CHAPTERS: Unit 8 Client Care

1. CHAPTERS: Unit 8 Client Care • Therapeutic Communication Skills • Admission, Transfer, and Discharge • Vital Signs • Data Collection in Client Care • Body Mechanics and Positioning • Beds and Bed Making • Personal Hygiene and Skin Care • Elimination

2. Learning Objectives • State the purposes of bed making in the healthcare facility. • Demonstrate the ability to make an unoccupied, occupied, and postoperative bed. • Demonstrate the ability to open a bed for a client. • Describe the use of a bed cradle. • Explain the purpose of side rails. • Demonstrate the ability to safely adjust side rails.

3. Learning Objectives, cont. • Describe three devices that may be added to the hospital bed and their uses. • Identify the purposes of specialized hospital beds. Describe at least three specialized beds.

4. bed cradle closed bed egg crate mattress flotation mattress footboard footdrop mitered (corners) occupied bed open bed postoperative bed traction trapeze unoccupied bed New Terminology

5. Gatch Bed • Most commonly used bed in healthcare facilities • Adjusts to different positions • An electric mechanism lowers and raises the bed. • The head and foot of the bed can be lowered or raised. • Client and caregivers can use controls. • Gatch adjustments may be operated using a hand crank.

6. Bed Making • Purpose • To help the client feel comfortable • To decrease pathogens in the client’s environment • To reduce the potential for skin breakdown • To control odor • Change linens that are soiled. • Proper body mechanics are an essential part of bed making.

7. Making an Unoccupied Bed • Unoccupied bed • Bed that is empty at the time it is made up; is the easiest bed to make • Closed bed • Bed that is made up when preparing the unit for a new client • Open bed • Bed to which a client is already assigned

8. Closed Bed

9. Open Bed

10. In Practice: Making a Closed or Unoccupied Bed See Nursing Procedure 49-1.

11. Surgical Bed • Surgical or postoperative bed • Closed bed that has been “opened” to receive a person on a stretcher. • Top linens are fan-folded to the side of the bed and out of the way. • Usually in high position to receive the client from the stretcher.

12. Occupied Bed • Bed holding a client that is unable to get up as a result of his or her condition or generalized weakness • Making an occupied bed • Changing bed linens with the client in the bed • Work quickly and disturb the client as little as possible. • If done efficiently, this procedure requires minimum exertion for both you and the client.

13. In Practice: Making an Occupied Bed See Nursing Procedure 49-2.

14. Opening a Bed for a Client • Turn the bedspread down from the top, and fold it around and over the top edge of the blanket. • Fold the sheet over the top of the blanket and spread. • Turn the top bedding down to the foot of the mattress and fold it back on itself. • Always leave the bed in low position after caring for the client.

15. Postoperative Bed • Bed prepared for a client who is returning from surgery or another procedure that requires transfer into the bed from a stretcher or wheelchair

16. Question Is the following statement true or false? The nurse should always wear gloves to remove used linens and wash hands after removing them; never place used linens on the floor or hold them against the uniform.

17. Answer True Linens may be soiled with body fluids. To prevent the spread of microorganisms, never shake linens or put them on the floor. Soiled linens from the bed or floor can contaminate the uniform, which may come in contact with other clients.

18. In Practice: Making a Postoperative Bed See Nursing Care Guidelines 49-1.

19. Attachments and Accessories • Bed cradle • Frame used to prevent the bedclothes from touching all or part of the client’s body • Side rails • To prevent the clients from falling out of bed and also help to change position while in bed • Footboard • To prevent abnormal plantar flexion or a deformity called footdrop Contracture deformity that prevents the client from putting the heel on the floor; results from improper positioning or anterior leg muscle paralysis

20. Question Is the following statement true or false? It is always safer to have side rails up.

21. Answer False In some cases, having the side rails up can be more dangerous than having them down. For example, an elderly client may continually try to crawl out of bed. In this case, he or she might crawl over the side rails, making a potential fall worse than if it were just from the lower level of the bed.

22. In Practice: Using a Bed Cradle See Nursing Procedure 49-3.

23. Other Equipment, cont. • Standard • Holds bags for intravenous (IV) or blood therapy • Stored on bed frame • Trapeze • Horizontal bar suspended above and attached to the bed, which is used by client to pull up to a sitting position or to lift the shoulders and hips off the bed

24. Other Equipment, cont. • Traction = exertion of a pulling force • An apparatus attached to the client to • Maintain stability of a joint • Maintain aligned fracture • Also used to exert a pulling force elsewhere • As in the lower back • To relieve pressure

25. Special Beds and Mattresses • Used for clients • On prolonged bed rest • With poor skin integrity • Several types, which differ in use and effectiveness • Egg crate mattress provides comfort • Flotation mattress • Mattress or pad filled with a gel-type material • Lessens pressure on bony prominences

26. Therapeutic Beds • Used for • Severe joint contractures • Prolonged immobility • Skin wounds; pressure ulcers • Severe burns • Functions • To reduce or relieve the effects of pressure against the skin using various mechanisms (air, water, rotation) • Examples • TheraPulse ATP bed • Microcomputerized bed • Orthopedic beds • Support clients who must remain immobilized • Example • Circle bed (Circ-O-Lectric)

27. Question Which equipment is used to prevent abnormal plantar flexion in a client confined to bed? a. Headboard b. Footboard c. Bed board d. Transfer board e. Bed cradle

28. Answer b. Footboard A footboard may be attached to the foot of the bed to prevent abnormal plantar flexion. A headboard or a transfer board may be placed under the client if CPR is needed. A bed board is placed under the mattress to support the body. A bed cradle is a frame used to prevent the bedclothes from touching all or part of the client’s body.

29. STUDENT SYNTHESIS Key Points • Organize work. Gather all supplies before making the bed. Strip and make one side of the bed at a time to conserve time and energy. • To prevent the spread of microorganisms, never shake linen or put it on the floor. • Hold soiled linen away from your uniform, and never place soiled linen from one client’s bed onto another client’s bed. • Place soiled linen in a laundry hamper or on a chair while continuing your work.

30. STUDENT SYNTHESIS, cont. • Keep in mind that a well-made bed promotes comfort and rest, helps prevent skin breakdown, and provides safety for clients. • Use special attachments and beds as available to meet particular client’s needs.