turning pts during sleep?

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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?

Specializes in Cardiac.

Q2 turns on pts who are immobilized, sedated, ventilated, or unable to change positions enough on thier own.

Always.

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

Letting them sleep=Letting them get a bedsore.

Which come October, we aren't getting paid for. Also, bedsores are an indication of poor nursing care.

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Specializes in ICU.

I agree, still need to turn q2-3 hours. We have a complete vent dependent quad on our unit right now. When I have him, ill usually put him on his side at bedtime, then 2-3 hrs later, just take the pillow out, and 2-3 hrs later, slightly turn him to his otherside...we can usually manage it withough waking him. When you just pull the pillows out, they rarely notice and stay sleeping.

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Specializes in ER; HBOT- lots others.

Most orders state- "do not wake"

depends what type of facility

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even if you are not wakening them, it is disruptive to the healing process....alternating pressure mattresses......good positioning, and trying to "catch" them when they wake naturally.....some "bed sores" are not pressure sores, but shear injurys, r/t elevating the HOB....need to be very careful with that

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Specializes in Cardiac.
Most orders state- "do not wake"

depends what type of facility

I have never seen this order. Even if it did exist on one of my order sheets, it would have to be an order that I did not follow.

I can see it now "Well, the order says do not wake, so I let the pt get a bedsore"

Turning is a nursing intervention. I don't need an order telling me to do it, nor do I need an order excusing me from doing it.

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Specializes in Critical care, private duty, office peds.

At least I know I'm asking a question that is 50/50, and not just a random thought. I know standards are Q2H, but if your patient ends up with seizures from lack of sleep and they just drifted off at the start of your shift, I'm inclined to opt out of moving. Believe you me- I'm one to mandate Q2H any other time.

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Specializes in Cardiac.

Well, you are held to standards of care, not what 50% of people on a bulletin board say.

Seizures? From turning pts? Lol!

If that were the case, all of ICU pts would be seizing all the time. And if turning is causing seizures (again, lol) then I'd say the person turning needs to be retrained on how to do a proper turn.

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i'm just trying to figure out why any med'l professional would think a quad's circulation isn't compromised??

whether they are up in a wc or bedbound, these folks need vigilant, atc weight shifts/repo's, always, always, always.

always.

leslie

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Anyone is free to do as they wish, but if problems ever develop with one of your patients and the standard is that they turned at least every two hours and that was not done; guess who they are going to go after.

You can easily reposition someone without waking them up.

And as mentioned above, if any patient develops a bedsore or decubitus ulcer, the facility is no longer going to get reimbursed for the care associated with that.

And patients do not have seizures because of lack of sleep. Never heard that one before..............

Then that means that every new mother in the universe has seizures because they had lack of sleep.

We are stating what the standards of care are, it is your choice what to do with them all of the time. But not following them can cause you to go as far as lose your license. This is why standards were developed and why hospitals love them as well as attornies.

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It's easy to reposition someone without waking them. Even light sleepers.

Repositioning is ESSENTIAL. Perhaps we're having some confusion here regarding how to do it. It's not necessary to flip them back and forth and stuff pillows here and there every time. Getting them positioned at HS is key. Make sure they're pulled up on the bed and raise the feet slightly to discourage them sliding right back down. Make sure their body/back is in good alignment. Stick a pillow under a linen saver in the hip area that you can use to slowly/gently pull out/reinsert on the other side when you reposition throughout the night. If they are awake/call you in there (and maybe they called you in there because they've been stuck in the same position too long!), then you can reposition a little more aggressively without fear of waking them up.

Lack of sleep causes seizures? No wonder parents of newborns, students working part/full time, insomniacs, and billions of other people who don't get enough sleep are seizing all over the place!

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Specializes in Cardiac.

Lack of sleep causes seizures? No wonder parents of newborns, students working part/full time, insomniacs, and billions of other people who don't get enough sleep are seizing all over the place!

:lol2: Lol...

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Specializes in Med/Surg ICU, NICU.

We too turn q2h unless the patient is able to reposition themselves. Once and a while the patient will briefly wake when being repositioned but are able to fall back to sleep quickly. I know myself I don't want to be the one that helps cause a decub or pneumonia from lack of turning. I can hear the conversation now, why yes Mrs. Smith, your mother came in to our facility three days ago with clear lungs and no breakdown at all and now she has a stage II on her coccyx and is working up a good pneumonia but she is well rested. I think I opt for turning.

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