Turning a morbidly obese patient

Hello Nurses,

I was just wondering what are your tips in turning a patient (eg. Q4 turning or pads change) who has a leg pain and is a morbidly obese? My patient is too big that I am ordering a big bariatic bed for him.

He helps a little to nothing when changing his pad. He came from a LTC with a long term IDC (with yellowish discharge and foul smell) so I decided to give him a pad change and wash. I asked for 4 people in the ward to help him get changed. Any tips?

Thank you.

[Kitiger, RN]

What is IDC?

International Data Corporation?

I Don't Care?

Internet Database Connector?

Instructor Development Course (SCUBA PADI course designed to train instructors)?

Internet Data Center?

Industrial Development Corporation (Trinidad and Tobago)?

Invasive Ductal Carcinoma?

etc.???

[Edmond Dantes]

Indwelling Catheter.

It's Q TWO hour turning. You would need at least 4 people...more if you can get them. By the way, get that foley out of him STAT it's an infection source.

[Edmond Dantes]

18 minutes ago, Been there,done that said:

By the way, get that foley out of him STAT it's an infection source.

Thank you for the input. He is Q4 turn because he is already on bariatic bed. Patient has BPH for a very long time. He couldn’t pass urine without it.

Edited Jun 23, 2020 by Edmond Dantes

Dude, if there is a foul smell and yellow discharge, there is infection. Patient has a UTI. You just need to CHANGE the foley, not discontinue forever.

[canoehead, BSN, RN]

Use a regular sheet as a huge draw sheet, and turn as a team. Put the head of the bed down when you move him up in bed so you aren't fighting against gravity. Trendelenburg him if possible. When you turn him, wash whatever is exposed, so you don't have to coordinate an hour long bed bath...it all gets washed at least once a day.

Their size shouldn’t matter with turning. It’s still q2 turning. I also just tell them to breathe through the pain.

Im confused by this whole story. If they have a UTI you need to change that catheter. The infection source needs to go. Is urology consulted with the bph and catheter issues?

[Edmond Dantes]

Hello thank you for all your nice inputs! My patient was just got admitted in our ward when I looked after him. The urinary catheter was just recently inserted and ofcourse we took a sample for urinalysis and culture (we replaced his old one).

He is q4 turn since he is now on bariatic bed. The urologist was aware of the BPH and deemed that it is vital for him to have the foley in. I just find it challenging to turn and do cares for this heavy patient who cannot turn himself and was in pain with the slight movement. I have asked for help for other nurses on the floor.

The reason I posted this is for me to get an idea on how to safely turn him and improve my practice on taking care of this kind of patient.

I would medicate for pain, and I'd try to time any major hygiene care with the medication's peak.

[NRSKarenRN, BSN, RN]

Agree with Sour Lemon: Premedicate for pain 30-45 min prior to turning. Try to alert colleagues ahead of time that help needed at xyz time. Gather all supplies needed for care, skin protectant ointment, pericare supplies etc.

Does your facility have reusable handled slide transfer sheet-- I'd use that, otherwise use large sheet folded in half per Canoehead. With four persons, once you start to turn client, if able to bend knee towards chest helps with roll over. Patients with extremely large heavy legs, have used draw sheet to wrap around one leg to lift and move while other staff help push to turn. Gets easier with experience--- often need to individualize for each patient.

[TriciaJ, RN]

I think there needs to be a care conference with the whole unit. This gentleman has major needs which can only be accomplished with a team effort.

Turning every four hours is NOT adequate for someone who can't move himself. After two hours in the same position, skin is starting to break down, no matter what kind of bed he is on. There needs to be scheduled Q2h turning, with the personnel pre-assigned so you don't need to be constantly trying to round up four people. And I don't need to mention meticulous cath care and adequate hydration.

Good luck.

[NRSKarenRN, BSN, RN]

Good article:

Turning and repositioning patients who are morbidly obese

https://www.myamericannurse.com/turning-and-repositioning-patients-who-are-morbidly-obese/

[Edmond Dantes]

3 hours ago, NRSKarenRN said:

Good article:

Turning and repositioning patients who are morbidly obese

https://www.myamericannurse.com/turning-and-repositioning-patients-who-are-morbidly-obese/

Good article. Thank you for this.

[Here.I.Stand, BSN, RN]

6 hours ago, Edmond Dantes said:

He is q4 turn since he is now on bariatic bed.

Nope. A bariatric bed can structurally handle more weight, and it’s wider to accommodate the extra width of the patient.... it does NOTHING to alleviate gravity. The pt’s skin is experiencing all of the same pressure as it was prior to the new bed and needs to be repositioned q2 hrs

Edited Jun 24, 2020 by Here.I.Stand

[K+MgSO4, BSN]

I think the OP is in Australia.

OP, I am assuming that the bed that has been ordered has an air mattress and turn assist functions on the bed.

I would also look at hiring a hover matt system and speak to the rep of the company of the hoist that you have, you could buy or rent a leg lifter sling attachment.

Contact your OHS person for advice and assistance with risk assessment. Also get the PT and OT involved.

Many health services have a bariatric / manual handling consultant. It is often the person who manages the equipment library. There are a few companies and people I could give you contacts for if you are in Australia. Shoot me a PM if you do.

Good luck.

[amoLucia]

Sometimes an overhead trapeze can help. Even if the pt has only very minimal ability to assist, any little bit helps! And he can begin to improve using it, esp if PT/OT can offer him some advice.

On 6/24/2020 at 12:20 AM, Edmond Dantes said:

Hello thank you for all your nice inputs! My patient was just got admitted in our ward when I looked after him. The urinary catheter was just recently inserted and ofcourse we took a sample for urinalysis and culture (we replaced his old one).

He is q4 turn since he is now on bariatic bed. The urologist was aware of the BPH and deemed that it is vital for him to have the foley in. I just find it challenging to turn and do cares for this heavy patient who cannot turn himself and was in pain with the slight movement. I have asked for help for other nurses on the floor.

The reason I posted this is for me to get an idea on how to safely turn him and improve my practice on taking care of this kind of patient.

It still doesn’t matter if they are on a bariatric bed. It’s q2 turning. These people are at a much higher risk of skin breakdown and infection. Even on a bari bed.

What kind of facility is this?