What type of hospital bed is recommended for an 80-year-old female with Covid-19, shortness of breath, previous Cerebrovascular Accident (CVA) with left-sided weakness, Coronary Artery Disease (CAD) with stents, and Parkinson's Disease (PD), who is unable to cough effectively due to weakness?

Hospital Bed Selection for Elderly COVID-19 Patient with Multiple Comorbidities

This patient requires a hospital bed with adjustable positioning capabilities, specifically one that allows for elevation of the head of the bed to at least 30-45 degrees and enables prone positioning when needed.

Patient Assessment and Bed Requirements

The 80-year-old female patient presents with multiple high-risk factors that influence bed selection:

• COVID-19 with respiratory symptoms (shortness of breath)
• Previous CVA with left-sided weakness
• Coronary artery disease with stents
• Parkinson's disease
• Inability to cough effectively due to weakness

Primary Considerations for Bed Selection

1. Respiratory Support Requirements

   • COVID-19 patients frequently require respiratory support, with approximately 70% of ICU patients needing some form of ventilatory support 1
   • Positioning is critical for optimizing oxygenation in COVID-19 patients

2. Mobility Limitations

   • Left-sided weakness from previous CVA
   • Parkinson's disease affecting movement
   • These conditions increase risk of pressure injuries and venous thromboembolism

3. Cardiac Considerations

   • CAD with stents requires monitoring for cardiac complications
   • COVID-19 can exacerbate underlying cardiovascular conditions 2

Specific Bed Features Required

1. Adjustable Positioning Capabilities

• Head Elevation: Must allow for elevation of the head of the bed to 30-45 degrees

  • Improves respiratory mechanics
  • Reduces work of breathing
  • Decreases risk of aspiration in patients with impaired cough reflex

• Prone Positioning Option

  • Prone positioning has been associated with improved outcomes for COVID-19 patients with respiratory distress 3
  • The bed should facilitate safe and efficient prone positioning with minimal staff exposure

2. Pressure Relief Surface

• Patient's mobility limitations and neurological conditions increase risk of pressure injuries
• A pressure-redistributing mattress is essential for prevention of pressure ulcers

3. Safety Features

• Side rails with multiple positioning options
• Bed alarm system to alert staff of unauthorized movement
• Low height position to minimize fall risk
• Brake system that can be easily engaged

4. Accessibility Features

• Controls that can be operated by the patient despite left-sided weakness
• Emergency call system within easy reach

Implementation Considerations

• The bed should be placed in a negative pressure room if available, or in a designated COVID-19 area 1
• Ensure adequate space around the bed for equipment and staff to perform necessary procedures
• Position the bed to allow staff to approach from the patient's stronger (right) side

Monitoring and Adjustments

• Regular repositioning schedule (every 2 hours) to prevent pressure injuries
• Daily assessment of skin integrity
• Adjustment of bed position based on respiratory status and oxygen requirements
• Early mobilization when appropriate, as studies show COVID-19 patients in ICU had a mean time to first mobilize of 14 ± 7 days 3

Pitfalls to Avoid

• Avoid standard flat hospital beds that don't allow for position changes
• Don't select beds with complicated controls that the patient cannot operate independently
• Avoid beds without pressure redistribution features given the patient's multiple risk factors for pressure injuries
• Don't place in shared rooms without appropriate infection control measures

By selecting a hospital bed with these specific features, healthcare providers can optimize respiratory support, reduce complications, and improve outcomes for this high-risk elderly patient with COVID-19 and multiple comorbidities.