Turning Patients

[Sg0223RN]

I know this sounds cruel but has anybody not turn a morbidly obese patient because they could not get help? I know we are suppose to be the patient care advocates, however, we need to watch for out health first and I am not willing to risk a severe back injury to turn a 300+ person myself! :dzed: I just get sooo mad when I see these patients that are severely obese and are taxing the resources of the hospital staff and health-care system. Sometimes I think it is all when can do just to make an obese patient comfortable!! Just ranting here but want some opinions from fellow nurses. I'm a relatively new RN and I don't know if I can stay in bedside care if this is the future of our patient care population! PLEASE GET SOME EXERCISE AND STOP EATING SO MUCH FAST FOOD AMERICA!!!:hdvwl:

[Darkfield]

I try to do a good turn and skin assessment at the beginning of the shift and a good turn at the end. Otherwise, they are at the mercy of the bed, which will turn just fine. We had a really really big guy with us for nearly two months and did this, and his skin looked great when he left.

[RNandRRT]

^ I think I remember management saying once that we were still supposed to turn when they are on a turning bed. Some of them are used more for lung issues, not skin breakdown. It still shifts the weight though (right?). Butt touching a air mattress, butt touching a pillow. Much difference? Beats me

Not quite. when the patient is in the bed and turning, the pressure remains the same on, for example, the sacrum. The rotation does not do anything to increase the blood flow to any pressure areas. When you put a pillow underneath one side of the patient, or butt, it lifts the sacrum even a little, allowing for better blood flow.

Our Total Care bed representative was very clear about this.

[RNFELICITY]

Well, I guess my viewpoint is that ALL people deserve care no matter what their size without me trying to pass judgement or push my own agenda on them. Not only for our own safety, but the safety of the patient, you should always get help with pretty much all turns. Patients rate turns as the most painful part of an ICU experience.

And, not all overweight people are over weight because they eat too much.

[evelyntanwy]

in my facility, no matter how big the patients, we must adhere by 2 hourly turnings for patients. if we complain a wee bit about any aches anywhere, my managers will just say this; " Just watch your body mechanics! What do they teach you in school?!"

helpful indeed. =/

[hcox1975, BSN, RN]

I once took care of a very large patient in clinicals that took 5 staff members to turn her. When we were through, I asked her if she would like me to turn the tv on. She couldn't move her rather large arms so I offered to turn the channel for her. When I asked her what she wanted to watch, she said "food network please". All I could think of was, "OMG! Really?!"

Where I work now we have these prevention measures we take with new admits. We apply a Meplilex pad to their sacrum and it seems to really help with breakdown. Of course, if they already have breakdown, this doesn't work.

I think every unit should have a wound care RN that just take care of wounds, dressings and turns. But this is real world nursing

[Hoozdo, ADN]

in my facility, no matter how big the patients, we must adhere by 2 hourly turnings for patients. if we complain a wee bit about any aches anywhere, my managers will just say this; " Just watch your body mechanics! What do they teach you in school?!"

helpful indeed. =/

I weigh 142 lbs and have a helper that weights approximately the same. One

patient 500 lbs another weighs 600 lbs. All the body mechanics in the world is not

going to help these patients or me.

One of the reasons I work PACU now.

[jrkingRN]

If everyone was healthy and perfect we'd all be out of jobs...

[resumecpr]

I too have felt the impact on my back and neck from lifting, boosting, and turning all kinds of patients (whether big or small). I've heard that some hospitals have a "Turning Team" specifically for heavier patients. It sounds nice, but I doubt the funds are there for most other places.

I do have a story about an obese (645lb) patient who died in the SICU. He was septic, in MODS and of course fluid resusitated. Daily weights were obtained. His family was more concerned about his weight gain of 2 pounds since admission than his poor prognosis. I remember one family member saying that "he better not gain another pound in this hospital or else!" I was appalled! What do you say to that?

Anywho, patient transport arrived after his death to take him to the morgue. There were about 8 staff in the room assisting with transfering him to the "cadillac morgue stretcher." They pulled the sheet on 3 and it tore, dropping the patient to the floor. I was working 2 units over and heard it.

It took 4 paramedics, two backboards, and 6 nurses to safely lift him off the floor and onto the stretcher.

I understand accidents happen, but I can't help but wonder if the size of the patient and lack of resources contributed to the poor outcome. There has got to be a better, more dignified way to care for bariatric patients.

[fiveofpeep]

^ what about a hoyer lift?

[3GTOBE]

Amen to job security. However ... even if obesity were eliminated, we would still have ETOH, drugs, overdose, suicide, attention seekers, drug seekers, psych ....... and the list of self-abusers goes on and on.