Comprehensive Nursing Study Guide: Bed Making, Patient Comfort, and Therapeutic Applications
Purposes and Principles of Bed Making
Definition and Objectives:
To provide patients with a safe and comfortable bed for rest and sleep.
To maintain a neat and orderly appearance for the unit or ward.
To adapt to specific patient needs and ensure readiness for emergencies or critical changes in illness.
To economize time, materials, and effort during nursing duties.
To prevent the development of bedsores (pressure ulcers).
To observe the patient during the process (e.g., checking for existing bedsores, monitoring oral hygiene, assessing the patient’s ability for self-care).
To promote overall cleanliness.
To establish an effective nurse-patient relationship.
To facilitate active and passive exercises for the patient.
To provide an opportunity for relatives to learn how to care for the sick at home.
Fundamental Principles:
Microbiology: Micro-organisms are ubiquitous, found on the skin, patient articles, and the general environment.
Infection Control: The nurse must prevents the transference of micro-organisms from a source to a new host via direct or indirect contact.
Patient Safety: A safe, comfortable bed ensures rest and prevents complications like bedsores and foot drop.
Body Mechanics: Utilizing good body mechanics maintains alignment and prevents nurse fatigue.
Efficiency: Systematic functioning saves time, energy, and material resources.
Standards for Handling Linens and Drawsheets
Medical Asepsis in Linen Handling:
Always practice medical asepsis when handling linens.
The nurse's uniform is considered dirty; always hold linens away from the body and uniform.
Never Shaking Linens: Shaking linens spreads microbes into the air.
Surface Placement: Clean linens must only be placed on a clean surface. Never place clean or dirty linens on the floor.
Drawsheets:
Definition: A small sheet placed over the middle of the bottom sheet.
Cotton Drawsheet: Helps keep the mattress and bottom linens clean.
Waterproof Drawsheet: Protects the mattress and bottom linens from dampness and soiling.
Types of Hospital Beds
Simple Beds:
Closed Bed: A bed that is not currently in use. It is prepared for a new patient upon admission or made for a patient who is up and out of bed during the day.
Open Bed: A bed currently in use. Top linens are fan-folded back so the person can easily get into bed.
Occupied Bed: A bed that is made while the patient remains in it.
Special Beds:
Surgical / Post-operative Bed: Specifically made to receive a patient after surgery or to transfer a person from a stretcher.
Cardiac Bed: Adapted for patients with heart conditions.
Fractured Bed: Designed for patients with bone fractures.
Amputation Bed: Specialized for patients who have undergone limb removal.
Cleaning and Carbolizing the Bed Unit
Carbolization Process:
Prepare the solution in a basin and use two mitten cloths (one wet for cleaning, one dry).
Mattress and Cot Cleaning:
Carbolize half of the mattress starting from the head end to the middle, removing dust.
Clean from the middle to the foot end.
Fanfold the mattress; carbolize half of the cot and the backside of the mattress.
Repeat for the next half of the mattress and cot.
Furniture Cleaning: Carbolize side rails, side lockers, chairs, and other adjacent surfaces.
Bed Making Procedures and Assessment
Preliminary Assessment:
Check doctor’s orders for precautions regarding patient movement and positioning.
Assess the quantity of clean linen needed.
Assess the patient's self-care ability.
Determine which comfort articles are required.
Key Execution Steps:
Gather all necessary items before starting (Rubber sheet, bed sheets, pillows, pillowcases).
Place all linen perfectly straight.
Tuck linens far enough under the mattress to remain fixed, tight, and free from wrinkles.
Mitered Corners: Create neat, firm, diagonal corners for stability.
Tucking Technique: Tuck in one side first, then tighten on the opposite side. Tighten each article separately.
Tightening Sequence: To preserve mattress shape, pull first on the center, then the foot, then the head.
Specific Placements:
Rubber Draw Sheet: Should extend from the shoulders to below the knees and be pulled smooth.
Cotton Draw Sheet: Placed under the shoulders down to the knees; the weight of the shoulders helps hold it in place to prevent wrinkling.
Upper Clothing: Tuck neatly at the bottom but allow sufficient room for foot movement. Leave the top free with enough length to turn over the spread and blanket.
Blankets: Should reach high enough to protect the shoulders.
Pillows: Tucked snugly into cases, appearing neat, flat, and smooth.
Definitions and Nursing Terminology
Bedboard: A board placed under a mattress to provide firm support.
Bed Cradle: A device placed over the bed to keep top covers off the patient's feet or legs.
Edema: Swelling caused by excess fluid trapped in body tissues.
Fanfolding: Folding linens back and forth like a fan.
Footboard: A board placed at the end of the bed to prevent footdrop.
Footdrop: A condition where the front of the foot cannot be lifted, often due to nerve injury or prolonged immobility.
Mitered Corners: A method of folding the corner of a bed sheet to create a tight, 45-degree angle.
Plantar Flexion: Movement of the foot in a downward direction (toward the sole).
Pressure Ulcer: Also known as a bedsore; localized injury to the skin and underlying tissue over a bony prominence.
Toe Pleat: A fold made in the top bedclothes to allow room for the patient's toes.
Trochanter Roll: A rolled towel or blanket placed against the hip to prevent external rotation of the leg.
Physical Comfort in Patient Care
Definition of Comfort: A state of complete physical and mental enjoyment; a body free from pain, hunger, cold, and fatigue.
Importance: Comfort is the first and most important factor in nursing care. Physical rest and relaxation conserve energy and build resistance to disease, significantly impacting recovery.
Physical Causes of Discomfort:
Pain resulting from illness.
Poor positioning (e.g., supine position may be uncomfortable for those with respiratory issues or back pain).
Restriction of movement due to weakness or medical appliances.
Delayed personal care or hygiene.
Improper arrangement of pillows or bed wrinkles (friction/chaffing).
Lack of exercise and dehydration.
Extreme temperatures and environmental noise.
Interference with bodily functions (sleeplessness, indigestion).
Anxiety and unskillful or clumsy handling by staff.
Factors Promoting Comfort:
Changing soiled linens immediately.
Keeping the patient in a comfortable position with a wrinkle-free bed.
Maintaining silence and comfortable room temperatures.
Planning pain management interventions and responding to needs immediately.
Comfort Devices and Their Uses
Pillows: For support and maintaining body alignment.
Back Rest: Supports the patient at an angle to maintain a sitting position.
Bed Cradle: Prevents pressure from bed linen and allows air circulation around limbs.
Cardiac Table: Enables the patient to eat or write while in bed.
Air and Water Mattresses: Protect thin or obese patients from pressure sores by distributing weight.
Trapeze Bar: Allows patients to grasp the bar to move up in bed or raise their trunk.
Footrest: Provides support for the feet.
Trochanter Rolls: Prevents external rotation of legs in the supine position.
Sandbags: Immobilize extremities and maintain specific body alignment.
Side Rails: Ensure safety and assist in mobility.
Abductor Pillow: Maintains legs in abduction following total hip replacement surgery.
Knee Rest: Relieves pain beneath the knees.
Bed Blocks: Raise the foot or head end of the bed.
Air Cushion / Rubber and Cotton Rings: Relieve pressure on specific body parts like elbows and heels.
Hand Rolls: Maintain the thumb in opposition to fingers and keep fingers slightly flexed.
Patient Positioning and Body Mechanics
Positions:
Supine: Lying on the back.
Prone: Lying face down.
Right/Left Lateral Recumbent: Lying on the right or left side.
Fowler’s Position: Fully sitting up or leaning slightly back.
Trendelenburg: Supine position with the head lower than the feet.
Body Mechanics:
Definition: Coordinated efforts of musculoskeletal and nervous systems to maintain balance, posture, and alignment.
Center of Gravity: The point where mass is centered; stability increases when the center of gravity is lower and closer to the base of support.
Uses: Prevents fatigue, promotes physiological function, reduces energy expenditure, and prevents deformities.
Moving and Lifting Principles:
Nurses are at high risk for injury to lumbar muscles.
The Rule: A nurse should not lift an object if its weight is or more of their own body weight. Example: A nurse weighing should not lift a patient weighing .
Lifting Steps:
Keep the object as close to the body as possible.
Bend the knees to maintain the center of gravity and use strong leg muscles.
Avoid twisting, which overloads the spine.
Tighten abdominal muscles and tuck the pelvis.
Posture Facts:
Poor posture (slouching) causes back pain, communicates boredom or self-consciousness, and can make a person look heavier or unattractive.
Good posture engages the core, aids digestion by opening the diaphragm, and increases energy.
Posture issues are the number reason for doctor visits and missed workdays after the common cold.
Therapeutic Exercise: Active and Passive
Active Exercises: Performed by the patient independently within their limitations.
Neck: Flexion, extension, hyperextension, rotation, lateral flexion.
Shoulder: Flexion, extension, hyperextension, abduction, adduction, inward/outward rotation.
Arm: Flexion, extension, supination, pronation.
Hand: Flexion, extension, hyperextension, ulnar/radial flexion, abduction, adduction, opposition to little finger.
Leg: Flexion, extension, abduction, adduction, inward/outward rotation.
Foot: Dorsal flexion, plantar flexion, pronation, supination, inversion, eversion.
Passive Exercises: Movements carried out by a nurse or physiotherapist.
Guidelines: Position self to avoid strain; explain the procedure to the patient; know the normal range of motion () to avoid joint damage (irreparable harm occurs if is exceeded).
Technique: Support the part with a gentle but firm grip; fix the bone proximal to the joint being moved. Perform movements times in each direction, to times a day. Movements should be smooth and slow.
Hot and Cold Applications
Nurse Responsibilities:
Understand normal body responses to temperature variations.
Assess skin integrity and the patient's ability to sense temperature.
The nurse has legal responsibility for safe administration.
Hot Applications:
Indications: Relieve pain/congestion, provide warmth, promote healing/suppuration, decrease muscle tone, soften exudates.
Contraindications: Malignancies, impaired kidney/heart/lung function, acute inflammation, paralysis, open wounds, migraine/headaches, metabolic disorders, very young or old patients, high fever.
Forms:
Local Dry: Hot water bottles, chemical bottles, infrared/ultraviolet rays, heating lamps/pads, diathermy.
Local Moist: Warm soaks, fomentations, poultices, stupes, paraffin/sitz baths.
General Dry: Sunbath, electric blanket bed.
General Moist: Steam/whirlpool baths, hot packs.
Cold Applications:
Indications: Reduce pain, lower body temperature, control hemorrhage/infection, prevent gangrene/edema, reduce inflammation.
Contraindications: Shock, circulatory disorders, muscle spasms, decreased sensation, low body temperature/shivering.
Forms:
Local Dry: Ice bag, ice collar, ice pack, chemical cold packs.
Local Moist: Ice to suck, cold compress, evaporating lotion.
General: Hypothermia (dry), cold sponging/bath/packs (moist).
Physiological Effects: | Feature | Hot Application | Cold Application | | :--- | :--- | :--- | | Vessel Response | Peripheral Vasodilation | Peripheral Vasoconstriction | | Blood Flow | Increased | Decreased | | Metabolism | Increased | Decreased | | Blood Viscosity | Decreased | Increased | | Muscle Tone | Decreased | Increased (Primary) | | Capillary Permeability | Increased | Decreased |
Secondary Effects (Rebound Phenomenon):
Heat: Maximum increase in circulation occurs within . Prolonged exposure (>40\,\text{minutes}) leads to secondary vasoconstriction. A recovery time of is required.
Cold: Primary effects last . Prolonged exposure leads to secondary vasodilation. A recovery time of is required.
Principles of Application:
Water is a good conductor; air is a poor conductor.
Heat flows from hot to less hot areas.
Prolonged moisture increases skin susceptibility to maceration.
Oil acts as an insulator; wool holds moisture longer than cotton.
Sensory nerve endings in the skin convey sensations interpreted by the brain.
Friction produces heat.