Promoting Comfort

" Describe comfort theory and its application to pain management
nursing practice.
" Discuss the application of comfort theory in clinical practice
"Individual
"Select Populations and Practice Settings
"Health Care Systems
" Discuss the importance of bed making and its procedures
" Demonstrate the proper procedures when doing bed bath, ROM
and positioning
" Assess the participants acquired knowledge after the presentation
Promoting Patient's Comfort

cDefinition:
-Latin word

1. PHYSICAL
COMFORT
- bodily
sensations,
homeostatic
mechanisms,
immune function
> Pain relief
> Regular bowel
function
> Fluid/electrolyte
balance
> Adequate oxygen
saturation
> Turning and
positioning

2. PSYCHOSPIRITUAL
COMFORT
- internal awareness
of self:
* esteem
* identity
* sexuality
* meaning in
one's life
- relationship to a higher
order or being.
> Deep breathing
> Imagery
> Change of dressing
> Coaching

3. ENVIRONMENTAL
COMFORT
- external background
* temperature
* light
* sound
* odor
* color

> Music
> Quiet/Silence
> Routine for sleep

4. SOCIOCULTURAL
COMFORT
- interpersonal
relationship
- family traditions,
rituals, and religious
practices.

> Family member
spend the night
> Connect with
friends/school
> Financial support-
meals
> Chaplin referral

Transcendence
Ease
Relief
Discomfort

cKozier, B. (2004). Fundamentals of Nursing.
NewJersey: Pearson Education.
c Kolcaba, K. (2010). Comfort Theory
. January 9, 2012,
http://www.thecomfortline.com/theory.html

PROMOT I NG PAT I ENT ' S COMF ORT
It helps maintain a clean, orderly and comfortable
room which contributes to the patients sense of
well-being.

Helps the patient secure proper rest and comfort
which are essential for health and refresh him/her
by providing cleanliness.

It helps prevent or avoid microorganisms to come in
contact with the patient which could cause
tribulations.

Physical and psychological comfort

To promote the clients comfort
To provide a clean neat
environment
To provide a smooth, wrinkle-
free bed foundation, thus
minimizing sources of skin
irritation.
Hold soiled linen away from uniform.
Do not shake soiled linen in the air.
Linen for one client is never placed on another
clients bed.
Gather all linen before starting to strip a bed.

1. Wash hands thoroughly before and after handling
clients bed linen.

2. Soiled linen is placed directly in a portable linen
hamper or tucked into a pillow case at the end of the
bed. Pillowcase is then tied and labeled with: name,
room number, communicable/non-communicable

3. When stripping and making a bed, conserve time and
energy by stripping and making up one side before
working on the other side.

4. Gather all materials before starting to strip the
linens.

5.Keep the patients environment as clean and as neat
as possible.
-Bottom sheet
-Rubber sheet
-Draw sheet
-Top sheet
-Pillow case
-Bed cover


It is a type of hospital
bed that does not
have a patient in it.


A. Open Bed the top covers are folded back to
make it easier for a client to get in.

B. Closed Bed - the top sheet, bed cover/spread
are drawn up to the top of the bed and under
the pillows.
Assess the clients readiness to be out of bed. Assist to a comfortable position.

Explain the procedure to the client.

Wash hands.
Assemble and arrange linen in order of use. Adjust the bed to an appropriate
working height.

Strip the bed.
a) Remove attached equipment. Remove cases from pillows and place pillow
in a chair or bedside table.

b.) Standing at the side of the bed nearest you, loosen top and bottom of sheet
from the mattress. Move from head to foot of bed and on opposite side.
c.) Remove items to be reused, fold into quarters and place at the back of
chair.

d.)Remove remaining linens, roll inside the bottom sheet, hold it away from
your uniform, and put into hamper.

Place bottom sheet at the foot of bed. Fanfold the upper half toward the head of
bed, then roll the other half towards the center of the bed. Smooth over the
mattress and tuck all the head part.

Miter the corner at the head part of the bed.
a) Pick up the side edge of the sheet approximately 12 inches from the
corner of the mattress to form a 45-degree angle. Hold it straight and
parallel to the side of the mattress to keep linens in place, bring it down and
tuck the mattress.

b) Tuck the part of the sheet that is hanging under the mattress.

c) Lift the folded part of the linen previously placed on top of the mattress (with
one hand on the side of the mattress to keep linens in place, bring it down,
bring it down and tuck under the mattress.
Lay rubber sheet halfway along center line of mattress and top and bottom
edge extend from the middle of the clients back to the area of the mid thigh or
knee. Place draw sheet over the rubber sheet in the same manner.
Tuck remainder of the bottom sheet, rubber and draw sheet under the mattress
all the way to the foot part.
*Repeat procedure on the side of bed (follow agency policy) or:

Place the centerfold of the top sheet folded lengthwise, seam side up, along
center of the bed and even with the head part of the bed.

Unfold half and then roll the other half towards center of the bed.
Tuck the top sheet under the foot part of the mattress.
Move to the other side of the bed and unroll all the bottom, rubber, and draw
sheet. Gently pulling to stretch and smoothen surface.
Straighten the top sheet, tuck the foot part or make a toe pleat (optional) and
miter the corner, leaving the side hanging free.
To open the bed, grasp the upper edge of the top sheet with both hands,
bringing it all the way toward the middle of the bed. This is termed as
fanfolding.
Cover the pillow.
a) Fold the open end of the pillowcase toward the middle, then grasp the
center of the closed end, gather the pillowcase up over the hand and grasp
the pillow.

b) Pulled the case down over the pillow with the other hand.

c) Straighten and smoothen the case over the pillow and place it on the head
part of the bed with open end and away from the door.

If available, a bed cover is placed on top to cover the entire bed. It may be
placed at the foot part of the bed or left hanging free on both sides.
Assist client to bed.
Wash hands.
Where there is a patient
physically on the bed or
the bed is being
retained for a patient
+The client is unable
or is contraindicated
to move from the
bed

+Presence of
equipment that limit
patients movement.

Assess clients health status.

Be mindful of the different equipment/s or materials that
can be dislodged.

Note specific orders or precautions for moving and
positioning the client.

Assess skin condition

Remind patients to move from one position to another to
prevent orthostatic hypotension.

Ask for assistance for patients with problems with
immobility.
Explain the procedure to client and how he or she can cooperate.
Wash hands.
Assemble equipment and arrange in order of use.
Assemble equipment and arrange in order of use.
Adjust bed to comfortable working position. Loosen top linen at foot of bed.
Remove bedspread, if soiled place them in linen bag, if to be reused, fold in
quarters and place over back of chair.
Cover client with bath blanket.
a) Unfold bath blanket over top sheet.

b) Ask client to hold top edge of blanket. If unable to help, tuck top of bath
blanket under shoulder.

c) Grasp top sheet under bath blanket and bring sheet down to foot of bed.

d) Remove sheet and discard in linen bag.
Position client on the far side of bed, facing away from you. Be sure side rail is
up. Adjust pillow under clients head.
Loosen bottom linens, moving from head to foot.
With seam side down, fanfold draw sheet , rubber sheet and bottom sheet
toward client. Tuck edges of linen just under buttocks, back and shoulder.

Unfold bottom sheet lengthwise along center of the bed. Fanfold top layer
toward center of bed alongside the client. Smooth bottom layer of sheet and
bring edge over closest side of mattress.
Miter bottom sheet at head of bed.
Tuck remaining portion of sheet under mattress, moving toward foot of bed.
Keep linen smooth. Folds of linen are source of irritation.

Place rubber sheet, with the centerfold against clients side. Fanfold top layer
toward client.
Place draw sheet over rubber sheet in the same manner.
Tuck rubber sheet and draw sheet under the mattress.

Roll client slowly toward you, over the layers of linen. Raise side rail and go to
other side.

Position client for removal and placement of linens.

Loosen edges of soiled linen from under the mattress.
Remove soiled linen by folding it into a bundle with soiled side turned in.
Discard linen in bag.
Pull clean, fanfold linen smoothly over edge of mattress from head to foot of
bed. Miter top corner of bottom sheet. Be sure sheet is smooth and free of
wrinkles.

Smooth fanfolded draw sheet out over bottom sheet. Grasp edge of sheet with
palms down, tuck sheet under mattress. Tuck from middle to top and then to
bottom.
Assist client in rolling back into supine position. Reposition pillow.
Place top sheet over client with centerfold lengthwise down middle of bed.
Open sheet from head to foot and unfold over client.
Ask client to hold clean top sheet. Remove bath blanket and discard.
Place spread/blanket over (optional)
Make cuff by turning edge of top sheet down over top edge of blanket and
spread.
Standing on one side at foot of bed, lift mattress corner slightly with one hand
and tuck top linens under mattress. Be sure that linens are loose enough to
allow movement of clients feet.
Change pillowcase. Place pillow under clients head.

Place call light within clients reach and return bed to comfortable position.
Discard dirty linen in hamper and wash hands.
The science of health and its
maintenance

Types:
a. Early morning care
b. Hour of sleep care
c. As-needed care
Removes accumulated oil,
perspiration, dead skin cells
and some bacteria
Stimulates circulation
Produces a sense of well
being
Offers an excellent
opportunity for the nurse to
assess client
1. An intact, healthy skin is the bodys first line of
defense.
2. The degree to which the skin protects the
underlying tissues from injury depends on the
general health of the cells, the amount of
subcutaneous tissue, and the dryness of the
skin.
3. Moisture in contact with the skin for more than
a short time can result in increased bacterial
growth and irritation.
4. Body odors are caused by resident skin bacteria
acting on body secretions.
5. Skin sensitivity to irritation and injury varies
among individuals and in accordance with their
health.
6. Agents used for skin care have selective actions
and purposes.
A. Cleaning baths given chiefly for hygiene
purposes
-Temperature should be 43C to 46C
B. Therapeutic baths given for physical
effects
-Temperature may be 37.7C to
46C for adults and 40.5C for
infants
A. Complete bed bath
B. Self-help bed bath
C. Partial bath
D. Bag bath
E. Tub bath
F. Shower
+ Gender (male or female)
+ Age group
(child/adolescent/adult)
+ Condition (health and physical
status)
+ Religion and culture
+ Environment

Consent (approval)
The purpose and type of bath the client
needs
Self care ability of client
Any movement or positioning precautions
specific to the client
Other care the client may be receiving
Clients comfort level while being bathed by
someone else
Basin
Soap and soap dish
Linens (bath blanket, two bath towels, wash
cloth, clean gown)
Gloves
Personal hygiene articles
Table for bathing equipments
Laundry hamper

Condition of skin
Fatigue
Presence of pain and need for adjunctive
measures before the bath
ROM of the joints
Any other aspects of health that may affect
clients bathing process
1. Explain the procedure.
2. Perform infection control procedure.
3. Provide privacy.
4. Prepare the client and environment.
5. Prepare bed and position client
properly.
6. Make a bath mit with a wash cloth.
7. Wash the face.
8. Wash arms and hands.
9. Wash chest and abdomen.
10. Wash legs and feet.
11. Wash back and perineum.
12. Assist client with grooming aids.
srefers to activity aimed at improving movement of a
specific joint.

sreduce stiffness, prevent deformities and help keep
your joint flexible.

srange-of-motion is the normal amount of your
choice can be moved in certain directions.
sEssential for establishing normal ROM of joints
and soft tissue
sImportant decreasing risk of injury to the
musculotendinous unit
sPrevent contractures and adaptive shortening
sCombats the effects of prolonged
immobilization
sOptimal flexibility will reduce stresses to
surrounding joints and tissues

sDo not stretch
o Around acutely inflamed or infected joints
o Patients who are already hypermobile
o Patients when shortened muscles are providing stability if normal joint
stability is decreased or assists with functional abilities such as in
persons with paraparesis
o Across a joint when a bony block prevents motion
sA. Passive Range of Motion (PROM)

sB. Active-Assistive Range of Motion
(AAROM)

sC. Active Range of Motion (AROM)

sD. Resistive Range of Motion (RROM)

sE. Isometric Range of Motion (IROM)

e
e
e
are performed by the patient, without assistance, to
increase muscle strength.

The patient performs the exercises alone or uses a
device such as a pulley or bicycle.
e

These are active exercises performed by the patient
by pulling or pushing against an opposing force.
e
These exercises are performed by the patient by contracting
and relaxing muscles while keeping the part in a fixed position.

These are done to maintain muscle strength when a joint is
immobilized. Full patient cooperation is required.
s Flexion - the state of being in a straight line. The cervical
spine is extended when the head is held straight.
s Hyperextension - the state of exaggerated extension. The
cervical spine is hyperextended when the person looks
overhead, toward the ceiling.
s Abduction - Lateral movement of a body part away from the
midline of the body. The arm is abducted when it is held away
from the body.
s Adduction - Lateral movement of a body part toward the
midline of the body. The arm is adducted when it is moved
from an outstretched position toward the body.

s Rotation - turning of a body part around an axis. The
head is rotated when moved from side to side to
indicate "no."
s Circumduction - rotating an extremity in a complete
circle. Circumduction is a combination of abduction,
adduction, extension, and flexion.
s Supination - the palm or sole is rotated in an upward
position
s Pronation - the palm or sole is rotated in a downward
position.
sWash your hands
sExplain what you are going to do
sProvide privacy. Make sure client is wearing
adequate clothing
sRaise bed to a comfortable working height if
possible
sLock the wheels of the bed or wheelchair
sAssist client into supine position
e
e
e
e
e
e
e
CPM for the Knee
Continuous Passive
Motion Machine
Knee CPM Machine
e
Continuous Passive Motion
(Movement) Machine (Bilateral
Total Knee Replacement) - CPM
Repair of Rotator Cuff
Tears: Continuous
passive motion machine
e
Finger Contracture
Disorders and the Use of
Continuous Passive
Motion (CPM)
continuous passive motion
Upper extremity CPM is used for returning
of full ROM to shoulder, elbow, wrist that
will not include hand movements. Useable
for orthopedic conditions.
1. Check the plan of care for instructions or limitations before
starting ROM exercises.
2. Always handle the client gently with open palms.
3. Be aware of the normal ROM for each joint.
4. Support each joint above and below the joint being
exercised. This prevents joint pain and possible injury.
5. Exercise as many times as ordered, usually three to five
times.
6. Never exercise or stretch a joint to the point of pain.
7. Exercise joints only within the range of easy movement.
Always stop the exercise if discomfort, pain, or spasms
develop.
8. Allow client to assist in procedure as much as possible.
Remember: hyperextension of the neck is not possible with
the client in a supine position.
s http://www.brooksidepress.org/Products/Nursing_Fundamen
tals_1/lesson_5_Section_1A.htm
s http://www.ehow.com/about_5070066_definition-passive-
range-motion.html
s http://nursingcrib.com/nursing-notes-
reviewer/fundamentals-of-nursing/passive-range-of-motion-
exercises/
s http://www.missouricareereducation.org/doc/ciha/CIHA_ch2
8.pdf
s http://www.digplanet.com/wiki/Continuous_passive_motion#
tabs-2

e
e
Why is it
important to do
active ROM
exercises?
e
e
Active ROM
exercises will help
keep good blood flow
going to the joint area
that is being
exercised. They may
help prevent blood
clots.
Exercising is natural and needed for
the body to stay well. Your heart
pumps stronger and easier when you
exercise regularly.
You also breathe quicker and more
often while exercising.
Walking and other exercises help make
your BMs and urine more regular.
e
e
e
e
e
e
e
e
e
e
e
Do all ROM
exercises
smoothly and
gently
e
e
e
Lock your bed or
wheelchair
wheels before you
start doing your
exercises.
Ask for help if you
think you cannot
do an exercise by
yourself.
e
e
e
How are active
ROM exercises
done?
e
Starting position: You may sit or stand. Face forward. Your
shoulders should be straight and relaxed.
e
Starting position: Stand or sit. Hold your arm straight down at your side.
Face palms in toward your body. It is best to use a chair without arms if you
are in a sitting position.
Shoulder movement, up
and down. Raise your right
arm forward and upward
over your head. Try to raise
it so that your inner arm
touches your ear. Bring
your arm back down to
your side. Bring it back as
far as possible behind your
body. Return your arm to
the starting position.
e
e
Starting position: Your forearm is the part of your arm between your elbow and
wrist. Sit down to do this exercise. Bend your elbow and keep it tucked against your
side. Rest your right forearm on your right thigh (your lap) or on a flat surface like a
table.
Palm up, palm down. Face
your palm down. Rotate (turn)
your palm so that it faces up
toward the ceiling. Rotate
your palm again so it faces
down.
e
e
Starting position: Sit down. Bend your right elbow and rest
your forearm on a flat surface, like a table. Make sure your
wrist hangs loosely over the side of the table.
Wrist bends. Bend
your hand back toward
your wrist so that your
fingers point toward the
ceiling. Bend your hand
down so that your
fingers point toward the
floor.
e
e
Starting position: Sit or stand. Place
your hand out in front of you.
Finger bends.
Make a tight fist.
Then open and
relax your hand.
e
e
Starting position: Lie flat on the bed with your legs flat and
straight. Only do hip exercises with instructions from your
caregiver if you have had a hip injury or surgery.
Hip and knee
bends. Point your
toes. Slowly bend
your right knee up as
close to your chest
as possible.
Straighten your leg
and return it to a flat
position on the bed.

e
Leg rotation, in and out. With your right leg
flat on the bed, roll your leg toward the middle
so the big toe touches the bed. Roll your leg
outward. Try to make your smallest toe touch
the bed.
e
e
Starting position: Sit in a chair with both feet flat on
the floor.
Ankle bends. Keep
your toes on the floor
and raise your heel as
high as you can. Lower
your heel and relax.
Keep your heel on the
floor and try to raise
your toes as high as
you can.
e
e
A providers order may be needed for complete
ROM exercises. The provider also may order
ROM exercises for specific joints.
Practice personal body mechanics, to prevent
injury.
Do not force joint movements.
Perform limited ROM movements during
treatments.
If the client becomes tired, allow reasonable
rest periods between exercises.
DESCRIPTION: Client lies face down
INDICATION: Alternate position for immobilized patient.
Promotes drainage from the mouth and is especially
useful for unconscious clients or those clients recovering
from surgery of the mouth or throat.
CONTRAINDICATION FOR USE: Post abdominal surgery,
and among those with respiratory or spinal problems.

DESCRIPTION: Client lies flat on the back

INDICATION: Clients on bedrest, post spinal surgery and
post anesthesia

CONTRAINDICATION FOR USE: Clients with dyspnea
or those at risk for aspiration.

DESCRIPTION: Clients lies on the side with weight on
the hip and shoulder, with pillows supporting legs, arm,
head, and back.

INDICATION: A choice position for clients with pressure
sore on bony prominences of back and sacrum.

CONTRAINDICATION FOR USE: Clients post hip
replacement and other orthopedic surgery.

DESCRIPTION: In this semiprone position, the client lies
on the side with weight distributed towards the anterior
ileum, humerus, and clavicle with pillows supporting
flexed arms and legs.

INDICATION: for unconscious clients because
itbfacilitates drainage from the mouth and prevents
aspiration of fluids.

CONTRAINDICATION FOR USE: Clients with spine or
orthopedic conditions.

DESCRIPTION: Sitting position raises clients head 80-90
degrees (high)with pillows support for head, arms and
legs.

INDICATION: Clients with difficulty of breathing. Also for
eating, improvement of cardiac output, and watching TV.

CONTRAINDICATION FOR USE: Post spine or brain
surgery.

DESCRIPTION: Semi-sitting position with head elevation
of 30-45 degrees.

INDICATION: Clients with difficulty of breathing. Also for
eating, improvement of cardiac output, and watching TV.

CONTRAINDICATION FOR USE: Post spine or brain
surgery.

DESCRIPTION: Lies prone with buttocks elevated and
knees drawn to the chest.

INDICATION: For rectal procedures and examination.

CONTRAINDICATION FOR USE: Arthritis, and other
joint deformity.

DESCRIPTION: Lies supine with head 30-40 degrees
lower than the feet.

INDICATION: For postural drainage and promotion of
venous blood return

CONTRAINDICATION FOR USE: Increased intra-cranial
pressure. hypotension may result from this position.

DESCRIPTION: Clients lies supine with legs flexed and
rotated outward.

INDICATION: For vginal examination.

DESCRIPTION: Lies supine with hips flexed, and calves
and heels parallel to the floor using stirrups

INDICATION: For vaginal and rectal examinations and
procedures (DRAPE!!!for comfort and privacy).

Help the patient assume the desired or required
bed position. the nurse assists the patient to
achieve proper body positioning and alignment.
Support patient's body in correct alignment using
pillows or splints.
Assure the proper use of supportive devices.
Frequently monitor and evaluate the position
selected.
Provide skin care.
Materials:
Pillow to support the client comfortably in the
required positions
Tissues for expectorated secretions
Sputum container for expectorated secretions
Mouthwash to clean and freshen the mouth following
the treatment
Bed that can be placed in trendelenburgs position
Gown or pajama to prevent undue exposure and to
protect the skin during percussion and vibration
A towel to place over the area to be percussed to
prevent discomfort

To drain the apical segments of the upper lobes
-Lie back at a 30-90 degrees angle.

-Percuss and vibrate between the clavicles (collar bones) and the
above the scapulae (shoulder blades
To drain the posterior segments of the upper lobes
-Have client sit upright in a chair or bed with the head bent slightly
forward.
-Percuss and vibrate the areas between the clavicles and the scapulae.

To drain the anterior segments of the upper lobes
-Have client on a flat bed with pillows under the knees to flex them.
-Percuss and vibrate the upper chest below the clavicles down to the
nipple line, except for women.

To drain the right lateral and medial segments
-Elevate the foot of the bed about 15 degrees or 40cm (15 in) and have
the client lie on the left side. Help the client to lean back slightly
(about a quarter turn) against the pillow extending at the back from
the shoulder to the hip. A pillow may be placed between the knee for
comfort.
-For male: percuss and vibrate over the right side of the chest at the
level of the nipple between the 4th and 6th rib.
-For female: position the heel of your hand toward the axilla and your
cupped finger extending forward beneath the breast to percuss and
vibrate beneath the breast.
To drain the left lingular segments.
-Elevate the foot of the bed about 15 degrees and have the client lie on
the right side.
-Percuss the left side of the chest beneath the breast

To drain the superior segments
-Have client lie on the abdomen on a flat bed and place two pillows
under the hips
-Percuss and vibrate the middle area of the back (below the scapulae)
on the both sides of the spine.

To drain the anterior basal segments
-Have client lie on the unaffected side, with the upper arm over the
head. Elevate the foot of the bed about 30 degree or 45cm (18 in), or
to the height tolerated by the client. Place one pillow between the
knee. Another under the head is optional.
-Percuss and vibrate the affected side of the chest over the lower ribs,
inferior to the axilla.
To drain the lateral basal segments
-Have the client lie partly on the unaffected side and partly on the
abdomen. Elevate the foot of the bed about 30 degrees or 45 cm (18
in) or to the height tolerated by the client. An alternative is to elevate
the hips with pillows.
-Percuss and vibrate the uppermost side of the lower ribs.

To drain the posterior basal segments
-Have client lie prone. Elevate the foot of the bed abput 30 degrees or
45cm (18 in) or to the height tolerated by the client. Elevate the hip
on two or three pillows to produce a jack knife position from the
knees to the shoulders.
-Percuss and vibrate over the lower ribs on both sides close to teh
spine, but not directly over the spine or the kidneys.

+ KOZIER BOOK ( 8
TH

EDITION)
+INTERNET ( GOOGLE)


Promoting Comfort

Загружено:

Сведения о документе

Исходное описание:

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Promoting Comfort

Загружено:

Авторское право:

Доступные форматы

" Describe comfort theory and its application to pain management

Вам также может понравиться