Bedmaking

DEFINITION OF TERMS
Bed making the ability of the nurse to keep the bed clean and comfortable the technique of preparing different types of bed in making patients/clients comfortable in his/her suitable position for a particular condition it requires keen inspection to be sure that the linens are clean, dry and wrinkle-free

2 Fanfold is done by grasping the upper edge of the linen with both hands specifically folding the edge of the sheet used in the bed 6-8 inches outward

3. Mitered corner a means of anchoring sheets on mattresses method of folding the bed clothes at the corners to secure them in place while the bed is occupied it is accomplished on the bottom sheet by placing the end of the sheet evenly under the mattress

4.Toe pleat a fold made in the top bed clothes to provide additional space for patients toes

TYPES OF BED

WATERBED

Water bed Special mattress filled with water.

It controls temperature of water reducing pressure on body parts.

Indications: Patients confined to bed for long periods

Turning Frames (Stryker Wedge)

Turning Frames (Stryker Wedge)

It allows repeated changes between the supine and prone positions without disturbing spinal alignment. Indications: complication of immobility such as atelectasis, pneumonia, decubitus ulcer and renal calculi.

Rotation Bed

Rotation Bed
promote postural drainage, peristalsis and helps prevent the complications of mobility
Indication: patients with spinal cord injury, severe burn

Circolectric Bed
Permits frequent turning of several injured or immobilized patient with minimal trauma or extraneous movement. Helps prevent and treat pressure ulcers, respiratory and circulatory complications Indications: Patients confined to bed for long periods of time

CIRCOLECTRIC

CircOlectric Bed:
An electronically controlled bed that can be vertically rotated 210 degrees, allowing a patient to move vertically from the prone to supine position. It is used especially in orthopedics and in the treatment of patients with severe burns and decubitus ulcers. The bed consists of a strong aluminum circular frame supporting an anterior and a posterior straight frame within the exterior aluminum circle. The patient is "sandwiched" and secured between the two straight frames during rotation.

Air therapy bed

Air Therapy Bed

For patients who have risk skin breakdown Provide different levels of support to different body parts. Indications Patients who are at risk to skin breakdown

Various safety features are present on hospital beds. These features include:
Wheel locks: These should be used whenever the bed is stationary. Side rails: They help to protect patients from accidentally falling out of bed, as well as provide support to the upper extremities as the patient gets out of bed. Removable headboard: This feature is important during emergency situations, especially during cardiopulmonary resuscitation. Headboard Footboard

GUIDELINES FOR BEDMAKING

1. Gather all the linens needed and bring extra sheets before making the bed. 2. Do not shake the linen to prevent the spread of microorganisms and dust particles. 3. Do not place clean or soiled linens on another patient's bed. 4. Avoid placing soiled/dirty linens on the floor. 5. Hold away dirty linens from your uniform. 6. Observe always good body mechanics; adjust the height of the bed at your working level to make bed-making easier. 7. To save time and energy, do first on one side of the bed until it is completely made. Then move to the other side and finish making the bed

KINDS OF LINENS
1. Blanket a large piece of cloth often soft, woolen and is used for warmth as a bed cover 2. Top sheet used to cover the patient to provide warmth, made of thick cotton, thermal material 3. Cotton drawn sheet a piece of cloth that covers the rubber sheet and is used to absorb and protect moisture 4. Bottom sheet used to cover the bed after mattress cover

5. Rubber sheet used to protect the bottom sheet from soothing due to patient secretions and prevent the patients from getting bedsore. It is usually placed over the center of the bottom sheet 6. Mattress cover a piece of cloth to cover the mattress 7. Woolen blanket a large rectangle piece of cloth of soft fabric often either bound edges used especially for warmth as a bed covering. It should be light, warm and large enough to cover the shoulder and to tuck in well at the foot and to extend over sides.

 PROCEDURES IN BEDMAKING

Unoccupied Bed
Unoccupied (Closed) Bed An unoccupied bed is one that is made when there is no patient occupying the bed.

PURPOSE:
To provide comfort for the patient and prevent spread of microorganisms.

Equipment:
1 bottom flat or fitted sheet 1 top sheet 1 rubber sheet (optional) 1 draw sheet (optional) pillowcases 1 or 2 pillow(s) 1 blanket (optional) linen hamper or bag clean gloves

ACTION

RATIONALE

1. Perform hand hygiene.

Reduces the transmission of microorganisms.

2. Assemble equipment and arrange it on the bedside chair in the order of use. Promotes efficient time management. 3. Raise the bed to appropriate working height, Minimizes the strain on back and muscles, to locked the wheels and remove call light. keep the bed from moving.

4. Grasp the mattress securely, pulling it toward you Allows more foot room for the client and moves and turning it. the mattress against the head of the bed.

5. Place the bottom with its center fold in the Proper placement of linen ensures that center of the bed with the bigger hem line with adequate length will be available to cover the foot of the mattress, bringing the extra to opposite side of bed. the head part.

6. Move the head part, open and tuck the Having the bottom linen free of wrinkles excess sheet under the head of the mattress. reduces discomfort to the bedridden client. FOR FITTED SHEET: first fit diagonal corners over the mattress.

7. Miter top cover of the bottom sheet.

To secure the bed linen and appear neater than sheets that is simply tucked under the mattress.

To make a mitered corner: a. Pick up the side edge of the sheet approximately 12 inches from the corner of the mattress and hold it straight up and down forming a double triangle.

b. Lay the upper part of the sheet on top of the mattress.

c. Tuck the hanging part of the sheet smoothly under the mattress.
d. Holding the sheet in place against the mattress with one hand, use your other hand to pick up top triangular fold and bring it down over side and tuck it under the mattress.

8. Tuck the remainder of the sheets under the side of the mattress all the way to the foot of the bed.

9. Lay the center fold of the rubber sheet at the center of the bed with the upper edge about 18 inches from the head part and open. 10. Place the cotton draw sheet over the Any exposed plastic or rubber can irritate rubber sheet making sure that the rubber the clients skin. sheet is completely covered

11. Tuck both the rubber and cotton draw sheets together.

13. Place the top sheet on the bed with center fold in the center and the wider hem even at the head of the mattress. Unfold the top sheet in place. Follow the same procedure with the top blanket or spread it placing the upper edge approximately 6 inches below the top sheet.

Opening linen by shaking them spreads microorganisms into the air. Holding linen overhead to open them causes strain on nurses arms.

14. Make a toe pleat by folding a 2-inch pleat across the shear about. 15. Miter the corner. Do not tuck at the sides. Keeps tope linen in place.

16. Fold the top sheet 6 inches down over the Make it easier for the client to get into bed head and make a cuff. and pull the covers up. 17. Move to the other side of the bed and follow Working on one side of the bed at a time same procedure for securing the bed linen. saves energy.

18. Apply clean pillowcase. With one hand, Eases sliding of case smoothly over pillow. grasp pillowcase at center of closed end. Gather case, turning it inside out over hand holding it. With same hand, pick up middle of one end of pillow. Pull pillow case down over pillow with other hand, be sure corners of case fit evenly over pillow

19. Place the pillow at the head of the bed with Maintains neat appearance. the open end facing away from entrance.
20. Fan fold or pie folds the top linen. Having linen opened makes it more convenient for the client to get into bed.

21. Place call light within clients reach and Provides for client safety. return bed to comfortable height. 22. Discard dirty linen in linen hamper or chute. Prevents transmission of microorganisms Wash hands

MAKING OCCUPIED BED

Purposes: To provide comfort for the client. To maintain a hygienic environment. To reduce transmission of microorganisms. To refresh the client. To conserve the clients energy. Equipment: 1 bath blanket 2 pillow case 1 bottom sheet bedside chair or table 1 draw sheet Disposable gloves 1 top sheet

ACTION ASSESSMENT

RATIONALE

1. Check the chart for orders or specific Ensures client safety and use of proper body precaution for movement or position. mechanics.
2. Assess the patient Determine whether there are any factors that might affect the ability of the patient to undergo the procedure and limitation. Determine which items need to be replaced or added to complete the procedure.

3. Check the condition of the linens. PLANNING: 4. Wash your hands

For infection control

5. Gather the equipments, supplies and arrange Organization facilitates the performance of the linen to be used and place it in order. task. 6. Obtain gloves. (optional) IMPLEMENTATION: 7. Explain the procedure to the patient. Minimizes anxiety and promotes cooperation. Prevent transfer of microorganism.

8. Close the door or draw room curtain around Maintains clients privacy, thus promoting bed. emotional and physical comfort. 9. Adjust bed height to comfortable working Minimizes strain on back. It is easier to position. Lower side rails nearest you. Place the remove and apply bed linen evenly to bed in flat position if client can tolerate it. bed in flat position. Provide easy access to bed land linen. 10. Check the bed for clients personal items. Remove attached equipment such as call light or any tubes if allowed. Wear gloves. (optional) It is costly and inconvenient when personal items are lost. Disconnect tubes and other equipment fro linen prevents discomfort and accidental dislodging of tubes. Prevents transfer of microorganism.

11. Place the bath blanket over client. Have him Provides warmth and privacy. hold onto the bath blanket while you reach under it and remove top linen. Discard soiled in laundry bag NOTE: Leave top sheet in place if bath.

Blanket is unavailable. Fold linen that is to be Folding method facilities replacement and reused over the back of the chair. prevents wrinkles.
12. Grasp the mattress security and shift it up Allows more foot room for the client and to the head of the bed. positions mattress against the head of

13. Position client facing the opposite far side Moving client to side provides space for of the bed, facing away. Adjust pillow under placement of clean linen. Side rail ensures head. Be sure side rail id up. clients safety. 14. Loosen all bottom linen from the head and Facilitates removal of linen. side of the bed. 15. Remove bottom linen, fanfold bottom sheet and draw sheet toward client: first draw sheet, then bottom sheet. Tuck edges of linen just under the buttocks. Back and shoulders. Do not fanfold rubber sheets if it is to be reused. Note: Wipe of any moisture on the exposed mattress with towel and appropriate disinfectant. 16. Use clean linen and make the near side of the bed following steps 3-11 in making unoccupied bed. Fanfold linen as close to the client as possible. Provides maximum work space for placing clean linen. Tucking soiled linen under the patient facilities removal of linen when client turns to the other side.

Applying linen over bed successive layers minimizes energy and time used. Proper positioning of linen on one side ensures that adequate linen will be available to cover opposite side of bed.

Raise the side rail. Move to the other side and Ensures safety. lower the side rail. Assist client to roll over the folded linen behind him and toward the other side. Reposition the pillow and bath blanket or top sheet. 17. Remove the pillow case and make it as a Support of neck muscles prevents injury during laundry bag. How: flexion and extension of neck. a. Have client raise head. While supporting neck remove pillow. Allow client to lower head. b. Removed soiled case by grasping pillow at open end with one hand and pulling case over pillow with other hand. Make it as a laundry bag by putting it at the back of a chair.
18. Roll soiled sheets one by one and remove. Proper disposal of soiled linen prevents the Place in the laundry bag. Hold uniform. Remove spread of microorganism. gloves (optional) 19. Spread clean, fan folded linen smoothly over Smooth linen will not irritate clients skin. edge of mattress from head to foot of the bed Pull and secure bottom sheet under the head of the mattress. Miter corner. Pull as you tuck excess linen under mattress. Tuck from middle to top and then to bottom. Repeat it with draws sheet.

20. Change pillow case: a. Lay on bed the clean pillowcase, grasp it at the center of close end. Gather case, turning it inside out over hand holding it. With same hand pick up middle of one end of pillow. Pull pillowcase down over the pillow with other hand. b. Be sure pillow corners fit evenly I corners of pillowcase. Note: Never lay uncover pillow case on bed.
21. Place the pillowcase at the center of the bed with the open end facing away from the entrance. 22. Assist client in rolling back into supine position. Maintains clients comfort. Reposition pillow as needed. 23. Place top sheet over the client with center fold Sheet should be equally distributed over bed lengthwise down middle of bed. Open the sheet by correctly positioning center fold. from head to foot and unfold it over the client. 24. Ask client to hold clean top sheet, or tuck sheet Sheets prevent exposure of body parts. around clients shoulders. Remove the bath Having client hold sheet encourages client blanket and discard it in laundry bag. participation in care. 25. (Optional) If blanket are to be used follow procedure #23 and should be tuck together with

26. Secure the top linen under the foot of the Makes neat-appearing bed. Pressure ulcers mattress and miter the corners. Loosen the can develop on clients toes and heels top linen over clients feet by grasping them rubbing between tight fitting bed sheets. in the area of feet and pulling gently towards the foot of the bed. Be sure that linens are loose enough to allow movement of clients feet. To make horizontal toe pleat: Stand at the foot of the bed and from fold in sheet 5-10 cm (2-4 in.) across the bed. Pull sheet up from bottom to make a fold. Fold should be approximately 15 cm (6in) From the bottom edge of the mattress. 27. Raise the side rail. Lower the bed height Ensures safety and comfort of the client. and adjust the head of the bed to a comfortable position. Place call light within clients reach. 28. Open room curtains. Rearrange furniture. Promotes sense of well-being. Return personal items within easy reach on overhead table or bedside stand. Thank the patient for his/her cooperation. 29. Discard dirty linen in hamper or chute; Prevents transmission of microorganism. wash hands.

30. Document pertinent observation. Careful recording is important for planning Observe the patient and document and individualizing clients care. 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.

POST-OPERATIVE BED (GENERAL ANESTHETIC BED) (Purpose: 1. To prepare a warm, safe and comfortable bed in which the patient can be quickly placed after surgery. 2. To protect the mattress from being wet and soiled and possible stained. General Consideration: See to it that all needed equipment for the patient post operatively is assembled and ready for use before the patient arrives from the operating table.

Equipments: Same as the ordinary bed with the addition of the following: bed protector bath blanket gown blanket I. V. Stand Urine bag Suction apparatus Suction catheter (Fr. 12-14 for adults; Fr. 8-10 for children.) Oxygen tank prepared necessary connection Goose neck lamp On the bedside table are: Kidney basin lined with tissue paper. Padded tongue depressor Mouth wipes

ACTION 1. Proceed in the same manner as making an unoccupied bed. 2. Spread the sheet the same manner as I open bed but do not tuck at the foot part.
3. Fold back top sheet at the foot part in line with the edge of the mattress. Fold back the upper 9-18 inches of the top sheet as well.

RATIONALE

4. Bring up the hanging sides of the top To provide easy accessibility. sheet in line with edge of the mattress at the sides. 5. Fanfold to the side away from the Protects linen from getting soiled. entrance. 6. Place the bed protector across the head Protects the linen from getting soiled. part of the bed, line it with the bath towel and tuck it (if long)

7. Place the pillow against the bar of the bed This will protect the head from injury. at the head part.
8. Place extra pillow under the waterproof pad If abdominal operation, this will relax the where the knees will rest. abdominal muscle. 9. Hang the gown at the head part of the bed. 10. Prepare the necessary equipments at the bedside before the patient arrives. 11. Once the patient is I place him Promote warmth and comfort. comfortably in bed and cover with top sheet. 12. Attach/hang the necessary gadgets such Facilitates easy entrance of the oxygen, IVF, urine bag. stretcher also for aesthetic reason. Note: Urine bag should be hanging away from the door. Facilitates access.

 NOTE: If weather is cold, use blanket and goose neck lamp for the patients comfort. Spread the blanket over the top sheet 16 inches from the head part. Fold the back top sheet in line with edge of the blanket on the head part and fold back the blanket and top sheet together in line with the edge of the mattress at the foot part. Bringing up one hanging side of both blanket and top sheet in line with the edge of the mattress at the side and fanfold to the side away from the entrance.

OBSTETRICAL BED
Purpose: To have a ready bed for patient who have just delivered. Equipments: Same as ordinary bed, with addition of the following: 1 cotton draw sheet 1 waterproof under pad Extra pillow Adult diaper (patients supply)

ACTION 1. Do the same as in open bed 2. Fanfold top sheet to the foot part.

RATIONALE

3. Place the waterproof under pad where the To avoid frequent changing of linen. buttocks lie and tuck it if long.

4. If pad is not available, fold any clean cotton sheet and put it where the buttocks will rest.
5. Slip the 2 pillow inside their cases. Put 1 Pillow at the head part protect the head from pillow against the headboard and the other injury and the other provide comfort. where the back of the knees will rest (with the open end facing away from the entrance) 6. Secure the call light within patients reach. Promotes safety.