Patient Positioning Nursing Cheat Sheet for NCLEX - Nurseslabs ionicons-v5-c

Bronchoscopy

After: Semi-Fowler’s

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.

Myelogram (air contrast)

Pre-op: surgical table will be moved to various positions during test.Post-op: HOB is lower than trunk.

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

Myelogram (water-based dye)

Pre-op: surgical table will be moved to various positions during test.Post-op: HOB elevated for 8 hours.

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.

Lung biopsy

Flat supine with arms raised above head and hands health together; head and arms on pillow.

Renal biopsy

PRONE with pillow under the abdomen and shoulders.

Arteriovenous fistula

Post-op: Elevate extremity

Peritoneal Dialysis

When outflow is inadequate: turn patient from side to side.

Meniere’s Disease

Change position slowly; bedrest during acute phase

Autografting

Immobilize site for 3 to 7 days.

Internal radiation, during treatment

Strict bedrest while implant is in place

Heart failure with pulmonary edema

Sitting up, with legs dangling

Myocardial infarction

Semi-Fowler’s

Pericarditis

High-Fowlers, upright leaning forward.

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.

Shock

Flat on bed.

Sickle Cell Anemia

HOB elevated 30 degrees, avoid knee gatch and putting strain on painful joints

Varicose veins, leg ulcers, and venous insufficiency

Elevate extremities above heart level.

Deep vein thrombosis

Bed rest with affected limb elevated.After 24 hours after heparin therapy, patient can ambulate if pain level permits.

Tracheoesophageal fistula (TEF)

HOB elevated 30-45 degrees.

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.

HyphemaBlood in anterior chamber of eye

HOB elevated 30-45 degrees, with night shield.

Abdominal aneurysm

Post-op: HOB no more than 45 degrees

Dehiscence

Place in low-Fowler’s position then raise knees or instruct knees and support them with a pillow.

Dumping Syndrome, prevention of

Take meals in reclining position, lie down for 20-30 minutes after.

Evisceration

Place in low-Fowler’s position.

Gastroesophageal reflux disease (GERD)

Reverse Trendelenburg, slanted bed with head higher.Pediatric: prone with HOB elevated.

Hiatal hernia

Upright position after meals.

Pyloric stenosis

RIGHT side-lying position after meals.

Extremity burns

Elevate extremity.

Facial burns or trauma

Head elevated

Autonomic dysreflexia

Initially place in sitting position or high Fowler’s position with legs dangling.

Cerebral aneurysm

HOB elevated 30-45 degrees; bed rest

Heat stroke

Supine, flat with legs elevated.

Hemorrhagic stroke

HOB elevated 30 degrees.

Increased intracranial pressure (ICP)

Elevate HOB 30-45 degrees, maintain head midline and in neutral position.

Ischemic stroke

HOB flat in midline, neutral position.

Seizure

Side-lying or recovery position.

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

Head injury

Elevate HOB 30 degrees, head should be kept in neutral position.

Buck’s Traction

Elevate FOB for counter-traction; use trapeze for moving; place pillow beneath lower legs.

Casted arm

Elevate at or above level of heart

Delayed prosthesis fitting

Elevate foot of bed to elevate residual limb.

Hip fracture

Affected extremity needs to be abducted.

Hip replacement

On unaffected side: maintain abduction when in supine position with pillow between legs.HOB raised to 30-45 degrees.

Immediate prosthesis fitting

Elevate residual limb for 24 hours.

Osteomyelitis

Support affected extremity with pillows or splints

Total hip replacement

Help to sitting position; place chair at 90 degrees angle to bed; stand on affected side; pivot patient to unaffected side.

Air embolism from dislodged central venous line

Turn to LEFT side or place in Trendelenburg.

Asthma

High Fowler’sTripod position: sitting position while leaning forward with hands on knees.

Chronic Obstructive Pulmonary Disease (COPD)

High Fowler’sOrthopneic position

Emphysema

High Fowler’sOrthopneic position

Pleural Effusion

High Fowler’s

Pneumonia

High Fowler’sLay on affected sideLay with affected lung up

Pneumothorax

High Fowler’s

Pulmonary edema

High Fowler’s, legs dependent position

Pulmonary embolism

High Fowler’sTurn patient to LEFT side and lower HOB

Flail chest

High Fowler’s

Rib fracture

High Fowler’s

Contraction stress test (CST)

Placed in semi-Fowler’s or side-lying position

Cord prolapse

Shrimp or fetal position; modified Sims’ or Trendelenburg.

Fetal distress

Turn mother to her LEFT side.

Late decelerations (placental insufficiency)

Turn mother to her LEFT side.

Placenta previa

Sitting position.

Variable decelerations (cord compression)

Place mother in Trendelenburg position.

Spina Bifida

Prone (on abdomen).

Cleft lip (congenital)

Position on back or in infant seat.Hold in upright position while feeding.

Prolapsed umbilical cord

During labor: Knee-chest position or Trendelenburg.

Cardiac catheterization (post)

HOB elevated no more than 30 degrees or flat as prescribed.May turn to either side

Continuous Bladder Irrigation (CBI)

Tape catheter to thigh; no other positioning restrictions

Ear drops

Position affected ear uppermost then lie on unaffected ear for absorption.

Ear irrigation

During procedure: Tilt head towards affected ear.After procedure: Lie on affected side for drainage.

Eye drops

Tilt head back and look up, pull lid down.

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.

Nasogastric tube insertion

High Fowler’s with head tilted forward

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

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

Postural Drainage

Trendelenburg

Rectal enema administration

Left side-lying (Sims’ position) with right knee flexed.

Rectal enemas and irrigation

Left side-lying, Sims’ position

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.

Total Parenteral Nutrition (TPN)

During insertion: Trendelenburg.

Vascular extremity graft

Bed rest for 24 hours, keep extremity straight and avoid knee or hip flexion

Appendectomy

Post-op: Fowler’s position

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.

Craniotomy

HOB elevated 30-45% with head in a midline, neutral position.Never put client on operative side, especially if bone was removed.

Hemorrhoidectomy

During: Prone Jackknife position.

Infratentorial surgery Incision at back of head, above nape of neck

Flat and lateral on either side; avoid neck flexing.

Kidney transplant

Post-op: Semi-Fowler’s, turn from back to non-operative side

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

Mastectomy

Semi-Fowler’s with arm on affected side elevated.

Mitral valve replacement

Post-op: semi-Fowler’s position.

Myringotomy

Post-op: Position on side of affected ear .

Retinal detachment

Bed rest with minimal activity and repositioning.Area of detachment should be in the dependent position.

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.

Thyroidectomy

Post-op: High Fowler’s or semi-Fowler’s.Avoid extension and movement by using sandbags or pillows.

Tonsillectomy

Post-op: prone or side-lying

Bone marrow aspiration/biopsy

Side lying with head tucked and legs pulled up or;Prone with arms folded under chin.

Amputation: above the knee

Elevate for first 24 hours using pillow.Position prone twice daily.

Amputation: below the knee

Foot of bed elevated for first 24 hours.Position prone daily.