Therapeutic Positions are used to promote comfort of the patient. Proper turning and positioning allows the health care provider to make clients, as comfortable as possible, prevent contractures, and pressure sore, and facilitate diagnostic test for surgical intervention. To relieve pressure to new positions every 2 hours. Three factors significant in positioning are- Pressure, Friction and Shear According to Annamma Jacob, Positioning is defined as placing the patient in good body alignment as needed therapeutically. According to nurseinfo.in, Positioning is defined as placing the person in such a way to perform therapeutic interventions to promote the health of an individual PURPOSE To promote comfort To prevent complication To stimulate circulation To promote normal physiologic functions. ARTICLES Clean, dry, firm bed Different types of mattress Bed Boards Pillows Footboards/ Foot boot Sandbags Hand rolls Trochanter rolls Bed blocks Over bed Table Additional Sheets Trapeze bar PRINCIPLES Maintain good body mechanics. Obtain assistance as required. Ensure that mattress is firm and level of bed is at working height. Ensure that sheets are clean and dry. Avoid placing a body part directly over another to prevent pressure. Plan a regular position change schedule for the patient for 24 hours.. Ensure patient comfort. Wash hand before and after procedure TYPES OF POSITIONING Fowler’s Position Orthopenic Position Prone Position Lateral/ Side Lying Position Sims’s Position/ Semi- Prone Position Lithotomy Position Trendelenburg Position Reverse Trendelenburg Position Supine Position Dorsal Recumbent Position Knee-chest Position Rose Position Other Position FOWLER’S POSITION Purpose To relieve or minimize dyspnea To relieve tension on abdominal sutures ORTHOPENIC POSITION High fowler’s position with over bed table placed in front of the client. Client to rest with both hands on over the bed table/on pillow placed on it and lean forward. Leaning forward facilitates respiration by allowing maximum chest expansion. Indications: Patient with severe dyspnea Cardiac Patients Position for thoracentesis Patient with chest drainage tubes Relieve Respiratory distress Pericarditis ARDS COPD Emphysema Asthma PRONE POSITION The client is in flat position only abdomen with head turned to one side. The head rest on a pillow, one or both hands beyond the head or at the sides. Indication Patients with pressure sores, burns, injuries, and operations on back For patients after 24 hours of amputation of lower limbs Position for renal biopsy To prevents aspiration NTD Recovery positions after anesthesia LATERAL POSTION Also known as SIDE LYING POSITION. Client lies on the side with weight on his hips, shoulder pillow support, and stabilizes. Upper most leg, arm, head and back. In this position, trunk is right angle to bed. Indication To promote lung and cardiac function During seizure attack and air embolism (Left lateral) Patient with pyloric stenosis after meals.

1. POSITIONING
BY;
ANUSHRI SRIVASTAVA

2. KEY TERMS
• Prone : Face down
• Supine : Lying on back
• High Fowler’ s : Head of bed elevated 80-90
degree
• Dorsal Recumbent : Supine with legs flexed in an
elevated position
• Flexion : Movement that decreases the
angle between two body
parts
• Extension : Straightening movement that
increases the angle
between two body parts
• Hyperextension : Excessive movement of a joint in
one direction (straightening)

3. INTRODUCTION
• Therapeutic Positions are used to promote comfort
of the patient.
• Proper turning and positioning allows the health
care provider to make clients, as comfortable as
possible, prevent contractures, and pressure sore,
and facilitate diagnostic test for surgical
intervention.
• To relieve pressure to new positions every 2 hours.
• Three factors significant in positioning are-
Pressure, Friction and Shear

4. DEFINITION
• According to Annamma Jacob,
Positioning is defined as placing the patient in
good body alignment as needed
therapeutically.
• According to nurseinfo.in,
Positioning is defined as placing the person in
such a way to perform therapeutic
interventions to promote the health of an
individual

5. PURPOSE
• To promote comfort
• To prevent complication
• To stimulate circulation
• To promote normal physiologic functions.

6. ARTICLES
• Clean, dry, firm bed
• Different types of mattress
• Bed Boards
• Pillows
• Footboards/ Foot boot
• Sandbags
• Hand rolls
• Trochanter rolls
• Bed blocks
• Over bed Table
• Additional Sheets
• Trapeze bar

7. PRINCIPLES
• Maintain good body mechanics.
• Obtain assistance as required.
• Ensure that mattress is firm and level of bed is at
working height.
• Ensure that sheets are clean and dry.
• Avoid placing a body part directly over another to
prevent pressure.
• Plan a regular position change schedule for the
patient for 24 hours..
• Ensure patient comfort.
• Wash hand before and after procedure.

8. 1. Fowler’ s Position
2. Orthopenic Position
3. Prone Position
4. Lateral/ Side Lying Position
5. Sims’ s Position/ Semi- Prone Position
6. Lithotomy Position
7. Trendelenburg Position
8. Reverse Trendelenburg Position
9. Supine Position
10. Dorsal Recumbent Position
11. Knee-chest Position
12. Rose Position

9. FOWLER’ S POSITION

10. Purpose
• To relieve or minimize dyspnea
• To relieve tension on abdominal sutures

11. Procedure:
NURSING ACTION RATIONALE
1. Inform patient of the
position, he will be in and
provide needed explanation
Understanding reduces
anxiety and promotes
relaxation
2. Elevate head of the bed
Fowlers (45-90)
Semi- Fowler (15- 45)
High Fowler (90)
Increases comfort and
relaxation
3. Rest head against mattress
and small pillow
Prevents cervical flexion and
contractures

12. NURSING ACTION RATIONALE
4. Use pillow to support arms. Prevents shoulder dislocation,
promote circulation and
prevents flexion contractures
of arms and wrists
5. Place a small pillow at
lower back
Supports lumbar vertebra and
prevents exaggerated flexion
of vertebrae
6. Place a small pillow/ roll
under thigh
Prevents hyperextension of
knee and occlusion of
popliteal artery from pressure
of body weight
7. Place small pillow under
ankle
Prevents prolonged pressure
on heels
8. Place footboard at bottom
of patients feet
Maintains dorsiflexion and
prevents foot drop

13. ORTHOPENIC POSITION

14. • High fowler’ s position with over bed table
placed in front of the client.
• Client to rest with both hands on over the bed
table/on pillow placed on it and lean forward.
Leaning forward facilitates respiration by
allowing maximum chest expansion.

15. Indications:
• Patient with severe dyspnea
• Cardiac Patients
• Position for thoracentesis
• Patient with chest drainage tubes
• Relieve Respiratory distress
• Pericarditis
• ARDS
• COPD
• Emphysema
• Asthma

16. PRONE POSITION
• The client is in flat position only abdomen with
head turned to one side. The head rest on a pillow,
one or both hands beyond the head or at the
sides.

17. Indication
• Patients with pressure sores, burns, injuries, and
operations on back
• For patients after 24 hours of amputation of
lower limbs
• Position for renal biopsy
• To prevents aspiration
• NTD
• Recovery positions after anesthesia

18. Procedure:
NURSING ACTION RAT IONALE
1. After providing
explanation about the
procedure, roll patient
over, with arm positioned
close to the body with
elbows straight, and
hands under hips.
Position the patient on
abdomen in center of bed
with bed flat
2. Turn the patient’ s head
to one side and support
with a small pillow
Reduces flexion or
hyperextension of cervical
vertebrae

19. NURSING ACTION RAT IONALE
3. Place small pillow under
abdomen below the
diaphragm
Reduces hyperextension of
lumbar vertebrae and strain on
lower back. Reduces pressure
on breasts for women and on
genitals for men
4. Support arm in flexed
position at level of
shoulder
Reduces risk of shoulder
dislocation
5. Support lower legs with
pillows to elevate toes
Reduces foot drop and
external rotation of legs.
Reduces pressure of mattress
on toes

20. LATERAL POSTION

21. • Also known as SIDE LYING POSITION.
• Client lies on the side with weight on his
hips, shoulder pillow support, and stabilizes.
Upper most leg, arm, head and back.
• In this position, trunk is right angle to bed.

22. Indication
• To promote lung and cardiac function
• During seizure attack and air embolism (Left
lateral)
• Patient with pyloric stenosis after meals
(Right lateral)
• Patients who required periodic positions
changes- bed ridden patients
• In immediate post-operative patients to
prevent the risk of aspiration (except in spinal
and epidural anesthesia)

23. Procedure:
NURSING ACTION RATIONALE
1. Provide explanation and
prepare patient for the
position change
2. Lower head of bed as
low as patient can
tolerate
3. Position patient to side
of bed

24. NURSING ACTION RATIONALE
4. Turn the patient to one side (in
helpless patient) flex’ s patient
knee that will be away from
mattress, place hand on that
side to patient’ s hip and the
other hand at shoulder, then roll
patient to one side
Prevents injury and trauma to tissue
5. Place pillow under patient’ s
head and neck.
Maintain’ s alignment , reduces
lateral neck flexion and decreases
strain on sternocliedomastoid
muscle
6. Bring shoulder blade forward Prevents weight from resting directly
over shoulder joint
7. Position both the arms in flexed
position. Upper most arm is
supported by pillow on level with
shoulder
Decreases internal rotation and
adduction of shoulder. Ventilation is
improved as chest can expand

25. NURSING ACTION RATIONALE
8. Place tuck-back pillow
under back (pillow folded
lengthwise and smooth
area tucked under back)
Provides support to maintain
patient on side
9. Place pillow under
semi-flexed upper leg level
at hip, from groin to foot
Prevents hyperextension of leg,
maintains alignment and
prevents foot drop
10.Place sand bag parallel to
plantar surface of
dependent foot
Prevents foot drop

26. SIM’ S POSITION
• Also known as Semi- Prone position

27. Indication
• Vaginal and rectal examination
• Administration of enema and suppository
• Position for sigmoidoscopy and proctoscopy
• To prevent aspiration

28. Procedure:
NURSING ACTION RATIONALE
1. Provide explanation and
prepare patient for the
position
2. Place head of the bed
flat
3. Place patient in supine
position
4. Turn patient onto lateral
position lying partially on
abdomen

29. NURSING ACTION RATIONALE
5. Place small pillow under
head and neck
Maintains alignment and
prevents lateral neck flexion
6. Place pillow under flexed
upper arm supporting arm
level with shoulder
Prevents internal rotation of
shoulder
7. Place pillow under flexed
upper leg, supporting leg
level with hip
Prevents internal rotation of
hip.
Maintains proper alignment
8. Place sandbags parallel to
plantar surface of
dependent foot
Prevents plantar flexion

30. LITHOTOMY POSITION

31. Indications
• For vaginal delivery and vaginal examination
• For rectal surgeries, example Hemorrhoidectomy,
Fissurotomy
• Childbirth
• For vaginal hysterectomy
• Transurethral Resection of Prostrate (TURP)

32. Procedure:
NURSING ACTION RATIONALE
1. Place patient in supine
position
2. Place pillow under head
and neck
Prevents hyperextension of
neck
3. Place both legs flexed at
hip and knee at angle 90
with legs supported on
stirrups

33. TRENDELENBURG POSITION
• Entire frame of bed tilted with head of bed down

34. Indication
• Postural drainage
• Management of hypotension and shock
• Patients with deep vein thrombosis
• Cord prolapse patient
• To shift abdominal organs upward in certain
surgeries

35. NURSING ACTION RATIONALE
1. Explain procedure to
patient
2. Place patient in supine
position
3. Lower head end of the
bed using bed key. If
bed key is not
adjustable type, used
bed block at foot end
and tilt entire frame of
bed down
Procedure

36. REVERSE TREDELENBURG
POSITION

37. • It is just opposite to Trendelenburg position.
In this position, head of the bed is elevated
then the foot level with no flexion at waist
level
Indication
To minimize gastro esophageal reflex

38. SUPINE POSITION
• It is a back lying position with arms on the
side

39. Indication
• Physical Examination
• Resting
• Undergoing anesthesia
• Lung biopsy

40. DORSAL RECUMBENT POSITION

41. It is also a back lying position, in this
position’ s head and shoulder may be
elevated on a small pillow. Arms are resting
on side. Legs are apart with knees flexed
and foot resting on the bed
Indication
• Physical examination of abdominal and genital
area
• Perineal area
• PV examination

42. KNEE – CHEST POSITION
(Genu-pectoral Position)

43. • Patient rests on the knees and chest with head is turned
to one side, arms extended on the bed, and elbows flexed
and resting so that they partially bear the patient weight;
the abdomen remains unsupported, though a small pillow
may be placed under the chest.
• In this position severe hypotension occurs because of
pooling of blood in the extremities.
Indication
• Sigmoidoscopy
• Lumbar Laminectomy

44. ROSE POSITION
• Both the head and neck are extended, done
by keeping a sand bag under the supine
patient’ s shoulder blade.
Indication
• Tonsillectomy
• Adenoidectomy
Contraindication
• Down Syndrome

45. For Colorectal
surgeries
For kidney surgeries

46. BEACH CHAIR POSITION
Commonly used position in upper extremity
surgery

47. CONCORDE POSITION
Neurosurgery

48. SQUATTING POSITION
•Strength training
•Exercise for legs and muscles
•Birth position

49. THREE QUARTER PRONE POSITION
For parieto-occipito surgery

50. CARDIAC CHAIR POSITION
Provide relief to the lungs and circulatory system

51. STANDING POSITION

52. SITTING POSITION

53. PARK BENCH POSITION
•Neurosurgery

54. LLOYD DAVIS POSITION
This position is used to assess the pelvis for
gyanecological, urological and colorectal procedures

55. Passive Leg Raising POSITION
This position is used in
hypovolumic shock

56. SUMMARY
Today I deal with ‘ Positioning’ . In this
topic, I discussed key terms, introduction of
positioning, definition of positioning,
purpose and articles required for
positioning, general principles in
positioning and various types of positions,
their purpose, procedures and uses.

57. CONCLUSION
Positioning the patient ensures comfort to
the patient, prevent complications like
contractures and decubitus ulcer and also
help to do therapeutic and diagnostic
procedures. Position of the client should be
change every 2 hours.

58. BIBLIOGRAPHY
• Jacob annamma, R rekha, Tarachand jadhav
sonali. Clinical Nursing Procedures: The Art of
Nursing Practice. Edition III. New Delhi: The
Health Science Publishers; Page number
137-42
• Correia cecy sister. Principles and Practice of
Nursing Art of Nursing Procedures. Volume I.
New Delhi: Jaypee Brothers Medical
Publishers; Page number 44-49
• https://nurseinfo.in/patient-positioning-nursin
g-procedures/ 2019 May

59. thanking
you !