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1-23. TURNING A PATIENT IN A SPICA CAST
Patients in body or spice casts must be turned from supine to prone to permit the cast to dry, to prevent pressure areas by redistribution of body weight, and to prevent respiratory and urinary complications. The patient is turned initially as ordered by the physician and must usually be turned a minimum of every two hours (unless otherwise indicated by the physician) for as long as he remains in the cast. Until the cast is thoroughly dry, at least three people should turn the patient so that there is no strain on the patient or on the damp cast. As the patient becomes accustomed to the cast and learns to help himself, less assistance may be required in turning the patient.
a. In any turning procedure, the patient must be turned "as a unit" with the affected side ("bad side") uppermost. The patient should be turned, or log-rolled, toward the unaffected side of his body ("good side").
b. Utilizing the pillows on which the patient is resting, and/or a draw sheet, move the patient to the side of the bed with a steady, even, pulling motion. Remember that
the patient must be moved as a unit. When the patient is in the proper position, his "bad side" will be at the edge of the bed and his "good side" will be near the center of the bed.
c. One person should remain at the patient's affected side, while the others move to the opposite side of the bed to straighten the bed linen and position another set of pillows along side the patient. The pillows should be arranged so that they will support the cast and the patient's head and shoulders when you turn the patient.
d. The patient should be instructed to raise the arm on his unaffected side above his head.
e. The person on the patient's affected side should place his hands, with palms up, under the patient's torso.
f. The assistants on the patient's unaffected side should reach across the bed and place their hands, with palms down, on the patient's affected side. The person nearest the patient's head should place his hands on the patient's shoulder while the person nearest the patient's feet should place his hands on the patient's hip and leg.
g. Moving simultaneously, the person on the patient's affected side should gently draw the patient toward himself while the assistants on the opposite side ease the patient over toward themselves. Care should be taken to support the leg and arm on the affected side of the body.
h. After the patient has been turned, check the placement of the supporting pillows. Be sure that there are no gaps between pillows. When the patient is turned to the prone position, place a pillow under the lower legs to allow the feet to rest in the position of function and avoid having the toes pushed against the mattress.
i. Position a pillow under the patient's head and shoulders and be sure to place the call bell within his reach.
