University of Cebu - Pardo & Talisay​

College of Nursing

➔​ During occupied bed making, confirm patient safety and

comfort.
BED MAKING
➔​ Wash hands before and after bed making and use gloves
during bed-making
➔​ The art of making beds ➔​ Maintain privacy while making the bed.
➔​ The ability of the nurse to keep the bed clean and ➔​ Keep soiled linen away from uniform which may have
comfortable germs.
➔​ A way of preparing the appropriate bed based on the ➔​ Do not shake dirty linen to prevent germs spread around
condition of the patient which adopts scientific the room.
principles of nursing. ➔​ Do not mix soiled and clean linen during bed-making.
➔​ A clean, dry and wrinkle -free bed increases comfort ➔​ For the bedridden patient, the mattress must be turned
➔​ Also helps prevent skin breakdown and pressure ulcers
➔​ Usually made in the morning after baths, or while the TYPES OF BED:
person is in the shower or out of the room
CLOSED BED
PURPOSE OF BED MAKING ➢​ Empty bed in which the top covers are so arranged that
-​ To provide rest and sleep. all linen beneath the spread is fully protected from dust
-​ To provide physical and psychological comfort and and dirt. top linens are not folded
security to the patient. ➢​ Made after the patient is discharged and after terminal
-​ To give the unit a neat appearance. cleaning of the unit
-​ To establish an effective nurse patients relationship. ➢​ The bed is ready for a new patient or resident
-​ To provide active and passive exercise to the patient. Purposes:
-​ To promote freshness and cleanliness 1. To provide the patient with a comfortable and safe bed to take
-​ To develop skill in the posture/body alignment of the rest and sleep.
nurse in bed-making 2. To give the unit or ward a neat appearance.
-​ To observe, identify, and prevent patient complications. treat nive me dice patie nursing
-​ To the patient's needs. 4. To prevent bed sores.
-​ To reduce patient's exertion by bed-making. 5. To promote cleanliness:
-​ To eliminate irritants to the skin from the patient's body. 6. To provide active and passive movements to the patient.
-​ To dispose of soiled and dirty linen properly. 7. To create an effective nurse-patient relationship.
-​ Another purpora of bed-making is to save time,

BASIC PRINCIPLE OF BED MAKING OPEN BED

-​ Least amount of energy and time is required ➢​ is in use, top linens are folded back so the person can
-​ Use good body movements and make each step get into bed
purposeful ➢​ a closed bed becomes an open bed by folding back the
-​ Keep everything ready on the bedside before starting top linens
bed ➢​ are made for newly admitted persons arriving by
-​ Change bed linen frequently to assure cleanliness. wheelchair.
-​ To ensure the patient's needs by providing a safe and ➢​ open bed lets the person get into bed with ease
comfortable bed. ➢​ Fanfold top sheets to welcome new patient or for
-​ It should have a finished appearance. straight lines on ambulatory patients.
the Purposes:
-​ To make the the bed tight and free from wrinkles, place 1. To prevent bed sores.
all linen 2. To economize time, material and effort.
-​ Prevent complications of prolonged bedridden patient 3. To help the relatives to learn to take care of the sick at home.
such as pressure sores. 4. To give to the unit or ward a neat appearance.
-​ Soiled linen or linen whether clean or dirty should not 5. To provide comfort and security.
be thrown on the floor, but it is should be kept in a dirty 6. To provide rest and sleep.
linen box. 7. To establish an effective nurse patient
-​ After cleaning the bed, dump soap water, and
disinfectant properly. OCCUPIED BED
-​ Try to prevent cross contamination. ➔​ - is made with the person in it
➔​ - when making an occupied bed, keep the person in
DO THE FOLLOWING TO KEEP BEDS NEAT AND CLEAN: good alignment
• Straighten linens whenever loose or wrinkled. ➔​ - you must know about the restrictions or limits in the
• Straighten loose or wrinkled linens at bedtime person's movement or position
• Check for and remove food and crumbs after meals ➔​ - explain each procedure step to the person before it is
•Check linens for denture, eyeglasses, hearing aids, sharp done, this is important even if the person is in coma
objects, and other items Purposes:
• Change linens whenever they become wet, soiled, or damp. 1. To provide active and passive exercises to the client.
2. To Promote cleanliness.
GUIDELINES IN BEDMAKING 3. To establish an effective nurse client relationship.
➔​ During bed-making, bed position keep elevated and 4. To prevent bed sores.
ensures nursing staffs good body alignments 5. To observe the clients. E.g. bed sore, oral hygiene, clients
➔​ During the procedure, the nurse should study her ability for self case etc.
movements to avoid waste of time and energy. 6. To provide the clients with safe and comfortable bed to take
➔​ After completing, the bed should be in a lower position. rest and sleep.
 SURGICAL BED • Do not use torn linen
➢​ it is a form of the open bed • Never shake linens, shaking linens spread microbes
➢​ is made to transfer a person from a stretcher to the bed • Extra linen in a person's room is considered contaminated, do
➢​ also called as POSTOPERATIVE BED OR RECOVERY BED not use it with other people, put it with the dirty laundry.
➢​ are made for persons who arrive at the agency by. • Hold linens away from your uniform. Dirty and clean linen must
ambulance not touch your uniform
• Never put dirty linens on the floor or on clean linens, follow
BED WITH CRADLE agency policy for dirty linen.
• Cradle is placed under top sheets to prevent linen from • Keep bottom linens tucked in and wrinkle- free.
touching parts of the patients body. • Cover a plastic drawsheet with cotton drawsheet. A Cotton
• Used for patients with burns, skin ulcers, blood clots, fractures, drawsheet must not touch the person's body
and other similar conditions. Straighten and tighten loose sheets, blankets, and bed spreads as
needed
LINENS • Make as much of one side of the bed as possible before going to
• When handling linens and making beds, practice medical the other side. This saves time and energy -
asepsis • Change wet, damp, and soiled linens right way
• Your uniform is considered dirty, always hold linens away from
your body and uniform BEDMAKING TIPS
• Never shake linens in the air, it will spread microbes • Observe correct body mechanics
• Clean linens are placed on a clean surface • Keep linens arranged in the order of use
• Never put clean or dirty linens on the floor • Make one side of the bed completely, then on the other side
•Collect enough linens, if the person has 2 pillows then get 2 • Roll dirty linens away from your body and place in hamper
pillowcases immediately
•Do not bring unneeded linens to a person's room
•Once in the person's room, extra linen is considered FEATURES OF THE MODERN HOSPITAL BED
contaminated, it is not used for another person
1.​ BED MAKING
COLLECT LINENS IN THE ORDER YOU WILL USE THEM: -​ Wheels enable easy movement of the bed, either within
●​ Mattress pad (if needed) parts of the facility they are located, or within the room.
●​ Bottom sheet (flat or fitted) -​ Wheels are lockable. For safety, wheels can be locked
●​ Plastic drawsheet, waterproof drawsheet, or waterproof when transferring the patient in or out of the bed
pad (optional)
●​ Cotton drawsheet (if needed) 2.​ ELEVATION
●​ Top sheet (if needed) -​ Beds can be raised and lowered at the head, feet, and
●​ Blanket their entire height.
●​ Bedspread -​ Raising the feet can help ease movement of the patient
●​ Pillowenses toward the headboard and may also be necessary for
●​ Bath towels certain conditions.
●​ Hand towel
●​ Washcloth 3.​ SIDE RAILS
●​ Gown -​ Beds have side rails that can be raised or lowered. These
●​ Bath blanket rails, which serve as protection for the patient and
sometimes can make the patient feel more secure
DRAWSHEET
- a small sheet placed over the middle of the bottom sheet, it
helps keep the mattress and bottom linens clean and dry; the
RANGE OF MOTION
cotton drawsheet

PLASTIC DRAWSHEET/ RUBBER DRAWSHEET Benefits of Physical Exercise

- a drawsheet placed between the bottom sheet and the cotton 1. Improved cardiopulmonary function
drawsheet to protect the mattress and bottom linens from 2. Reduced blood pressure
dampness and soiling; 3. Increased muscle tone and strength
waterproof sheet 4. Greater physical endurance
5. Increased weight loss
MITTER 6. Reduced blood glucose level
• A tight-fitting triangular fold made by tucking a sheet and 7. Decreased low-density blood lipids
blanket securely under a mattress on the end and on each side at 8. Improved physical appearance
the corners. 9. Increased bone density
10. Regularity of bowel elimination
PURPOSE OF MITTERED CORNER 11. Promotion of sleep
•Used to hold the linens firmly in place. 12. Reduced tension and depression

RULES FOR BED MAKING:

• Use good body mechanics at all time EXERCISE
• Follow the rules of medical asepsis 1.​ Based on Muscle Contraction
• Follow Standard Precautions and the Bloodborne -​ Isotonic Exercise
Pathogen Standard -​ cause muscle contraction and active movement.
•Practice hand hygiene before handling dirty linen o Bring -​ Isometric Exercise
enough linen to the person's room -​ tightening or tensing of muscles without
•Bring only the linens that you will need, extra linens cannot be shortening (there is no movement). This
used to another. increases muscle tension but do not change the
length of muscle fibers.
 JOINT MOVEMENTS
-​ Isokinetic Exercise
-​ Involves muscle contractions with resistance. -​ ABDUCTION
-​ Resistance is provided by an external source -​ MOVING A BODY PART AWAY FROM THE
MIDLINE
2.​ Based on Source of energy -​ ADDUCTION
-​ Active Exercise -​ MOVING A BODY PART TOWARD THE MIDLINE
-​ is a therapeutic activity that the client performs OF
independently. -​ EXTENSION
-​ Passive Exercise -​ STRAIGHTENING A BODY PART
-​ therapeutic activity that the client performs -​ FLEXION
with assistance and is provided when a client -​ BENDING A BODY PART
cannot move one or more parts of the body. -​ ROTATION
-​ TURNING THE JOINT
RANGE OF MOTION EXERCISES -​ INTERNAL ROTATION
Definition: -​ TURNING THE JOINT INWARD
-​ The movement of a joint to the extent possible without -​ EXTERNAL ROTATION
causing pain -​ TURNING THE JOINT OUTWARD
Purposes: -​ PLANTAR FLEXION
• Promote and maintain joint mobility -​ THE FOOT DOWN AT THE
• Prevent contractures and shortening of muscles and -​ PRONATION
tendons -​ TURNING THE JOINT DOWNWARD
• Increase circulation to extremities. -​ SUPINATION
• Facilitate comfort for the patient -​ TURNING THE JOINT UPWARD
-​ INVERSION
-​ TURNING THE SOLE OF THE FOOT TOWARDS
Contraindications of ROM THE MIDLINE
-​ Any illness/disorder where increased use of energy or -​ EVERSION
increased circulation is hazardous. -​ TURNING THE SOLE OF THE FOOD AWAY
FROM THE MIDLINE
Types of ROM Exercise
●​ Active ROM exercises
Joint Movements Possible Examples
○​ Exercises the client is able to perform
independently. Temporo ●​ Open ●​ Opening mouth
●​ Passive ROM exercises Mandibular
○​ Exercises performed for the client by someone ●​ Close ●​ Closing Mouth
​
else.
●​ Protrusion ●​ Bringing lower jaw
●​ Active assisted ROM exercises forward
○​ Performed by a client with some assistance. ●​ Retraction ●​ Taking lower jaw
Client can move a limb partially through its inside
●​ Lateral
ROM, but needs help completing the ROM.
Deviation​ ●​ Moving to jaw to a
​ side

Guidelines for Performing ROM Exercises Neck ●​ Flexion ●​ Look at the toes
➢​ Start with the head and move down, always do
●​ Extension ●​ Look straight ahead
bilaterally
​
➢​ Do not grasp the joint directly ●​ Hypertension ●​ Look up at the ceiling
➢​ Do not grasp fingernails or toenail. Be sure to support
the distal and proximal end of the limbs ●​ Lateral flexion ●​ Look straight ahead,
➢​ Important joints - thumb, hip, knee, ankle ​ ​ tilt head to shoulder
➢​ Move joint through movement 5 times/session
➢​ Return body part to normal anatomical position Shoulder ●​ Flexion ●​ Raise arm forward &
➢​ Move each joint through full range of motion overhead
➢​ Move to point of resistance not pain ●​ Extension ●​ Return arm to side of
​ body
➢​ Allow for rest periods whenever required
●​ Abduction ●​ Raise arm to side to
➢​ Avoid friction. LIFT body part, don't drag position above head
➢​ Note drastic change in vital signs, extreme fatigue. with pain away from
➢​ Should not disrupt the healing process head
➢​ Warm water relaxes the muscles and joints, bathing is an ●​ Adduction ●​ Return arm & bring
across chest
ideal time to perform ROM
●​ Internal ●​ Elbow flexed, rotate
rotation the shoulder by
moving arm til thumb
Patient Preparation is turned inward &
-​ Explain steps and advantages of ROM exercises. toward the back
(fingers to the floor)
-​ Remove all restrictive clothing, linen, splint, and
●​ Elbow flexed, move
dressings. ●​ External arm until thumb is
-​ Drape appropriately Rotation lateral to head
-​ Raise the bed to a comfortable height. (fingers point up)
●​ Circumduction ●​ Move arm in full
-​ Position the patient comfortably- preferably supine
​ ​ circle
position.
 Joint Movements Possible Examples Foot ●​ Inversion ●​ Turn sole of foot
medially
Elbow ●​ Flexion ●​ Bend elbow
●​ Eversion ●​ Turn sole of foot
●​ Extension ●​ Straighten elbow laterally

●​ Hyperextension ●​ Bend lower arm back ●​ Flexion ●​ Curl toes downward

as far as possible
●​ Extension ●​ Straighten toes
Forearm ●​ Supination ●​ Turn lower hand so
palm is up ●​ Abduction ●​ Spread toes apart

●​ Pronation ●​ Turn lower hand so ●​ Adduction ●​ Bring toes together

palm is down
Spine ●​ Flexion ●​ When standing– bend
forward from the waist
Wrist ●​ Flexion ●​ Bend wrist forward
●​ Extension ●​ Straighten up
●​ Extension ●​ Straighten wrist
(fingers, wrist & arm in ●​ Hyperextension ●​ Bend backward
●​ Hyperextension same place)
●​ Lateral flexion ●​ Bend to the side
●​ Abduction ●​ Bring dorsal surface of
hand as far back as ●​ Rotation ●​ Twist from the waist
possible
●​ Adduction
●​ Bring wrist medially
towards the thumb

●​ Bend wrist laterally

towards 5th finger

Fingers ●​ Flexion ●​ Bend fingers & thumb

& into palm make a fist
Thumb
●​ Extension ●​ Straighten fingers &
thumb

●​ Hyperextension ●​ Bend fingers as far as

back as possible

●​ Abduction ●​ Spread fingers apart/

extend thumb laterally

●​ Adduction ●​ Bring fingers

together/ thumb back
to hand

●​ Circumduction ●​ Move fingers/thumb

in circular motion

●​ Touch thumb to each

●​ Opposition finger of same hand

Hip ●​ Flexion ●​ Move leg forward

●​ Extension ●​ Move leg back beside

other leg

●​ Hyperextension ●​ Move leg backwards

●​ Abduction ●​ Move leg laterally away

from body

●​ Adduction ●​ Move leg back to

medial position &
beyond if possible

Knee ●​ Flexion ●​ Bring heel toward back

of thigh

●​ Extension​ ●​ Return leg to floor

Ankle ●​ Dorsiflexion ●​ Move foot so toes are

pointed upward

●​ Plantar flexion ●​ Move foot so toes are

​ pointed downward