Posted 6/25/2015 10:42 AM (GMT -6)
Make certain that the bed is very firm. You might need
to stiffen it with a sheet of plywood under the mattress.
Learn all the body mechanics required of the patient for
yourself, and practice them. Use them all the time, as you
prepare to watch over the patient, in the coming days.
You need to know what they need to know!
There was once an awareness campaign that advocated
pretending that there was a raw egg still in the shell,
between your foot and the gas pedal of your car. You
were supposed to drive in such a way as not to break
Similarly, try to imagine a giant, brittle taco shell is on
top of the mattress of the bed, but under you as you lay
on the bed. You want to be able to get in and out of the
bed without breaking the taco shell; especially, the elbows
are going to punch a hole in the taco shell.
Obviously you can't avoid breaking the shell, so imagine
whatever comes to mind that would probably not break
into very many pieces, but would still be thin and brittle
enough to serve as constant reminder not to apply a lot
of muscle power to any small area of the bed, when moving
in and out of the bed.
Most importantly is if the bed (or any soft or low furniture)
is to be used by the post-operative patient, that they be
told a few times about any compromises in support --
absolutely no surprises are tolerable, as the patient is
too inexperienced with median sternotomy recovery to
easily predict if a given room furnishing will be supportive
Make sure you are with them the first time they try to
use anything that will support their body weight.
The lifting power of the knees is apt to be severely
limited -- there may be chairs too low for them to
escape from, when it is time to stand up.
Getting up from the floor, for any reason, will be almost
(or fully) impossible. Once the patient gets bored with
compliance, expect them to try to do things they probably
cannot do, and strand themselves. Asking for help is
difficult, and you can expect they'll do a lot on their own,
rather than ask for the help they need -- and will often
wave you away when you offer help.
A physical therapist, visiting in the home, is the right way
to handle many of these kinds of ambulatory issues. The
PT will teach the new patient the safest way to get in and
out of the bed, the shower, and so forth.
A hospital bed is needed for greatest patient safety. The
fact that such a bed can support the patient in a half
sitting posture is what makes it so valuable. The fact that,
once the patient is safely in the bed, it can be lowered
under the shoulders (to lay more flat) contributes to
patient comfort, when they want to sleep. At least, some
patients will want to lay more flat.
Going from flat on a bed, to standing next to the bed, takes
a few (several?) distinct postures (body positionings) to
achieve, safely. Same is true of getting into the bed. The
patient will have some experience, doing for themself, in
hospital. But the hospital normally has the correct kinds
of room furnishings. This isn't ordinarily the case, in the home.
Learn all 'sternal precautions' and pretend they apply to you.
Try to solve these problems, ahead of need. The point is to
find the worst hazards still in the home, identify them, and
have a (simple, but) written plan for patient safety, around
Doors that aren't easily opened, especially, are a known
hazard to the healing sternum. The patient must develop a
habit to (at a minimum) not become trapped behind a door
too difficult to open. Public restrooms and stairwell doors
are often too strongly sprung (by door closers).