Condition/

Patient Position Rationale & Additional Info

Procedure

Bronchoscopy After: Semi-Fowler’s To reduce aspiration risk from difficulty of swallowing

During: Flat on bed with

arms at sides; kept still.
Cerebral
After: Extremity in which
angiography Apply firm pressure on site for 15 minutes after the procedure.
contrast was injected is
kept straight for 6 to 8
hours. Flat, if femoral
artery was used.

Pre-op: surgical table will

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

Pre-op: surgical table will

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

Pre-op: surgical table will

be moved to various
Myelogram (water- positions during test.
To prevent dye from irritating the meninges.
based dye)
Post-op: HOB elevated for
8 hours.

During: Supine with RIGHT

side of upper abdomen
exposed; RIGHT arm raised
and extended behind and
To expose the area.
Liver biopsy and 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
Lung biopsy To expose and provide easy access to the area.
hands health together;
head and arms on pillow.

PRONE with pillow under

Renal biopsy the abdomen and To expose the area.
shoulders.

Arteriovenous Don’t sleep on affected side; encourage exercise by squeezing a rubber ball.
Post-op: Elevate extremity
fistula Don’t use AV arm for BP reading and venipuncture.

Turning facilitates drainage; check for kinks in the tubing.

When outflow is
Peritoneal Dialysis inadequate: turn patient Possible to have abdominal cramps and blood-tinged outflow if catheter was pl
from side to side.
Cloudy outflow is never normal.

Change position slowly;

Meniere’s Disease bedrest during acute Provide protection when ambulating
phase

Immobilize site for 3 to 7

Autografting To promote healing and maximal adhesion.
days.

Internal radiation, Strict bedrest while To prevent dislodgement of the implant device.
during treatment implant is in place Provide own urinal or bedpan to patient.

Heart failure with Sitting up, with legs

To decrease venous return and reduce congestion; promotes ventilation and re
pulmonary edema dangling
Myocardial
Semi-Fowler’s To help lessen chest pain and promote respiration.
infarction

High-Fowlers, upright
Pericarditis To help lessen pain.
leaning forward.

Depending on desired
outcome.

Slight elevation of legs but

Peripheral artery
not above the heart or To slow or increase arterial return
disease
slightly 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,

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

Varicose veins, leg

Elevate extremities above
ulcers, and venous To prevent pooling of blood in the legs and facilitate venous return; avoid prolo
heart level.
insufficiency

Bed rest with affected limb

elevated.
Deep After 24 hours To promote circulation.
vein thrombosis after heparin therapy,
patient can ambulate
if pain level permits.

Tracheoesophageal HOB elevated 30-45

To prevent reflux.
fistula (TEF) degrees.

Ventriculoperitone After shunt placement:

al shunt (for Hydro Place on non-operative
Avoid rapid fluid drainage.
cephalus treatmen side in flat position.
t)
HOB raised 15-30 degrees
 if ICP is increased.

Do not hold infant with

head elevated.

HyphemaBlood in
HOB elevated 30-45
anterior chamber To allow the hyphema to settle out inferiorly and avoid obstruction of vision an
degrees, with night shield.
of eye

Abdominal aneurys Post-op: HOB no more

To avoid flexion of the graft.
m than 45 degrees

Place in low-Fowler’s
position then raise knees
Dehiscence or instruct knees and To decrease tension on the abdomen.
support them with a
pillow.

Dumping Take meals in reclining To delay gastric emptying time.

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

Place in low-Fowler’s Instruct not to cough; place on NPO; keep intestines moist and covered with ste
Evisceration
position. to OR.

Reverse Trendelenburg,
Gastroesophageal slanted bed with head
reflux disease higher. To promote gastric emptying and reduce reflux.
(GERD) Pediatric: prone with HOB
elevated.

Upright position after

Hiatal hernia To prevent gastric content reflux.
meals.

RIGHT side-lying position

Pyloric stenosis To facilitate entry of stomach contents into the intestines.
after meals.

Extremity burns Elevate extremity. To reduce dependent edema and pressure.

Facial burns or trau
Head elevated To reduce edema
ma

Autonomic Initially place in sitting

dysreflexia position or high Fowler’s
To reduce blood pressures below dangerous levels and provide partial symptom
position with legs
dangling.

HOB elevated 30-45

Cerebral aneurysm To prevent pressure on aneurysm site
degrees; bed rest

Supine, flat with legs

Heat stroke To promote venous return and maintain blood flow to the head.
elevated.

Hemorrhagic strok
HOB elevated 30 degrees. To reduce ICP and encourage blood drainage.Avoid hip and neck flexion which
e

Elevate HOB 30-45

Increased To promote venous drainage.
degrees, maintain head
intracranial
midline and in neutral Avoid flexion of the neck, head rotation, hip flexion, coughing, sneezing and be
pressure (ICP)
position.

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

Side-lying or recovery
Seizure To drain secretions and prevent aspiration.
position.

Immobilize on spinal
backboard, head in neutral
position and immobilized
with a firm, padded
Spinal cord injury cervical collar. To prevent any movement and further injury.

Must be log rolled without

allowing any twisting or
bending movements
 Elevate HOB 30 degrees, To decrease intracranial pressure (ICP).Keep head from flexing or rotating.
Head injury head should be kept in
neutral position. Avoid frequent suctioning.

Elevate FOB for counter-

traction; use trapeze Ask patient to dorsiflex foot of the affected leg to assess function of peroneal n
Buck’s Traction
for moving; place pillow on the nerve.
beneath lower legs.

Elevate at or above level of

Casted arm To minimize swelling
heart

Delayed prosthesis Elevate foot of bed to

To hasten venous return and prevent edema.
fitting elevate residual limb.

Affected extremity needs Use splints, wedge pillow, or pillows between legs.
Hip fracture
to be abducted. Avoid stooping, flexion position during sex, and overexertion during walking or

On unaffected
side: maintain abduction
when in supine position
Hip replacement with pillow between legs. Avoid extreme internal or external rotation.

HOB raised to 30-45

degrees.

Immediate Elevate residual limb for

Rigid cast acts to control swelling.
prosthesis fitting 24 hours.

Support affected extremity

Osteomyelitis To maintain proper body alignment; avoid strenuous exercises.
with pillows or splints
 Help to sitting position;
place chair at 90 degrees
Total hip
angle to bed; stand on To prevent dizziness and orthostatic hypotension.
replacement
affected side; pivot patient
to unaffected side.

Acute Respiratory
Distress High Fowler’s To promote oxygenation via maximum chest expansion.
Syndrome (ARDS)

Air embolism from

Turn to LEFT side or place Patient should be immediately repositioned with the right atrium above the ga
dislodged central
in Trendelenburg. move into the pulmonary circulation.
venous line

Tape catheter to thigh; no

Continuous Bladde
other positioning Prevents the catheter from being dislodged.
r Irrigation (CBI)
restrictions

Position affected ear

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

During procedure: Tilt

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

Tilt head back and look up, Drop to center of the lower conjunctival sac; blink between drops; press inner c
Eye drops
pull lid down. prevent systemic absorption.

During: Shrimp or fetal

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

After: Flat on bed for 4-12

hours.

Nasogastric High Fowler’s with head

Closes the trachea and opens the esophagus; prevents aspiration.
tube insertion tilted forward

HOB elevated 30 to 45
degrees; keep elevated for
1 hour after an
intermittent feeding.
Nasogastric tube To prevent aspiration.Promotes emptying of the stomach and prevents aspirati
With decreased
irrigation and tube
LOC: RIGHT side-lying with To prevent aspiration.
feedings
HOB elevated.

With tracheostomy: Maint

ain in semi-Fowler’s
position

During: Semi-Fowler’s in
bed or sitting upright on
side of bed with chair;
Paracentesis support the feet. Empty the bladder before procedure; report elevated temperature; assess for h

Post: Assist into any

comfortable position

Postural Drainage Trendelenburg Lung area needing drainage should be in uppermost position

Left side-lying (Sims’

Rectal enema
position) with right knee Allows gravity to work into the direction of the colon by placing the descending
administration
flexed.

Rectal enemas and Left side-lying, Sims’

To allow fluid to flow in the natural direction of the colon.
irrigation position
Sengstaken-
Blakemore and HOB elevated To enhance lung expansion and reduce portal blood flow, permitting esophago
Minnesota tubes

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.
Thoracentesis Prevent fluid leakage into the thoracic cavity.
(2) Lying in bed on
unaffected side with HOB
elevated to Fowler’s.

After: Assist patient into

any comfortable position
preferred.

Total Parenteral During

To prevent air embolism.
Nutrition (TPN) insertion: Trendelenburg.

Bed rest for 24 hours, keep

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

Perineal
Lithotomy For better visualization of the area.
procedures
Appendectomy Post-op: Fowler’s position To relieve abdominal pain and 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.

Hemorrhoidectom During: Prone Jackknife

Provides better visualization of the area.
y position.
Hypophysectomy
Surgical removal of HOB elevated. To prevent increase in ICP.
the pituitary gland.

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

Post-op: Semi-Fowler’s,
Kidney transplant turn from back to non- To promote gas exchange
operative side

Back is kept
straight.Patient is logrolled
if turned.
Laminectomy
Sit straight in straight-
backed chair when out of
bed or when ambulating.

HOB elevated 30-45

Laryngectomy To maintain airway and decrease edema.
degrees

Semi-Fowler’s with arm on To allow lymph drainage.

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

Mitral valve Post-op: semi-Fowler’s

To assist in breathing.
replacement position.

Post-op: Position on side

Myringotomy To allow drainage of secretions
of affected ear .

Bed rest with minimal

activity and repositioning.
Retinal
Area of detachment Helps detached retina fall into place.
detachment
should be in the
dependent position.
 HOB elevated 30-45
Supratentorial
degrees; maintain
surgery
head/neckline in midline
Incision front of To facilitate drainage.
neutral position; avoid
head below
extreme hip and neck
hairline
flexion.

Post-op: High Fowler’s or

semi-Fowler’s.
To reduce swelling and edema in the neck area.
Thyroidectomy Avoid extension and
To decrease tension on the suture line and support the head and neck.
movement by using
sandbags or pillows.

Post-op: prone or side-

Tonsillectomy To facilitate drainage and relieve pressure on the neck.
lying

Side lying with head

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

Elevate for first 24 hours To prevent edema.

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

Foot of bed elevated for

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