Editing Fundamentals of Nursing (section)

=== Positions ===

* '''Supine (dorsal recumbent):''' flat on the back. Support the lumbar curve, place a small pillow under the head, and use a trochanter roll along the outer thigh to prevent external hip rotation. Foot supports prevent foot drop.
* '''Prone:''' on the abdomen, head turned to the side. Promotes hip extension. Poorly tolerated by patients with cardiac or respiratory compromise.
* '''Lateral (side lying):''' pillow between the knees and supporting the upper arm to prevent internal rotation and adduction.
* '''Sims:''' semiprone left side lying with the upper leg flexed. The position of choice for enema administration and rectal suppository insertion because it follows the natural curve of the sigmoid colon.
* '''Fowler variations:''' low or semi Fowler at 30 to 45 degrees, Fowler at 45 to 60 degrees, high Fowler at 60 to 90 degrees. High Fowler maximizes lung expansion and is used for dyspnea and for feeding.
* '''Trendelenburg:''' head lower than feet. Rarely used and contraindicated with increased intracranial pressure.
* '''Modified Trendelenburg:''' flat with legs elevated, sometimes used for hypotension or shock.
* '''Orthopneic:''' sitting up, leaning forward over a bedside table. Relieves severe dyspnea by allowing maximal chest expansion.

Position specific safety notes: elevate the head of the bed to at least 30 degrees for any patient receiving enteral feeding and keep it elevated for 30 to 60 minutes afterward to prevent aspiration. For pressure redistribution, however, avoid sustained head elevation above 30 degrees, because higher angles increase shear at the sacrum. Reposition patients in bed at least every two hours and patients sitting in a chair at least every hour, or teach chair bound patients to shift weight every 15 minutes.