turning pts during sleep?

Nurses General Nursing

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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?

op, please take the time and read the following link.

it clearly explains the medical necessity of repositioning of those with sci (spinal cord injury).

this should put any questions to rest.

from nih:

Medical Management of Pressure Ulcers

Pathophysiology

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?indexed=google&rid=spinalcord.section.4609

leslie

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Pressure ulcers can develop overnight. I turn Q2H at a minimum, this is the standard of care for anyone unable to turn themselves, and results in better patient outcomes. They can be very difficult to get rid of once they're there, so it's best just to prevent them.

Among patients who are neurologically impaired, pressure sores occur with an annual incidence of 5-8%, with lifetime risk estimated to be 25-85%. Moreover, pressure sores are listed as the direct cause of death in 7-8% of all paraplegics.

from http://www.emedicine.com/med/topic2709.htm

I'm not sure about the death rates r/t pressure ulcers in quadraplegics, however.

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Specializes in ICU.

I work in a general ICU. All our patients are nursed on an air mattress and their Waterlow Score is assessed daily. We assess our patients on an individual basis. Some are turned 2 hourly but for others we turn perhaps 3 to 4 hourly.

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if they have a condition that compromises their mobility, i turn them every 2 hours. i try to be as gentle as possible so as to not wake them. if it wakes them up, then i am sorry. i'd rather they wake up than let them get a bed sore.

it doesn't have to be a full-on turn... simply lift them up on one side, and put a couple of pillows there, and you're done! it only takes a few seconds.

i have a question for you all: how do you assess the back/butt skin of a post-op hip patient who is in a LOT of pain? I had a patient that was a post-op hip, and the slighest movement would cause her god awful pain. i premedicated with all the pain medication i could give, but still had a lot of pain with any type of movement. so during my repositioning (a couple of pillows on her side every 2 hours), i just briefly looked at her skin but could not turn her far enough to do a total assessment (for example, the coccyx area) what do you do in these types of situations??

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Specializes in Critical care, private duty, office peds.

I am suprised I got such a blunt response from some of you. I don't think some words were called for, much less necessarry. I want the best for my patients, and that's why I asked. If I have a question about why or what the "real" standard is- not what nursing school taught you necessarily, but what is done that is acceptible on a routine basis. You should know who you are; please be more mindful of your posts in the future. There's enough workload on us as there is.

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so during my repositioning (a couple of pillows on her side every 2 hours), i just briefly looked at her skin but could not turn her far enough to do a total assessment (for example, the coccyx area) what do you do in these types of situations??

Not to sound sassy - but, how was this pt cleansed after having a BM? If pt is in this much pain, I would probably get two things done at once. If that makes sense.

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she was post-op and hadn't had a bm

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Specializes in Med/Surg.
Not to sound sassy - but, how was this pt cleansed after having a BM? If pt is in this much pain, I would probably get two things done at once. If that makes sense.

Quads are on bowel programs and have to be stimulated digitally and the stool must be pulled out by a licensed nurse.

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oh lord

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Specializes in Cardiothoracic Transplant Telemetry.
I am suprised I got such a blunt response from some of you. I don't think some words were called for, much less necessarry. I want the best for my patients, and that's why I asked. If I have a question about why or what the "real" standard is- not what nursing school taught you necessarily, but what is done that is acceptible on a routine basis. You should know who you are; please be more mindful of your posts in the future. There's enough workload on us as there is.

It sounds as though you were looking for an excuse not to turn your patients. Never ask a question that you don't want to hear the answer to. I think that most of the "harsh" words were aimed at others who responded-not necessarily to you.

As to the answer to your question, I always turn my patients every two hours. I work on a cardiac floor, and we do vitals q 4 hours. What I will do it turn the patient all the way on to their side, with two pillows. After two hours I will pull one or both of the pillows, then turn them to the other side with the next set of vitals. Just going in and pulling a pillow shouldn't wake them.

You change positions in your sleep at night, and so should the patient. Just because they may not be able to sense pain does not mean that staying in one position cannot have severe consequences. Not moving puts them at risk for skin breakdown, PNA, DVT, and autonomic dysreflexia. The discomfort from lack of movement that they cannot feel can lead to the dysreflexia with blood pressures that are very difficult to control- thus increasing their risk for stroke and further deterioration of function.

Patients that are in a dysreflexic crisis can suffer seizures- maybe the seizures that one poster was attributing to lack of sleep were in fact caused by dysreflexia from lack of turning!

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Specializes in Cardiac.
I am suprised I got such a blunt response from some of you. I don't think some words were called for, much less necessarry. I want the best for my patients, and that's why I asked. If I have a question about why or what the "real" standard is- not what nursing school taught you necessarily, but what is done that is acceptible on a routine basis. You should know who you are; please be more mindful of your posts in the future. There's enough workload on us as there is.

What's "Real" is that we turn Q2. Yes, that's what we really, really do.

It doesn't matter what the workload it, or what is "routine" as per a bulletin board. What is acceptable, what is standard, and what is RIGHT, is Q2 turns.

And yes, this is what I really do in my nursing practice.

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When I did adult med-surg at night (and when I did nursing home at night as a CNA), my patients that couldn't turn themselves, I tried to turn every 2 hours. Even just a little helps. Like was said above, if you can do the put them on their side to start, then pull out the pillows at next turn, then add them on the other side, you get to where you can do it pretty gently. (With some you're having to change a pad too, so double padding helps with making that quick and gentle.) In reality, at both those jobs, it tended to end up being q3 hours. Not for lack of trying, but because the load was too heavy to get it done every 2 hours.

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