What alterations for the lithotomy position would you consider for a client with copd?

Not a lot: When the patient is put in the lithotomy position it is for access to a certain area in the pelvis or perineum. The legs can sometimes be adjusted based on the type of surgery. The big concern for lung issues would be to keep excess pressure off of the lungs so they can function properly. If the table is tilted to far in a head down position the lungs can not work as well.