POSITIONING

Putting the client in an appropriate position to prevent development of complications and to

promote a function.
Change position frequently every 2 hours to prevent muscle discomfort, pressure ulcer, and
contractures. It can maintain muscle tone and stimulate postural reflexes.
Assess clients skin and provide skin care before and after positioning.
Use appropriate support devices or get assistance to co-workers if client cant move
independently and cannot be assisted with moving or turning.
Provide a firm mattress not sagging (contributes to low back pain and hip flexion contractures)
and bed and beddings should be dry, clean, and not wrinkled.

Position Description Indications Contraindications
Standing Anatomical position PA: best to assess for posture,
body alignment, and contours;
front, back, side parts of the body.

Rombergs Test
Leg problems
Back problems
Weak elderly
Hypotensive
Provide hand grip for
clients who cant stand.
Sitting Upright, sitting position

Promotes lung expansion
PA: Vital Signs, good visualization
of front and back upper body.

Thoracentesis
Physically weak
Orthopneic /
Tripod
Sitting in bed or on the side
of bed with arms leaning on
overbed table in front and
with pillow/s on top of table
to rest on.
Promotes maximum
chest expansion
Orthopnea (DOB except in upright
sitting position)





Supine Back-lying with or w/o
pillow on head and
shoulder, legs extended,
and feet dorsiflexed to
prevent foot drop; can
elevate forearm on pillow
placed on side.
Most relaxing position
PA: best for abdominal
assessment; V/S, easy access to
pulse sites, frontal body parts

Post lumbar puncture (NO
PILLOW) for 6 12 hours
Cardio and respiratory
problems

Dorsal
Recumbent
Back-lying with knees
flexed and feet flat on
surface


PA: perineal and rectal
IE of perineum
Perineal flushing and shaving
Peri-lighting after NSD
Catheterization
Cardiac and respiratory
problems
Prone Lying on the abdomen,
head turned to one side.
Hips are not flexed. Arms in
line with head.


Allows full extension of hip and
joints and prevents hip and
knee contractures
Unconscious client to prevent
aspiration.
Post surgery of mouth and
throat (Post tonsillectomy and
adenoidectomy)
Meningocele repair (birth defects
of spine and spinal membranes)
Post amputation (after the first
24 hours) for 20 minutes, several
times a day.
Poor body alignment
Lumbar spine
abnormalities
Cervical and neck
problems
Cardiac and respiratory
Causes plantar flexion
ONLY USED FOR
SHORT PERIODS OF
TIME


Side-lying /
Lateral
Lying on the side, partially
on the abdomen, flexing top
hip and knee, and placing
this leg in front of the body.
Reduces lordosis and promotes
good back alignment
Relieve pressure on sacrum
Lumbar puncture (spinal tap)
Limited joint movement
(hinders to bend hip
and knee)
Weak Elders

Support upper arm and leg
with pillows to prevent
adduction of shoulder and
hip.
After liver biopsy (right S lying)
Seizures (recovery position)
Supine Vena Cava Syndrome
(lateral recumbent)
Fetal heart rate deceleration
Sims or
Semi-prone
Lying on the side, semi
prone (lower arm behind
the body, uppermost leg
flexed at hip and knee,
upper arm flexed at
shoulder and elbow.


PA: rectum, vaginal
Rectal procedures & surgery
Rectal Enema (cleansing enema
b/c of the direction of colon)
Unconscious client to prevent
aspiration
Paralyzed clients (reduces
pressure on sacrum)
Comfortable for Pregnant
women
Obese
Weak Elders
Limited joint movement
Lithotomy Lying on the back with feet
supported on stirrups

Minimize time and keep
client well draped
PA: max exposure of vagina,
rectum
Perineal, vaginal, and rectal
procedures
Labor and Delivery, D&C
Catheterization
DOB
Leg problems
Weak Elders
Low Fowlers
or Semi-sitting
HOB elevated at 30

Allows chest expansion
and lung ventilation
Do not place overly large
pillow or pillows under the
neck which can lead to
neck flexion contractures
Dyspnea (DOB)
Normal Feeding
Increased ICP
Post-cataract surgery
Spinal problems
Cervical and neck
problems
Semi
Fowlers
HOB elevated at 45 Dyspnea (DOB)
Normal Feeding
Increased ICP
Autonomic Dysreflexia
Bleeding Esophageal Varices
Post - thyroidectomy

High Fowlers HOB elevated at 90 Dyspnea (DOB)
Normal Feeding
NGT Insertion and Feeding
Increased ICP
Autonomic Dysreflexia
Status Asthmaticus
Pneumothorax
Hiatal Hernia
GERD

Genupectoral /
Knee Chest
Trunk perpendicular to the
chest

WOF: do not leave client
alone. May feel dizzy,
faint, and fall.

N/A if Hypertensive
PA: rectum
Rectal Exam
Rectal (Fleet & Suppository)
Enema
Prostate Gland Exam
TX to bring uterus back to
normal position
DOB
Spinal, Cervical, and
neck problems
Leg problems
Weak Elders
Trendelenburg


Modified
Trendelenburg
Head down and legs
elevated

Lying on back & feet
elevated at 30 45* for
venous return
SHOCK
Circulatory Stasis
Hypotension
Clients who need increased
cerebral perfusion

Increased ICP & IOP
Cerebral Edema
Patient who will vomit
(increases pressure to
brain)

Reverse
Trendelenburg
Entire bed tilted with feet
downward
Prevents Gastric Reflux

Note:
Best position for a client to assume when moved up in bed is SUPINE with knees flexed (dorsal
recumbent)
Rectal Exam: Genupectural, Sims, and Horizontal Recumbent


Transport of Client

Always lock wheels on bed, stretcher, or wheelchair. Unexpected movements may result to injury

A. Bed to Wheelchair
Position wheelchair PARALLEL to bed.
Lock the wheels of the wheelchair and foot pedals up.

B. Bed to Stretcher
Place stretcher parallel to the bed.
Push the stretcher from the end where clients head is positioned.
Lock the wheels of the bed and stretcher.
When entering elevator, clients head goes in first.

Others:
* Use draw sheet when moving CVA clients up in bed.
* Highest priority of hemiplegic clients is SAFETY.

Assisting Clients in Ambulation
To increase muscle strength and joint mobility
To prevent potential problems of immobility
To increase sense of independence and self- esteem of client
Ambulate client gradually to prevent ORTHOSTATIC HYPOTENSION
If OHP or extreme weakness occurs, assist client quickly in a SITTING position and LOWER THE
HEAD between the knees to facilitate blood flow to brain.
If the client becomes dizzy or starts to fall during ambulation, slowly and gently lower him to the
floor and call for help. If the client is at high risk for falls, 2 nurses may be required to assist with
ambulation.

Controlling Orthostatic Hypotension
1. Avoid sudden position changes. Arise in bed in 3 stages
a. Sit up in bed for 1 minute
b. Sit on the side of bed, legs dangling for 1 minute
c. Stand holding to the edge of bed or another non-movable object for 1 minute

2. Wear elastic stockings at night to prevent venous pooling in legs
3. BEWARE of signs of OHP:
30 60 minutes after heavy meal.
1 2 hours after anti-hypertensive drugs
4. Get out of hot bath slowly. High temp can lead to venous pooling.
5. Refrain from strenuous activity which results to Vasalva Maneuver which DECREASES HEART
RATE leading to DECREASE BP.