Comprehensive Nursing Study Guide: Bed Making, Physical Comfort, and Therapeutic Applications
Bed Making in Nursing
Purposes of Bed Making
To provide the patient with a safe and comfortable surface for rest and sleep.
To give the hospital unit or ward a neat and orderly appearance.
To adapt to the specific needs of the patient and ensure readiness for emergencies or critical illness conditions.
To economize time, material, and effort for the nursing staff.
To prevent the development of bedsores (pressure ulcers).
To observe the patient during the process, specifically checking for the presence of existing bed sores, monitoring oral hygiene, and assessing the patient's ability for self-care.
To promote overall cleanliness.
To establish an effective nurse-patient relationship through interaction.
To provide active and passive exercises to the patient.
To serve as an educational opportunity for relatives to learn how to care for the sick at home.
Principles of Bed Making
Microbial Control: Microorganisms are found everywhere—on the skin, on articles used by patients, and in the immediate environment. The nurse must take care to prevent the transference of these microorganisms from the source to a new host via direct or indirect contact.
Comfort and Safety: A safe and comfortable bed ensures rest and sleep while preventing complications for bed-ridden patients, such as bedsores and foot drop.
Body Mechanics: Utilizing good body mechanics maintains proper body alignment and prevents nurse fatigue.
Efficiency: Systematic ways of functioning save time, energy, and material resources.
Guidelines for Handling Linens
Practice medical asepsis at all times when handling linens and making beds.
The nurse's uniform is considered dirty; always hold linens away from the body and uniform to prevent cross-contamination.
Never shake linens: Shaking linens spreads microbes into the air and environment.
Place clean linens only on clean surfaces.
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 Beds
Simple Beds:
Closed Bed: This bed is not currently in use. It is prepared for a new patient upon admission or made for a patient who remains up and out of bed during the day.
Open Bed: These beds are in use. The top linens are fan-folded back so the patient can easily get into the bed.
Occupied Bed: A bed that is made while the patient is still in it.
Special Beds:
Surgical/Postoperative Bed: Made to transfer a person from a stretcher or to receive a patient immediately following surgery.
Cardiac Bed: Specialized for patients with heart conditions.
Fractured Bed: Designed for patients with bone fractures.
Amputation Bed: Tailored for patients who have undergone limb removals.
Cleaning the Bed (Carbolizing)
Definition: The process of disinfecting the mattress and cot.
Method:
Prepare the cleaning solution in a basin.
Use two mitten cloths: one for wet application and one for drying.
Carbolize half of the mattress starting from the head end to the middle; remove dust, then clean from the middle to the foot end.
Fanfold the mattress and carbolize half of the cot and the back side of the mattress.
Repeat for the remaining half of the mattress and cot.
Carbolize side rails, lockers, and chairs.
Bed Making Procedure and Assessment
Preliminary Assessment:
Check the doctor’s orders for specific precautions regarding patient movement and positioning.
Assess the quantity of clean linen needed.
Assess the patient’s ability for self-care.
Identify articles needed for patient comfort.
Standards of Execution:
The bed is the most important furniture in the ward and the most noticeable to anyone entering.
The bed must be made for durability, use, and comfort, maintaining a finished appearance.
Have all necessary items on hand before starting.
Place all linen perfectly straight.
Ensure linen is tucked in far enough under the mattress ($fixed$, $tight$, and $free$ $from$ $wrinkles$).
Tuck in one side first, then tighten on the opposite side.
Tighten each article separately using Mitered Corners.
Rubber Draw Sheet: Must be smooth, well-tucked, and extend from the shoulders to below the knees.
Tightening Rule: Do not alter the mattress shape or cause sagging. Pull on the center first, then the foot, then the head. Do not pull solely on corners.
Cotton Draw Sheet: Placed under the shoulders and down to or below the knees. The weight of the shoulders holds it in place to prevent loosening or wrinkling.
Upper Clothing: Tucked neatly and well, but not too tightly; allow sufficient room for foot movement.
Upper Sheet: Tucked well at the bottom but left free at the top with enough length to turn over the spread and blanket.
Blankets: Should be high enough to protect the shoulders.
Pillows: Snugly tucked into corners of the pillowcase, appearing neat, flat, and smooth.
Physical Comfort in Nursing Care
Defining Physical Comfort
Comfort is a state of complete enjoyment in both physical and mental states.
It implies a body free from pain, hunger, cold, and fatigue.
Making the patient as comfortable as possible in mind and body is the most important factor in nursing care upon admission.
Physical rest and relaxation conserve energy and build resistance to disease; recovery depends largely on comfort provided by nursing care.
Physical Causes of Discomfort in Illness
Pain: Physical pain resulting from the illness itself.
Positioning: Incorrect positioning (e.g., supine may be uncomfortable for those with respiratory issues or back injuries).
Restricted Movement: Due to weakness or medical appliances.
Inadequate Care: Delayed attention to personal needs like cleanliness.
Environment: Wrinkles in bed causing friction/chaffing, lack of exercise, dehydration, and noise.
Temperature: Extremes of being too warm or too cold.
Physiological Interference: Sleeplessness, loss of appetite, and indigestion.
Psychological Factors: Anxiety due to illness.
Nursing Technique: Unskillful handling, sudden jerky movements, or noisy starts.
Factors Promoting Physical Comfort
Changing soiled linens immediately.
Maintaining comfortable positioning and silent environments.
Keeping beds wrinkle-free and arranging pillows properly.
Planning interventions for pain management.
Maintaining comfortable room temperatures and responding to needs immediately.
Comfort Devices and Their Uses
Pillows: Used for support and to maintain body alignment.
Back Rest: Supports the patient's back at an angle to maintain a sitting position.
Bed Cradle: Prevents pressure from bed linens on the body and allows air circulation around limbs.
Cardiac Table: Facilitates meals and writing for the patient.
Air and Water Mattresses: Used for comfort and to protect thin or obese patients from pressure sores.
Trapeze Bar: Allows patients to grasp the bar to move up in bed or raise their trunk.
Footrest: Supports the feet.
Trochanter Rolls: Prevents external rotation of the legs when the patient is in a supine position.
Sandbags: Immobilize extremities and maintain specific body alignment.
Side Rails: Ensure patient safety and aid in mobility.
Abductor Pillow: Maintains legs in abduction following total hip replacement surgery.
Knee Rest: Provides relaxation and relieves pain beneath the knees.
Bed Blocks: Used to raise the foot or head end of the bed.
Air Cushion: Relieves pressure on specific body parts by taking the weight off the body.
Rubber and Cotton Rings: Relieve pressure on specific parts such as elbows and heels.
Hand Rolls: Maintain the thumb in slight adduction and opposition to fingers; maintain fingers in a slightly flexed position.
Standard Positioning Types
Supine: Lying on the back.
Prone: Lying face down.
Right Lateral Recumbent: Lying on the right side.
Left Lateral Recumbent: Lying on the left side.
Fowler’s Position: Sitting straight up and leaning slightly back.
Trendelenburg: Lying supine with the head slightly lower than the feet.
Principles of Moving, Lifting, and Body Mechanics
Safety in Moving and Lifting
Nurses are at high risk for lumbar muscle injury.
The 35% Rule: A nurse should not lift an object if its weight is or more of the nurse's body weight.
Example: A nurse weighing should not lift a patient weighing due to the risk of dropping the patient or spinal injury.
Steps for Safe Lifting:
Keep the object as close to the body as possible to maintain balance.
Bend the knees: Uses strong leg muscles and maintains the center of gravity.
Avoid twisting: Twisting overloads the spine.
Tighten abdominal muscles and tuck the pelvis.
Body Mechanics Overview
Definition: Coordinated efforts of the musculoskeletal and nervous systems to maintain balance, posture, and alignment.
Stability: An object is more stable when it is closer to its base of support.
Center of Gravity: The point where mass is centered; stability is highest when the center of gravity is lower and closer to the base of support.
Uses: Prevents fatigue and deformities, promotes physiological function, reduces energy expenditure, and contributes to appearance.
Posture and Health
Bad Posture: Causes back pain, makes one feel sluggish/fearful, communicates boredom/nervousness, and makes one look unhealthy or heavier.
Good Posture: Engages the core, improves breathing via the diaphragm, aids digestion, increases energy/productivity, and communicates confidence.
Stat: Posture is the number 1 reason for doctor visits and missed workdays after the common cold.
Activity and Exercise
Active vs. Passive Exercise
Active Exercises: Performed by the patient themselves within their limitations.
Passive Exercises: Movements carried out by a nurse or physiotherapist to maintain range of movement.
Scope of Active Exercises
Neck: Flexion, Extension, Hyperextension, Rotation, Lateral flexion.
Shoulder: Flexion, Extension, Hyperextension, Abduction, Adduction, Outward rotation, Inward rotation.
Arm: Flexion, Extension, Supination, Pronation.
Hand: Hyperextension, Extension, Flexion, Ulnar flexion, Radial flexion, Abduction, Adduction, Opposition to little finger.
Leg: Flexion, Extension, Abduction, Adduction, Outward/Inward rotation.
Foot: Dorsal flexion, Plantar flexion, Pronation, Supination, Flexion, Extension, Adduction, Abduction.
Passive Exercise Guidelines
Position yourself to move without strain or loss of balance.
Explain the procedure to the patient to build confidence.
Know the normal range of movement; exceeding it can cause damage.
Support the part being moved with a gentle but firm grip, avoiding bony prominences.
Fix the bone proximal to the joint being moved.
Frequency: Perform movements three times in each direction, 2–3 times a day.
Movements must be smooth, slow, and pain-free.
Hot and Cold Applications
Nursing Responsibilities
Understand normal body responses to temperature variation.
Assess skin integrity and the client’s ability to sense temperature.
Ensure equipment is functioning properly.
Acknowledge the legal responsibility for safe administration.
Hot Applications
Definition: Application of an agent warmer than the skin in moist or dry form.
Indications: Relieve pain/congestion, provide warmth, promote suppuration/healing, decrease muscle tone, soften exudates.
Contraindications: Malignancies, impaired kidney/heart/lung function, acutely inflamed areas, paralysis, open wounds, edema from venous disease, headaches, metabolic disorders, very young/old, high temperature.
Types:
Local Dry: Ultra-violet rays, electric cradles, heating lamps, heating pads, short wave diathermy, hot water bottles, chemical heating bottles, infra-red rays.
Local Moist: Warm soaks, hot fomentations, poultices, stupes, paraffin baths, sitz baths.
General Dry: Sunbath, electric cradle, blanket bed.
General Moist: Steam baths, hot packs, whirlpool baths.
Cold Applications
Definition: Application of an agent cooler than skin in moist or dry form.
Indications: Reduce pain/temperature, control hemorrhage/infection, prevent gangrene/edema, reduce inflammation.
Contraindications: Shock and collapse, edema, circulatory disorders, muscle spasm, decreased sensation, infected wounds, low body temperature/shivering.
Types:
Local Dry: Ice bag, ice collar, ice pack, chemical cold packs, ice cradle.
Local Moist: Ice to suck, cold compress, evaporating lotion.
General Dry: Hypothermia.
General Moist: Cold sponging, cold bath, cold packs.
Physiological and Therapeutic Effects
Primary Effects of Heat: Peripheral Vasodilation, increased capillary permeability, increased local metabolism and consumption, increased blood/lymph flow, increased motility of leucocytes, decreased blood viscosity, decreased muscle tone.
Primary Effects of Cold: Peripheral Vasoconstriction, decreased capillary permeability, decreased local metabolism and consumption, decreased blood/lymph flow, decreased motility of leucocytes, increased muscle tone, increased blood viscosity.
Secondary/Rebound Effects:
Prolonged Heat: After 20–40 minutes, maximal circulation occurs. Prolonged exposure leads to vasoconstriction.
Prolonged Cold: Primary effects last 30–60 minutes. Prolonged exposure leads to vasodilation.
Recovery Rule: Allow 1 hour of recovery time between applications.
Factors Influencing Tolerance
Duration: Short exposures are better tolerated.
Body Part: Sensitive areas include the neck, inner wrist, forearm, and perineal region. Hands and feet are less sensitive.
Skin Condition: Damaged or exposed skin layers are more sensitive.
Surface Area: Less tolerance when large areas of the body are exposed.
Complications
Heat: Pain, burns, maceration, redness, edema, pallor.
Cold: Pain, blisters, skin breakdown, maceration, grey/bluish discoloration, thrombus formation.
Scientific Principles of Application
Water is a good conductor; air is a poor conductor of heat.
Heat flows from hotter areas to less hot areas.
Steam increases the temperature of hot applications.
Oil acts as an insulator.
Woolen materials absorb moisture slowly but hold it longer and cool slower than cotton.
Friction produces heat.
Important Terminology
Bedboard: A board placed under a mattress to provide hard support.
Bed Cradle: Frame used to keep covers off a patient's parts.
Edema: Swelling caused by excess fluid trapped in body tissues.
Fanfolding: Folding linens in accordion-like pleats.
Footdrop: Difficulty lifting the front part of the foot (plantar flexion deformity).
Mitered Corners: A method of folding bed linens at corners to create a tight, professional fit.
Plantar Flexion: Movement of the foot in a downward direction.
Pressure Ulcer: A sore caused by prolonged pressure on the skin (bedsore).
Toe Pleat: A fold made in top linens to allow room for the patient's toes.
Trochanter Roll: Cylindrical prop used to prevent external rotation of the hip.