the affected leg
place pillow beneath to assess
Condition/Proced Rationale &
Patient Position
ure Additional Info

function of
peroneal nerve,
lower legs. weakness may
indicate pressure
on the nerve.
Elevate at or above To minimize
Casted arm
level of heart swelling
To hasten
Delayed prosthesis Elevate foot of bed to venous return
fitting elevate residual limb. and prevent
edema.
Use splints,
wedge pillow, or
pillows between
legs.
Avoid
stooping,
flexion
Affected extremity
Hip fracture
needs to be abducted. position
during sex,
and
overexertion
during walking
or exercise.

On unaffected
side: maintain
abduction when in
supine position with Avoid extreme
Hip replacement pillow between legs. internal or
HOB raised to 30-45 external rotation.
degrees.

Rigid cast acts

Immediate Elevate residual limb
to control
prosthesis fitting for 24 hours.
swelling.
Osteomyelitis Support affected To maintain
extremity with pillows proper body
or splints alignment; avoid
Condition/Proced Rationale &
Patient Position
ure Additional Info

strenuous
exercises.
Help to sitting
position; place chair at To prevent
Total hip 90 degrees angle to dizziness and
replacement bed; stand on affected orthostatic
side; pivot patient to hypotension.
unaffected side.
To promote
Acute Respiratory
oxygenation via
Distress Syndrome High Fowler’s
maximum chest
(ARDS)
expansion.
Patient should
be immediately
repositioned
with the right
Air embolism from Turn to LEFT side or atrium above the
dislodged central place in gas entry site so
venous line Trendelenburg. that trapped air
will not move
into the
pulmonary
circulation.
High Fowler’s
Tripod position:
sitting position To promote
while leaning oxygenation via
Asthma
maximum chest
forward with hands
expansion.
on knees.

To promote
Chronic High Fowler’s maximum lung
Obstructive Orthopneic position expansion and
Pulmonary
assist in
Disease (COPD)
breathing.
High Fowler’s To promote
Emphysema Orthopneic position maximum lung
expansion
Pleural Effusion High Fowler’s To provide
Condition/Proced Rationale &
Patient Position
ure Additional Info

maximal
To maximize
breathing
High Fowler’s mechanisms.
Lay on affected side To splint and
reduce pain.
Pneumonia
Lay with affected
lung up To reduce
congestion.

To promote
maximum lung
Pneumothorax High Fowler’s expansion and
assist in
breathing.
To decrease
High Fowler’s, legs
Pulmonary edema edema and
dependent position
congestion
High Fowler’s To promote
Turn patient to LEFT maximum lung
Pulmonary
side and lower HOB expansion and
embolism
assist in
breathing.
To provide
maximal
comfort and
Flail chest High Fowler’s
maximize
breathing
mechanisms.
To promote
maximum lung
Rib fracture High Fowler’s expansion and
assist in
breathing.
Placed in semi- Monitor for
Contraction stress
Fowler’s or side-lying post-test labor
test (CST)
position onset.
Cord prolapse Shrimp or fetal To prevent
position; modified pressure on the
Sims’ or cord. If cord
Condition/Proced Rationale &
Patient Position
ure Additional Info

prolapses, cover
with sterile
Trendelenburg.
saline gauze to
prevent drying.
To reduce
Turn mother to her compression of
Fetal distress
LEFT side. the vena cava
and aorta.
Late decelerations To allow more
Turn mother to her
(placental blood flow to
LEFT side.
insufficiency) the placenta.
To minimize
Placenta previa Sitting position.
bleeding.
To remove
pressure off the
presenting part
Variable Place mother in
of the cord and
decelerations (cord Trendelenburg
prevent gravity
compression) position.
from pulling the
fetus out of the
body.
To prevent sac
Spina Bifida Prone (on abdomen).
rupture.
Position on back or in
infant seat.
Cleft lip Hold in upright To prevent
position while trauma to suture
(congenital)
line.
feeding.

Relieves
pressure or
gravity from
pulling the cord.
During labor: Knee- Hand in
Prolapsed
umbilical cord
chest position or vagina to hold
Trendelenburg. presenting
part of fetus
off cord.
Condition/Proced Rationale &
Patient Position
ure Additional Info

HOB elevated no more

Cardiac Affected
than 30 degrees or flat
catheterization extremity should
as prescribed.May turn
(post) be kept straight.
to either side
Continuous Tape catheter to thigh; Prevents the
Bladder Irrigation no other positioning catheter from
(CBI) restrictions being dislodged.
Pull outer ear
Position affected ear upward and back
uppermost then lie on for adults;
Ear drops
unaffected ear for upward and
absorption. down for
children.
During
procedure: Tilt head
towards affected ear. Better
visualization and
After
drainage of the
Ear irrigation procedure: Lie on medium to the
affected side for ear canal via
drainage. gravity.

Drop to center
of the lower
conjunctival sac;
blink between
Tilt head back and drops; press
Eye drops
look up, pull lid down. inner canthus
near nose bridge
for 1-2 min to
prevent systemic
absorption.
Lumbar puncture During: Shrimp or To maximize
fetal position (side- spine flexion.
lying with back To prevent
bowed, knees drawn spinal
up to abdomen, neck
headache and
flexed to rest chin on
chest). CSF leakage.
After: Flat on bed
Condition/Proced Rationale &
Patient Position
ure Additional Info

for 4-12 hours.

Closes the
trachea and
Nasogastric tube High Fowler’s with opens the
insertion head tilted forward esophagus;
prevents
aspiration.
HOB elevated 30 to 45
degrees; keep elevated
for 1 hour after an
intermittent feeding. To prevent
With decreased aspiration.Prom
LOC: RIGHT side- otes emptying of
Nasogastric tube lying with HOB the stomach and
irrigation and tube elevated. prevents
feedings aspiration.
To prevent
With aspiration.
tracheostomy: Mai
ntain in semi-
Fowler’s position

During: Semi-
Fowler’s in bed or
Empty the
sitting upright on side
bladder before
of bed with chair;
procedure;
support the feet.
Paracentesis report elevated
Post: Assist into temperature;
any comfortable assess for
position hypovolemia.

Lung area
needing
Postural Drainage Trendelenburg drainage should
be in uppermost
position
Rectal enema Left side-lying (Sims’ Allows gravity
administration position) with right to work into the
Condition/Proced Rationale &
Patient Position
ure Additional Info

direction of the
colon by placing
knee flexed. the descending
colon at its
lowest point.
To allow fluid to
Rectal enemas and Left side-lying, Sims’ flow in the
irrigation position natural direction
of the colon.
To enhance lung
expansion and
reduce portal
Sengstaken-
blood flow,
Blakemore and HOB elevated
permitting
Minnesota tubes
esophagogastric
balloon
tamponade.
Before: (1) Sitting on
edge of bed while
leaning on bedside
table with feet
supported by stool; or
lying in bed on
unaffected side with
head elevated 45
degrees.
(2) Lying in bed on Prevent fluid
Thoracentesis unaffected side leakage into the
with HOB elevated thoracic cavity.
to Fowler’s.

After: Assist patient
into any
comfortable
position preferred.

During
Total Parenteral To prevent air
insertion: Trendelenb
Nutrition (TPN) embolism.
urg.
Condition/Proced Rationale &
Patient Position
ure Additional Info

Bed rest for 24 hours,

Vascular extremity keep extremity straight For maximal
graft and avoid knee or hip adhesion.
flexion
For better
Perineal
Lithotomy visualization of
procedures
the area.
To relieve
Post-op: Fowler’s abdominal pain
Appendectomy
position and ease
breathing.
Sleep on unaffected
side with a night shield
for 1 to 4 weeks.
Semi-Fowler’s or
To prevent
Cataract surgery Fowler’s on back or edema.
on non-operative
side.

HOB elevated 30-45%

with head in a midline,
neutral position.
Never put client on
To facilitate
Craniotomy operative side, venous drainage.
especially if bone
was removed.

Provides better
Hemorrhoidectom During: Prone
visualization of
y Jackknife position.
the area.
Hypophysectomy
Surgical removal To prevent
HOB elevated.
of the pituitary increase in ICP.
gland.
Infratentorial
surgery Flat and lateral on
To facilitate
Incision at back of either side; avoid neck
drainage.
head, above nape flexing.
of neck
Condition/Proced Rationale &
Patient Position
ure Additional Info

Post-op: Semi-
Fowler’s, turn from To promote gas
Kidney transplant
back to non-operative exchange
side
Back is kept
straight.Patient is
logrolled if turned.
Sit straight in
Laminectomy straight-backed
chair when out of
bed or when
ambulating.

To maintain
HOB elevated 30-45
Laryngectomy airway and
degrees
decrease edema.
To allow lymph
drainage.
Turn only on
Semi-Fowler’s with
Mastectomy arm on affected side back and on
elevated. unaffected
side.

Mitral valve Post-op: semi- To assist in

replacement Fowler’s position. breathing.
To allow
Post-op: Position on
Myringotomy drainage of
side of affected ear .
secretions
Bed rest with minimal
activity and
repositioning.
Area of detachment Helps detached
Retinal
should be in the retina fall into
detachment
dependent place.
position.

Supratentorial HOB elevated 30-45 To facilitate

surgery degrees; maintain drainage.
Condition/Proced Rationale &
Patient Position
ure Additional Info

head/neckline in
Incision front of midline neutral
head below position; avoid
hairline extreme hip and neck
flexion.
To reduce
swelling and
Post-op: High edema in the
Fowler’s or semi- neck area.
Fowler’s. To decrease
Avoid extension
tension on the
Thyroidectomy and movement by
suture line
using sandbags or
and support
pillows.
the head and
neck.

To facilitate
Post-op: prone or side- drainage and
Tonsillectomy
lying relieve pressure
on the neck.
To expose the
area.
Side lying with head Apply
tucked and legs pulled pressure to
Bone marrow up or;
the area after
aspiration/biopsy Prone with arms
the procedure
folded under chin.
to stop the
bleeding.

Amputation: above Elevate for first 24 To prevent

the knee hours using edema.
pillow.Position prone To provide for
twice daily. hip extension
and stretching
of flexor
muscles;
prevent
contractures,
Condition/Proced Rationale &
Patient Position
ure Additional Info

abduction

Foot of bed elevated To prevent

for first 24 hours. edema.
Amputation: Position prone To provide for
below the knee daily. hip extension.