HOME » NOTES » PATIENT POSITIONING: COMPLETE GUIDE AND CHEAT SHEET FOR NURSES

Patient Positioning: Complete Guide and Cheat

Sheet for Nurses
UPDATED ON JULY 2, 2023 BY MATT VERA BSN, R.N.
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.

Table of Contents
What is Patient Positioning?
Goals of Patient Positioning
Guidelines for Patient Positioning
Common Patient Positions
Supine or Dorsal Recumbent Position
Fowler’s Position
Orthopneic or Tripod Position
Prone Position
Lateral Position
Sims’ Position
Lithotomy Position
Trendelenburg’s Position
Reverse Trendelenburg’s Position
Knee-Chest Position
Jackknife Position
Kidney Position
Support Devices for Patient Positioning
Documenting Patient Positioning
Cheat Sheet for Patient Positions
References and Sources

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 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.

Goals of Patient Positioning

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

Provide patient comfort and safety. Support the patient’s airway and maintain circulation
throughout the procedure (e.g., surgery, 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 the perioperative phase.

Guidelines for Patient Positioning

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:

Explain the procedure. Explain to the client why their 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 the 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 of
exercise, increasing the client’s independence and self-esteem.
Get adequate help. When planning to move or reposition the client, ask for 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
the ease of changing positions.
Raise the client’s bed. Adjust or reposition the client’s bed so that the weight is at the
nurse’s center of gravity level.
Frequent position changes. Note that any correct or incorrect position can be detrimental
to the patient if maintained for a long time. Repositioning the patient every two 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 your and your patient’s safety.
Position yourself close to the client.
Avoid twisting your back, neck, and pelvis by keeping them aligned.
Flex your knees and keep your feet wide apart.
Use your arms and legs and not your back.
Tighten abdominal muscles and gluteal muscles in preparation for the move.
A person with the heaviest load coordinates the efforts of the nurse and initiates the
count to 3.

Common Patient Positions

The following are the commonly used patient positions, including a description of how they are
performed and the rationale:
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 (Dorsal Recumbent) 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 type of
surgery.
Most commonly used position. Supine or dorsal recumbent 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 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 an extreme rotation of the head during surgery can
lead to occlusion of the vertebral artery.

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 with cardiac, respiratory, or
neurological problems and is often optimal for patients with a nasogastric tube.
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 a 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 the 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 drops.
Etymology. Fowler’s position is named after George Ryerson Fowler, who saw it as a way to
decrease the mortality of peritonitis.
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 with difficulty of breathing are often placed in this
position because it allows maximum chest expansion.
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.

Prone Position

In prone position, the patient lies on the abdomen with their 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 is
useful for unconscious clients or those recovering from surgery on 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.

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. An 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 and comfortably position the patient in lateral
position, support pillows are needed.

Sims’ Position

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.
 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 the legs.

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:
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.
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.
Hemilithotomy Position: The patient’s non-operative leg is positioned in standard
lithotomy. The patient’s operative leg may be placed in traction.
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.
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.

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.

Reverse Trendelenburg’s Position

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.
 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.

Knee-Chest 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.
 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.

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 on 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 pillows are required on the operating table to support the body
and reduce pressure on the pelvis, back, and abdomen. The jackknife position also puts
excessive pressure on the knees. While positioning, surgical staff should put extra padding
for the knee area.

Kidney Position

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.
 Right lateral kidney position

Access to the retroperitoneal area. The kidney position allows access and visualization of
the retroperitoneal area. A kidney rest or a small pillow is placed under the patient at the
location of the lift.
Risk for falls. The patient may fall off the table at any time until the position is secured.
Padding and stabilization support. The contralateral arm underneath the body is protected
with padding. The contralateral knee is flexed, and the uppermost leg is left straight to
improve stability. A large soft pillow is placed in between the legs. A 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 placed under the mattress’s entire surface
area and are useful for increasing back support and body alignment.
Foot Boots. Foot boots are rigid plastic or heavy foam shoes that 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 slight adduction and the wrist in slight dorsiflexion.
 Pillows. Pillows provide support, elevate body parts and 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 substances that can be used to shape or
contour 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 increased mobility. They also assist in rolling from side to side or
sitting in bed. Check with your agency’s policies regarding the use of side rails as they vary
from state to state.
Trochanter Rolls. These rolls prevent the 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 is 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, including a downloadable copy of the different
positions above.

Patient positioning cheat sheet

 Click on the image to enlarge Click on the image to enlarge

Patient positioning cheat sheet for different conditions and procedures

Condition/Procedure Patient Position Rationale & Additional Info

To reduce aspiration risk from

Bronchoscopy After: Semi-Fowler’s
difficulty of swallowing

During: Flat on bed with arms

at sides; kept still.

After: Extremity in which Apply firm pressure on site for 15

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

Pre-op: surgical table will be

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

Pre-op: surgical table will be

moved to various positions
during test.
Myelogram (oil-based To disperse dye.To prevent CSF
dye) leakage.
Post-op: Flat on bed for 6 to 8
hours

Myelogram (water-based Pre-op: surgical table will be To prevent dye from irritating the
dye) moved to various positions meninges.
during test.

Post-op: HOB elevated for 8

hours.
 Condition/Procedure Patient Position Rationale & Additional Info
During: Supine with RIGHT
side of upper abdomen
exposed; RIGHT arm raised To expose the area.
and extended behind and and
Liver biopsy overhead and shoulder. To apply pressure and minimize
bleeding.
After: RIGHT side-lying with
pillow under puncture site.

Flat supine with arms raised

above head and hands health To expose and provide easy
Lung biopsy
together; head and arms on access to the area.
pillow.

PRONE with pillow under the

Renal biopsy To expose the area.
abdomen and shoulders.

Don’t sleep on affected side;

encourage exercise by squeezing
a rubber ball.
Arteriovenous fistula Post-op: Elevate extremity
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 inadequate: cramps and blood-tinged outflow
Peritoneal Dialysis
turn patient from side to side. if catheter was placed in the last
1-2 weeks.

Cloudy outflow is never normal.

Change position slowly; Provide protection when

Meniere’s Disease
bedrest during acute phase ambulating

To promote healing and maximal

Autografting Immobilize site for 3 to 7 days.
adhesion.

Internal radiation, during Strict bedrest while implant is To prevent dislodgement of the
treatment in place implant device.
 Condition/Procedure Patient Position Rationale & Additional Info

Provide own urinal or bedpan to

patient.

To decrease venous return and

Heart failure with
Sitting up, with legs dangling reduce congestion; promotes
pulmonary edema
ventilation and relieves dyspnea.

To help lessen chest pain and

Myocardial infarction Semi-Fowler’s
promote respiration.

High-Fowlers, upright leaning

Pericarditis To help lessen pain.
forward.

Depending on desired
outcome.

Slight elevation of legs but not

above the heart or slightly
Peripheral artery disease To slow or increase arterial return
dependent.

Dangle legs on side of the

bed.

To improve or increase circulation.

Shock Flat on bed. Trendelenburg is no longer a

recommended position.

HOB elevated 30 degrees,

To promote maximum lung
Sickle Cell Anemia avoid knee gatch and putting
expansion and assist in breathing.
strain on painful joints

To prevent pooling of blood in

Varicose veins, leg ulcers, Elevate extremities above
the legs and facilitate venous
and venous insufficiency heart level.
return; avoid prolonged standing.

Bed rest with affected limb

elevated.

Deep vein thrombosis After 24 hours after heparin To promote circulation.

therapy, patient can ambulate
if pain level permits.
 Condition/Procedure Patient Position Rationale & Additional Info

Tracheoesophageal fistula
HOB elevated 30-45 degrees. To prevent reflux.
(TEF)

After shunt placement: Place

on non-operative side in flat
position.

Ventriculoperitoneal
HOB raised 15-30 degrees if
shunt (for Hydrocephalus Avoid rapid fluid drainage.
ICP is increased.
treatment)

Do not hold infant with head

elevated.

To allow the hyphema to settle

HyphemaBlood in anterior HOB elevated 30-45 degrees, out inferiorly and avoid
chamber of eye with night shield. obstruction of vision and to
facilitate resolution

Post-op: HOB no more than

Abdominal aneurysm To avoid flexion of the graft.
45 degrees

Place in low-Fowler’s position

then raise knees or instruct To decrease tension on the
Dehiscence
knees and support them with abdomen.
a pillow.

To delay gastric emptying time.

Take meals in reclining

Dumping Syndrome, Restrict fluids during meals, low
position, lie down for 20-30
prevention of carb, low fiber diet in small
minutes after.
frequent meals.

Instruct not to cough; place on

NPO; keep intestines moist and
Evisceration Place in low-Fowler’s position.
covered with sterile saline until
patient can be wheeled to OR.

Reverse Trendelenburg,
slanted bed with head higher.
Gastroesophageal reflux To promote gastric emptying and
disease (GERD) Pediatric: prone with HOB reduce reflux.
elevated.
 Condition/Procedure Patient Position Rationale & Additional Info

Hiatal hernia Upright position after meals. To prevent gastric content reflux.

RIGHT side-lying position after To facilitate entry of stomach

Pyloric stenosis
meals. contents into the intestines.

To reduce dependent edema and

Extremity burns Elevate extremity.
pressure.

Facial burns or trauma Head elevated To reduce edema

Initially place in sitting To reduce blood pressures below

Autonomic dysreflexia position or high Fowler’s dangerous levels and provide
position with legs dangling. partial symptom relief.

HOB elevated 30-45 degrees; To prevent pressure on aneurysm

Cerebral aneurysm
bed rest site

To promote venous return and

Heat stroke Supine, flat with legs elevated.
maintain blood flow to the head.

To reduce ICP and encourage

blood drainage.Avoid hip and
Hemorrhagic stroke HOB elevated 30 degrees.
neck flexion which inhibits
drainage.

To promote venous drainage.

Elevate HOB 30-45 degrees,

Increased intracranial Avoid flexion of the neck, head
maintain head midline and in
pressure (ICP) rotation, hip flexion, coughing,
neutral position.
sneezing and bending forward.

To facilitate venous drainage and

encourage arterial blood flow.
HOB flat in midline, neutral
Ischemic stroke
position. Avoid hip and neck flexion which
inhibits drainage

Side-lying or recovery To drain secretions and prevent

Seizure
position. aspiration.

Spinal cord injury Immobilize on spinal To prevent any movement and

backboard, head in neutral further injury.
position and immobilized with
a firm, padded cervical collar.
 Condition/Procedure Patient Position Rationale & Additional Info

Must be log rolled without

allowing any twisting or
bending movements

To decrease intracranial pressure

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

Elevate FOB for counter- Ask patient to dorsiflex foot of the

traction; use trapeze for affected leg to assess function of
Buck’s Traction
moving; place pillow beneath peroneal nerve, weakness may
lower legs. indicate pressure on the nerve.

Elevate at or above level of

Casted arm To minimize swelling
heart

Elevate foot of bed to elevate To hasten venous return and

Delayed prosthesis fitting
residual limb. prevent edema.

Use splints, wedge pillow, or

pillows between legs.

Affected extremity needs to be

Hip fracture Avoid stooping, flexion position
abducted.
during sex, and overexertion
during walking or exercise.

On unaffected side: maintain

abduction when in supine
position with pillow between
Avoid extreme internal or external
Hip replacement legs.
rotation.

HOB raised to 30-45 degrees.

Immediate prosthesis Elevate residual limb for 24

Rigid cast acts to control swelling.
fitting hours.

To maintain proper body

Support affected extremity
Osteomyelitis alignment; avoid strenuous
with pillows or splints
exercises.
 Condition/Procedure Patient Position Rationale & Additional Info

Help to sitting position; place

chair at 90 degrees angle to
To prevent dizziness and
Total hip replacement bed; stand on affected side;
orthostatic hypotension.
pivot patient to unaffected
side.

Acute Respiratory Distress To promote oxygenation via

High Fowler’s
Syndrome (ARDS) maximum chest expansion.

Patient should be immediately

Air embolism from repositioned with the right atrium
Turn to LEFT side or place in
dislodged central venous above the gas entry site so that
Trendelenburg.
line trapped air will not move into the
pulmonary circulation.

High Fowler’s

Tripod position: sitting To promote oxygenation via

Asthma
position while leaning forward maximum chest expansion.
with hands on knees.

High Fowler’s
Chronic Obstructive
To promote maximum lung
Pulmonary Disease
Orthopneic position expansion and assist in breathing.
(COPD)

High Fowler’s
To promote maximum lung
Emphysema
Orthopneic position expansion

Pleural Effusion High Fowler’s To provide maximal

To maximize breathing
High Fowler’s
mechanisms.

Lay on affected side

Pneumonia To splint and reduce pain.

Lay with affected lung up

To reduce congestion.

To promote maximum lung

Pneumothorax High Fowler’s
expansion and assist in breathing.
 Condition/Procedure Patient Position Rationale & Additional Info

High Fowler’s, legs dependent To decrease edema and

Pulmonary edema
position congestion

High Fowler’s

To promote maximum lung

Pulmonary embolism Turn patient to LEFT side and
expansion and assist in breathing.
lower HOB

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.

Contraction stress test Placed in semi-Fowler’s or

Monitor for post-test labor onset.
(CST) side-lying position

Shrimp or fetal position; To prevent pressure on the cord. If

Cord prolapse modified Sims’ or cord prolapses, cover with sterile
Trendelenburg. saline gauze to prevent drying.

To reduce compression of the

Fetal distress Turn mother to her LEFT side.
vena cava and aorta.

Late decelerations To allow more blood flow to the

Turn mother to her LEFT side.
(placental insufficiency) placenta.

Placenta previa Sitting position. To minimize bleeding.

To remove pressure off the

Variable decelerations Place mother in Trendelenburg presenting part of the cord and
(cord compression) position. prevent gravity from pulling the
fetus out of the body.

Spina Bifida Prone (on abdomen). To prevent sac rupture.

Position on back or in infant

seat.

Cleft lip (congenital) To prevent trauma to suture line.

Hold in upright position while
feeding.

Prolapsed umbilical cord During labor: Knee-chest Relieves pressure or gravity from
position or Trendelenburg. pulling the cord.
 Condition/Procedure Patient Position Rationale & Additional Info

Hand in vagina to hold presenting

part of fetus off cord.

HOB elevated no more than

Cardiac catheterization 30 degrees or flat as Affected extremity should be kept
(post) prescribed.May turn to either straight.
side

Continuous Bladder Tape catheter to thigh; no Prevents the catheter from being
Irrigation (CBI) other positioning restrictions dislodged.

Position affected ear Pull outer ear upward and back

Ear drops uppermost then lie on for adults; upward and down for
unaffected ear for absorption. children.

During procedure: Tilt head

towards affected ear.
Better visualization and drainage
Ear irrigation of the medium to the ear canal via
After procedure: Lie on
gravity.
affected side for drainage.

Drop to center of the lower

conjunctival sac; blink between
Tilt head back and look up,
Eye drops drops; press inner canthus near
pull lid down.
nose bridge for 1-2 min to
prevent systemic absorption.

During: Shrimp or fetal

position (side-lying with back
bowed, knees drawn up to To maximize spine flexion.
abdomen, neck flexed to rest
Lumbar puncture chin on chest). To prevent spinal headache and
CSF leakage.
After: Flat on bed for 4-12
hours.

Nasogastric tube High Fowler’s with head tilted Closes the trachea and opens the
insertion forward esophagus; prevents aspiration.

Nasogastric tube HOB elevated 30 to 45 To prevent aspiration.Promotes

irrigation and tube degrees; keep elevated for 1 emptying of the stomach and
feedings hour after an intermittent prevents aspiration.
feeding.
 Condition/Procedure Patient Position Rationale & Additional Info

With decreased LOC: RIGHT To prevent aspiration.

side-lying with HOB elevated.

With tracheostomy: Maintain

in semi-Fowler’s position

During: Semi-Fowler’s in bed

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

Lung area needing drainage

Postural Drainage Trendelenburg
should be in uppermost position

Allows gravity to work into the

Rectal enema Left side-lying (Sims’ position) direction of the colon by placing
administration with right knee flexed. the descending colon at its lowest
point.

Rectal enemas and To allow fluid to flow in the

Left side-lying, Sims’ position
irrigation natural direction of the colon.

To enhance lung expansion and

Sengstaken-Blakemore reduce portal blood flow,
HOB elevated
and Minnesota tubes permitting esophagogastric
balloon tamponade.

Thoracentesis Before: (1) Sitting on edge of Prevent fluid leakage into the
bed while leaning on bedside thoracic cavity.
table with feet supported by
stool; or lying in bed on
unaffected side with head
elevated 45 degrees.

(2) Lying in bed on unaffected

side with HOB elevated to
Fowler’s.

After: Assist patient into any

comfortable position
 Condition/Procedure Patient Position Rationale & Additional Info

preferred.

Total Parenteral Nutrition During insertion:

To prevent air embolism.
(TPN) Trendelenburg.

Bed rest for 24 hours, keep

Vascular extremity graft extremity straight and avoid For maximal adhesion.
knee or hip flexion

For better visualization of the

Perineal procedures Lithotomy
area.

To relieve abdominal pain and

Appendectomy Post-op: Fowler’s position
ease breathing.

Sleep on unaffected side with

a night shield for 1 to 4 weeks.

Cataract surgery To prevent edema.

Semi-Fowler’s or Fowler’s on
back or on non-operative side.

HOB elevated 30-45% with

head in a midline, neutral
position.

Craniotomy To facilitate venous drainage.

Never put client on operative
side, especially if bone was
removed.

During: Prone Jackknife Provides better visualization of

Hemorrhoidectomy
position. the area.

Hypophysectomy
Surgical removal of the HOB elevated. To prevent increase in ICP.
pituitary gland.

Infratentorial surgery
Flat and lateral on either side;
Incision at back of head, To facilitate drainage.
avoid neck flexing.
above nape of neck

Post-op: Semi-Fowler’s, turn

Kidney transplant from back to non-operative To promote gas exchange
side
 Condition/Procedure Patient Position Rationale & Additional Info

Back is kept straight.Patient is

logrolled if turned.

Laminectomy Sit straight in straight-backed

chair when out of bed or when
ambulating.

To maintain airway and decrease

Laryngectomy HOB elevated 30-45 degrees
edema.

To allow lymph drainage.

Semi-Fowler’s with arm on

Mastectomy Turn only on back and on
affected side elevated.
unaffected side.

Post-op: semi-Fowler’s
Mitral valve replacement To assist in breathing.
position.

Post-op: Position on side of

Myringotomy To allow drainage of secretions
affected ear .

Bed rest with minimal activity

and repositioning.
Helps detached retina fall into
Retinal detachment
Area of detachment should be place.
in the dependent position.

HOB elevated 30-45 degrees;

Supratentorial surgery
maintain head/neckline in
Incision front of head To facilitate drainage.
midline neutral position; avoid
below hairline
extreme hip and neck flexion.

Post-op: High Fowler’s or To reduce swelling and edema in

semi-Fowler’s. the neck area.

Thyroidectomy Avoid extension and To decrease tension on the suture

movement by using sandbags line and support the head and
or pillows. neck.

To facilitate drainage and relieve

Tonsillectomy Post-op: prone or side-lying
pressure on the neck.
 Condition/Procedure Patient Position Rationale & Additional Info

Side lying with head tucked To expose the area.

and legs pulled up or;
Bone marrow Apply pressure to the area after
aspiration/biopsy Prone with arms folded under the procedure to stop the
chin. bleeding.

To prevent edema.

Elevate for first 24 hours using

Amputation: above the To provide for hip extension and
pillow.Position prone twice
knee stretching of flexor muscles;
daily.
prevent contractures, abduction

Foot of bed elevated for first

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

References and Sources

The following are the references and sources for this patient positioning study guide:

Beckett, A. E. (2010). Are we doing enough to prevent patient injury caused by positioning
for surgery?. Journal of perioperative practice, 20(1), 26-29.
Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., … & Stanley, D.
(2018). Kozier and Erb’s Fundamentals of Nursing [4th Australian edition].
Miranda, A. B., Fogaça, A. R., Rizzetto, M., & Lopes, L. C. C. (2016). Surgical positioning:
nursing care in the transoperative period. Rev SOBECC, 21(1), 52-8. [Link]
Ritchie, I. K. (2003). Positioning Patients for SurgeryBy Chris Servant & Shaun Purkiss
Greenwich Medical Media ISBN 1841100528£ 22.50.
Rosdahl, C. B., & Kowalski, M. T. (Eds.). (2008). Textbook of basic nursing. Lippincott Williams
& Wilkins.
Park, C. K. (2000). The effect of patient positioning on intraabdominal pressure and blood
loss in spinal surgery. Anesthesia & Analgesia, 91(3), 552-557.
Price, P., Frey, K. B., & Junge, T. L. (2004). Surgical technology for the surgical technologist: A
positive care approach. Taylor & Francis.

Fundamentals of Nursing, Notes

Cheat Sheets, Exercise and Physical Activity
That One Patient with a Bullet in His Lungs
A Nurse’s Guide on How to Display Your Credentials