Patient is falling while standing up while sleeping

  1. The patient is 53 years old, 272 pounds, and 6 feet 4 inches tall. What can you do for a patient that keeps falling while sleeping on his feet? He has a spinal cord injury and just had a morphine pump intalled in his abdomen to control pain. He cannot sit at all and cannot lay down for long periods of time without feeling uncomfortable.
    He is a smoker and is not allowed to smoke in the house, therefore a smoking stand was built for him so he could lean on a hard surface for support. Rubber mats have been places on the cement floor to cushion his fall, but these are a poor answer to the problem. Is there a restraint system available which will hold him in case he falls again? Something that attaches to the ceiling beams perhaps?
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  2. 16 Comments

  3. by   ShirleyR
    Quote from hapyguy
    The patient is 53 years old, 272 pounds, and 6 feet 4 inches tall. What can you do for a patient that keeps falling while sleeping on his feet? He has a spinal cord injury and just had a morphine pump intalled in his abdomen to control pain. He cannot sit at all and cannot lay down for long periods of time without feeling uncomfortable.
    He is a smoker and is not allowed to smoke in the house, therefore a smoking stand was built for him so he could lean on a hard surface for support. Rubber mats have been places on the cement floor to cushion his fall, but these are a poor answer to the problem. Is there a restraint system available which will hold him in case he falls again? Something that attaches to the ceiling beams perhaps?
    Is he eligable for a motorized wheelchair (or even a regular wheelchair)? That way he can get around & if he falls asleep he will be in his chair. Also there are Clear acrylic trays that can fit on chairs that would restrict his falling out of the chair without making him feel imprisoned.
  4. by   ShirleyR
    Quote from ShirleyR
    Is he eligable for a motorized wheelchair (or even a regular wheelchair)? That way he can get around & if he falls asleep he will be in his chair. Also there are Clear acrylic trays that can fit on chairs that would restrict his falling out of the chair without making him feel imprisoned.
    Hope this helps
  5. by   meownsmile
    Sounds like he needs some serious smoking cessation first. If he isnt able to keep himself awake because of medication or narcalepsy he is the last person that should be smoking due to fire hazard.
    Next if his pain medication isnt keeping him any more comfortable than this, he needs a different route for pain control. Maybe a pain specialist would be in order. His first priority should be pain control not how to avoid falling when outside smoking.
    I think the priority is wrong in this patient and until he can learn to manage his condition certain things need to be put on the "back burner".
    I dont know that there is any equipment that will do what you are wanting, outside of a cattle hoist type of rig and i dont think that would really be appropriate.
  6. by   LPN1974
    I don't know what kind of "hard surface" you have for him, but in my mind it looks like some seat belt type things could be attached thru heavy screws, nuts, bolts, whatever, for his arms to go thru, so if he falls asleep he would still be held up.
    Poor man, he must really be suffering.
  7. by   hapyguy
    Quote from LPN1974
    I don't know what kind of "hard surface" you have for him, but in my mind it looks like some seat belt type things could be attached thru heavy screws, nuts, bolts, whatever, for his arms to go thru, so if he falls asleep he would still be held up.
    Poor man, he must really be suffering.
    It's like a stand up bar. I'm thinking a service bar rail might due the trick.
  8. by   hapyguy
    He has a motorized wheelchair but cannot sit in it for long periods of time. Patient will not quit smoking. patient is under pain managemnet- has been for several years- he just had the pump put in and is in the process of titration. He will be adjusting morphine for 4.5 months. He is being weaned of 200 mcg duralgesic patches and 800 mcg actiq lozenges. Hopefully the pain will be cotrolled after this period. I'm just concerned he will seriously hurt himself during this time frame.
  9. by   hollyster
    Hi
    It sounds as if your pt needs to be changed over to a dilaudid pump if the morphine has him in and out of conciousness and is still not giving him pain relief. Does he have an interferential stimulator(different then a TENS?) They do a great job disrupting the pain pathways.
  10. by   hapyguy
    Quote from hollyster
    Hi
    It sounds as if your pt needs to be changed over to a dilaudid pump if the morphine has him in and out of conciousness and is still not giving him pain relief. Does he have an interferential stimulator(different then a TENS?) They do a great job disrupting the pain pathways.
    The neurostimulator was not an option due to the location of the injury (the base of the coccyx). Pt is just sleep depived, not going in and out of conciousness.The Medline Synchromed II programmable pump, an interthecal drug delivery system, was installed 2/10/05. Pt is just starting to feel better with morphine dosage going up 1/3 of total dose each week. PT started with 1 mg morhine per day and is now at 1.758 mg a day. It is working-unfortunately pt has neuropathy in his legs that will not go away with the pain, causing difficulty when walking.
  11. by   hollyster
    Quote from hapyguy
    The neurostimulator was not an option due to the location of the injury (the base of the coccyx). Pt is just sleep depived, not going in and out of conciousness.The Medline Synchromed II programmable pump, an interthecal drug delivery system, was installed 2/10/05. Pt is just starting to feel better with morphine dosage going up 1/3 of total dose each week. PT started with 1 mg morhine per day and is now at 1.758 mg a day. It is working-unfortunately pt has neuropathy in his legs that will not go away with the pain, causing difficulty when walking.
    There is an external stimulator that can be used even at the base of the coccyx(it uses a the current runs through eight leads applied to the skin it does not need to be at exact site of the injury.
    I had surgery for two herniated disk,an anular tear and a cracked veterbra
    three weeks ago(work injury.) The stimulator has made all the difference. Understand the sleep deprivation (Ironic to be stuck in bed and not be able to sleep.) Is your pt taking Ambien or Sonata?
  12. by   ShirleyR
    Quote from hapyguy
    The neurostimulator was not an option due to the location of the injury (the base of the coccyx). Pt is just sleep depived, not going in and out of conciousness.The Medline Synchromed II programmable pump, an interthecal drug delivery system, was installed 2/10/05. Pt is just starting to feel better with morphine dosage going up 1/3 of total dose each week. PT started with 1 mg morhine per day and is now at 1.758 mg a day. It is working-unfortunately pt has neuropathy in his legs that will not go away with the pain, causing difficulty when walking.
    Is the patient on neurontin? Our Docs usually start with 100mg bid or tid for nerve pain.
  13. by   hapyguy
    Yes- Pt is on 300 mg Neurontin every eight hours. Pt unually takes this med once a day because of side effects.
  14. by   Liddle Noodnik
    Quote from hollyster
    There is an external stimulator that can be used even at the base of the coccyx(it uses a the current runs through eight leads applied to the skin it does not need to be at exact site of the injury.
    I had surgery for two herniated disk,an anular tear and a cracked veterbra
    three weeks ago(work injury.) The stimulator has made all the difference. Understand the sleep deprivation (Ironic to be stuck in bed and not be able to sleep.) Is your pt taking Ambien or Sonata?

    {{{{{{{{{{{{{{{{{Hollyster}}}}}}}}}}}}}}

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