turning pts during sleep?

Nurses General Nursing

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Specializes in Critical care, private duty, office peds.

I strive to make my patients comfortable. With a quadriplegic pt who has good circulation and no hx pressure sores/skin breakdown, do you still need to change positions while sleeping?

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Specializes in Med/Surg.
I strive to make my patients comfortable. With a quadriplegic pt who has good circulation and no hx pressure sores/skin breakdown, do you still need to change positions while sleeping?

Not if they are up during the day in a wheelchair, etc...but pad the areas prone to breakdown.

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Repositioning is always important to prevent skin breakdown, even if the are up in a wheelchair during the day. Not only for skin breakdown, but for comfort, too! How many times does one change positions when they sleep? I for one change positions frequently. If lying in one positions too long, that position gets uncomfortable. So, repositioning regularly equals not only skin breakdown prevention, but also comfort!

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Specializes in Nursing Home ,Dementia Care,Neurology..

We tend to do a 30 degree tilt on some of ours just to change the pressure.All you need is to pull them over slightly and place a pillow so that they are nor lying on their backs.

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Specializes in Med/Surg.
We tend to do a 30 degree tilt on some of ours just to change the pressure.All you need is to pull them over slightly and place a pillow so that they are nor lying on their backs.

and...it wakes them up. I worked with a quads the entire time I was in nursing school and we never woke up the ones who were up in the chair during the day. They have enough trouble getting to sleep. Think about it. You lay there, can't move and just when you get to sleep someone wakes you up.

Not a single quad who was up during the day got a breakdown. Good skin care and ROM at bedtime does wonders :nurse:

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Absolutely you need to turn them at night! They can't feel pain, so they won't wake up for that. Slight position changes will work, ie, weight shifts. You never know who will break down.

As a rehab RN for many years, I know family are not going to awaken pts q2hrs for turning. A new quad needs to be turned q 2, and gradually increase that amount to q 3 hrs max. Turning also helps decrease the spasms and tone they get later on. Some pts will still need q2hrs turning, or even more frequently- and get a sleeper ordered.

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we never woke up the ones who were up in the chair during the day. .... Not a single quad who was up during the day got a breakdown. Good skin care and ROM at bedtime does wonders :nurse:

I find this surprising. Was this at a hosp or LTC? This would never fly at my hospital. Q2 hrs 24/7. Having said that - I hate disturbing people when they are sleeping.

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I find this surprising. Was this at a hosp or LTC? This would never fly at my hospital. Q2 hrs 24/7. Having said that - I hate disturbing people when they are sleeping.

It shouldn't matter if it is hospital or LTC, either one they should be repositioned Q2hrs. I work in LTC and all of our residents that don't have complete ROM or can't reposition independently in bed are repositioned Q2hr in bed and in their wheelchairs. Just the slightest amount of change of position counts as it puts pressure in a little bit different area. Anyone and everyone that has impaired mobility is at risk for skin breakdown. Especially those that are wheelchair/bed bound. Regular repositioning is a must - eventhough it sucks to have to bother people when they are sleeping!

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Sitting in a chair all day is one of the worst causes of skin breakdown; and that is very well documented.

Even more important to be turning them at night. You can make small shifts in body weight that usually does not even wake patients.

And more importantly to anyone that is in a chair most of the day. Their position does not get changed enough.

And better point to make is that most of the patients that come into a hospital for surgical treatment of decubitus ulcers are those that are up in chairs and not getting their weight shifted around enough.

Suggest that you contact some of the plastic surgeons in your area for their take on this and some of the certified wound care nurses in your area as well.

Turn, turn, turn.

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looks like it's a 50/50 on to turn pts at night while they are sleeping

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It shouldn't matter if it is hospital or LTC, either one they should be repositioned Q2hrs.

Oh yes, I agree, and didn't mean to make it sound otherwise. I just couldn't help being curious what type of place had a policy like this :D

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looks like it's 50/50 on letting the pt sleep and turning them at night

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