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.
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 15

Cerebral angiography
After: Extremity in which contrast 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 to various positions during
Myelogram (air contrast) test. To disperse dye.

Post-op: HOB is lower than trunk.

Pre-op: surgical table will be

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

Pre-op: surgical table will be

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

During: Supine with RIGHT side of

upper abdomen exposed; RIGHT
To expose the area.
arm raised and extended behind
Liver biopsy and 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

To expose and provide easy access
Lung biopsy head and hands health together;
to the area.
head and arms on pillow.
Condition Position Rationale & Additional Info

PRONE with pillow under the

Renal biopsy To expose the area.
abdomen and shoulders.

Don’t sleep on affected side;

encourage exercise by squeezing a
Arteriovenous fistula Post-op: Elevate extremity rubber ball.

Don’t use AV arm for BP reading

and venipuncture.

Turning facilitates drainage; check

for kinks in the tubing.

Possible to have abdominal cramps

When outflow is inadequate: turn
Peritoneal Dialysis and blood-tinged outflow if
patient from side to side.
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 maximal

Autografting Immobilize site for 3 to 7 days.
adhesion.

To prevent dislodgement of the

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

To decrease venous return and

Heart failure with pulmonary
Sitting up, with legs dangling reduce congestion; promotes
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.

Peripheral artery disease Depending on desired outcome. To slow or increase arterial return
Condition Position Rationale & Additional Info

Slight elevation of legs but not

above the heart or 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

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

To prevent pooling of blood in the

Varicose veins, leg ulcers, and Elevate extremities above heart
legs and facilitate venous return;
venous insufficiency level.
avoid prolonged standing.

Bed rest with affected limb

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

Tracheoesophageal fistula
HOB elevated 30-45 degrees. To prevent reflux.
(TEF)

After shunt placement: Place on

non-operative side in flat position.
Ventriculoperitoneal shunt
HOB raised 15-30 degrees if ICP is
(for Hydrocephalus Avoid rapid fluid drainage.
increased.
treatment)
Do not hold infant with head
elevated.

To allow the hyphema to settle out

HyphemaBlood in anterior HOB elevated 30-45 degrees, with
inferiorly and avoid obstruction of
chamber of eye night shield.
vision and to facilitate resolution

Post-op: HOB no more than 45

Abdominal aneurysm To avoid flexion of the graft.
degrees
Condition Position Rationale & Additional Info

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, low
prevention of down for 20-30 minutes after. carb, low fiber diet in small
frequent meals.

Instruct not to cough; place on

NPO; keep intestines moist and
Evisceration Place in low-Fowler’s position.
covered with sterile saline until
patient can be wheeled to OR.

Reverse Trendelenburg, slanted

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

Hiatal hernia Upright position after meals. To prevent gastric content reflux.

RIGHT side-lying position after To facilitate entry of stomach

Pyloric stenosis
meals. contents into the intestines.

To reduce dependent edema and

Extremity burns Elevate extremity.
pressure.

Facial burns or trauma Head elevated To reduce edema

Initially place in sitting position or To reduce blood pressures below

Autonomic dysreflexia high Fowler’s position with legs dangerous levels and provide
dangling. partial symptom relief.

HOB elevated 30-45 degrees; bed To prevent pressure on aneurysm

Cerebral aneurysm
rest 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

Hemorrhagic stroke HOB elevated 30 degrees. drainage.Avoid hip and neck
flexion which inhibits drainage.
Condition Position Rationale & Additional Info

To promote venous drainage.

Elevate HOB 30-45 degrees,
Increased intracranial Avoid flexion of the neck, head
maintain head midline and in
pressure (ICP) rotation, hip flexion, coughing,
neutral position.
sneezing and bending forward.

To facilitate venous drainage and

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

To drain secretions and prevent

Seizure Side-lying or recovery position.
aspiration.

Immobilize on spinal backboard,

head in neutral position and
immobilized with a firm, padded
cervical collar. To prevent any movement and
Spinal cord injury
further injury.
Must be log rolled without allowing
any twisting or bending
movements

To decrease intracranial pressure

Elevate HOB 30 degrees, head (ICP).Keep head from flexing or
Head injury
should be kept in neutral position. rotating.
Avoid frequent suctioning.

Ask patient to dorsiflex foot of the

Elevate FOB for counter-traction;
affected leg to assess function of
Buck’s Traction use trapeze for moving; place
peroneal nerve, weakness may
pillow beneath lower legs.
indicate pressure on the nerve.

Casted arm Elevate at or above level of heart To minimize swelling

Elevate foot of bed to elevate To hasten venous return and

Delayed prosthesis fitting
residual limb. prevent edema.

Affected extremity needs to be Use splints, wedge pillow, or

Hip fracture
abducted. pillows between legs.
Condition Position Rationale & Additional Info

Avoid stooping, flexion position

during sex, and overexertion
during walking or exercise.

On unaffected side: maintain

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

Immediate prosthesis fitting Elevate residual limb for 24 hours. Rigid cast acts to control 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 To prevent dizziness and
Total hip replacement
on affected side; pivot patient to orthostatic hypotension.
unaffected side.

Acute Respiratory Distress To promote oxygenation via

High Fowler’s
Syndrome (ARDS) maximum chest expansion.

Patient should be immediately

repositioned with the right atrium
Air embolism from dislodged Turn to LEFT side or place in
above the gas entry site so that
central venous line Trendelenburg.
trapped air will not move into the
pulmonary circulation.

High Fowler’s

Tripod position: sitting position To promote oxygenation via

Asthma
while leaning forward with hands maximum chest expansion.
on knees.

Chronic Obstructive High Fowler’s To promote maximum lung

Pulmonary Disease (COPD) Orthopneic position expansion and assist in breathing.

High Fowler’s To promote maximum lung

Emphysema
Orthopneic position expansion

Pleural Effusion High Fowler’s To provide maximal

Condition Position Rationale & Additional Info

To maximize breathing
High Fowler’s
mechanisms.
Pneumonia Lay on affected side
To splint and reduce pain.
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

Pulmonary edema To decrease edema and congestion
position

High Fowler’s
To promote maximum lung
Pulmonary embolism Turn patient to LEFT side and lower expansion and assist in breathing.
HOB

To provide maximal comfort and

Flail chest High Fowler’s
maximize breathing mechanisms.

To promote maximum lung

Rib fracture High Fowler’s
expansion and assist in breathing.

Placed in semi-Fowler’s or side-

Contraction stress test (CST) Monitor for post-test labor onset.
lying position

To prevent pressure on the cord. If

Shrimp or fetal position; modified
Cord prolapse cord prolapses, cover with sterile
Sims’ or Trendelenburg.
saline gauze to prevent drying.

To reduce compression of the vena

Fetal distress Turn mother to her LEFT side.
cava and aorta.

Late decelerations (placental To allow more blood flow to the

Turn mother to her LEFT side.
insufficiency) placenta.

Placenta previa Sitting position. To minimize bleeding.

To remove pressure off the

Variable decelerations (cord Place mother in Trendelenburg presenting part of the cord and
compression) position. prevent gravity from pulling the
fetus out of the body.

Spina Bifida Prone (on abdomen). To prevent sac rupture.

Condition Position Rationale & Additional Info

Position on back or in infant seat.

Cleft lip (congenital) Hold in upright position while To prevent trauma to suture line.
feeding.

Relieves pressure or gravity from

During labor: Knee-chest position pulling the cord.
Prolapsed umbilical cord
or Trendelenburg. Hand in vagina to hold presenting
part of fetus off cord.

HOB elevated no more than 30

Affected extremity should be kept
Cardiac catheterization (post) degrees or flat as prescribed.May
straight.
turn to either side

Continuous Bladder Irrigation Tape catheter to thigh; no other Prevents the catheter from being
(CBI) positioning restrictions dislodged.

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

During procedure: Tilt head

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

Drop to center of the lower

conjunctival sac; blink between
Tilt head back and look up, pull lid
Eye drops drops; press inner canthus near
down.
nose bridge for 1-2 min to prevent
systemic absorption.

During: Shrimp or fetal position To maximize spine flexion.

(side-lying with back bowed, knees
Lumbar puncture drawn up to abdomen, neck flexed
to rest chin on chest). To prevent spinal headache and
After: Flat on bed for 4-12 hours. CSF leakage.

High Fowler’s with head tilted Closes the trachea and opens the
Nasogastric tube insertion
forward esophagus; prevents aspiration.
Condition Position Rationale & Additional Info

HOB elevated 30 to 45 degrees;

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

Lung area needing drainage should

Postural Drainage Trendelenburg
be in uppermost position

Allows gravity to work into the

Left side-lying (Sims’ position) with direction of the colon by placing
Rectal enema administration
right knee flexed. the descending colon at its lowest
point.

To allow fluid to flow in the natural

Rectal enemas and irrigation Left side-lying, Sims’ position
direction of the colon.

To enhance lung expansion and

Sengstaken-Blakemore and reduce portal blood flow,
HOB elevated
Minnesota tubes permitting esophagogastric balloon
tamponade.

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

After: Assist patient into any

comfortable position preferred.
Condition Position Rationale & Additional Info

Total Parenteral Nutrition

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

Bed rest for 24 hours, keep

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

Perineal procedures Lithotomy For better visualization of the area.

To relieve abdominal pain and ease

Appendectomy Post-op: Fowler’s position
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.

Provides better visualization of the

Hemorrhoidectomy During: Prone Jackknife position.
area.

Hypophysectomy
Surgical removal of the HOB elevated. To prevent increase in ICP.
pituitary gland.

Infratentorial surgery
Flat and lateral on either side;
Incision at back of head, To facilitate drainage.
avoid neck flexing.
above nape of 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.
Laminectomy Sit straight in straight-backed chair
when out of bed or when
ambulating.
Condition Position Rationale & Additional Info

To maintain airway and decrease

Laryngectomy HOB elevated 30-45 degrees
edema.

To allow lymph drainage.

Semi-Fowler’s with arm on
Mastectomy Turn only on back and on
affected side elevated.
unaffected side.

Mitral valve replacement Post-op: semi-Fowler’s position. To assist in breathing.

Post-op: Position on side of

Myringotomy To allow drainage of secretions
affected ear .

Bed rest with minimal activity and

repositioning. Helps detached retina fall into
Retinal detachment
Area of detachment should be in place.
the dependent position.

HOB elevated 30-45 degrees;

Supratentorial surgery
maintain head/neckline in midline
Incision front of head below To facilitate drainage.
neutral position; avoid extreme hip
hairline
and neck flexion.

To reduce swelling and edema in

Post-op: High Fowler’s or semi-
the neck area.
Fowler’s.
Thyroidectomy To decrease tension on the suture
Avoid extension and movement by
line and support the head and
using sandbags or pillows.
neck.

To facilitate drainage and relieve

Tonsillectomy Post-op: prone or side-lying
pressure on the neck.

To expose the area.

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

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

Foot of bed elevated for first 24

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