It wasn’t long ago when the two of us came into a patient’s room to do a positioning therapy – we reposition the person affected, for example from left to right, so that they are not sore. So: We wanted to do something good for the man, because once there are sores, they are persistent and painful. But our patient, he was maddened. “Actually, I’m not that bad, except when you come!” He hurled at us when my colleague and I explained what we were up to.
Our patients are often annoyed by our tenacity when it comes to such prophylaxis. But getting well is a tough job in the intensive care unit. It’s not like a flu-like infection, where rest in bed and a few tablets are usually enough to get fit again. In the intensive care unit, every patient must actively do something to achieve this goal. And prophylaxis such as positioning therapy are part of it.
If we do not carry out any prophylaxis on a bedridden patient, there will be consequences, and not just sore spots on the body. Joints also become stiff and muscles atrophy, so that the entire musculoskeletal system is severely restricted. The lack of exercise also increases the risk of developing thrombosis. The bowel movements are no longer working properly. The gums can start to bleed, as a result of which teeth tend to fall out – and there is a lot more. So it is not a “slapstick” that arises from a lack of prophylaxis, but a painful matter.
That is why prophylaxis also shape the everyday work of every nurse. The goal is to be at least one step ahead of any potential problem so that it doesn’t even arise. But now I don’t go to the patient and say “Well, Hey, now let’s do a prophylaxis”. Instead, I incorporate them into my bedside care activities. When washing, for example, I try to move each joint well so that they don’t get stiff. I move my immobile patients every few hours so that they don’t get sore. In the mornings and evenings and often in between, I pay attention to brushing my teeth so that the bacteria balance in the mouth is correct and pneumonia does not develop – this can happen quickly if in doubt: Bacteria get from the oral cavity down into the lungs and cause inflammation there.
It is always astonishing for me to see how much the patients benefit from our prophylaxis. We also explained this to the patient on whom my colleague and I wanted to perform positioning therapy. Every time we came back, his litany started all over again. But in the end he did participate, albeit reluctantly.
Julia Rettenberger is an intensive care nurse. In this column, the 27-year-old tells every week about her work at the district clinic in Ebersberg. The collected texts can be found under sueddeutsche.de/thema/Auf_Station