Condition 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.

Apply firm pressure on site for

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

Pre-op: surgical table will be moved

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

Pre-op: surgical table will be moved

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

Pre-op: surgical table will be moved

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

During: Supine with RIGHT side of

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

Flat supine with arms raised above

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

Turning facilitates drainage;

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

Change position slowly; bedrest Provide protection when

Meniere’s Disease
during acute phase ambulating
To promote healing and
Autografting Immobilize site for 3 to 7 days.
maximal adhesion.
To prevent dislodgement of the
implant device.
Internal radiation, Strict bedrest while implant is in
Provide own urinal or bedpan
during treatment place
to patient.
 Condition Position Rationale & Additional Info

To decrease venous return and

Heart failure with reduce congestion; promotes
Sitting up, with legs dangling
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 To slow or increase arterial
dependent.
disease return

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 To promote maximum lung

Sickle Cell Anemia knee gatch and putting strain on expansion and assist in
painful joints breathing.
To prevent pooling of blood in
Varicose veins, leg
Elevate extremities above heart the legs and facilitate venous
ulcers, and venous
level. return; avoid prolonged
insufficiency
standing.
Bed rest with affected limb elevated.
Deep vein thrombosis After 24 hours after heparin therapy, To promote circulation.
patient can ambulate if pain level
 Condition Position Rationale & Additional Info

permits.

Tracheoesophageal
HOB elevated 30-45 degrees. To prevent reflux.
fistula (TEF)
After shunt placement: Place on
non-operative side in flat position.
Ventriculoperitoneal HOB raised 15-30 degrees if ICP is
shunt (for increased.
Avoid rapid fluid drainage.
Hydrocephalus
treatment) Do not hold infant with head
elevated.

To allow the hyphema to settle

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

Instruct not to cough; place on

Evisceration Place in low-Fowler’s position. NPO; keep intestines moist
and covered with sterile saline
 Condition Position Rationale & Additional Info

until patient can be wheeled to

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

To prevent gastric content

Hiatal hernia Upright position after meals.
reflux.
RIGHT side-lying position after To facilitate entry of stomach
Pyloric stenosis
meals. contents into the intestines.
To reduce dependent edema
Extremity burns Elevate extremity.
and pressure.
Facial burns or trauma Head elevated To reduce edema
Initially place in sitting position or To reduce blood pressures
Autonomic dysreflexia high Fowler’s position with legs below dangerous levels and
dangling. provide partial symptom relief.
HOB elevated 30-45 degrees; bed To prevent pressure on
Cerebral aneurysm
rest aneurysm 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.
Elevate HOB 30-45 degrees, To promote venous drainage.
Increased intracranial
maintain head midline and in neutral Avoid flexion of the neck,
pressure (ICP)
position. head rotation, hip flexion,
 Condition Position
HOB flat in midline, neutral
Ischemic stroke
position.
Seizure Side-lying or recovery position.
Immobilize on spinal backboard,
head in neutral position and
immobilized with a firm, padded
Spinal cord injury cervical collar.
Must be log rolled without allowing
any twisting or bending movements
Elevate HOB 30 degrees, head
Head injury
should be kept in neutral position.
Elevate FOB for counter-traction;
Buck’s Traction use trapeze for moving; place pillow
beneath lower legs.
Casted arm Elevate at or above level of heart
Delayed prosthesis Elevate foot of bed to elevate
Rationale & Additional Info
coughing, sneezing and
bending forward.
To facilitate venous drainage
and encourage arterial blood
flow.
Avoid hip and neck flexion
which inhibits drainage
To drain secretions and
prevent aspiration.
To prevent any movement and
further injury.
To decrease intracranial
pressure (ICP).Keep head from
flexing or rotating.
Avoid frequent suctioning.
Ask patient to dorsiflex foot of
the affected leg to assess
function of peroneal nerve,
weakness may indicate
pressure on the nerve.
To minimize swelling
To hasten venous return and
 Condition Position Rationale & Additional Info

fitting residual limb. prevent edema.

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

On unaffected side: maintain

abduction when in supine position
Avoid extreme internal or
Hip replacement with pillow between legs.
external rotation.
HOB raised to 30-45 degrees.

Immediate prosthesis Rigid cast acts to control

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

circulation.
High Fowler’s
Tripod position: sitting position
To promote oxygenation via
Asthma while leaning forward with hands on
maximum chest expansion.
knees.

Chronic Obstructive High Fowler’s To promote maximum lung

Pulmonary Disease Orthopneic position expansion and assist in
(COPD) breathing.
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
To splint and reduce pain.
Pneumonia
Lay with affected lung up
To reduce congestion.

To promote maximum lung

Pneumothorax High Fowler’s expansion and assist in
breathing.
High Fowler’s, legs dependent To decrease edema and
Pulmonary edema
position congestion
High Fowler’s
To promote maximum lung
Turn patient to LEFT side and lower
Pulmonary embolism expansion and assist in
HOB
breathing.

To provide maximal comfort

Flail chest High Fowler’s
and maximize breathing
 Condition Position Rationale & Additional Info

mechanisms.
To promote maximum lung
Rib fracture High Fowler’s expansion and assist in
breathing.
Contraction stress test Placed in semi-Fowler’s or side- Monitor for post-test labor
(CST) lying position onset.
To prevent pressure on the
Shrimp or fetal position; modified cord. If cord prolapses, cover
Cord prolapse
Sims’ or Trendelenburg. with sterile 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
(placental Turn mother to her LEFT side.
the placenta.
insufficiency)
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.
Hold in upright position while To prevent trauma to suture
Cleft lip (congenital)
feeding. line.

Relieves pressure or gravity

Prolapsed umbilical During labor: Knee-chest position from pulling the cord.
cord or Trendelenburg. Hand in vagina to hold
presenting part of fetus off
 Condition Position
HOB elevated no more than 30
Cardiac catheterization
degrees or flat as prescribed.May
(post)
turn to either side
Continuous Bladder Tape catheter to thigh; no other
Irrigation (CBI) positioning restrictions
Position affected ear uppermost then
Ear drops
lie on unaffected ear for absorption.
During procedure: Tilt head
towards affected ear.
Ear irrigation After procedure: Lie on affected
side for drainage.
Tilt head back and look up, pull lid
Eye drops
down.
During: Shrimp or fetal position
(side-lying with back bowed, knees
drawn up to abdomen, neck flexed to
Lumbar puncture
rest chin on chest).
After: Flat on bed for 4-12 hours.
Nasogastric tube High Fowler’s with head tilted
insertion forward
Rationale & Additional Info
cord.
Affected extremity should be
kept straight.
Prevents the catheter from
being dislodged.
Pull outer ear upward and back
for adults; upward and down
for children.
Better visualization and
drainage of the medium to the
ear canal via gravity.
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.
To maximize spine flexion.
To prevent spinal headache
and CSF leakage.
Closes the trachea and opens
the esophagus; prevents
aspiration.
 Condition Position Rationale & Additional Info

HOB elevated 30 to 45 degrees;

keep elevated for 1 hour after an
To prevent
intermittent feeding.
aspiration.Promotes emptying
Nasogastric tube With decreased LOC: RIGHT
of the stomach and prevents
irrigation and tube side-lying with HOB elevated.
aspiration.
feedings
To prevent aspiration.
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 feet.
Paracentesis
Post: Assist into any comfortable
position
Empty the bladder before
procedure; report elevated
temperature; assess for
hypovolemia.

Lung area needing drainage

Postural Drainage Trendelenburg should be in uppermost
position
Allows gravity to work into
Rectal enema Left side-lying (Sims’ position) with the direction of the colon by
administration right knee flexed. placing 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
Sengstaken-Blakemore and reduce portal blood flow,
HOB elevated
and Minnesota tubes permitting esophagogastric
balloon tamponade.
Before: (1) Sitting on edge of bed Prevent fluid leakage into the
Thoracentesis
while leaning on bedside table with thoracic cavity.
 Condition Position Rationale & Additional Info

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
During insertion:Trendelenburg. To prevent air embolism.
Nutrition (TPN)
Bed rest for 24 hours, keep
Vascular extremity
extremity straight and avoid knee or For maximal adhesion.
graft
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 Semi-Fowler’s or Fowler’s on back To prevent edema.
or on non-operative side.

HOB elevated 30-45% with head in

a midline, neutral position.
Craniotomy Never put client on operative side, To facilitate venous drainage.
especially if bone was removed.

Provides better visualization of

Hemorrhoidectomy During: Prone Jackknife position.
the area.
 Condition Position Rationale & Additional Info

Hypophysectomy
Surgical removal of the HOB elevated. To prevent increase in ICP.
pituitary gland.
Infratentorial surgery
Incision at back of Flat and lateral on either side; avoid
To facilitate drainage.
head, above nape of neck flexing.
neck
Post-op: Semi-Fowler’s, turn from
Kidney transplant To promote gas exchange
back to non-operative side
Back is kept straight.Patient is
logrolled if turned.
Sit straight in straight-backed chair
Laminectomy
when out of bed or when
ambulating.

To maintain airway and

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

Mitral valve
Post-op: semi-Fowler’s position. To assist in breathing.
replacement
Post-op: Position on side of affected To allow drainage of
Myringotomy
ear . secretions
Bed rest with minimal activity and
repositioning.
Helps detached retina fall into
Retinal detachment Area of detachment should be in the
place.
dependent position.
 Condition Position Rationale & Additional Info

HOB elevated 30-45 degrees;

Supratentorial surgery
maintain head/neckline in midline
Incision front of head To facilitate drainage.
neutral position; avoid extreme hip
below hairline
and neck flexion.
To reduce swelling and edema
Post-op: High Fowler’s or semi-
in the neck area.
Fowler’s.
To decrease tension on the
Thyroidectomy Avoid extension and movement by
suture line and support the
using sandbags or pillows.
head and neck.

To facilitate drainage and

Tonsillectomy Post-op: prone or side-lying
relieve pressure on the neck.
To expose the area.
Side lying with head tucked and legs
Apply pressure to the area
Bone marrow pulled up or;
after the procedure to stop the
aspiration/biopsy Prone with arms folded under chin.
bleeding.

To prevent edema.
To provide for hip extension
Amputation: above the Elevate for first 24 hours using and stretching of flexor
knee pillow.Position prone twice daily. muscles; prevent contractures,
abduction

Foot of bed elevated for first 24

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