I am 2 months into LPN school and so far all my patients are bound to the bed and maybe in a gerichair 2 hours out of the day. They all have 1 thing in common body contractures. Whether it be hand, arm, and legs. It's very challenging to provide care to these patients. I try my best to clean them but sometimes you can't get into those tight spots, for example(armpit)Patient is so contracted you can't open his arm to clean his armpit well.
Is there many potential nursing diagnosis for patients like this besides high risk for skin break down?
Thanks in advance,
Quote from waitingforthedream
What objective/subjective data do you have to back up a nursing dx?? Does he tell you he has pain, is he on meds for pain? Does he have bedsores?
NO bedsores, or any sign of skin breakdown.
You can see it in his face when we turn him that he is uncomfortable, or when we try to get his blood pressure. He does moan when we turn him but when I ask him if hes in pain he always shakes his head no. He does have pain meds prn. I think its because he doesn't care or doesn't wish to be bothered. I have never seen such a severe case of contractures ever before even working 10 years as a CNA I have never encountered anything like it. He refuses medication for the pain so my only option is to make him as comfortable as possible by giving him very good care, which is bathing, back rub with lotion, preventative skin ointment in his peri-area and positioning his body q2h, refuses mouth care but hopefully soon he will allow me to do that.
My main goal is maintaining his skin by keeping it clean and turning him every 2 hours. I also visit him often throughout my shift to just let him know I am there, check his foley and gtube site.
Last edit by deemarys on Mar 21, '09