Patient Positioning Nursing Cheat Sheet for NCLEX - Nurseslabs
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.
Acute Respiratory Distress Syndrome (ARDS)
High Fowler’s
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
Sengstaken-Blakemore and Minnesota tubes
HOB elevated
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
Perineal procedures
Lithotomy
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.
Hypophysectomy Surgical removal of the pituitary gland.
HOB elevated.
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.