Patient is falling while standing up while sleeping

[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?

[Liddle Noodnik]

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}}}}}}}}}}}}}}

[canoehead, BSN, RN]

A parachute harness and some hooks to the ceiling?

Or something like a dolly for moving furniture, rigged with a backboard, so he is still standing but laying back at a 10-20 degree angle. At least if he starts at an angle you'll be controlling where he falls, and it won't be a free fall.

[javanurse2000, BSN, RN]

Does he realize when he starts to doze off? I have seen merrywalkers used...if you've never seen one its like a walker made of PVC pipe and has a seat that follows him around....if he feels like he's going to nod off he would just sit down and rest his head to the side on the support frame. Also, have you viewed him falling asleep? Does his head nod down or to one side...perhaps a tab alert could be attached in such a way to alert him that he needs a "nap" period. Has he been DXed with narcolepsy? I can't remember the name of the med (I do remember its a narcotic and very expensive) that helps not to fall asleep. My patient was on it and duragesic patches at the same time. Hope some of this helps...you must be wound tighter than an eight day clock trying to keep him safe.

[hapyguy]

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.

The motorized wheelchair placed next to his smoking stand seems to have done the trick. The chair has been modified with pillows sewn into the head piece for comfort and a tilt and swing mechanism and that behaves like a lazy boy recliner. It also has roho cushioning on the back and seat. If he chooses to stand and begins to fall, the pillowed chair will break his fall. He has been choosing to lie in the chair whem he feels wobbly. Thank you for your suggestion...it's made all the difference.

[hapyguy]

Does he realize when he starts to doze off? I have seen merrywalkers used...if you've never seen one its like a walker made of PVC pipe and has a seat that follows him around....if he feels like he's going to nod off he would just sit down and rest his head to the side on the support frame. Also, have you viewed him falling asleep? Does his head nod down or to one side...perhaps a tab alert could be attached in such a way to alert him that he needs a "nap" period. Has he been DXed with narcolepsy? I can't remember the name of the med (I do remember its a narcotic and very expensive) that helps not to fall asleep. My patient was on it and duragesic patches at the same time. Hope some of this helps...you must be wound tighter than an eight day clock trying to keep him safe.

Pt is on Provigil during the day to combat the lethargic effect of the duralgesic patches. He is unaware when he doses off. ...and yes I was wound tighter than an eight day clock (I love that). Seeing it in print has helped me to let go and relax. Thanks :)