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Discussion

Am I right or wrong...please tell me

First off, let me sit the scenerio of prob #1.

Res. is 99 y/o. Fell in room and fx r. hip. at nursing home about a week ago. Sent to lg. hosp. and they sent res. back saying surgery wasn't possible d/t heart being too weak. She was at hosp. for 2 days. The lg. hosp. set the hip and started lovenox. They didn't send her back to the nursing home w/no PT, OT, or ST orders. Just no weight bearing on r. leg. They didn't give res. an abductor pillow to put between her legs. They just put a pillow against the inside of her leg and wrapped it with a blanket. The order said to put demend on resident and change PRN. I got to work today and she was one of my res. The only thing we're following up on is that she has an antibiotic for UTI. Nothing about the fracture. Then I started working on the orders that I had received and there was an order that it was ok to get res. up in G-chair. Res. weighs almost 200 pounds. So, I went to PT and asked if they had or were going to eval and tx. res. They said they asked the dr. for permission to, but no reply so far. I showed PT the order to get res. up in G-chair and she suggested that I didn't get her up yet. I told my CNA's to leave res. in bed for supper, not to move her at all unless they moved the entire body at one time, and not to raise the head of bed unless she was at a 90 degree angle. I went in the res. room to give her meds and do an accu check. Res was sitting at between a 45 and 90 degree angle. Also, I had heard through the grapevine, that we were suppose to use a Hoyer to get res. up. Am I right or wrong that the res. doesn't need to be a Hoyer or in a G-chair until PT evals and decides that its ok or at least longer than a week after she feel and fractured it??

Gripe #2!

My opinion of what I'm suppose to do as a patient advocate.

If I see or hear something or someone not treating a resident right whether that res. is on my "hall", then my job is to stop the actions ASAP and go to higher athority whether the person doing wrong is my best friend or my worst enemy. Also whether it could make my life a living h*ll for the next umpteen weeks. I figure it doesn't matter who it makes mad, as long as that res. is beening treated like they should be.

Right or wrong?

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I wouldn't get that dude up either. That guy has has done himself in though. Stay tuned for the inevitable... An impressive fulminant pneumonia or fat emboli to the pulmonary artery will soon follow.

I guess what you would do depends upon your facility/therapy policy states. At my facility, we can get them up even if therapy has not seen them. We know what NWB means and as long as we follow those rules, then we can get them up. You can use the Hoyer lift on someone without therapy telling you to as long as the doc did not specify bedrest except for therapy (which I have had). We just recently had a similar situation. She went to hospital after a fall @ home, no surgery, and was sent to my facilty with NWB status. This is a demented LOL. Her hubs refused to even let us put shoes on this lady. He refused for her to be up out of bed. No props under her feet. This lady is not going to get better now because she has footdrop so bed it will never be right. We educated this man and his family to no avail.

As for number two, if you see someone mistreating any patient, it should not matter who they are, you are to put a stop to it immediately and then get the "powers that be" involved in the situation. Even if they are a friend. No patient should be abused or mistreated.

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I too feel like it's fine to get the patient up as long as there is NWB on the leg and as long as the patient is made as comfortable as possible while being gotten up. And of course, the staff uses proper technique for getting the patient up. If you wait for the doctor to order it, the patient is liable to have pneumonia by then.

As to gripe number 2.... yep, you are absolutely right.

I don't understand the PT order to sit her up only if she is at 90 degrees but I may have missed the purpose of why they suggested that. With hip replacement patients, I understand the precautions are:

The patients hip should bend less than 90 degrees. For instance, when sitting, the patient's knees should be lower than their hips in a chair.

Place a pillow between the patients thighs to keep their knees from touching.

Always have a pillow between the patients legs when turning.Keep the patients toes from turning inward.

Don't allow the patient to cross their legs.

I am concerned about the NA's picking her up, the method I have seen and done in many nursing homes is one at the shoulders, one at the knees, and seems that you could un-set the hip doing that. Ask PT, but the hoyer, with a wedge or pillow between the thighs (hoyers will squeeze the legs together) would be safer. Again, the hip angle should be less than 90.

She/he only had her hip set, so maybe the precautions are different.

This is a 99 yr old with a non-operable fractured hip? Where is hospice? That's the direction I'd be going into.How badly do you think the hoyer lift will hurt? OUCH .I would NOT be in any hurry to get this person OOB at this point.

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