Lying patients due to lack of mobility need special care. The correct position of the patient in bed plays an important role in the treatment of complex cases when the number of movements is minimized. Allowed physical activity is determined by the doctor who is directly involved in the care of the patient; also a nurse takes care of the patient. In the case of care for the bedridden patient at home, actions to change the position in bed are performed by family members who have been instructed and attended practical classes.
Characterization of the position of the lying patient
In the treatment of patients with fractures, intoxication of the body, after blood loss and surgery, the doctor prescribes bed rest. There are three types of mobility limitations for diseases and injuries:
- active, in which the patient is able to independently serve himself, turn around, sit down and get up, but excessive physical activity is contraindicated to him;
forced, which the patient takes to relieve pain on his own or with the help of a nurse;
passive, when the patient cannot independently move, turn, change the position of the body.
There is a certain concept of the position of patients in bed: this is a pose in which the patient feels comfortable with any form of physical activity prescribed by the doctor. The motor regimen depends on the disease and can be strict bed rest, with limited activity and general. There are several types of provisions in bed, designed for certain manipulations: Fowler, Sims, on the back, on the right side and on the stomach.
Appointment of a special bed
To place the patient in a physiologically advantageous position, a medical bed is used, which facilitates care in a hospital and at home. The special design of the bed allows you to serve postoperative, seriously ill patients and the disabled. A multi-sectional device allows you to change the angle of inclination of individual parts of the body, equipped with a mechanical or electric drive, folding side rails, wheels for movement and a device for pulling up. The functionality of the bed is designed in such a way as to give an optimal position to the body with cardiovascular diseases, damage to the neuromuscular system.
The consequences of strict bed rest
Since strict bed rest implies patient immobility, pollution and pressure sores occur on his body. Prevention of pressure sores includes measures to control the condition of the bed, removing coarse seams and unevenness of the mattress, shaking off crumbs and changing underwear. Contaminants are constantly removed, for which the patient’s position in bed changes and a set of procedures for cleaning the skin is carried out.
Fowler position
The Fowler position of the patient in bed allows the lying person to take a reclining position in which it is easier to breathe and communicate more freely. Laying is carried out after explaining all future actions to the patient. Manipulations are performed in the following way:
the bed is brought into a horizontal position, rises to a sufficient height, convenient for manipulating with the patient;
the section at the head rises at an angle of 45-60 degrees depending on the position to be given - half-sitting or reclining;
the patient’s head is placed on a low pillow or on a mattress, pillows are placed under immobilized hands and lower back;
a roller is placed under the hips and a pillow under the lower third of the lower leg;
emphasis is placed on the feet at an angle of 90 degrees.
Before all the manipulations, everything superfluous is removed from the bed - pillows, blankets, rollers, the fence leans back.
Sims position
In contrast to the semi-sitting position of the patient according to the Fowler method, Sims proposed an intermediate - between the position on the abdomen and on the right side. Manipulations are performed by two or one person:
the handrails of the bed are lowered, all sections are brought into a horizontal position, the pillows are removed, the mattress and the sheet are aligned;
the patient rolls over on his back and moves to the edge of the bed, and then fits in the supine position;
partial position on the abdomen;
under the bent arm located above, at the shoulder level, a pillow is placed, and the other is pulled down and laid on the bed, sometimes a lining is used in the form of a half of a rubber ball;
a cushion is placed under the bent leg so that the knee is at hip level.
General recommendations
The position of the patient in bed with various diseases should always be comfortable, not impede breathing and not contribute to the crushing of arteries with excessive inversion of the knee and elbow joints. Before starting a change of position, you need to make sure that the patient understands the purpose and actions of the person caring for him. The physical and mental condition of the patient is also evaluated. The bed should be flat, without folds.
If manipulations to change the position of the patient in bed are carried out at home, it is sometimes more profitable to hire a nurse who has professional skills in the treatment of bedridden patients with strict bed rest. Functional position changes every two hours.
In case of muscle hypotrophy associated with a long stay of the patient in an immobilized state, actions are performed carefully, gently, in order to avoid damage to muscle fibers. The joints should expand slowly, since over time, persistent contracture appears (restriction of movement).