Bed Bound Clients

Clients who are bed bound are immobile. Here are some of the problems that can develop from immobility—regardless of the client’s age:

Early signs of a pressure sore may be pale skin or slightly reddened skin over a bony area. The client may complain of pain, burning, or tingling.

Stage 1: The skin over a bony area is intact but pink or slightly reddened. In clients with dark skin, the skin may appear ashen.

Stage 2: The skin is red and swollen. There will either be a blister or an open area.

Stage 3: The area begins to look like a crater. The sore will extend deeper into the skin.

Stage 4: The sore extends deep into the fat, muscle, or bone. There may be a thick black scab, called eschar.

Clean incontinent clients as soon as they are soiled. Urine and stool are uncomfortable, foul smelling and highly irritating to the skin. Keep the skin clean and dry. Wash with mild soap, rinse well and then dry the skin completely.
Follow the client’s care plan for re-positioning. If no plan is stated, re-position every two hours. (Consider the “turn clock” method.)
Follow your workplace guidelines for monitoring intake and output. Fluid imbalances can be dangerous for the bed bound client.
Keep the bed clean, dry and wrinkle-free. Keep at least 3-4 pillows available. Use pillows creatively to position the client and to pad bony areas. For example, place a pillow between the knees for the side-lying position.
If your workplace has access to a mechanical patient lift, consider using it to transfer your bed bound client into a recliner, a wheelchair, or even to the bathroom for a tub bath.
Encourage family members to help soothe the client by providing favorite music, photos, and comfort foods (if allowed).