The Importance of

frequent turning of the

bedridden and unconscious
patient

Presented by
Krysta Powell
Objectives:
At the end of the presentation, each person should
be able:
• to define turning and unconsciousness
• to identify the importance of turning
• to know the types of positioning
• to define, outline the risk factors, symptoms and
stages of the one complication of not turning
patients: Decubitus Ulcer
• to know the guidelines on turning an
unconscious patient
Key Terms

• Turning
• Unconscious
• Decubitus Ulcer
• Recovery Position
Definition of Turning
• According to Nursing Home Law Center LLC, “
Turning is the physical act of moving a patient’s
body to prevent the formation of bed sores.”
• When a patient remains stationary for too long,
his or her blood begins pooling in the parts of
the body closest to the ground.
Definition of unconsciousness
• Unconsciousness is an abnormal state in which a
person is not alert and not fully responsive to
his/her surroundings.
• Levels of unconsciousness range from
drowsiness to collapse and may range in severity
from fainting to coma.
Importance of Turning or Repositioning

• It helps encourage healthy blood flow for

patients confined to bed rest or wheelchairs.

• It provides patient comfort and safety. It

supports the patient’s airway and maintain the
circulation throughout the procedure (e.g., in
surgery, in examination, specimen collection,
and treatment).
• to reduce or relieve the pressure on the area at
risk, maintain muscle mass and general tissue
integrity and ensure adequate blood supply to
the risk area.
• it maintains patient dignity and privacy. In
surgery, proper positioning is a way to respect
the patient’s dignity by minimizing exposure of
the patient who often feels vulnerable
perioperatively.
• Turning allows maximum visibility and access.
Proper positioning allows ease of surgical access
as well as for anesthetic administration during
perioperative phase.

• As a general rule, turning should occur every two

hours at least. Changing a patient's position in
bed every 2 hours helps keep blood flowing. This
helps the skin stay healthy and prevents
bedsores.
Types of Position/Turning
• Supine
• semi-fowlers
• low or high fowlers
• prone
• Sims
• Lithotomy
• Trendelenburg
Complication:
What is Decubitus Ulcer?
• A decubitus ulcer is also known as a pressure
ulcer, pressure sore, or bedsore. It’s an open
wound on your skin. It often occur on the skin
covering bony areas. The most common places
for a decubitus ulcer are your:
• hips
• back
• ankles
• buttocks
This condition is common among people who:

• are older
• have decreased mobility
• spend long periods in bed or a wheelchair
• can’t move certain body parts without help
• have fragile skin.
What are the symptoms of a decubitus
ulcer?
• skin discoloration
• pain in the affected area
• infection
• open skin
• skin that doesn’t lighten to the touch
• skin that’s softer or firmer than the surrounding
skin
Stages of decubitus ulcers
• Stage 1
The skin isn’t broken, but it’s discolored. The area
may appear red if you have a light complexion. The
discoloration may vary from blue to purple if you have
a dark complexion. It may also be warm and swollen.
• Stage 2
There is breakage in the skin revealing a shallow ulcer
or erosion. There might also be a blister filled with
fluid.
• Stage 3
The ulcer is much deeper within the skin. It affects
your fat layer and looks like a crater.
• Stage 4
Many layers are affected in this stage, including
your muscle and bone.
• Unstageable
Other complication of not turning patients can
result in:

• Severe cellulitis (deep tissue infection),

• Osteomyelitis (bone infection),
• Gangrene, sepsis (blood infection)
• Necrotizing fasciitis (flesh-eating bacteria).
Guidelines for turning an unconscious
patient:
• If a person is unconscious but is breathing and
has no other life-threatening conditions, they
should be placed in the recovery position.
Putting someone in the recovery position will
keep their airway clear and open. It also ensures
that any vomit or fluid won't cause them to
choke.
• With the person lying on their back, kneel on the
floor at their side.
• Extend the arm nearest you at a right angle to their
body with their palm facing up.
• Take their other arm and fold it so the back of their
hand rests on the cheek closest to you, and hold it in
place.
• Use your free hand to bend the person's knee farthest
from you to a right angle.
• Carefully roll the person onto their side by pulling on
the bent knee.
• Their bent arm should be supporting the head, and
their extended arm will stop you rolling them too far.
• Make sure their bent leg is at a right angle.
• Open their airway by gently tilting their head
back and lifting their chin, and check that
nothing is blocking their airway.
• Stay with the person and monitor their condition
until help arrives.
• If you do think there is a possible spinal injury,
leave the person as you found him/her (as long
as breathing continues). If the person vomits or
bleeds out of his/her mouth, roll his/her entire
body at one time to the side. Be sure to support
the person's neck and back to keep the head and
body in the same position while you roll him/her
Reference
• Nursing Home Law Center LLC (2022)
What is “Turning” and Why is It Important to
Prevention of Bed Sores?
https://www.nursinghomelawcenter.org

• Healthline. (2021).Bedsores: What You Should

Know About Decubitus Ulcers
https://www.healthline.com/health/pressure-
ulcer