Pulling Up a 214-Pound Stroke Resident at 3 a.m.
Mr. Alvin Thibodeaux is 78, 5 ft 7 in, 214 lb, and nine days out from a right-hemisphere stroke that left his left arm and leg flaccid. He can push with his right foot and grip a gait belt with his right hand. He has an indwelling urinary catheter, has had two loose stools this shift, and a 3 cm area over his sacrum is pink and fades when you press it. At 3:10 a.m. he has slid toward the foot of the bed, his call light is on, and he is short of breath lying flat. You are the only aide on the hall; your coworker is in another room with a resident who is vomiting.
1. It is 3:10 a.m., Mr. Thibodeaux is sliding down in bed, and you are alone on the hall. What do you do first, and why is pulling him up by yourself the wrong move?
Read the worked answer
Do not lift or pull him alone.
- Raise the head of the bed first. He is short of breath flat, and easing his breathing takes priority over repositioning.
- Lower the bed to its lowest position, put the call light in his right hand, and tell him in one short sentence what you are doing ("I'm getting help to move you, I'll be right back").
- Get help - your coworker or the licensed nurse - and use a mechanical lift or a two-person move per his care plan.
Why one aide is not enough:
- He cannot assist with his left side, so you would be moving essentially dead weight of 214 lb.
- Dragging him upward creates shear and friction directly over the sacral area that is already showing blanchable redness - the exact mechanism that turns redness into an open injury.
- A single aide improvising a heavy move is how aides get back injuries and how residents get dropped.
The judgment the exam is testing: urgency does not override safe handling. Buy time with positioning and breathing support, then get the second person.
2. The 3 cm pink area over his sacrum fades when you press it. What should the aide do about it, and what should the aide NOT do?
Read the worked answer
What to do:
- Treat it as a pressure injury in the making. Blanchable redness over a bony prominence is the earliest stage and it is reportable.
- Report it to the licensed nurse this shift - describe size, location, color, whether it blanches, and that it appeared or changed on your shift.
- Keep it clean and dry. With two loose stools this shift, check and change promptly; moisture plus shear accelerates breakdown.
- Reposition at the ordered interval, offload the sacrum, and keep the head of the bed as low as his breathing allows, because a high Fowler's position increases sacral pressure.
What NOT to do:
- Do not massage or rub the red area.
- Do not apply lotion, powder, or a donut cushion on your own.
- Do not decide it is "just redness" and leave it out of the report.
Reasoning: the aide cannot stage a wound - that is the nurse's assessment - but the aide is the only person who sees the skin at 3 a.m., so an unreported change is a lost opportunity to prevent an open wound.
3. After you get help and reposition him, he says he wants to be transferred to the chair "to sit up like a man." How do you respond?
Read the worked answer
Acknowledge the wish without promising the chair.
- Ask why he wants up: is he uncomfortable, does he need to urinate, is he short of breath? Often the need behind the request can be met in bed by raising the head.
- Explain what you can do now (head of bed up, pillows arranged, call light in reach) and that getting into a chair is not scheduled at 3 a.m. and needs two staff and the nurse's OK.
- Report the request to the nurse. If the nurse approves an out-of-bed transfer, it happens with a lift or two staff, a gait belt, and shoes with tread.
Why not just do it:
- He has a flaccid left side, a recent stroke, and has been lying down for hours - dangling him upright fast risks orthostatic dizziness and a fall at the worst hour for staffing.
- His right to make choices does not erase the facility's duty to transfer him safely. The compromise is to honor the preference as far as it is safe tonight, and flag it for the care plan so his daytime schedule includes chair time.