Group1: Positioning

and Turning
Group Members
• April Ramirez
• Mikhail Robles 💞
• Jasmine De Lara
• Zsarina Mae Mercado
• Harold Angeles
• Ericka Biazon
• Lanzen Gio Cruz
2
“ “Safety brings first aid to the
uninjured.”

– F.S. Hughes

3
What is
Patient
Positioning?
4
 What is Patient
Positioning?
Patient positioning involves properly
maintaining a patient’s neutral body alignment
by preventing hyperextension and extreme
1 lateral rotation to prevent complications of
immobility and injury. Positioning patients is an
essential aspect of nursing practice and a
responsibility of the registered nurse.
 What is Patient
Positioning?
In surgery, specimen collection, or
other treatments, proper patient positioning

2 provides optimal exposure of the

surgical/treatment site and maintenance of the
patient’s dignity by controlling unnecessary
exposure. In most settings, positioning patients
provide airway management and ventilation,
maintaining body alignment, and provide
physiologic safety.
Goals of
Patient
Positioning
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Goals Of Patient
Positioning:
The ultimate goal of proper patient
positioning is to safeguard the patient from
injury and physiological complications of
3 immobility. Specifically, patient positioning
goals include:
• Provide Patient Comfort and Safety
• Maintaining Patient Privacy and Dignity
• Allows Maximum Visibility and Access
Provide Patient Comfort
and Safety:
Support the patient’s airway and maintain the
circulation throughout the procedure.
Impaired venous return to the heart, and

4 ventilation-to-perfusion mismatching are

common complications.
Proper positioning promotes comfort by
preventing nerve damage and by preventing
unnecessary extension or rotation of the body.
Maintaining Patient
Privacy and Dignity:
In surgery, proper positioning is a
way to respect the patient’s
5 dignity by minimizing exposure of
the patient who often feels
vulnerable perioperatively.
Allows Maximum
Visibility and Access:
Proper positioning allows ease of
surgical access as well as for
6 anesthetic administration during
perioperative phase.
Guidelines
for Patient
Positioning
& Turning
12
Important Guidelines:
Proper execution is needed during patient positioning to prevent injury
for both the patient and the nurse. Remember these principles and
guidelines when positioning clients:

• Explain the procedure. Provide explanation to the client on why his

or her position is being changed and how it will be done. Rapport
with the patient will make them more likely to maintain the new

7 •
position.
Encourage client to assist as much as possible. Determine if the
client can fully or partially assist. Clients that can assist will save
strain on the nurse. It will also be a form exercise, increase
independence, and self-esteem for the client.
• Get adequate help. When planning to move or reposition the client,
ask help from other caregivers. Positioning may not be a one-
person task.
• Use mechanical aids. Bed boards, slide boards, pillows, patient lifts
and slings can facilitate ease of changing positions.
Important Guidelines:
• Raise client’s bed. Adjust or reposition the client’s bed so
that the weight is at the level of the nurse’s center of
gravity.
• Frequent position changes. Note that any position, correct
or incorrect, can be detrimental to the patient if

8 maintained for a long period. Repositioning the patient

every 2 hours helps prevent complications like pressure
ulcers and skin breakdown.
• Avoid friction and shearing. When moving patients, lift
rather than slide to prevent friction that can abrade the
skin making it more prone to skin breakdown.
Important Guidelines:
Proper body mechanics. Observe good body
mechanics for you and your patient’s safety.

Position self close to the client.

 Avoid twisting your back, neck, and pelvis by
keeping them aligned.
9  Flex your knees and keep feet wide apart.
 Use your arms and legs and not your back.
 Tighten abdominal muscles and gluteal muscles in
preparation for the move.
 Person with the heaviest load coordinates efforts of
the nurse and initiates the count to 3.
 Position self close to the client.
Common
Patient
Positions
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• Supine or Dorsal
Recumbent Position
•
Supine position, or dorsal
recumbent, is wherein the
patient lies flat on the back with
head and shoulders slightly
elevated using a pillow unless
contraindicated (e.g.,
spinal anesthesia, spinal
surgery).
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Supine Position:
 Variation in position. In supine position, legs may be extended or
slightly bent with arms up or down. It provides comfort in general for
patients under recovery after some types of surgery.
 Most commonly used position. Supine position is used for general
examination or physical assessment.
 Watch out for skin breakdown. Supine position may put patients at risk
for pressure ulcers and nerve damage. Assess for skin breakdown and
pad bony prominences.
 Support for supine position. Small pillows may be placed under the
head to and lumbar curvature. Heels must be protected from pressure
by using a pillow or ankle roll. Prevent prolonged plantar flexion and
stretch injury of the feet by placing a padded footboard.
 Supine position in surgery. Supine is frequently used on procedures
involving the anterior surface of the body (e.g., abdominal area, cardiac,
thoracic area). A small pillow or donut should be used to stabilize the
head, as extreme rotation of the head during surgery can lead to
occlusion of the vertebral artery.
19
• Fowler’s Position
•
Fowler’s position, also known
as semi-sitting position, is a bed
position wherein the head of the
bed is elevated 45 to 60
degrees. Variations of Fowler’s
position include: low Fowler’s (15
to 30 degrees), semi-
Fowler’s (30 to 45 degrees),
and high Fowler’s (nearly
vertical).
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Fowler’s Position:
 Promotes lung expansion. Fowler’s position is used for patients who
have difficulty breathing because in this position, gravity pulls
the diaphragm downward allowing greater chest and lung expansion.

 Useful for NGT. Fowler’s position is useful for patients who have
cardiac, respiratory, or neurological problems and is often optimal for
patients who have nasogastric tube in place.

 Prepare for walking. Fowler’s is also used to prepare the patient for
dangling or walking. Nurses should watch out for dizziness or faintness
during change of position.

 Poor neck alignment. Placing an overly large pillow behind the patient’s
head may promote the development of neck flexion contractures.
Encourage patient to rest without pillows for a few hours each day to
extend the neck fully.

 Used in some surgeries. Fowler’s position is usually used in surgeries

that involve neurosurgery or the shoulders
Fowler’s Position:

 Use a footboard. Using a footboard is recommended to

keep the patient’s feet in proper alignment and to help
prevent foot drop.

 Etymology. Fowler’s position is named after George

Ryerson Fowler who saw it as a way to decrease mortality
of peritonitis.
• Orthopneic or Tripod
position
• Places the patient 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. 23
Orthopneic Position:
 Maximum lung expansion. Patients who
are having difficulty breathing are often
placed in this position because it allows
maximum expansion of the chest.
 Helps in exhaling. Orthopneic position is
particularly helpful to patients who have
problems exhaling because they can press
the lower part of the chest against the
edge of the overbed table.
• Prone Position:
• In prone position, the patient
lies on the abdomen with
head turned to one side and
the hips are not flexed.

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Prone Position:
 Extension of hips and knee joints. Prone position is the only bed position that
allows full extension of the hip and knee joints. It also helps to prevent flexion
contractures of the hips and knees.

 Contraindicated for spine problems. The pull of gravity on the trunk when the
patient lies prone produces marked lordosis or forward curvature of the spine
thus contraindicated for patients with spinal problems. Prone position should
only be used when the client’s back is correctly aligned.

 Drainage of secretions. 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.

 Placing support in prone. To support a patient lying in prone, place a pillow

under the head and a small pillow or a towel roll under the abdomen.

 In surgery. Prone position is often used for neurosurgery, in most neck and
spine surgeries.
• 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. Increase in
flexion of the top hip and knee provides
greater stability and balance. This flexion
reduces lordosis and promotes good back
alignment.

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Lateral Position:
 Relieves pressure on the sacrum and heels. Lateral
position helps relieve pressure on the sacrum and
heels especially for people who sit or are confined
to bed rest in supine or Fowler’s position.
 Body weight distribution. 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.
 Support pillows needed. To correctly position the
patient in lateral position, use of support pillows are
needed.
• Sims’ Position:
• Sims’ position or semi prone position
is when the patient assumes a posture
halfway between the lateral and the
prone positions. The lower arm is
positioned behind the client, and the
upper arm is flexed at the shoulder and
the elbow. The upper leg is more
acutely flexed at both the hip and the
knee, than is the lower one.

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Sims’ Position:
 Prevents aspiration of fluids. Sims’ may be used for unconscious clients
because it facilitates drainage from the mouth and prevents aspiration of
fluids.

 Reduces lower body pressure. It is also used for paralyzed clients because
it reduces pressure over the sacrum and greater trochanter of the hip.

 Perineal area visualization and treatment. It is often used for clients

receiving enemas and occasionally for clients undergoing examinations or
treatments of the perineal area.

 Pregnant women comfort. Pregnant women may find the Sims position
comfortable for sleeping.

 Promote body alignment with pillows. Support proper body alignment in

Sims’ position by placing a pillow underneath the patient’s head and under
the upper arm to prevent internal rotation. Place another pillow between
legs.
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• Lithotomy Position:
• Lithotomy position is
commonly used for
vaginal examinations and
childbirth.

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36
Lithotomy Position:
Modifications of the lithotomy position include low, standard, high, hemi, and
exaggerated based on how high the lower body is raised or elevated for the procedure.

Low Lithotomy Position: The patient’s hips are flexed until the angle between the
posterior surface of the patient’s thighs and the O.R. bed surface is 40 degrees to
60 degrees. The patient’s lower legs are parallel with the O.R. bed.2

Standard Lithotomy Position: The patient’s hips are flexed until the angle between
the posterior surface of the patient’s thighs and the O.R. bed surface is 80 degrees
to 100 degrees. The patient’s lower legs are parallel with the O.R. bed.

Hemi lithotomy Position: The patient’s non-operative leg is positioned in standard

lithotomy. The patient’s operative leg may be placed in traction.

High Lithotomy Position: The patient’s hips are flexed until the angle between the
posterior surface of the patient’s thighs and the O.R. bed surface is 110 degrees to
120 degrees. The patient’s lower legs are flexed.

Exaggerated Lithotomy Position: The patient’s hips are flexed until the angle
between the posterior surface of the patient’s thighs and the O.R. bed surface is 130
degrees to 150 degrees. The patient’s lower legs are almost vertical.
• Trendelenburg
Position:
• Trendelenburg’s
position involves lowering
the head of the bed and
raising the foot of the bed of
the patient. The patient’s
arms should be tucked at
their sides
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Trendelenburg Position:
 Promotes venous return. Hypotensive patients
can benefit from this position because it
promotes venous return.
 Postural drainage. Trendelenburg’s position is
used to provide postural drainage of the basal
lung lobes. Watch out for dyspnea, some
patients may require only a moderate tilt or a
shorter time in this position during postural
drainage. Adjust as tolerated.
40
• Reversed
Trendelenburg
Position:
• Reverse Trendelenburg’s is a
patient position wherein the
the head of the bed is
elevated with the foot of the
bed down. It is the opposite
of Trendelenburg’s position.
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Reversed Trendelenburg
Position:
 Gastrointestinal problems. Reverse Trendelenburg is often
used for patients with gastrointestinal problems as it
helps minimize esophageal reflux.
 Prevent rapid change of position. Patients with decreased
cardiac output may not tolerate rapid movement or
change from a supine to a more erect position. Watch out
for rapid hypotension. It can be minimized by gradually
changing the patient’s position.
 Prevent esophageal reflux. Promotes stomach emptying
and prevents reflux for clients with hiatal hernia.
• Knee Chest Position:

• Knee-chest position, can be in

lateral or prone position. In lateral
knee-chest position, the patient
lies on their side, torso lies
diagonally across the table, hips
and knees are flexed. In prone
knee-chest position, the patient
kneels on the table and lower
shoulders on to the table so chest
and face rests on the table.
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Knee-Chest Position:
 Two ways. Knee-chest position can be lateral
or prone.
 Sigmoidoscopy. Usual position adopted for
sigmoidoscopy without anesthesia.
 Patient dignity. Prone knee-chest position can
be embarrassing for some patients.
 Gynecologic and rectal examinations. Knee-
chest position is assumed for a gynecologic or
rectal examination.
Jackknife Position:

• Jackknife position, also

known as Kraske, is wherein
the patient’s abdomen lies
flat on the bed. The bed is
scissored so the hip is lifted
and the legs and head are
low.
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Jackknife Position:
 In surgery. Jackknife position is frequently used for surgeries
involving the anus, rectum, coccyx, certain back surgeries, and
adrenal surgery.
 Requires team effort. At least four people are required to perform
the transfer and position the patient in the operating table.
 Cardiovascular effects. In jackknife position, compression of the
inferior vena cava from abdominal compression also occurs, which
decreases venous return to the heart. This could increase the risk
for deep vein thrombosis.
 Support paddings. Many pillow sare required on the operating
table to support the body and reduce pressure on the pelvis, back,
and the abdomen. Jackknife position also puts excessive pressure
on the knees. While positioning, surgical staff should put extra
padding for the knee area.
Kidney Position:
• In kidney position, the patient assumes a
modified lateral position wherein the
abdomen is placed over a lift in the
operating table that bends the body. Patient
is turned on their contralateral side with
their back placed on the edge of the table.
Contralateral kidney is placed over the
break in the table or over the kidney body
elevator (if attachment is available). The
uppermost arm is placed in a gutter rest at
no more than 90º abduction or flexion.

47
Kidney Position:
 Access to retroperitoneal area. Kidney positions allows
access and visualization of the retroperitoneal area. A
kidney rest is placed under the patient at the location of
the lift.
 Risk for falls - Patient may fall off the table at anytime
until the position is secured.
 Padding and stabilization support. Contralateral arm
underneath the body is protected with padding.
Contralateral knee is flexed and the uppermost leg is left
straight to improve stability. A large soft pillow is placed
in between the legs. Kidney strap and tape are placed over
the hip to stabilize the patient.
Support Devices
& Aids:
Positioning and
Turning
Support Devices:
Bed Boards. Bed boards are plywood boards that are placed under the
entire surface area of the mattress and are useful for increasing
back support and body alignment.
Foot Boots. Foot boots are shoes made of rigid plastic or heavy foam
and keep the foot flexed at the proper angle. It is recommended
that they should be removed 2 to 3 times a day to assess the skin
integrity and joint mobility.
Hand Rolls. Hand rolls maintain the fingers in a slightly flexed and
functional position and keep the thumb slightly adducted in
opposition to the fingers.
Hand-Wrist Splints. These splints are individually molded for the client
to maintain proper alignment of the thumb in a slight adduction
and the wrist in slight dorsiflexion.
Support Devices:
Pillows. Pillows provide support, elevate body parts, splint incision
areas, and reduce postoperative pain during activity, coughing or
deep breathing. They should be of the appropriate size for the
body to be positioned.
Sandbags. Sandbags are soft devices filled with substance that can be
used to shape or contour to the body’s shape and provide support.
They immobilize extremities and maintain specific body alignment.
Side Rails. Side rails are bars along the sides of the length of the bed.
They ensure client safety and are useful for increasing mobility.
They also provide assistance in rolling from side to side or sitting
up in bed. Check with your agencies policies regarding the use of
side rails as they vary state to state.
Support Devices:
Trochanter Rolls. These rolls prevent external rotation of the legs when
the client is in the supine position. To form a roll, use a cotton bath
blanket or a sheet folded lengthwise to a width extending from the
greater trochanter of the femur to the lowest border of the
popliteal space.
Wedge Pillows. Are triangular pillows made of heavy foam and are used
to maintain legs in abduction following total hip replacement
surgery.
Nursing
Responsibilities :
Patient
Positioning
Nursing Responsibilities:
1. Help the patient assume the desired or required
bed position. The nurse assists the patient to
achieve proper body positioning and alignment.
2. Support patient’s body in correct alignment using
pillows or splints.
3. Assure the proper use of supportive devices.
4. Frequently monitor and evaluate the position
selected.
5. Provide skin care as necessary.
6. Proper Documentation
7. Insurance of Patient’s Dignity and Privacy
Documenting Patient Positioning:
• Date and time of the procedure.
• Explanation of the procedure to the
patient.
• Notation of the position the patient was
placed in including rationale.
• Pertinent teaching given.
• Patient’s response to the procedure.
Leader’s Comments
• April Ramirez
• Mikhail Robles 💞
• Jasmine De Lara
• Zsarina Mae Mercado
• Harold Angeles
• Ericka Biazon
• Lanzen Gio Cruz
56
Thanks,
Questions?