Elderly Care

Patient Positioning
 Patient positioning is vital to a safe and effective surgical procedure. Patient
positioning involves properly maintaining a patient’s neutral body alignment by
preventing hyperextension and extreme lateral rotation to prevent complications of
immobility and injury.

PATIENT
POSITIONING
  Fowler’s Position
 Supine Position

BASIC BED  Prone Position

 Lateral Position
POSITIONS  Sim’s Position
 Trendelenburg’s Position
 Reverse Trendelenburg’s Position
 FOWLER’S POSITION
 Semi-sitting position
 Involves elevating the head of the bed to
a semi-sitting position
 The head of the bed is elevated between
45-60 degrees. Good body alignment for
Fowler’s position involves keeping the
spine straight, supporting the arms with
pillow.
 Eating, watching TV, visiting and reading
are easier in this position
 Residents with heart and respiratory
disorders usually can breathe easier in this
position
 SUPINE POSITION
 Dorsal recumbent position is the back
lying position
 Good body alignment involves having the
bed flat, supporting the resident’s head
and shoulder on a pillow and placing the
arms and hands at the resident’s sides.
 Arms may be supported with a regular size
pillow. Hands may be supported with
small pillows with the palms down.
 A small folded or rolled towel may be
place under the resident’s back and
under the thigh as instructed
 PRONE POSITION

 The resident lies on their abdomens with

their heads turned to one side.
 Place a small pillow under the head.
One under the abdomen and one
under the legs.
 Most elderly resident do not tolerate the
prone position well due to limited range
of motion in their necks.
 Women – pressure created to their
chest.
 LATERAL POSITION

 Lateral or side lying positions lies on one

side
 Pillows are used to maintain good
alignment, place a pillow under the
resident’s head and shoulders. Support
the upper leg and thigh with pillows.
 Place a small pillow under the upper
hand, arms and place a pillow against
the resident’s back.
 SIM’S POSITION

 A side lying position with the upper leg is

sharply flexed so that it is not on the
lower leg and the lower arm is behind
the resident.
 Good body alignment involves placing
a pillow under the resident’s head and
shoulder.
 Supporting the upper leg with a pillow
and placing a pillow under the upper
arm and hand.
 Not usually a comfortable position for
elderly residents.
 TRENDELENBURG’S POSITION

 Involves lowering the head of the bed

and raising the foot of the bed.
 Not used unless ordered by nurse or MD
 Can be achieved by putting blocks
under the lower legs of the bed
 REVERSE TRENDELENBURG’S POSITION

 The opposite of Trendelenburg position

 The head of the bed is elevated, and
the foot of the bed is lowered.
 Blocks are placed under the legs at the
head of the bed, or the bed frame is
tilted.
RESTRAINTS
(Protective Devices)
  Also called protective devices used to
protect resident from harming
themselves or others.
 Applied to chest waist, wrist or ankles
 Made from either linen or leather
 Used to prevent client from

RESTRAINTS
 Falling out of bed or from wheelchair or
stretcher
 Crawling over side rails or foot of the bed
 Interfering with therapies (pulling-out
tubes, removing dressings or
disconnecting equipment)
 Harming themselves or others; confused
or disoriented residents do not know
what they are doing. Some have violent
behavior and are dangerous to
themselves and others.
Consideration Regarding Restraints

 Restraints are for protecting residents not for staff convenience

 Restraints require doctor’s order
 Restraints of a resident unnecessarily constitutes false imprisonment
 The restrained resident’s basic needs must be met by the nursing team. It should be snug
and firm but not tight.
Consideration Regarding Restraints

 It should not interfere circulation, breathing and movement of the restrained part should
be possible to a limited and safe extent
 Resident is checked frequently and fluids, bed pans or urinals is offered with each check
 Restraint may have to be applied rapidly.
 Give repeated explanation and reassurance.
  Never apply restraint unless you have been
instructed in its proper use
 Make sure resident is in good body alignment
before applying restraints
 Pad bony areas and skin that may be injured.

SAFETY
Padding protects body parts from pressure and
injury
 Apply restraint securely enough to protect the
resident but allow enough slacks so that some

RULES
movement of the part possible.
 Make sure the resident can breathe easily if the
restraint is applied to the chest.
 Check the resident’s circulation every 15 minutes.
Check the pulse, finger and toes must be warm
and pink in color
  Notify nurse immediately for any abnormalities.
 Tie restraints with a square knot.
 Secure the restraints to the bed frame not the

SAFETY
side rails.
 Keep scissors handy in your pocket.
 Remove restraints and reposition the resident

RULES
every 2 hours.
 Make sure the resident receives food and fluids
while restrained. Offer drink of water and
bedpan or urinals every 2 hours.
 Make sure signal switch is always within reach.
Bed Making - Key Terms
 Bath Blanket – a thin,
light-weight cotton
blanket used to cover
the resident during a
bath or other
procedures. It absorbs
water and provides
warmth.
 Draw Sheet – is a smaller
size than the bottom
sheet or top sheet.
 It is placed over the
middle of the bottom
sheet.
 It helps keep the
mattress and bottom
sheet dry and can
be used for turning
and moving the
residents on bed.
 Often called “rubber
sheet”.
 Mitered Corner
A way of tucking
linens under the
mattress.
It helps to keep the
linen straight and
smooth.
 Plastic Drawsheet
 A draw sheet made of
plastic.
 It is placed between
the bottom sheet and
cotton draw sheet to
keep the mattress and
bottom linens clean
and dry.
 Others made of rubber
are called “Rubber
sheet”
Certain Facts About The Bed

 Some patients or residents are out of bed while others must be in bed at all times.
 They eat their meals and are bathed in bed.
 Some cannot get up to use the bathroom and many are incontinent.
 Incontinent residents cannot control the passage of urine from their bladders and must
have their bed linens changed frequently.
 Many forms of treatment and procedures require them to stay in bed and may be
precautionary measures to improve conditions.
Certain Facts About The Bed

 Bed making is a very important part of your role as a professional caregiver.

 Clean and neat beds help make your client more comfortable.
 Resident/client depends on you for their comfort and well being by keeping the beds
clean, dry and wrinkle free.
 These helps prevent skin breakdown and decubitus ulcers which is often fatal to elderly
clients.
 Beds are usually made after the resident are up for the day.
Certain Facts About The Bed

 Those who are confined to bed will have their pads changed in the morning after
breakfast and after they have been bathed.
 For incontinent residents linens are changed throughout the day whenever they become
wet, soiled or damp.
 Bed is made and room is cleaned before visitors arrive.
Beds are made in the
following ways
Closed bed

 A bed that will not be used by

the resident until bedtime.
 A bed that is ready for a
resident/client/patient.
 Top linens are not folded back
 Open Bed

 A bed that will soon be used by a

resident.
 The top linens are folded back so that the
resident can get into the bed easily.
 A closed bed becomes an open bed by
just folding back the top linens.
 Made for clients who will be out of bed
by folding back the top linens.
 Made for clients who will be out of bed
for a short time.
 Occupied Bed

 A bed that is made with the

resident in it.
 Made when client is unable to get
out of bed because of illness or
injury.
 Be sure to explain the procedure
before it is done even if the patient
is comatose or cannot respond.
 Surgical Bed

 A bed that is made so that a resident can be

moved from a stretcher to the bed.
 The surgical bed is also called recovery bed.
Post operative bed or anesthetic bed.
 Bottom of the top linens are folded back onto
the bed. The fold is even with the edge of the
mattress.
 Top linens fan folded lengthwise to the
opposite side of the bed.
 Top linen fan folded from the head of the bed
to the foot.
LINENS
 Needs special attention.
 Follow medical asepsis when handling.
 Hold linens away from your body.
 Never shake.
 Clean linens are placed on clean surfaces.
 Never put dirty linen on the floor.
LINENS
 Always collect linen in the order they will
be used.
 Collect linens for residents’ personal care.
Pillowcases and extra blanket may be
needed.
 Don’t bring extra linen in the client's room
because their room is considered
contaminated and cannot be used for
another resident
 Collect linen in the following order:

 Linen bag for dirty linen

 Mattress pad
 Bath towels
 Bottom sheet (flat or contour sheet)
 Hand towel
 Plastic drawsheet
 Hand towel
 Cotton drawsheet
 Wash cloth
 Top sheet (flat sheet)
 Hospital gown
 Blanket
 Bath blanket
 Bedspread
 Pillowcase(s)
Linens

 Linens are pressed and fan folded in a certain way to prevent the spread of
microorganism.
 The center crease is placed in the center of the bed from the head to foot and unfolded
in the direction that they are placed.
 The inside of the linen that touched the resident will be inside the roll.
 Mattress pad, plastic drawsheet, blanket and bedspread may be reused if they are not
soiled.
 When flat sheet is used as top sheet it may be reused as bottom sheet.
Linens

 Plastic and rubber sheet protect the mattress and bottom linen from becoming damp and
soiled.
 If plastic or rubber sheet is used it is required to use a cotton drawsheet to protect the
client from contact with plastic or rubber sheet and to absorb moisture this can cause
discomfort and skin breakdown.
 A disposable waterproof bed protector is now available is often called chax.
 Cotton drawsheet is used to move and position the client in bed if it is used.
 For purpose of positioning, it is not tucked.
Making a Closed Bed
Making A Closed Bed

1 2 3 4 5 6 7
Wash hands. Collect all linens. Place clean Best to begin on Raise the bed to Move the Put the mattress
linen on bedside the side near the its highest mattress to the pad on the
chair on the side door. horizontal level or head of the bed. mattress even
of the bed. of good level for with the mattress
good body pad.
mechanics.
Making A Closed Bed

Place the bottom sheet

on top of mattress
•Unfold it lengthwise.
•Place center crease in the Pick the sheet up
middle of the bed.
from the side to
•Position the lower edge of the Go to the head of
sheet even of the bottom of open it. Fan fold
the bed.
the mattress. toward the other
•Place the larger hem at the side of the bed.
top of the mattress and the
small hem at the bottom
•Face hem stitching toward
the mattress pad
Making A Closed Bed

Tuck the top of the sheet under the Make sure the sheet is tight and Make a mitered corner.
mattress. Lift the mattress slightly. smooth.
Raise the side of sheet onto the
mattress. Top edge should be
tucked in.
Tuck the remaining portion of the
sheet down off the bed.
Bring the raised portion of the sheet
down off the bed.
Making A Closed Bed

1 2 3 4 5

Place plastic Open the plastic Open now the cotton Open now the cotton Pull bottom sheet and
drawsheet in the bed drawsheet and fan drawsheet over the drawsheet over the make sure to tuck it so
about fourteen (14) folded it toward the plastic drawsheet and plastic drawsheet, tuck sheet is tight and no
inches from the top other side of the bed fan folded it toward under the mattress wrinkles
mattress the other side of the then go to the other
bed side and tuck it.
Making A Closed Bed

1 2 3 4 5

Put now the top sheet Pull bottom sheet and Put now the top sheet, Do not yet tuck, never Place now blanket on
make sure to tuck it so unfold, place center tuck your top linens on the bed.
the sheet is tight and crease, large hem on the sides.
has no wrinkles. top and even on top of
the mattress face hem
stitching toward
outside.
Making A Closed Bed

 Unfold, put center crease in the middle.

 Put upper hem about 6 to 8 inches from the top of the mattress.
 Open the blanket and fan fold extra.
 Place now the bedspread, should extend 18 inches from top of the
mattress.
 Used to cover pillows.
Making A Closed Bed

1 2 3
Cover now pillow put Cover bed to lowest Wash hands
on top of the bed, the horizontal position.
open end should be
away from the door.
Making an Open Bed
Making An Open Bed

The same procedure as making a closed bed.

Except do not cover the bed up to the

pillows.

Unfold back the top hem part towards the

middle area of the bed
Making an Occupied Bed
Making An Occupied Bed

Explain Wash Collect Place Pull Raise Place

Explain to Wash Collect all Place Pull Raise bed Place bed
the hands. linens. clean privacy to highest flat.
resident. linen on a curtain. horizontal
clean level.
chair.
Making An Occupied Bed

Bed Loosen Remove Place on Cover Ask

Lower bed side rail, Loosen top linen at Remove the Place on linen bag Cover resident with Then ask patient to
opposite side rail up the foot of the bed. bedspread and if soiled if not fold bath blanket, place hold and grasp
to protect patient blanket separately. each separately on top of the top tightly the bath
from not falling. and put at the foot sheet. blanket then pull
of the bed. the top sheet under
the bath blanket,
fold and put on the
laundry bag.
Making An Occupied Bed

1 2 3 4 5 6

Then ask patient to Position the Loosen bottom Fan fold bottom Place now clean Place bottom
hold and grasp resident on to the linen from head to linens one a time linens, unfold the sheet so hem
tightly the bath side of the bed foot. toward the client,, linen lengthwise so stitching is away
blanket then pull away from you if a mattress pad is the center crease is from the resident.
the top sheet adjust pillow. going to be reused, in the middle of the
under the bath do not fan fold bed.
blanket, fold and toward client.
put on the laundry
bag.
 Make Make a mitered corner at the head, tuck sheet under the
mattress from the head to the foot.

Making An Pull Pull the sheet towards you and tuck.

Occupied
Position Position the client now to turn towards and then put up the

Bed
side rails.

Go to the other side unstuck the mattress, bottom sheet,

Go plastic and cotton drawsheet from head to bottom of bed
then fold towards the center and discard soiled linens.

Pull Pull the clean sheet now over to the side towards you, tuck
now the sheet head to foot.
 Then position now client supine / back lying and
then spread now the top linen on top of the
middle of the bed pull ends at your side then

Making An
make sure hem stitching facing up and large
hem on head.

Occupied Top now with blanked and bedspread and

Bed
then ask client to hold and the pull the bath
blanket at the bottom.

Tuck now top sheet, blanket and bedspread,

under the mattress together make sure it is lose
to allow movement make a mitered.
Making An Occupied Bed

 Change pillowcase
 Raise the side rail
 Give the nurse button
 Lower the bed
 Put all materials in order
 Unscreen the client
 Get all dirty linens
 Wash hands
Cleanliness and Skin Care
Cleanliness and Skin Care
Aspiration – breathing fluid or an object into the lungs
Cleanliness and Skin Care
Bed Sore – a decubitus ulcer, a pressure sore
Cleanliness and Skin Care
Decubitus Ulcer – an area where the skin and underlying tissues are eroded as a result of a
lack of blood flow due to pressure on bony areas of the body
Cleanliness and Skin Care
Oral Hygiene – measures performed to keep the mouth and teeth clean
Cleanliness and Skin Care
Perineal Care – cleansing the genital and anal areas of the body also called Pericare
 Are necessary for comfort, safety and health
 The skin is the body’s first line of defense against
disease
Cleanliness
 Intact skin prevents microorganism from entering and Skin
the body and causing infection
 The mucous membrane of the mouth, genitals Care
areas and anus need to be kept clean and intact
 Besides cleaning, good personal hygiene practices
prevent body and breath odors.
 Promotes also relaxation and increase circulation. Cleanliness
 The need for cleanliness and skin care is affected
by perspiration, vomiting, urinary and bowel and Skin
elimination, drainage from wounds or body
openings, bed rest and the amount of activity. The Care
nurse supervisor decides the amount and type of
personal hygiene you will need to provide
 Personal hygiene practices are performed as often as
necessary to stay clean and comfortable

DAILY People who can are for themselves practice personal

CARE
hygiene routinely and out of habit.

OF
Bushing the teeth, washing the face and hands and other
hygiene measures may be done routinely in the morning,
before, and after meals and before going to bed.

THE Weak or disabled residents need help with hygiene

measures.

PATIENT Routine care is given throughout the day. Remember to

assist residents with personal hygiene whenever necessary.
Before Breakfast
(Early Morning Care or AM Care)
 Before Breakfast

1. Get the resident ready for breakfast or diagnostic test scheduled early in the day
2. Personal hygiene measures
3. Offering bedpan or urinals or assisting client to the bathroom
4. Helping resident/client wash heir faces and hands
5. Assisting residents with oral hygiene
6. Positioning client into Fowler’s position or into bedside chairs for breakfast
7. Straightening linens or fixing bed
8. Straightening resident’s units
After Breakfast
(Morning Care/Given after breakfast)
 After Breakfast

1. Cleanliness and skin care measures are more thorough

2. Offering bedpan or urinals or assisting client to the bathroom
3. Helping resident/client wash their faces and hands
4. Assisting residents with oral hygiene
5. Shaving residents
6. Providing showers, tub baths, or complete or partial bath
 After Breakfast

7. Giving perineal care

8. Giving back massage
9. Performing range of motion exercises
10. Changing gowns or pajamas or dressing residents in street clothes as necessary
11. Brushing and combing hair
12. Assist in ambulation
13. Changing bed linens
14. Straightening resident’s units
 Afternoon Care
(Personal hygiene measures performed after lunch and supper)
 Afternoon Care

1. Offering bedpan or urinals or assisting client to the bathroom

2. Helping resident/client wash their faces and hands
3. Assisting residents with oral hygiene
4. Changing gowns or pajamas or clothes if needed
5. Brushing and combing hair if needed
6. Changing damp or soiled bed linens
7. Straightening resident’s units
Evening Care
(HS Care)
 Evening Care

1. Care given to residents in the evening at bedtime

2. Personal hygiene measures performed right before the resident is ready for sleep
3. They help increase comfort and ability to relax and promote better sleep.
HS Cares involves

o Offering bedpan or urinals or assisting client to the bathroom

o Helping resident/client was their faces and hands
o Assisting residents with oral hygiene
o Changing damp or soiled linens and straightening all other linens
o Changing gowns or pajamas or clothes of needed
o Helping residents in street clothes to undress and put on gowns or
pajamas
o Back Massages
o Giving straightening resident’s units
END
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