CARING FOR BED BOUND CLIENTS - At Home …

1 A Client Care Module: CARING FOR BED. BOUND CLIENTS . 1998-2011. May be copied for use within each physical location that purchases this inservice. Inservices For Nursing Assistants We hope you enjoy this inservice, prepared by A Client Care Module: registered nurses especially for nursing CARING for assistants like you. Bed BOUND CLIENTS After nishing this inservice, you will be able to: Instructions for the Learner Give at least two If you are studying the inservice on your own, reasons a client please do the following: may become bed BOUND . Read through all the material. You may nd it useful to have a List at least four highlighting marker nearby as you read. Highlight any information possible that is new to you or that you feel is especially important. complications of immobility. If you have questions about anything you read, please ask Describe pressure _____. ulcers and contractures and Take the quiz. Think about each statement and pick the best answer. how to prevent them.

2 Check with your supervisor for the right answers. You need 8 correct to pass! List two important reasons for keeping Print your name, write in the date, and then sign your name. skin clean, dry and moisturized. Keep the inservice information for yourself and turn in the quiz page Discuss the bene ts to _____ no later than of exercise and massage for CLIENTS _____. Show your Inservice Club Membership Card who are bed to _____ so that it can be initialed. BOUND . A Client Care Module: CARING for the Bed BOUND Client Being Bed BOUND Inside This Inservice: Can you imagine being con ned to end stage Parkinson's, multiple your bed, day after day, unable to care sclerosis, severe obesity or they may The Importance of for your most basic needs? be nearing the end of their lives. 2. Excellent Skin Care While a sudden accident or injury can Sixty years ago, it was common for The Facts about Pressure 3 cause someone to become bed BOUND doctors to put their patients on bed Ulcers overnight, most people end up that rest.

3 After childbirth, new mothers The Importance of 4. way after a period of immobility. stayed in bed for two weeks. And, Nutrition and Hydration patients were on bed rest for four For example, you may work with CLIENTS weeks after a heart attack! Providing Comfort and 5 who are bed BOUND due to a short term Positioning immobility related to stroke, injury, Today, we know that bed rest and Hygiene and the 6 fracture of the spine or hip or surgery. immobility can lead to a variety of Incontinent Client For them, rehabilitation is usually serious complications. If you care for possible. CLIENTS who are con ned to bed . The Importance of 7. whether it is temporary or Exercise and Massage You may have other CLIENTS who are permanent you can help improve Mechanical Lifts and 8 bed BOUND due to a long term their quality of life. Keep reading to Good Body Mechanics immobility. This may be related to learn more about CARING for bed 9 paralysis, severe stroke, certain disease BOUND CLIENTS .

4 Activities for Bed BOUND processes, end stage Alzheimer's, CLIENTS 10. Some Final Tips! Here are some of the problems that can develop from immobility regardless of the client's age: Loss of muscle mass, Blood clots in the 2011 In the Know, Inc. strength and legs endurance Contractures Pressure Sores Depression May be copied for use within each physical location that Muscle pain Confusion purchases this inservice Osteoporosis from In the Know. Anxiety Pneumonia Mood swings All other copying or distribution is strictly Constipation Social isolation prohibited. THE DANGERS Incontinence and Loss of urinary tract OF IMMOBILITY infections independence A Client Care Module: CARING for the Bed BOUND Client 2011 In the Know, Inc. Page 2. SKIN CARE FOR BED BOUND CLIENTS . Did you know skin is considered an organ just like the TIPS FOR PROTECTING THE SKIN. heart and lungs? Skin is the largest organ of the Keep the skin clean and dry. Wash with mild human body. soap, rinse well and then dry the skin You wouldn't ignore an abnormal heart rate or completely.

5 Abnormal respirations, so you shouldn't ignore Only give a complete bed bath once or twice a abnormal changes in your client's skin. week, or as needed, to avoid over drying. Functions of the skin include: preventing bacteria or Moisturize with dye-free, fragrance-free lotions other pathogens from entering the body; preventing if available. water from leaving the body; protecting internal organs; and regulating body temperature. Make sure your CLIENTS stay well hydrated. Any break in the skin, whether it is a cut, tear, burn or Provide blankets, socks, and clothing in layers if pressure ulcer, leaves the body vulnerable to CLIENTS are cold and adjust room temperature if infection. they become too warm. NEVER use an electric blanket or heating pad. If Why Does Skin Break Down More Easily in a client has trouble sensing heat, a burn could Elderly CLIENTS ? result. As aging occurs, skin becomes thin and fragile. Always follow the care plan and re-position the Oil and sweat secretion bed BOUND client as ordered.

6 If no order is in slows, leaving the skin dry place, re-position every two and itchy. hours. Use pillows to pad pressure Nerve endings become less sensitive, making it di cult points and prevent pressure to sense heat, cold and pain. sores. How is the Bed BOUND Monitor for Changes Client A ected? Take every opportunity to Immobility presents special assess your client's skin carefully challenges to the skin. Individuals who cannot for any changes. move or re-position themselves when they feel Look for any cuts, scrapes, tears, friction burns, pain are at risk of developing pressure ulcers. bruises or reddened areas. CLIENTS who require the help of a draw sheet to be If you notice any changes, report them to the pulled up in bed or transferred are at risk for skin nurse or your supervisor immediately. tears. If you accidentally cause a cut or tear, apply CLIENTS with paralysis or altered mental status may pressure to stop the bleeding. Tell a nurse or not feel pain at all. ( is a warning supervisor right away so treatment can be that some part of the body needs attention.)

7 Started. Accidents happen and it's better to deal with them immediately! A Client Care Module: CARING for the Bed BOUND Client 2011 In the Know, Inc. Page 3. THE FACTS ABOUT PRESSURE ULCERS. Pressure ulcers, also known as bedsores, pressure sores, and decubitus ulcers are a serious cause for concern in the bed BOUND STAGES OF. client. PRESSURE ULCERS. Hospitalizations involving patients with pressure ulcers increased Early signs of a pressure sore may by nearly 80 percent in the last decade! be pale skin or slightly reddened REMEMBER: Any break in the skin leaves the client vulnerable to skin over a bony area. infection. Stage 1: The skin over a bony area is intact but pink or slightly Christopher Reeve, also known as reddened. Superman , su ered from pressure ulcers In CLIENTS with dark skin, the after being paralyzed in a horseback riding skin may appear ashen. accident. He died from complications of an The client may sense slight infected pressure ulcer. itching or mild tenderness.

8 Stage 2: The skin is red and A pressure ulcer is any injury to the skin caused by unrelieved swollen. pressure. There will either be a blister or Pressure ulcers usually occur over bony areas called pressure a shallow open wound. points.. Stage 3: The area begins to look While there are more than 20 possible pressure points where a like a crater. pressure ulcer could occur, the most common areas are: heels, The sore will extend deeper tailbone, elbows, and the back of the head. into the skin. PREVENTING PRESSURE ULCERS Stage 4: The sore extends deep into the fat, muscle or bone. Follow the client's care plan for re-positioning. If no plan is stated, There may be a thick black re-position every two hours. scab, called eschar, which is Provide excellent skin care, keeping skin clean, dry and moisturized. actually dead skin. Use powder on areas where skin rubs together. ADDITIONAL CATEGORIES. Check incontinent CLIENTS frequently. Change immediately after Suspected Deep Tissue Injury: soiling to keep stool and urine o the skin.

9 An area of unbroken skin that is Keep linens clean, dry and free of wrinkles. purple or maroon may mean Massage the back during position changes but NEVER rub or damage deep under the skin. massage reddened areas. Un-Stageable: Pressure sores are Use pillows to pad bony areas such as knees, elbows, hips and un-stageable when there is a layer shoulders. of dead tissue (yellow, tan, gray, Keep heels o the bed by placing a pillow under leg between the green, brown or black) inside the calf and ankle. wound. A Client Care Module: CARING for the Bed BOUND Client 2011 In the Know, Inc. Page 4. THE IMPORTANCE OF NUTRITION AND HYDRATION. WHAT DO YOU KNOW HOW DO YOU. ABOUT NUTRITION? HANDLE HYDRATION? Immobility and poor appetite often leave the bed Follow your workplace guidelines for monitoring BOUND client with weight and muscle loss. intake and output. Fluid imbalances can be dangerous for the bed BOUND client. Always check the care plan for any special diets or feeding instructions.

10 Always consult the care plan to see if the client has any special orders involving uids. If your CLIENTS need help with feeding, place them in an upright, seated position for comfort and Some special uid orders a bed BOUND client may safety. O er small bites at a relaxed pace. have include: Assess the Encourage Fluids: client's ability to Look for a chew and swallow speci c amount safely at every of uids meal. If chewing or ordered for the swallowing client to drink becomes di cult, in a 24 hour stop the feeding period. Keep and inform the uids within nurse. reach or o er sips often to the client who cannot drink on his or her own. CLIENTS who have trouble chewing or swallowing Restrict Fluids: Fluids should be limited to the are at risk for aspiration. Aspiration is when uid amount stated in the care plan. Only leave or food is sucked into the lung. small amounts of uid within the CLIENTS reach. The Dysphasia Diet is ordered for CLIENTS who More frequent mouth care may be needed for cannot chew or swallow safely.