Fundamentals - Principles, part 10: Patient Positions
by Meris Shuwarger BSN, RN, CEN, TCRN July 19, 2021 Updated: December 07, 2022 4 min read 2 Comments
In this article, you'll learn about the major patient positions like supine, prone, all three Fowler's, Lateral, Trendelenburg and reverse Trendelenburg, lithotomy. You'll also learn about Sims' position and why we want to change its name.
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
What is patient positioning?
Patient positioning is assisting patients to move their bodies into specific positions that maintain a safe and healthy body alignment, provide optimal exposure to treatment sites, and/or prevent complications from immobility.
Before you learn about patient positioning, it might seem like one of those obvious things you never really think about. Can open heart surgery be performed while someone is lying on their front? Probably not. But as you will learn, there is a science to positioning patients optimally depending on circumstances, conditions, and medical procedures.
Supine position is your patient lying on their back in a neutral back. Neutral back means that the neck, pelvis, or otherwise are not twisted in any direction or hyperextended.
SUPine - patient is facing UP.
Prone position is your patient lying on their stomach in a neutral position. Their head will usually be to one side or the other, but there are special pillows or shelves available so that patients can have a truly neutral neck and upper spine (i.e., be "facedown") if that is required.
Prone position helps prevent hip flexion contractures in patients who have had lower extremity amputations, and improves oxygenation in respiratory distress.
Semi-Fowler's is when your patient is sitting up, but they are at an angle between 30 and 45 degrees.
A little geometry reminder: 0 degrees is flat (which would be supine), and 90 degrees is straight up (e.g., sitting up in a chair). So 45 degrees is about halfway between that.
In Fowler's position, your patient is sitting up with the head of the bed between 45 and 60 degrees.
Who was Fowler? Fowler's position is named for George Ryerson Fowler, a turn-of-the-century American surgeon. Fowler performed many abdominal surgeries, and noticed that accumulated drainage under the diaphragm was causing sepsis in patients who were lying down. Sitting his patients up allowed gravity to assist with safer drainage.
High Fowler's position
In high Fowler's position, your patient is sitting straight up with the head of the bed between 60 to 90 degrees. This is the ideal position to help with difficulty breathing.
This is one of the easiest interventions you can give to a patient who is having respiratory distress, and it is very noninvasive and safe.
Lateral position is your patient lying on their left or right side, with their weight on their hip and shoulder.
Exaggerated runner's position / Sims' position
Exaggerated runner's position / Sims' position is a mix of lateral and prone position. The patient is lying on their left side, their leg is extended, their right leg is flexed at the hip. This position is ideal for enema administration.
The name Sims' position comes from J. Marion Sims, who was a surgeon in the 1800s who became known as "the father of modern gynecology." However, Sims only knew what he knew about gynecology by experimenting on enslaved women, without their consent, and without anesthesia, using experimental methods.
It is important when you provide culturally competent care, to think about how history impacts how we know medicine, how we practice medicine, and how we interact with our patients.
In your clinical practice, exaggerated runner's position is a good term to use because it does not have an offensive and upsetting history, unlike the Sims' position. Exaggerated runner's position is useful because it reflects how the position actually looks, like someone running in bed.
Your facility may still use the term Sims' position. Nurses are advocates, so if you are interested in making this change in your facility, we encourage you to advocate for a new name for the position.
In the Trendelenburg position, the bed is flat, but tilted back, so the head of the bed is lower than the foot of the bed.
Trendelenburg position is ideal for patients with hypotension, especially if they have shock. However, Trendelenburg position should not be used for a long time, because it can increase the intracranial pressure due to the blood rushing back to the head.
Check out our Lab Values Flashcards for Nursing Students to learn more about expected intracranial pressure levels.
Reverse Trendelenburg position
In the reverse Trendelenburg position, the bed is flat, but tilted forward, so the head of the bed is higher than the foot of the bed. In this position, gravity helps lower the risk of gastroesophageal reflux.
Lithotomy position is when your patient is lying supine, but their legs are flexed and abducted. This is what you would see for a patient who is having a gynecologic, rectal, or urological procedure.
Hi. I'm Meris, and in this video, we are going to be talking about patient positions. I'm going to be following along with our Fundamentals of Nursing flashcards, which are available on our website, levelupRN.com.
So if you have these, and you are following along with me, I'm starting on card number 30.
All right. Let's get started. Okay. So starting off on card number 30. If you look at the back, you will notice that there are a lot of red words on here, which means that there is some really important stuff for you to know on this card.
So, first and foremost, we have the supine position.
Supine position is your patient laying on their back in a neutral back, and we do have a Cool Chicken hint here to help you remember what supine means.
So supine, the U-P in supine can help you to remember that your patient is facing up.
Moving on, we have prone. Now, prone means to be laying on your front, so laying on your stomach.
We do have some red text here that says that this improves oxygenation in respiratory distress, but it also helps to prevent flexion contractures in people who have had lower extremity amputations. Very, very, very important to know that positioning, especially as you progress through the program.
So then, we have three positions of Fowler's.
So we have semi-Fowler's. Semi-Fowler's is your patient is sitting up, but they are at an angle between 30 and 45 degrees.
Fowler's position, they are sitting up with the head of the bed at 45 to 60 degrees.
And then High Fowler's means that they are sitting up with the head of the bed at 60 to 90 degrees. Now, who do you think is going to benefit from sitting up all the way up in High Fowler's?
Think about it for a second. It's going to be patients who have difficulty breathing. Very important to know because this is one of the easiest interventions you can give to a patient who is having respiratory distress that doesn't require any kind of invasive or potentially dangerous intervention. So definitely keep that in mind.
Okay. So moving on to the next card, card 31, this is going to be the second part of patient positions. Now one of the first ones on here is lateral positioning. Lateral means the side, so this is going to be your patient laying on one of their sides with the hip on their weight and shoulder.
Now, there's a position on here that is called Sims' position. And for your test-taking purpose, for probably documenting in the hospital, Sims' position is the name that you need to know. And I'm going to talk to you about this in just a second.
But Sims' position is a mix of lateral and prone. So this means that your patient is lying on their left side. Their left leg is extended. Their right leg is flexed at the hip. And this is really ideal for enema administration.
Now, the reason I want to you about Sims' position is because the name of this position comes from J. Marion Sims, who is thought of as "the father of gynecology. This is very important for you to know that J. Marion Sims only knew what he knew about gynecology by experimenting on enslaved woman, without their consent, and without anesthesia, using experimental methods. So it's very important when you provide culturally competent care, to think about these very small things that impact how we know medicine, how we practice medicine, and how we interact with our patients. I would encourage you in clinical practice to use the term exaggerated runner's position. This is going to be a name that is not going to be offensive or upsetting in any way, and also kind of gives you a better description of what it looks like. It looks like somebody is running in bed. Now, this may be something that your facility does not use. But, again, nurses are advocates, so if you are interested in making a change like this, I would definitely encourage you to advocate for changing the language around Sims position to be exaggerated runners.
But, again, I want you to know that for your nursing school exams and for the NCLEX, Sims position is the name that you need to know.
Okay. Moving on. Trendelenburg. Trendelenburg means that the bed bed is flat, but the foot of the bed is elevated, okay? So the whole bed itself is flat, but the foot is elevated. So this means that the head of the bed goes down.
This is ideal for people struggling with hypotension, especially if they have shock. But you do want to note that this should not be used for a long time because it can increase the intracranial pressure due to the blood rushing back to the head.
Now we have reverse Trendelenburg. Same idea. Bed is flat, but head of the bed is up, and feet are down. This is different from Fowler's. Fowler's is this, right, where the legs are flat, but the head is elevated. Reverse Trendelenburg is like this. The feet are down, the head is up.
Then we also have lithotomy position. Lithotomy position is going to be your patient is lying supine, but their legs are flexed and abducted. So this is what you would see for a patient maybe who is having a gynecologic procedure or maybe undergoing a rectal or urologic procedure.
So very important to understand what all of the patient positioning terms mean because you will see them come up time and time again on your nursing exams.
Okay, so that is it for patient positions. I hope that was helpful for you. In my next video, I'm going to be talking about the chain and stages of infection, so definitely be sure that you are subscribed to our channel so that you can see that when it comes up. If you found this video helpful, please leave us a like or a comment. We would love to hear back from you. Thank you so much, and happy studying!
September 30, 2022
Nice explanation madam thank you so much !!! Exlent
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November 16, 2022
Thank you so much for your awesome explanation.