Patient'Positioning'Cheat'Sheet'

Patient'Positioning'Cheat'Sheet'

! Positioning!patients!correctly!is!important!for!a!variety!of!reasons.!In!surgery,!proper!positioning!provides!optimal!exposure!of!the! surgical!site!and!maintenance!of!the!patient's!dignity!by!controlling!unnecessary!exposure.!Additionally,!positioning!patients!provides! airway!management!and!ventilation,!maintaining!body!alignment,!and!provide!physiologic!safety.!Here's!a!list!of!the!common! conditions,!procedures,!and!diseases!with!their!recommended!position!and!rationale!for!each.!!

!

Condition'

Position'

Rationale'&'Additional'Info'

Bronchoscopy!

After:!SemiAFowler's!

To!reduce!aspiration!risk!from!difficulty!of!swallowing!

Cerebral!angiography!

During:'Flat!on!bed!with!arms!at!sidesF!kept!still.!!

' After:!Extremity!in!which!contrast!was!injected!is!kept!

straight!for!6!to!8!hours.!Flat,!if!femoral!artery!was! used.!

Apply!firm!pressure!on!site!for!15!minutes!after!the! procedure.!

Myelogram!(air!contrast)!

Pre9op:!surgical!table!will!be!moved!to!various! positions!during!test.!

! Post9op:!HOB!is!lower!than!trunk.!!

To!disperse!dye.!!

Myelogram!(oilAbased!dye)!

Pre9op:!surgical!table!will!be!moved!to!various!

positions!during!test.!! ! Post9op:!Flat!on!bed!for!6!to!8!hours!

To!disperse!dye.! ! !

To!prevent!CSF!leakage.!!

Myelogram!(waterAbased! dye)! Liver!biopsy!

Lung!biopsy! Renal!biopsy! Arteriovenous!fistula! Peritoneal!Dialysis!

Meniere's!Disease!!

Pre9op:!surgical!table!will!be!moved!to!various! positions!during!test.!!

! Post9op:!HOB!elevated!for!8!hours.! During:'Supine!with!RIGHT!side!of!upper!abdomen!

exposedF!RIGHT!arm!raised!and!extended!behind! and!and!overhead!and!shoulder.!! After:'RIGHT!sideAlying!with!pillow!under!puncture!site.!!

Flat!supine!with!arms!raised!above!head!and!hands! health!togetherF!head!and!arms!on!pillow.!

PRONE!with!pillow!under!the!abdomen!and!shoulders.! Post9op:!Elevate!extremity!

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

Change!position!slowlyF!bedrest!during!acute!phase!

! ! ! To!prevent!dye!from!irritating!the!meninges.!

To!expose!the!area.!! ! ! !

To!apply!pressure!and!minimize!bleeding.!!

To!expose!and!provide!easy!access!to!the!area.!!

To!expose!the!area.!

Don't!sleep!on!affected!sideF!encourage!exercise!by! squeezing!a!rubber!ball.!

Don't!use!AV!arm!for!BP!reading!and!venipuncture.!!

Turning!facilitates!drainageF!check!for!kinks!in!the! tubing.!!

Possible!to!have!abdominal!cramps!and!bloodAtinged! outflow!if!catheter!was!placed!in!the!last!1A2! weeks.!!

Cloudy!outflow!is!never!normal.!!

Provide!protection!when!ambulating!

Autografting!

Internal!radiation,!during! treatment!

Heart!failure!with!pulmonary! edema!

Immobilize!site!for!3!to!7!days.! Strict!bedrest!while!implant!is!in!place!

Sitting!up,!with!legs!dangling!

To!promote!healing!and!maximal!adhesion.!

To!prevent!dislodgement!of!the!implant!device.!! Provide!own!urinal!or!bedpan!to!patient.!!

To!decrease!venous!return!and!reduce!congestionF! promotes!ventilation!and!relieves!dyspnea.!

Myocardial!infarction! Pericarditis! Peripheral!artery!disease!

Shock!

SemiAFowler's!

HighAFowlers,!upright!leaning!forward.!!

Depending!on!desired!outcome.!Slight!elevation!of!legs! but!not!above!the!heart!or!slightly!dependent.!

Dangle!legs!on!side!of!the!bed.!

Flat!on!bed.!

Sickle!Cell!Anemia!

Varicose!veins,!leg!ulcers,! and!venous!insufficiency!

Deep!vein!thrombosis!

Tracheoesophageal!fistula! (TEF)!

Ventriculoperitoneal!shunt! (for!Hydrocephalus! treatment)!

Hyphema! Blood%in%anterior%chamber%of% eye! Abdominal!aneurysm!

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

Elevate!extremities!above!heart!level.!

Bed!rest!with!affected!limb!elevated.! After!24!hours!after!heparin!therapy,!patient!can!

ambulate!if!pain!level!permits.!

HOB!elevated!30A45!degrees.!

After!shunt!placement:!Place!on!nonAoperative!side!in! flat!position.!

! HOB!raised!15A30!degrees!if!ICP!is!increased.!! ! Do!not!hold!infant!with!head!elevated.!!

HOB!elevated!30A45!degrees,!with!night!shield.!!

Post9op:!HOB!no!more!than!45!degrees!!

To!help!lessen!chest!pain!and!promote! respiration.! To!help!lessen!pain.!! To!slow!or!increase!arterial!return!

To!improve!or!increase!circulation.! Trendelenburg!is!no!longer!a!recommended!position.!! To!promote!maximum!lung!expansion!and!assist!in!

breathing.!! To!prevent!pooling!of!blood!in!the!legs!and!facilitate!

venous!returnF!avoid!prolonged!standing.!! To!promote!circulation.!

To!prevent!reflux.!

Avoid!rapid!fluid!drainage.!!

To!allow!the!hyphema!to!settle!out!inferiorly!and! avoid!obstruction!of!vision!and!to!facilitate! resolution!

To!avoid!flexion!of!the!graft.!!

Dehiscence!

Dumping!Syndrome,! prevention!of!

Evisceration!

Gastroesophageal!reflux! disease!(GERD)!

Hiatal!hernia!

Place!in!lowAFowler's!position!then!raise!knees!or! instruct!knees!and!support!them!with!a!pillow.!

Take!meals!in!reclining!position,!lie!down!for!20A30! minutes!after.!

Place!in!lowAFowler's!position.!

Reverse!Trendelenburg,!slanted!bed!with!head!higher.! ! Pediatric:!prone!with!HOB!elevated.! Upright!position!after!meals.!

To!decrease!tension!on!the!abdomen.!!

To!delay!gastric!emptying!time.!! Restrict!fluids!during!meals,!low!carb,!low!fiber!diet!in!

small!frequent!meals.!! Instruct!not!to!coughF!place!on!NPOF!keep!intestines!

moist!and!covered!with!sterile!saline!until!patient! can!be!wheeled!to!OR.!! To!promote!gastric!emptying!and!reduce!reflux.!

To!prevent!gastric!content!reflux.!!

Pyloric!stenosis!

Extremity!burns! Facial!burns!or!trauma! Autonomic!dysreflexia!

RIGHT!sideAlying!position!after!meals.!

Elevate!extremity.! Head!elevated! Initially!place!in!sitting!position!or!high!Fowler's!position!

with!legs!dangling.!!

To!facilitate!entry!of!stomach!contents!into!the! intestines.!

To!reduce!dependent!edema!and!pressure.!

To!reduce!edema!

To!reduce!blood!pressures!below!dangerous!levels! and!provide!partial!symptom!relief.!!

!

2!

Source:!!!

For!more!cheat!sheets!visit:!!

Cerebral!aneurysm! Heat!stroke! Hemorrhagic!stroke! Increased!intracranial! pressure!(ICP)! Ischemic!stroke!

Seizure!

HOB!elevated!30A45!degreesF!bed!rest! Supine,!flat!with!legs!elevated.!! HOB!elevated!30!degrees.!! Elevate!HOB!30A45!degrees,!maintain!head!midline!and!

in!neutral!position.!! HOB!flat!in!midline,!neutral!position.!

SideAlying!or!recovery!position.!!

To!prevent!pressure!on!aneurysm!site!

To!promote!venous!return!and!maintain!blood!flow!to! the!head.!

To!reduce!ICP!and!encourage!blood!drainage.! Avoid!hip!and!neck!flexion!which!inhibits!drainage.!

To!promote!venous!drainage.! Avoid!flexion!of!the!neck,!head!rotation,!hip!flexion,!

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.!

Spinal!cord!injury!

Head!injury! Buck's!Traction! Casted!arm! Delayed!prosthesis!fitting! Hip!fracture!

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!

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

Elevate!FOB!for!counterAtractionF!use!trapeze!for! movingF!place!pillow!beneath!lower!legs.!

Elevate!at!or!above!level!of!heart!

Elevate!foot!of!bed!to!elevate!residual!limb.!

Affected!extremity!needs!to!be!abducted.!

Hip!replacement!

Immediate!prosthesis!fitting! Osteomyelitis!

On!unaffected!side:!maintain!abduction!when!in!supine! position!with!pillow!between!legs.!

HOB!raised!to!30A45!degrees.!

Elevate!residual!limb!for!24!hours.!

Support!affected!extremity!with!pillows!or!splints!

Total!hip!replacement!

Acute!Respiratory!Distress! Syndrome!(ARDS)!! Air!embolism!from!dislodged! central!venous!line!

Help!to!sitting!positionF!place!chair!at!90!degrees!angle! to!bedF!stand!on!affected!sideF!pivot!patient!to! unaffected!side.!!

High!Fowler's!

Turn!to!LEFT!side!or!place!in!Trendelenburg.!

Asthma!

Chronic!Obstructive! Pulmonary!Disease!(COPD)! Emphysema!

High!Fowler's! Tripod!position:!sitting!position!while!leaning!forward!

with!hands!on!knees.!

High!Fowler's! Orthopneic!position!

High!Fowler's!

!

Source:!!! For!more!cheat!sheets!visit:!!

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!prevent!edema.! Use!splints,!wedge!pillow,!or!pillows!between!legs.!! Avoid!stooping,!flexion!position!during!sex,!and! overexertion!during!walking!or!exercise.!! Avoid!extreme!internal!or!external!rotation.!

Rigid!cast!acts!to!control!swelling.!! To!maintain!proper!body!alignmentF!avoid!strenuous!

exercises.!

To!prevent!dizziness!and!orthostatic!hypotension.!

To!promote!oxygenation!via!maximum!chest! expansion.!!

Patient!should!be!immediately!repositioned!with!the! right!atrium!above!the!gas!entry!site!so!that! trapped!air!will!not!move!into!the!pulmonary! circulation.!!

To!promote!oxygenation!via!maximum!chest! expansion.!!

To!promote!maximum!lung!expansion!and!assist!in! breathing.!!

To!promote!maximum!lung!expansion!

3!

Pleural!Effusion! Pneumonia!

Pneumothorax! Pulmonary!edema!

Orthopneic!position!

High!Fowler's!

High!Fowler's! ! Lay!on!affected!side! ! Lay!with!affected!lung!up!

High!Fowler's!

High!Fowler's,!legs!dependent!position!

To!provide!maximal!!

To!maximize!breathing!mechanisms.!! !

To!splint!and!reduce!pain.!! !

To!reduce!congestion.!

To!promote!maximum!lung!expansion!and!assist!in! breathing.!!

To!decrease!edema!and!congestion!

Pulmonary!embolism! Flail!chest! Rib!fracture!

High!Fowler's! Turn!patient!to!LEFT!side!and!lower!HOB!

High!Fowler's!

High!Fowler's!

Contraction!stress!test!(CST)! Placed!in!semiAFowler's!or!sideAlying!position!

To!promote!maximum!lung!expansion!and!assist!in! breathing.!!

To!provide!maximal!comfort!and!maximize!breathing! mechanisms.!!

To!promote!maximum!lung!expansion!and!assist!in! breathing.!!

Monitor!for!postAtest!labor!onset.!!

Cord!prolapse! Fetal!distress!

Shrimp!or!fetal!positionF!modified!Sims'!or! Trendelenburg.!

Turn!mother!to!her!LEFT!side.!

To!prevent!pressure!on!the!cord.!If!cord!prolapses,! cover!with!sterile!saline!gauze!to!prevent!drying.!!

To!reduce!compression!of!the!vena!cava!and!aorta.!!

Late!decelerations!(placental! insufficiency)!

Turn!mother!to!her!LEFT!side.!

Placenta!previa!

Sitting!position.!

To!allow!more!blood!flow!to!the!placenta.!! To!minimize!bleeding.!

Variable!decelerations!(cord! compression)!

Place!mother!in!Trendelenburg!position.!

Spina!Bifida!

Prone!(on!abdomen).!

To!remove!pressure!off!the!presenting!part!of!the! cord!and!prevent!gravity!from!pulling!the!fetus!out! of!the!body.!

To!prevent!sac!rupture.!

Cleft!lip!(congenital)! Prolapsed!umbilical!cord!

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

During'labor:!KneeAchest!position!or!Trendelenburg.!

Cardiac!catheterization!(post)!

Continuous!Bladder!Irrigation! (CBI)! Ear!drops!

HOB!elevated!no!more!than!30!degrees!or!flat!as! prescribed.!!

May!turn!to!either!side!

Tape!catheter!to!thighF!no!other!positioning!restrictions!

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.!!

!

Source:!!! For!more!cheat!sheets!visit:!!

To!prevent!trauma!to!suture!line.!

Relieves!pressure!or!gravity!from!pulling!the!cord.!! Hand!in!vagina!to!hold!presenting!part!of!fetus!off!

cord.! Affected!extremity!should!be!kept!straight.!!

Prevents!the!catheter!from!being!dislodged.!

Pull!outer!ear!upward!and!back!for!adultsF!upward! and!down!for!children.!!

Better!visualization!and!drainage!of!the!medium!to! the!ear!canal!via!gravity.!!

4!

Eye!drops!

Tilt!head!back!and!look!up,!pull!lid!down.!

Lumbar!puncture!

Nasogastric!tube!insertion! Nasogastric!tube!irrigation! and!tube!feedings!

During:'Shrimp!or!fetal!position!(sideAlying!with!back! bowed,!knees!drawn!up!to!abdomen,!neck!flexed!to! rest!chin!on!chest).!!

! After:'Flat!on!bed!for!4A12!hours.!

High!Fowler's!with!head!tilted!forward!

HOB!elevated!30!to!45!degreesF!keep!elevated!for!1! hour!after!an!intermittent!feeding.!

! With'decreased'LOC:'RIGHT!sideAlying!with!HOB!

elevated.! ! With'tracheostomy:!Maintain!in!semiAFowler's!position!

Paracentesis! Postural!Drainage!

During:'SemiAFowler's!in!bed!or!sitting!upright!on!side! of!bed!with!chairF!support!the!feet.!!

Post:!Assist!into!any!comfortable!position!

Trendelenburg!

Rectal!enema!administration! Left!sideAlying!(Sims'!position)!with!right!knee!flexed.!

Rectal!enemas!and!irrigation! Left!sideAlying,!Sims'!position!

SengstakenABlakemore!and! Minnesota!tubes!

HOB!elevated!

Thoracentesis!

Total!Parenteral!Nutrition! (TPN)! Vascular!extremity!graft! Perineal!procedures!

Before:'(1)!Sitting!on!edge!of!bed!while!leaning!on! bedside!table!with!feet!supported!by!stoolF!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.!

During'insertion:!Trendelenburg.!

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

Lithotomy!

Drop!to!center!of!the!lower!conjunctival!sacF!blink! between!dropsF!press!inner!canthus!near!nose! bridge!for!1A2!min!to!prevent!systemic!absorption.!!

To!maximize!spine!flexion.! To!prevent!spinal!headache!and!CSF!leakage.!

Closes!the!trachea!and!opens!the!esophagusF! prevents!aspiration.!

To!prevent!aspiration.!! ! !

Promotes!emptying!of!the!stomach!and!prevents! aspiration.! !

To!prevent!aspiration.!! Empty!the!bladder!before!procedureF!report!elevated!

temperatureF!assess!for!hypovolemia.!

Lung!area!needing!drainage!should!be!in!uppermost! position!

Allows!gravity!to!work!into!the!direction!of!the!colon! by!placing!the!descending!colon!at!its!lowest!point.!!

To!allow!fluid!to!flow!in!the!natural!direction!of!the! colon.!!

To!enhance!lung!expansion!and!reduce!portal!blood! flow,!permitting!esophagogastric!balloon! tamponade.!!

Prevent!fluid!leakage!into!the!thoracic!cavity.!

To!prevent!air!embolism.!

For!maximal!adhesion.!!

For!better!visualization!of!the!area.!!

Appendectomy!

Post9op:!Fowler's!position!

To!relieve!abdominal!pain!and!ease!breathing.!

Cataract!surgery! Craniotomy!

Sleep!on!unaffected!side!with!a!night!shield!for!1!to!4! weeks.!!

SemiAFowler's!or!Fowler's!on!back!or!on!nonAoperative! side.!

HOB!elevated!30A45%!with!head!in!a!midline,!neutral! position.!

To!prevent!edema.! To!facilitate!venous!drainage.!

!

5!

Source:!!!

For!more!cheat!sheets!visit:!!

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