Several positions are used during a physical assessment including standing, sitting, supine, dorsal recumbent, prone, lateral, Sims', lithotomy, knee-chest, jackknife, and Trendelenburg's. Each position allows examination of different body areas while considering the patient's comfort, abilities, and medical conditions.

1. DIFFERENT PATIENT
POSITIONS

2. • Several positions are frequently required during the physical
assessment.
• It is important to consider the client’s ability to assume a position.
• The client’s physical condition, energy level, and age should also be
taken into consideration
• Some positions are embarrassing and uncomfortable and therefore
should not be maintained for long.
• The assessment is organized so that several body areas can be
assessed in one position.

3. STANDING POSITION

4. Standing Position
• The client stands still in a normal, comfortable, resting posture.
• This position allows the examiner to assess posture, balance, and gait.
• This position is also used for examining the male genitalia.

5. SITTING POSITION

6. Sitting Position
• The client should sit upright on the side of the examination table,
with back unsupported and legs hanging freely.
• In the home or office setting, the client can sit on the edge of a chair
or bed.
• Areas Assessed: head, neck, lungs, chest, back, breasts, axillae, heart,
vital signs, and upper & lower extremities.
• This position is also useful because it permits full expansion of the
lungs, and it allows the examiner to assess symmetry of upper body
parts.
• Cautions: Elderly and weak clients may require support

7. SUPINE POSITION

9. Supine Position aka “Horizontal Recumbent”
• Ask the client to lie down with the legs together on the examination
table (or bed if in a home setting). Back-lying with legs extended
• A small pillow may be placed under the head to promote comfort. (If
the client has trouble breathing, the head of the bed may need to be
raised)
• Areas assessed: head, neck, chest, breasts, axillae, abdomen, heart,
lungs, and all extremities.
• Cautions: Tolerated poorly by clients with cardiovascular and
respiratory problems

10. Fowler’s Position
Low Fowler’s position
Semi Fowler’s position
High Fowler’s
position

11. • 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).
USES
• 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.

12. • 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
• Use a footboard. Using a footboard is recommended to keep the
patient’s feet in proper alignment and to help prevent foot drop.

13. DORSAL RECUMBENT

14. Dorsal Recumbent
• The client lies down on the examination table or bed with the knees
bent, the legs separated, and the feet flat on the table or bed.
• This position may be more comfortable than the supine position for
clients with pain in the back or abdomen.
• Areas assessed: head, neck, chest, axillae, lungs, heart, extremities,
breasts, and peripheral pulses.
• Cautions: May be contraindicated for client’s who have
cardiopulmonary problems. Not used for abdominal assessment
because of the increased tension of abdominal muscle

15. PRONE POSITION

16. Prone position
• The client lies down on his or her abdomen with the head to the side.
• Areas assessed: Posterior thorax and hip joint movement
• Cautions: Often not tolerated by the elderly and people with
cardiovascular and pulmonary problems

17. LATERAL OR SIDE-LYING POSITION

19. 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.
• Areas assessed: occiput, posterior neck, upper and lower back area,
buttocks
• Cautions: Difficult for elderly and people with limited joint
movement.

20. SIMS’ POSITION

21. Sims’ position
• The client lies on his or her right or left side with the lower arm
placed behind the body and the upper arm flexed at the shoulder and
elbow. The lower leg is slightly flexed at the knee while the upper leg
is flexed at a sharper angle and pulled forward.
• Areas Assessed: rectum, vagina
• Cautions: Difficult for elderly and people with limited joint
movement.

22. LITHOTOMY POSITION

23. • The client lies on his or her back with the hips at the edge of the
examination table and the feet supported by stirrups.
• Areas Assessed: female genitalia, reproductive tracts, and the rectum.
• Cautions:
• The client may require assistance getting into this position. It is an
exposed position, and clients may feel embarrassed.
• In addition, elderly clients may not be able to assume this position
for very long or at all.

24. KNEE – CHEST POSITION

25. • Prone knee-chest: The client kneels on the examination table with the
weight of the body supported by the chest and knees. A 90-degree
angle should exist between the body and the hips. The arms are
placed above the head, with the head turned to one side
• Areas assessed: rectum
• Lateral knee-chest: The patient lies on their side, torso lies diagonally
across the table, hips and knees are flexed
• Areas assessed: low back, used for lumbar puncture
• Caution: This position may be embarrassing and uncomfortable for
the client, and, therefore, the client should be kept in the position for
as limited a time as possible. Elderly clients and clients with
respiratory and cardiac problems may be unable to tolerate this
position.

26. JACKKNIFE POSITION

27. Jackknife position
• Also known as Kraske
• It 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.
• Areas assessed: anus, rectum and lower back area
• Cautions: 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. It also puts
excessive pressure on the knees.

28. TRENDELENBURG’S POSITION

29. TRENDELENBURG’S POSITION
• It 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
• Not commonly use in assessment.
• 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.

30. Other Positions