Patient Positioning Nursing Cheat Sheet for NCLEX

Patient positioning is an essential aspect of nursing practice. Maintaining good body alignment, changing positioning regularly and systematically are essential principles of patient positioning that nurses must consider.

Positioning patients correctly is important for a variety of reasons. In surgery, proper positioning provides optimal exposure of the surgical site and maintenance of the patient’s dignity by controlling unnecessary exposure. Additionally, positioning patients provides airway management and ventilation, maintaining body alignment, and provide physiologic safety.

Here’s a list of the common conditions, procedures, and diseases with their recommended position and rationale for each. Get a copy and print this out as a reviewer for your clinicals or the NCLEX.

Common Positions


Fowler’s

  • Fowler’s position, is a bed position wherein the head and trunk are raised 40 to 90 degrees.
  • Fowler’s position is used for people who have difficulty breathing because in this position, gravity pulls the diaphragm downward allowing greater chest and lung expansion.
  • In low Fowler’s or semi-Fowler’s position, the head and trunk are raised to 15 to 45 degrees; in high Fowler’s, the head and trunk are raised 90 degrees.
  • This position is useful for patients who have cardiac, respiratory, or neurological problems and is often optimal for patients who have nasogastric tube in place.
  • Using a footboard is recommended to keep the patient’s feet in proper alignment and to help prevent foot drop.

Orthopneic or Tripod

  • Orthopneic or tripod position places the patients 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.
  • Patients who are having difficulty breathing are often placed in this position since it allows maximum expansion of the chest.

Dorsal Recumbent

  • In dorsal recumbent or back-lying position, the client’s head and shoulders are slightly elevated on a small pillow.
  • This position provides comfort and facilitates healing following certain surgeries and anesthetics.

Supine or Dorsal position

  • Supine is a back-lying position similar to dorsal recumbent but the head and shoulders are not elevated.
  • Just like dorsal recumbent, supine position provides comfort in general for patients recover after some types of surgery.

Prone

  • In prone position, the patient lies on the abdomen with head turned to one side; the hips are not flexed.
  • This is the only bed position that allows full extension of the hip and knee joints.
  • 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.
  • Prone position should only be used when the client’s back is correctly aligned, and only for people with no evidence of spinal abnormalities.
  • To support a patient lying in prone, place a pillow under the head and a small pillow or a towel roll under the abdomen.

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.
  • The greater the flexion of the top hip and knee, the greater the stability and balance in this position. This flexion reduces lordosis and promotes good back alignment.
  • Lateral position helps relieve pressure on the sacrum and heels in people who sit for much of the day or confined to bed rest in Fowler’s or dorsal recumbent.
  • 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.

Sims’ Position

  • Sims’ is a semi-prone position where the patient assumes a posture halfway between the lateral and prone positions. The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. Both legs are flexed in front of the client. The upper leg is more acutely flexed at both the hip and the knee, than is the lower one.
  • Sims’ may be used for unconscious clients because it facilitates drainage from the mouth and prevents aspiration of fluids.
  • It is also used for paralyzed clients because it reduces pressure over the sacrum and greater trochanter of the hip.
  • It is often used for clients receiving enemas and occasionally for clients undergoing examinations or treatments of the perineal area.
  • Pregnant women may find the Sims position comfortable for sleeping.
  • Support proper body alignment in Sims’s position by placing a pillow underneath the patient’s head and under the upper arm to prevent internal rotation. Place another pillow between legs.

Trendelenburg’s

  • Trendelenburg’s position involves lowering the head of the bed and raising the foot of the bed of the patient.
  • Patient’s who have hypotension can benefit from this position because it promotes venous return.

Reverse Trendelenburg

  • Reverse Trendelenburg is the opposite of Trendelenburg’s position.
  • Here the HOB is elevated with the foot of bed down.
  • This is often a position of choice for patients with gastrointestinal problems as it can help minimize esophageal reflux.

Cheat Sheet for Patient Positions


Below is the cheat sheet for the common patient positioning.

Condition Position Rationale & Additional Info
Bronchoscopy After: Semi-Fowler’s To reduce aspiration risk from difficulty of swallowing
Cerebral angiography During: Flat on bed with arms at sides; kept still.

After: Extremity in which contrast was injected is kept straight for 6 to 8 hours. Flat, if femoral artery was used.

Apply firm pressure on site for 15 minutes after the procedure.
Myelogram (air contrast) Pre-op: surgical table will be moved to various positions during test.

Post-op: HOB is lower than trunk.

To disperse dye.
Myelogram (oil-based dye) Pre-op: surgical table will be moved to various positions during test.

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

To disperse dye.To prevent CSF leakage.
Myelogram (water-based dye) Pre-op: surgical table will be moved to various positions during test.

Post-op: HOB elevated for 8 hours.

To prevent dye from irritating the meninges.
Liver biopsy During: Supine with RIGHT side of upper abdomen exposed; RIGHT arm raised and extended behind and and overhead and shoulder.

After: RIGHT side-lying with pillow under puncture site.

To expose the area.

To apply pressure and minimize bleeding.

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

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

Peritoneal Dialysis When outflow is inadequate: turn patient from side to side. Turning facilitates drainage; check for kinks in the tubing.

Possible to have abdominal cramps and blood-tinged outflow if catheter was placed in the last 1-2 weeks.

Cloudy outflow is never normal.

Meniere’s Disease Change position slowly; bedrest during acute phase Provide protection when ambulating
Autografting Immobilize site for 3 to 7 days. To promote healing and maximal adhesion.
Internal radiation, during treatment Strict bedrest while implant is in place To prevent dislodgement of the implant device.

Provide own urinal or bedpan to patient.

Heart failure with pulmonary edema Sitting up, with legs dangling To decrease venous return and reduce congestion; promotes ventilation and relieves dyspnea.
Myocardial infarction Semi-Fowler’s To help lessen chest pain and promote respiration.
Pericarditis High-Fowlers, upright leaning forward. To help lessen pain.
Peripheral artery disease Depending on desired outcome.

Slight elevation of legs but not above the heart or slightly dependent.

Dangle legs on side of the bed.

To slow or increase arterial return
Shock Flat on bed. To improve or increase circulation.

Trendelenburg is no longer a recommended position.

Sickle Cell Anemia HOB elevated 30 degrees, avoid knee gatch and putting strain on painful joints To promote maximum lung expansion and assist in breathing.
Varicose veins, leg ulcers, and venous insufficiency Elevate extremities above heart level. To prevent pooling of blood in the legs and facilitate venous return; avoid prolonged standing.
Deep vein thrombosis Bed rest with affected limb elevated.

After 24 hours after heparin therapy, patient can ambulate if pain level permits.

To promote circulation.
Tracheoesophageal fistula (TEF) HOB elevated 30-45 degrees. To prevent reflux.
Ventriculoperitoneal shunt (for Hydrocephalus treatment) After shunt placement: Place on non-operative side in flat position.

HOB raised 15-30 degrees if ICP is increased.

Do not hold infant with head elevated.

Avoid rapid fluid drainage.
HyphemaBlood in anterior chamber of eye HOB elevated 30-45 degrees, with night shield. To allow the hyphema to settle out inferiorly and avoid obstruction of vision and to facilitate resolution
Abdominal aneurysm Post-op: HOB no more than 45 degrees To avoid flexion of the graft.
Dehiscence Place in low-Fowler’s position then raise knees or instruct knees and support them with a pillow. To decrease tension on the abdomen.
Dumping Syndrome, prevention of Take meals in reclining position, lie down for 20-30 minutes after. To delay gastric emptying time.

Restrict fluids during meals, low carb, low fiber diet in small frequent meals.

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

Pediatric: prone with HOB elevated.

To promote gastric emptying and reduce reflux.
Hiatal hernia Upright position after meals. To prevent gastric content reflux.
Pyloric stenosis RIGHT side-lying position after meals. To facilitate entry of stomach contents into the intestines.
Extremity burns Elevate extremity. To reduce dependent edema and pressure.
Facial burns or trauma Head elevated To reduce edema
Autonomic dysreflexia Initially place in sitting position or high Fowler’s position with legs dangling. To reduce blood pressures below dangerous levels and provide partial symptom relief.
Cerebral aneurysm HOB elevated 30-45 degrees; bed rest To prevent pressure on aneurysm site
Heat stroke Supine, flat with legs elevated. To promote venous return and maintain blood flow to the head.
Hemorrhagic stroke HOB elevated 30 degrees. To reduce ICP and encourage blood drainage.Avoid hip and neck flexion which inhibits drainage.
Increased intracranial pressure (ICP) Elevate HOB 30-45 degrees, maintain head midline and in neutral position. To promote venous drainage.

Avoid flexion of the neck, head rotation, hip flexion, coughing, sneezing and bending forward.

Ischemic stroke HOB flat in midline, neutral position. To facilitate venous drainage and encourage arterial blood flow.

Avoid hip and neck flexion which inhibits drainage

Seizure Side-lying or recovery position. To drain secretions and prevent aspiration.
Spinal cord injury Immobilize on spinal backboard, head in neutral position and immobilized with a firm, padded cervical collar.

Must be log rolled without allowing any twisting or bending movements

To prevent any movement and further injury.
Head injury Elevate HOB 30 degrees, head should be kept in neutral position. To decrease intracranial pressure (ICP).Keep head from flexing or rotating.

Avoid frequent suctioning.

Buck’s Traction Elevate FOB for counter-traction; use trapeze for moving; place pillow beneath lower legs. Ask patient to dorsiflex foot of the affected leg to assess function of peroneal nerve, weakness may indicate pressure on the nerve.
Casted arm Elevate at or above level of heart To minimize swelling
Delayed prosthesis fitting Elevate foot of bed to elevate residual limb. To hasten venous return and prevent edema.
Hip fracture Affected extremity needs to be abducted. Use splints, wedge pillow, or pillows between legs.

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

Hip replacement On unaffected side: maintain abduction when in supine position with pillow between legs.

HOB raised to 30-45 degrees.

Avoid extreme internal or external rotation.
Immediate prosthesis fitting Elevate residual limb for 24 hours. Rigid cast acts to control swelling.
Osteomyelitis Support affected extremity with pillows or splints To maintain proper body alignment; avoid strenuous exercises.
Total hip replacement Help to sitting position; place chair at 90 degrees angle to bed; stand on affected side; pivot patient to unaffected side. To prevent dizziness and orthostatic hypotension.
Acute Respiratory Distress Syndrome (ARDS) High Fowler’s To promote oxygenation via maximum chest expansion.
Air embolism from dislodged central venous line Turn to LEFT side or place in Trendelenburg. Patient should be immediately repositioned with the right atrium above the gas entry site so that trapped air will not move into the pulmonary circulation.
Asthma High Fowler’s

Tripod position: sitting position while leaning forward with hands on knees.

To promote oxygenation via maximum chest expansion.
Chronic Obstructive Pulmonary Disease (COPD) High Fowler’s

Orthopneic position

To promote maximum lung expansion and assist in breathing.
Emphysema High Fowler’s

Orthopneic position

To promote maximum lung expansion
Pleural Effusion High Fowler’s To provide maximal
Pneumonia High Fowler’s

Lay on affected side

Lay with affected lung up

To maximize breathing mechanisms.

To splint and reduce pain.

To reduce congestion.

Pneumothorax High Fowler’s To promote maximum lung expansion and assist in breathing.
Pulmonary edema High Fowler’s, legs dependent position To decrease edema and congestion
Pulmonary embolism High Fowler’s

Turn patient to LEFT side and lower HOB

To promote maximum lung expansion and assist in breathing.
Flail chest High Fowler’s To provide maximal comfort and maximize breathing mechanisms.
Rib fracture High Fowler’s To promote maximum lung expansion and assist in breathing.
Contraction stress test (CST) Placed in semi-Fowler’s or side-lying position Monitor for post-test labor onset.
Cord prolapse Shrimp or fetal position; modified Sims’ or Trendelenburg. To prevent pressure on the cord. If cord prolapses, cover with sterile saline gauze to prevent drying.
Fetal distress Turn mother to her LEFT side. To reduce compression of the vena cava and aorta.
Late decelerations (placental insufficiency) Turn mother to her LEFT side. To allow more blood flow to the placenta.
Placenta previa Sitting position. To minimize bleeding.
Variable decelerations (cord compression) Place mother in Trendelenburg position. To remove pressure off the presenting part of the cord and prevent gravity from pulling the fetus out of the body.
Spina Bifida Prone (on abdomen). To prevent sac rupture.
Cleft lip (congenital) Position on back or in infant seat.

Hold in upright position while feeding.

To prevent trauma to suture line.
Prolapsed umbilical cord During labor: Knee-chest position or Trendelenburg. Relieves pressure or gravity from pulling the cord.

Hand in vagina to hold presenting part of fetus off cord.

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

After procedure: Lie on affected side for drainage.

Better visualization and drainage of the medium to the ear canal via gravity.
Eye drops Tilt head back and look up, pull lid down. Drop to center of the lower conjunctival sac; blink between drops; press inner canthus near nose bridge for 1-2 min to prevent systemic absorption.
Lumbar puncture During: Shrimp or fetal position (side-lying with back bowed, knees drawn up to abdomen, neck flexed to rest chin on chest).

After: Flat on bed for 4-12 hours.

To maximize spine flexion.

 

To prevent spinal headache and CSF leakage.

Nasogastric tube insertion High Fowler’s with head tilted forward Closes the trachea and opens the esophagus; prevents aspiration.
Nasogastric tube irrigation and tube feedings HOB elevated 30 to 45 degrees; keep elevated for 1 hour after an intermittent feeding.

With decreased LOC: RIGHT side-lying with HOB elevated.

With tracheostomy: Maintain in semi-Fowler’s position

To prevent aspiration.Promotes emptying of the stomach and prevents aspiration.

To prevent aspiration.

Paracentesis During: Semi-Fowler’s in bed or sitting upright on side of bed with chair; support the feet.

Post: Assist into any comfortable position

Empty the bladder before procedure; report elevated temperature; assess for hypovolemia.
Postural Drainage Trendelenburg Lung area needing drainage should be in uppermost position
Rectal enema administration Left side-lying (Sims’ position) with right knee flexed. Allows gravity to work into the direction of the colon by placing the descending colon at its lowest point.
Rectal enemas and irrigation Left side-lying, Sims’ position To allow fluid to flow in the natural direction of the colon.
Sengstaken-Blakemore and Minnesota tubes HOB elevated To enhance lung expansion and reduce portal blood flow, permitting esophagogastric balloon tamponade.
Thoracentesis 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 unaffected side with HOB elevated to Fowler’s.

After: Assist patient into any comfortable position preferred.

Prevent fluid leakage into the thoracic cavity.
Total Parenteral Nutrition (TPN) During insertion: Trendelenburg. To prevent air embolism.
Vascular extremity graft Bed rest for 24 hours, keep extremity straight and avoid knee or hip flexion For maximal adhesion.
Perineal procedures Lithotomy For better visualization of the area.
Appendectomy Post-op: Fowler’s position To relieve abdominal pain and ease breathing.
Cataract surgery Sleep on unaffected side with a night shield for 1 to 4 weeks.

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

To prevent edema.
Craniotomy HOB elevated 30-45% with head in a midline, neutral position.

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

To facilitate venous drainage.
Hemorrhoidectomy During: Prone Jackknife position. Provides better visualization of the area.
Hypophysectomy
Surgical removal of the pituitary gland.
HOB elevated. To prevent increase in ICP.
Infratentorial surgery
Incision at back of head, above nape of neck
Flat and lateral on either side; avoid neck flexing. To facilitate drainage.
Kidney transplant Post-op: Semi-Fowler’s, turn from back to non-operative side To promote gas exchange
Laminectomy Back is kept straight.Patient is logrolled if turned.

Sit straight in straight-backed chair when out of bed or when ambulating.

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

Turn only on back and on unaffected side.

Mitral valve replacement Post-op: semi-Fowler’s position. To assist in breathing.
Myringotomy Post-op: Position on side of affected ear . To allow drainage of secretions
Retinal detachment Bed rest with minimal activity and repositioning.

Area of detachment should be in the dependent position.

Helps detached retina fall into place.
Supratentorial surgery
Incision front of head below hairline
HOB elevated 30-45 degrees; maintain head/neckline in midline neutral position; avoid extreme hip and neck flexion. To facilitate drainage.
Thyroidectomy Post-op: High Fowler’s or semi-Fowler’s.

Avoid extension and movement by using sandbags or pillows.

To reduce swelling and edema in the neck area.

To decrease tension on the suture line and support the head and neck.

Tonsillectomy Post-op: prone or side-lying To facilitate drainage and relieve pressure on the neck.
Bone marrow aspiration/biopsy Side lying with head tucked and legs pulled up or;

Prone with arms folded under chin.

To expose the area.

Apply pressure to the area after the procedure to stop the bleeding.

Amputation: above the knee Elevate for first 24 hours using pillow.Position prone twice daily. To prevent edema.

To provide for hip extension and stretching of flexor muscles; prevent contractures, abduction

Amputation: below the knee Foot of bed elevated for first 24 hours.

Position prone daily.

To prevent edema.

To provide for hip extension.

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