For most of us, it’s hard to imagine being in a position where we can’t get out of bed. For some people, that is the daily reality. As a CNA, one of your duties may be helping people in this situation navigate the challenges of this living condition. Knowing how to care for your bedbound patients isn’t just a matter of being able to do your job correctly. It’s a matter of improving the quality of life for some of the most vulnerable.
Reasons To Be Bedbound
Before delving into how to care for bedbound patients, it’s valuable to briefly highlight some of the key reasons that patients are unable to get out of bed. The reason a patient is bedbound will inform how you go about each of the care tips we will suggest. Some conditions include:
- Multiple sclerosis
- Missing limbs
- Traumatic injuries
- Muscle weakness
Reposition Patients Regularly
Although patients are staying in bed to protect their health, lying in bed for long periods can result in its own medical difficulties. One of the most common of these ailments is bedsores or pressure ulcers. These occur when the skin sustains constant pressure for prolonged periods, such as when a person is lying in the same position in bed.
To avoid this, CNAs and RNs need to reposition patients in bed regularly, usually every two hours. Since bedridden patients are typically prone to injury, the utmost care is necessary when performing this task. Medical staff should never grab patients by the skin. Instead, where possible, they should use the draw sheet beneath the patient to turn them.
When the patient is in position, you will likely want to place pillows strategically to avoid both skin-to-bed and skin-to skin-contact. For instance, a patient lying on their side will likely need a pillow at their tailbone, between their legs, and between their legs and the bed. Take particular care of common pressure areas, such as the ears and the elbows.
Even when you reposition patients regularly, bedsores can still occur. Because of this, it’s important to examine a patient’s skin periodically for signs of bedsores and rash. Common places to find bedsores are those where the bone comes in close contact with the skin, including hips, tailbone, ankles, knees, heels, and shoulders. Since pressure ulcers can also occur where skin meets skin, you should also check places where the skin folds over itself.
Bedridden patients naturally won’t be able to get up and use the restroom. Some of the conditions that leave them bedridden may leave them incontinent as well, so more likely than not, changing diapers will be part of how you’ll care for your bedridden patient.
Although a diaper may not be wet this frequently, it’s best practice to check diapers for moisture when repositioning a patient. Before changing a diaper, make sure you explain to the patient what you are doing to ensure that they are ready for this care. While changing and performing perineal care, do a quick visual check for broken skin and bedsores, and record them as they occur.
The process of changing a bedridden patient’s clothes largely depends on the patient’s level of independence. If they are more independent or able to sit up in bed, they may be able to dress with only limited assistance. If a patient is entirely dependent, you will need to perform this task with care, being wary of adding excessive friction against the patient’s skin. For this purpose, some CNAs choose to apply a moisturizing cream to patients’ skin as they change them.
For putting on or taking off a shirt, you will start with the sleeve closest to you, removing or putting it on the patient’s arm. Then, roll the patient on their side, tucking the shirt under them. Roll the patient onto their back, and then remove or put on the remaining sleeve. For pants, it is a matter of gently lifting legs and supporting the back of the knees as you remove or put on the pants.
Performing bed baths not only keeps patients clean and comfortable but helps improve blood flow and keeps the skin healthier. It’s important to keep the patient’s comfort in mind during the entire process. As much as possible, keep their private areas covered when not performing perineal care, and allow them to be involved with the process of cleaning if they are able.
When washing patients, it’s good to start with the face, then move to the abdomen, arms, legs, feet, and perineal care last. Water should be comfortably warm, and you should check the temperature throughout the process. Change washcloths frequently, preferably whenever washing a different part of the body. As you wash, be sure that you are supporting their joints at all times and checking the skin for lesions or bedsores.
Regularly changing bedsheets is crucial to the comfort of bedridden patients, especially those who are incontinent. But changing the sheets of an occupied bed poses a unique challenge for CNAs. To change the sheets, you will want to untuck the old sheets on one half the bed and roll them under the patient. Then, begin to attach the clean sheets to the other side of the bed.
At this point, you can roll the patient onto their side before tucking the dirty sheets further under them and then pulling the clean sheets under the dirty ones. Roll the patient onto their back on top of the bump created by the two sets of sheets, then onto their other side. This will get them completely off the dirty sheets so that you can remove them from the bed and finish tucking the corners of the clean sheets onto the mattress.
Since a patient is spending their time primarily in their bedroom, keeping the room comfortable is essential. Keep the room at a comfortable temperature with good lighting. Things that they use regularly, including personal effects and nurse call lights, should be within ready access. And even though patients are not able to navigate the room, the room should be free of clutter and dirt for the sake of smell, comfort, and air quality.
Caring for bedbound patients takes patience, strength, and skills that no CNA should enter the profession without. Fortunately, our CNA classes here in Jacksonville, FL, will equip you to provide the care that your patients deserve.