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Home » Notes » Patient Positioning: Complete Guide and Cheat Sheet for Nurses
Fowler’s position has different variations.
Orthopneic or tripod position is useful for maximum lung expansion.
Prone position is comfortable for some patients.
Lateral knee-chest position. Can also be done prone.
Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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In this guide for patient positioning, learn about the common bed positions such as Fowler’s, dorsal recumbent, supine, prone, lateral, lithotomy, Sims’, Trendelenburg’s, and other surgical positions commonly used. Learn about the different patient positioning guidelines, how to properly position the patient, and the nursing considerations and interventions you need to know.
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 to the surgical/treatment site and maintenance of the patient’s dignity by controlling unnecessary exposure. In most settings, proper positioning of patients provides airway management and ventilation , maintains body alignment, and provides physiologic safety.
The ultimate goal of proper patient positioning is to safeguard the patient from immobility injury and physiological complications. Specifically, patient positioning goals include:
Proper execution is needed during patient positioning to prevent injury for both the patient and the nurse. Remember these principles and guidelines when positioning clients:
The following are the commonly used patient positions, including a description of how they are performed and the rationale:
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).
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).
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.
In prone position , the patient lies on the abdomen with their head turned to one side and the hips are not flexed.
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. An increase in flexion of the top hip and knee provides greater stability and balance. This flexion reduces lordosis and promotes good back alignment.
Sims’ position or semi-prone 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.
Lithotomy is a patient position in which the patient is on their back with hips and knees flexed and thighs apart.
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
Reverse Trendelenburg’s is a patient position wherein the head of the bed is elevated with the foot of the bed down. It is the opposite of Trendelenburg’s position.
Knee-chest position can be in a lateral or prone position. In lateral knee-chest position , the patient lies on their side, the torso lies diagonally across the table, and the hips and knees are flexed. In prone knee-chest position , the patient kneels on the table and lowers their shoulders onto the table, so their chest and face rest on the table.
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 the 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. The patient is turned on their contralateral side with their back placed on the edge of the table. The contralateral kidney is placed over the break in the table or over the kidney body elevator (if an attachment is available). The uppermost arm is placed in a gutter rest at no more than 90º abduction or flexion.
The following are the devices or apparatus that can be used to help position the patient properly.
Documenting change of patient position in the patient’s chart. Note the following:
The section below is a nursing cheat sheet for different conditions or procedures and their appropriate patient position with rationale, including a downloadable copy of the different positions above.
Patient positioning cheat sheet for different conditions and procedures
After: Extremity in which contrast was injected is kept straight for 6 to 8 hours. Flat, if femoral artery was used.
Post-op : Head of bed (HOB) is lower than trunk.
Post-op : Flat on bed for 6 to 8 hours
Post-op : HOB elevated for 8 hours.
After: RIGHT side-lying with pillow under puncture site.
To apply pressure and minimize bleeding .
Don’t use AV arm for BP reading and venipuncture.
Possible to have abdominal cramps and blood -tinged outflow if catheter was placed in the last 1-2 weeks.
Provide own urinal or bedpan to patient.
Slight elevation of legs but not above the heart or slightly dependent.
Trendelenburg is no longer a recommended position.
After 24 hours after heparin therapy, patient can ambulate if pain level permits.
HOB raised 15-30 degrees if ICP is increased.
Do not hold infant with head elevated.
Restrict fluids during meals, low carb, low fiber diet in small frequent meals.
Pediatric: prone with HOB elevated.
Avoid flexion of the neck, head rotation, hip flexion, coughing, sneezing and bending forward.
Avoid hip and neck flexion which inhibits drainage
Must be log rolled without allowing any twisting or bending movements
Avoid stooping, flexion position during sex, and overexertion during walking or exercise.
Tripod position: sitting position while leaning forward with hands on knees.
Turn patient to LEFT side and lower HOB
Hold in upright position while feeding.
Hand in vagina to hold presenting part of fetus off cord.
After procedure: Lie on affected side for drainage.
To prevent spinal headache and CSF leakage.
With decreased LOC: RIGHT side-lying with HOB elevated.
With tracheostomy : Maintain in semi-Fowler’s position
Post: Assist into any comfortable position
(2) Lying in bed on unaffected side with HOB elevated to Fowler’s.
After: Assist patient into any comfortable position preferred.
Semi-Fowler’s or Fowler’s on back or on non-operative side.
Never put client on operative side, especially if bone was removed.
Sit straight in straight-backed chair when out of bed or when ambulating.
Turn only on back and on unaffected side.
Area of detachment should be in the dependent position.
Avoid extension and movement by using sandbags or pillows.
To decrease tension on the suture line and support the head and neck.
Apply pressure to the area after the procedure to stop the bleeding.
To provide for hip extension and stretching of flexor muscles; prevent contractures, abduction
The following are the references and sources for this patient positioning study guide:
why semi fowlers after bronchoscopy? can the pt be totally upright instead?
This not completel add more positions
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