King Saud University College of Nursing Medical surgical Nursing

Module 2 -122

:Prepared By
Lecturer/ Magda Bayoumi

.HOSPITAL BEDS BED MAKING .PRACTICE GUIDELINES FOR BEDMAKING TYPES OF BED-MAKING .IMPLEMENTATION FOR BED-MAKING PROCEDURES

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 2

Bed Making

Hospital Beds

Hospital beds are designed to easily change the body position of the user. They are electric so the user can adju their own comfort. Hospital beds are usually 66 cm. high and 0.9 m wide, narrower than the usual bed, so that t nurse can reach the client from either side of the bed without undue stretching. The length is usually 1.9 m. Som .beds can be extended in length to accommodate very tall clients

A trapeze bar attaches to the headboard of a hospital bed and is helpful in changing positions, for instance
pulling patient up in the bed or sitting up.

.An over bed table rolls under the bed and provides a nice table top for eating, reading, or writing They are adjustable in height

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 3

Bed Making

A patient lift is used to move a person from their bed to a wheelchair, etc. This would be a person who is unable to stand or transfer. A sling is used under the patient and is attached to the lift.

Mattresses

A mattress is a piece of bedding on which to sleep or lie. Hospital mattress protectors are suitable for autoc washing and provide optimum sterilization against microorganisms. Many special mattresses are also used hospitals to relieve pressure on the body's bony prominences, such as the heels. They are particularly helpful fo clients confined to bed for a long time. for example: air mattress designed for use by individuals at risk for pres .sores / decubitis ulcers

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 4

Bed Making

Commonly Used Bed Positions

,F lat:m attress is com p letely horizontal, C lient sleeping in a variety of bed P ositio ns, Such as back-lyin and p ro ne position .

Fowler's position: Semi-sitting position in which convenient for eating, reading, visiting, Watching TV, head of
bed is raised to angle of at least 45. Knee may be flexed or horizontal relief from lying positions, to promote lung . expansion for client Respiratory problem

Semi-Fowler: head of bed is raised only to 30 angle, relief from lying position, to promote lung expansion

Trandelengurg's position: head of bed is lowered and the foot raised in a straight incline, used to
.promote venous circulation in and certain clients to provide postural drainage of basal lung lobes

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 5

Bed Making

Reverse Trndelenburg's: head of bed raised and the foot lowered. Straight tilt in direction opposite to
trendelenburg's position. Used to promote stomach emptying and prevent esophageal reflex in client with hiatal .hearia

Side Rails
Safety sides are used on both hospital beds and stretchers. They are of various shapes and sizes and are usually .made of metal

Footboard or Footboot
These are used to support the immobilized client's foot is a normal right angle to the legs to prevent planner .flexion contracture

Bed Cradles

A bed cradle is a device designed to keep the top bedclothes off the feet, legs, and even abdomen of a client. Th bedclothes are arranged over the device and may be pinned in place. Designed to fit under the mattress to form

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 6

Bed Making

.support to keep bedclothes clear of the feet and legs

Intravenous Rods

Intravenous rods (poles, stands, standards), usually made of metal, support intravenous (IV) infusion containers .while fluid is being administered to a client. Some hospital units have overhead hanging rods on a track for IVs

MAKING BEDS

Nurses need to be able to prepare hospital beds in different ways for specific purposes. The be is occupied or unoccupied, or the purpose for which the bed is being prepared, Certain practic .guidelines pertain to all bed-making

Practice Guidelines for Bed-Making

.Wash hands thoroughly after handling a client's bed linen Linens and equipment that have been soiled with secretions and excretions harbor .microorganisms that can be transmitted to others directly or by the nurse's hands or uniform .Hold soiled linen away from uniform .Linen for one client is never (even momentarily) placed on another client's bed Place soiled linen directly in a portable linen hamper or tucked into a pillow case at the .end of the bed before it is gathered up for disposal Do not shake soiled linen in the air because shaking can disseminate secretions and .excretions and the microorganisms they contain When stripping and making a bed, conserve time and energy by stripping and making .up one side as much as possible before working on the other side To avoid unnecessary trips to the linen supply area, gather all linen before starting to .strip a bed

:Types of bed making procedures

Unoccupied bed, used when the client is able to get out of bed, is left open with the top-1 sheets folded down
Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577
Page 7

Bed Making

Postoperative (post op) or surgical bed, used when clients have left for the operating room-2 or procedural area, is left with the top sheets fanfolded lengthwise and not tucked in to .facilitate the client's return to bed .Occupied bed, used when the client is not allowed out of bed-3

ASSESSMENT
.Check the activity order, and assess the client's ability to get out of bed-1 .Rationale: This determines whether an unoccupied or occupied bed should be made .Assess the client's self-toileting ability; note the presence of any wounds, drainage tubes-2 .Rationale: This determines if placement of waterproof pads should be on the bed

PLANNING
.Expected outcomes focus on the client's safety and comfort Expected Outcomes .Client has a clean, safe environment throughout hospitalization-1 .Client verbalizes a sense of comfort while in bed-2 .Client's skin remains free of irritation throughout hospitalization -3

.1

Unoccupied Bed making -1

Equipment

Linen bag, matters (change only when soiled ),bottom sheet (flat or fitted), drawsheet (optional), top sheet, blanke bedspread, waterproof pads (optional), pillowcases, bedside chair or table, disposable gloves (if linen is soiled), .washcloth, and antiseptic cleanser

:STEPS
.Determine if client has been incontinent or if excess drainage is on linen. Gloves will be necessary Assess activity orders or restrictions in mobility in planning if client can get out of bed for procedure. .Assist to bedside chair or recliner .Lower side rails on both sides of bed, and raise bed to comfortable working position .Remove solid linen, and place in laundry bag. Avoid shaking or fanning linen .thoroughly .Apply all bottom linen on one side of bed before moving to opposite side .6 Be sure fitted sheet is placed smoothly over mattress. To apply a flat unfitted sheet, allow about 25 cm (10 .Pull remaining top portion of sheet over top edge of mattress .4 .3

.1

Reposition mattress, and wipe off any moisture using a washcloth moistened in antiseptic solution. Dry

inches) to hang over mattress edge. Lower hem of sheet should lie seam down, even with bottom edge of mattress

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 8

Bed Making

.While standing at head of bed, miter top corner of bottom sheet .Tuck remaining portion of unfitted sheet under mattress .9

.8

Optional: Apply drawsheet, laying center fold along middle of bed lengthwise. Smooth drawsheet over .mattress, and tuck excess edge under mattress, keeping palms down Move to opposite side of bed, and spread bottom sheet smoothly over edge of mattress from head to foot .of bed .Apply fitted sheet smoothly over each mattress corner .12 .For an unfitted sheet, miter top corner of bottom sheet (see Step 8), making sure corner is taut Grasp remaining edge of unfitted bottom sheet, and tuck tightly under mattress while moving from head to .then at bottom .If needed, apply waterproof pad over bottom sheet or draw sheet .head to foot, being sure top edge of sheet is even with top edge of mattress .sheet up. From bottom to make fold Approximately 15 cm (6 inches) from bottom edge of mattress .top edge of sheet and 15 to 20 cm (6 to 8 inches) down from edge of sheet .Make cuff by turning edge of top sheet down over top edge of blanket and spread .18 .blanket, and spread under mattress. Be sure toe pleats are not pulled out .(of triangle (see illustration .14 Place top sheet over bed with vertical center fold lengthwise down middle of bed. Open sheet out from

foot of bed. Smooth folded drawsheet over bottom sheet, and tuck under mattress, first at middle, then at top, and

make horizontal toe pleat; stand at foot of bed and fan fold in sheet 5 to 10cm (2 to 4 inches) across bed. Pull .16

Tuck in remaining portion of sheet under foot of mattress. Then place blanket over bed with top edge parallel to .

Standing on one side at foot of bed, lift mattress corner slightly with one hand, and with other hand tuck top sheet

Make modified mitered corner with top sheet, blanket, and spread. After triangular fold is made, do not tuck tip .2

Go to other side of bed. Spread sheet, blanket, and spread over evenly. Make cuff with top sheet and blanket. .21 .Make modified corner at foot of bed

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 9

Bed Making

.Apply clean pillowcase .22 .Assist client to bed .Arrange client's room. Remove and discard supplies. Perform hand hygiene .24

Place call light within client's reach on bed rail or pillow, and return bed to height allowing for client transfer. .23

COMMUNICATION TIP
Use an organized approach and reassuring tone of voice so the client feels safe and . comfortable during bedmaking Encourage the client to report any discomfort or special requests while the bed is . being made When making an occupied bed, ask the client to as sist as able and to report any . discomfort or the need to rest . Interact throughout the entire procedure, even if client is not responsive

.SURGICAL BED BEDMAKING

S s tep

-2

.See standard protocol .1 .Postoperative (post op) or surgical bed. Begin with clean unoccupied bed .2 .Rational: Facilitates transfer of postoperative client from stretcher to bed a-Fold all top linen from foot of bed toward center of mattress. Linen fold should be flush with bottom edge of .mattress b. Fold top linen that is hanging down over sides of bed toward center of mattress. Face one side of bed and fold nearest bottom corner back and over toward opposite side of bed, forming a triangle. Repeat for top corner (see .(illustration .c. Grasp apex of triangle and fanfold top linen over to far side of bed .d. Leave bed in high position with side rails down .R.d.Matches height of stretcher and facilitates client transfer

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 10

Bed Making

-3 :Occupied Bed Making

a-Raise entire bed to comfortable working height. Lower head of bed, if tolerated by client. Lower side rail on
.nurse's side; leave far side rail up .R. a. It is easier to apply wrinkle-free, tight linens if bed is in the flat position

b. Loosen all top linens. Remove spread and blanket, leaving client covered with top sheet or bath blanket. Fold spread and blanket in quarters, and place over bottom of bed or on back of chair if they are clean and are to be .reused .R.b. Gloves are worn to remove linen only if it is soiled with body secretions

c. Assist client to a side-lying position on far side of bed. Slide pillow over so it remains under client's head. Ch .that any tubing is not being pulled .R. c. Provides privacy and warmth

.d. Roll bottom sheet, drawsheet, and any pads as far as possible toward client. Clean and dry mattress if necess .R. d. Reduces transmission of organisms and keeps new linen dry .e. Place clean bottom sheet on bed with seam side down .Bottom sheets may be fitted (1) .If flat, center sheet on bed and pull bottom hem to foot end of mattress. Open sheet toward client (2) .Unfold flat bottom sheet lengthwise to cover mattress. Tuck top of sheet under head end of mattress .g.Miter top corner of a flat bottom sheet, and tuck in side of sheet under mattress .R. g. Reduces transmission of organisms and keeps new linen dry

h- Place folded drawsheet and/or waterproof pads on center of bed with seam side down. Fanfold toward client. .Provides additional protection to bed linen i-Cover unoccupied portion of bed with half the material, tucking drawsheet under mattress. Place remaining .materials as close to client as possible. Keep clean linen and soiled linen separate

j. Place waterproof pads with absorbent side up and plastic side down. Some pads go under cloth drawsheet. Ne .(larger absorbent pads go on top of drawsheet or replace it (check agency policy .R.j. Waterproof absorbent pads protect bedding and keep moisture away from client's skin

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 11

Bed Making

Assist client with logrolling over all linen and facing you. Keep client covered with top sheet or bath .blanket. Raise side rail on the side client is facing. Go to other side of bed, and lower side rail Remove soiled linens. Hold them away from uniform. Place on chair seat or in disposable bag or hamper if it is close by. Do not leave client alone with side rail down, even for a moment. Remove gloves if worn, and .dispose of them properly .R.l. Reduces transmission of microorganisms .Gently slide clean linen toward you, and straighten the clean linen out .m .R.m. Avoids friction of linen being pulled across skin. n.Miter the top corner of bottom sheet as before .n. Miter the top corner of bottom sheet as before .o. Grasp side of flat bottom sheet tightly. Keeping it taut, tuck it under mattress. Proceed from head to foot .p.Repeat by tucking drawsheet, proceeding from middle to top to bottom .q.Straighten out waterproof pads that are on top of drawsheet r.Assist client into a supine position; place a clean top sheet, blanket, and spread over client, leaving several .inches of sheet at top to be folded down

s. with client grasping clean top linens, slide out used top sheet or bath blan .Cuff top sheet over blanket and spread R.s. prevent exposure of client. Give a neat appearance to bed and keeps .client's face off blanket

t. Make a modified mitter corner with linens at foot of bed Miter the corner as before, but donot tuck in lower edge o .tringle

u-Loosen linen at client's feet to client's comfort R.u. Allows for movement of client's feet, prevents top line from forcing feet into plantar flexion, and prevents pressu ulcers from developing v. Supporting client's head remove pillow and change pillowcase

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 12

Bed Making

Slide out used top sheet while keeping client covered

EVALUATION
.Observe client's linens for cleanliness and tightness .Ask if client is comfortable after bed is made .2 .Observe client's skin for signs of irritation .3 .1

Unexpected Outcomes and Related Interventions

.Client is not comfortable in bed .1 .Check that linens are clean and dry. Tighten them .Assist client with changing position in bed .b .a

.Client's skin appears red and irritated .2 .Reposition client frequently. Consider use of pressure-relieving mattress .Keep client's bedding clean and dry .b

.a

Recording and Reporting

Bed making is usually not documented. Some agencies require the nurse to check off this activity on a flow .sheet

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 13

Bed Making

2-4. GUIDELINES FOR BED-MAKING a. Gather all the required linen and accessories before making the bed. Sheets. Pillowcases. Blankets. Bedspread. Extra pillows.

b. Avoid shaking the linen to prevent the spread of microorganisms and dust particles. c. Avoid placing linens, clean or dirty, on another patient's bed. d. Do not place dirty linen on the floor. e. Do not hold dirty linen against your uniform. f. Always use good body mechanics; raise the bed to its highest position to make bed-making easier. g. Stay on one side of the bed until it is completely made; then move to the other side and finish the bed. This saves time and steps. h. Observe the patient and document any nursing observations. Check for areas of redness that may lead to decubiti formation. Note tolerance of activity level while out of bed. Note observations about the physical and emotional status of the patient. Note any patient teaching or reinforced teaching given and the patient's response. Check for drainage, wetness, or other body fluids and record observations.

2-5. METHODS OF BED-MAKING

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 14

Bed Making

a. Unoccupied (Closed) Bed. An unoccupied bed is one that is made when not occupied by a patient. (1) Raise the bed to a comfortable working height, if adjustable. (2) Lower siderails, if present. (3) Remove pillows and pillowcases. Set the pillows aside in a clean area. (4) Fold and set the blankets and spreads aside (to be reused). (5) Loosen the linen along the edges of the bed, and move toward the end of the bed. (6) Wash the mattress if necessary, turn the mattress to the opposite side if necessary, and replace the mattress pad as needed. Observe the mattress for protruding springs. (7) Place the bottom sheet. (a) Flat sheet. 1 Position evenly on the bed. 2 Miter the corners at the top of the bed. Lift the mattress slightly, then stretch and tie the ends of the sheet together beneath the mattress. Repeat these steps for the bottom of the bed. 3 Stretch and tuck the free edges at the sides. (b) Fitted sheet. 1 Fit the sheet on the lower edges of the mattress first. Then lift the mattress and fit the sheet on the top edges of the mattress. 2 Stretch and tuck the free edges at the sides. (8) Place a draw sheet on the center of the bed, if it is needed. (a) Tuck in the free edge on one side. (b) Stretch the draw sheet from the opposite side and tuck in the free edge. (9) Place the top sheet, blanket (if used), and bedspread. (a) Position evenly on the bed. (b) Miter the bottom corners, tucking all three parts together. (c) Leave the loose ends free. (10) Fanfold the top linen back to the foot of the bed. (11) Place a clean pillowcase over the pillow and place it at the head of the bed. (a) Invert the pillowcase over one hand so the inner back seam is visible. (b) Grasp the edge of the pillow with one hand holding the pillowcase at the seam.

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 15

Bed Making

(c) Use the opposite hand to guide the pillowcase over the pillow. (12) Adjust the bed to its lowest position, if adjustable. (13) Reposition the head up slightly, if the patient prefers. (14) Raise the siderail opposite the side of the bed where the patient will enter. b. Occupied (Open) Bed. An occupied bed is one that is made while occupied by a patient. (1) Wash your hands. (2) Identify the patient, explain the procedure, and be sure you will have the patient's cooperation. (3) Check the condition of the bed linens to determine which supplies you will need. (4) Provide for the patient's privacy (throughout the procedure). (5) Obtain the articles of linen that you will need. (6) Place the bath blanket over the patient and the top cover. (7) Loosen the top bedding from the foot of the bed and remove it. If possible, have the patient hold the bath blanket while you pull the top covers from under it from the foot of the bed. (8) Move the mattress to the head of the bed. (9) Move the patient to the distal side of the bed. (10) Make the bed on one side. (11) Move or turn the patient to the clean side of the bed, and finish making the bed on the opposite side. Place the clean linen on top, and remove the bath blanket. (12) Attach the patient's signal cord within reach. (13) Provide for the patient's safety and comfort. (14) Tidy the room. c. Anesthetic, Surgical, or Post-Op Bed. This is a bed that is prepared to receive a patient from the operating room. (1) Gather all needed supplies: (a) Large sheets (2). (b) Drawsheet (1) or an additional large sheet. (c) Blanket. (d) Pillow(s). (e) Pillowcase(s).

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 16

Bed Making

(f) Towel. (g) Chux , if drainage is anticipated. (2) Make the bed as though you are making an unoccupied bed, except that the top sheet and blanket are not tucked under the mattress at the foot of the bed, and the corners are not mitered. (3) Fanfold the top covers to the side or to the foot of the bed. (4) Place a towel or disposable pad (Chux ) at the head of the bed. This is intended to protect the sheet if the patient should vomit. (5) It is a good idea to place a drawsheet on the bed because it can be used to move the patient more easily. (6) Place the pillow(s) on a chair near the bed or in an upright position at the head of the bed. (7) Leave the bed in the high position. (8) Lock the brakes on the bed. (9) Move the furniture away from the bed to allow for easier access to the bed for the recovery room stretcher and personnel. (10) Make certain an emesis basin is readily available and suction is available where indicated. (11) Keep Chux available to use if necessary.

NOTE: If a l i ne n h a mp e r is n o t available wi t hi n or adjacent to t h e be d u ni t , h a n g t h e u s e d pillowcase on t h e back of t h e chair to receive t h e soiled li ne n. Do n o t a l l o w soiled l i ne n to t o u c h t h e floor

Lecturer/ Magda Bayoumi http://faculty.ksu.edu.sa/73577

Page 17

Bed Making