We have a bariatric pt that I am having problems caring for. On night shift it is usually 2 nurses and no CNA on my floor. I dont' know how to turn/reposition/pull and otherwise provided the minimum standards of care for a 480 pound pt with just one other person to help. The pt is on a specialty bed that is so high off the ground that I have to stand on a stool to be able to do trach/oral care, and because it is a specialty bed, the "draw sheet" is the flimsy kinair brand blue pad. Something about how you can't use a regular draw sheet with the air mattress. The pt is almost twice as wide as the pad, you have to lift her abdomen to reach the blue pad.
No lifts available in my building that can handle greater than 350 pounds. I ended up calling another floor to borrow help, but later that floor had a code situation and couldn't send help, poor pt had to lay in stool until early dayshift arrived, almost 1 1/2 hours, poor thing, because without a true draw sheet, the 2 of us literally could not get her turned on her side without additional help. Did I mention pt prob has cdif? :stone
Does anyone have any ideas for a draw sheet that isn't contraindicated in a kinair bed that will actually be large enough to be effective? Or know of any way to move this pt. I'm short, 5'1" and my arms are too short to reach all the way across this pt without standing on my tiptoes balancing on the stool, and laying on the pt. I'm terrified I am going to hurt the pt or myself, or loose my balance and fall off the darn stool.
The problem is the pt isn't sedated, she's wide awake, extremely anxious and won't let you pull her arm to pull her over...Thanks for the suggestion though.
First of all, you definitely need to document the lack of adequate staffing and equipment.
Then, is she able to understand? If so, gently explain to her that you would appreciate it if she could help you as much as possible. If she is strong enough to fight you, she is strong enough to help, IF you can overcome her anxiety. That is a hurdle that can possibly be tough to jump.
Good luck and I hope you are able to work things out to the patient's advantage as well as your own.
Thank you for the advice, if noone else has done so already, I'll try to get an order for a rectal tube tonight.
I did try to keep the pt well medicated, she has backpain so I gave her the lortab routinely, and did give her some ativan after asking her is she wanted "something to help you be less nervous". It seemed to help some, she was more cooperative, I just hope the next shift kept medicating her also. The problem is the doctors say give her the bare minimum due to her respiratory status, and so some don't give her any at all.
Also, I'm going to ask for "proof" that all we can use is the flimsy little blue pads with no bottom sheet. If no proof, she's getting a real draw sheet.
I seem to be developing a good rapport with her, so maybe it will go better tonight.
If we don't recieve help with her in a timely manner tonight, I'm filling out an incident report.
Incidentally, this hospital is actually striving to become more nurse friendly, it's becoming a main focus, with "town hall" meetings with nursing staff monthly.
They are building a new hospital, each floor will have bariatric rooms with installed lifts in the ceiling and other assistive devices, including the coolest shower set up I've ever seen for pt care. I've seen the mockups and it is very "back friendly" for providing care to bariatrics, but for the here and now I'm in a building that was built in the late 50's/early 60's, with tiny rooms that don't even have showers.
With the bariatric pts I have assisted, I have found it helps to give them the sense that they are in control as much as possible. The bariatric person feels literally trapped in their own bodies, has experienced the disdain of many care givers, and emotionally is usually pretty needy. When you go to turn her, always explain every move. Give her clear directions. Reassure her that you are approaching this in a safe way.
You just HAVE TO have a turning sheet. I can't imagine turning her without that. Not only is it physically close to impossible, you also are increasing the opportunity for shearing, tugging and pulling on joints, and hurting yourself to boot. If two of you are all you have this is what I would do. (assuming you are starting with her on her back)Have the turning sheet (it needs to be thick and sturdy) go up to her shoulders and about down to her knees. Both of you should begin by standing side by side on the opposite side of the bed from the direction you are turning her. Side by side, grasp the turning sheet and slowly slide her towards you. Most likely you will have to stop half way to adjust her head position and lower legs, and again at the end. OK, get your breath! MOve to the other side of the bed ( the side she will be facing when you have her on her side). Ask her to reach for the hand rail in the direction you are turning her as much as possible during the roll. Bend the top knee and lean it towards the roll. She will be reaching towards you, so that will make her feel less frightened. Reach over her and grasp the turning sheet towards you as your partner assist on the other side of the bed. Use her weigh as much as possible instead of fighting it.When you think of a roll, instead of a turn, you think in terms of using gravity to your advantage.
This has worked with my pts, but every situation is different. I wish you the best!:balloons:
I do think your patient is heavier, and you will probably need more than two.
I had a 300? pound patient, and I could do her alone, but she could reach and pull some of her weight and was very cooperative.
Oh yeah! if you need to pull her up in bed and she can tolerate it , put the feet up and the head down a bit to use gravity to your advantage.
tvccrn, ASN, RN
762 Posts
First of all, you definitely need to document the lack of adequate staffing and equipment.
Then, is she able to understand? If so, gently explain to her that you would appreciate it if she could help you as much as possible. If she is strong enough to fight you, she is strong enough to help, IF you can overcome her anxiety. That is a hurdle that can possibly be tough to jump.
Good luck and I hope you are able to work things out to the patient's advantage as well as your own.
tvccrn