GUIDELINES FOR BED-MAKING

a. Gather all the required linen and accessories before making the bed.

Sheets.

Pillowcases.

Blankets.

Bedspread.

Extra pillows.

b. Avoid shaking the linen to prevent the spread of microorganisms and dust particles.
c. Avoid placing linens, clean or dirty, on another patient's bed.
d. Do not place dirty linen on the floor.
e. Do not hold dirty linen against your uniform.
f. Always use good body mechanics; raise the bed to its highest position to make bed-making easier.
g. Stay on one side of the bed until it is completely made; then move to the other side and finish the bed.
This saves time and steps.
h. Observe the patient and document 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.

2-5. METHODS OF BED-MAKING

a. Unoccupied (Closed) Bed. An unoccupied bed is one that is made when not occupied by a patient.
(1) Raise the bed to a comfortable working height, if adjustable.
(2) Lower siderails, if present.

(3) Remove pillows and pillowcases. Set the pillows aside in a clean area.
(4) Fold and set the blankets and spreads aside (to be reused).
(5) Loosen the linen along the edges of the bed, and move toward the end of the bed.
(6) Wash the mattress if necessary, turn the mattress to the opposite side if necessary, and replace the
mattress pad as needed. Observe the mattress for protruding springs.
(7) Place the bottom sheet.
(a) Flat sheet.
1 Position evenly on the bed.
2 Miter the corners at the top of the bed. Lift the mattress slightly, then stretch and tie the ends of the
sheet together beneath the mattress. Repeat these steps for the bottom of the bed.
3 Stretch and tuck the free edges at the sides.
(b) Fitted sheet.
1 Fit the sheet on the lower edges of the mattress first. Then lift the mattress and fit the sheet on the top
edges of the mattress.
2 Stretch and tuck the free edges at the sides.
(8) Place a draw sheet on the center of the bed, if it is needed.
(a) Tuck in the free edge on one side.
(b) Stretch the draw sheet from the opposite side and tuck in the free edge.
(9) Place the top sheet, blanket (if used), and bedspread.
(a) Position evenly on the bed.
(b) Miter the bottom corners, tucking all three parts together.
(c) Leave the loose ends free.
(10) Fanfold the top linen back to the foot of the bed.
(11) Place a clean pillowcase over the pillow and place it at the head of the bed.
(a) Invert the pillowcase over one hand so the inner back seam is visible.
(b) Grasp the edge of the pillow with one hand holding the pillowcase at the seam.
(c) Use the opposite hand to guide the pillowcase over the pillow.

(12) Adjust the bed to its lowest position, if adjustable.

(13) Reposition the head up slightly, if the patient prefers.
(14) Raise the siderail opposite the side of the bed where the patient will enter.
b. Occupied (Open) Bed. An occupied bed is one that is made while occupied by a patient.
(1) Wash your hands.
(2) Identify the patient, explain the procedure, and be sure you will have the patient's cooperation.
(3) Check the condition of the bed linens to determine which supplies you will need.
(4) Provide for the patient's privacy (throughout the procedure).
(5) Obtain the articles of linen that you will need.
(6) Place the bath blanket over the patient and the top cover.
(7) Loosen the top bedding from the foot of the bed and remove it. If possible, have the patient hold the
bath blanket while you pull the top covers from under it from the foot of the bed.
(8) Move the mattress to the head of the bed.
(9) Move the patient to the distal side of the bed.
(10) Make the bed on one side.
(11) Move or turn the patient to the clean side of the bed, and finish making the bed on the opposite side.
Place the clean linen on top, and remove the bath blanket.
(12) Attach the patient's signal cord within reach.
(13) Provide for the patient's safety and comfort.
(14) Tidy the room.
c. Anesthetic, Surgical, or Post-Op Bed. This is a bed that is prepared to receive a patient from the
operating room.
(1) Gather all needed supplies:
(a) Large sheets (2).
(b) Drawsheet (1) or an additional large sheet.
(c) Blanket.
(d) Pillow(s).

(e) Pillowcase(s).
(f) Towel.
(g) Chux , if drainage is anticipated.
(2) Make the bed as though you are making an unoccupied bed, except that the top sheet and blanket are
not tucked under the mattress at the foot of the bed, and the corners are not mitered.
(3) Fanfold the top covers to the side or to the foot of the bed.
(4) Place a towel or disposable pad (Chux ) at the head of the bed. This is intended to protect the sheet
if the patient should vomit.
(5) It is a good idea to place a drawsheet on the bed because it can be used to move the patient more
easily.
(6) Place the pillow(s) on a chair near the bed or in an upright position at the head of the bed.
(7) Leave the bed in the high position.
(8) Lock the brakes on the bed.
(9) Move the furniture away from the bed to allow for easier access to the bed for the recovery room
stretcher and personnel.
(10) Make certain an emesis basin is readily available and suction is available where indicated.
(11) Keep Chux available to use if necessary.
HAIR CARE
1. Explain the procedure to the patient.
2. Move the patients head to the bed, face away from the nurse in a diagonal position.
3. Place the towel under the patients head; loosen the hair and part tat the middle.
4. Brush hair thoroughly and apply oil or Vaseline for matted hair. For long hair part at the middle
and braid.
5. Clean everything and disinfect the brush and comb.
HAIR SHAMPOO
1. Explain the procedure to the patient, prepare equipment and take to the bedside.
2. Screen the bed. Loosen the patients gown.
3. Replace the top sheet with a bath blanket. Fold the top sheet down to the middle of the bed and
cover chest with a bath towel.

4. Remove pillow and bring the patient to the edge of the bed or in a diagonal position.
5. Protect one pillow with rubber protector and cover with a bath towel and place under the patients
shoulder. Arrange Kelly pad under the shoulder.
6. Comb hair, cover eyes with folder face towel, and plug ears with cotton balls.
7. Wet hair lukewarm water, shampoo and massage with your fingers.
8. Rinse the hair, repeat until hair is clean. Squeeze water from hair.
9. Remove face towel from eyes and cotton balls from ears.
10. Drop the Kelly pad to the pail, cover hair with the bath towel.
11. Bring the patient to the normal position; the rubber protector is still in place, covering the pillow
while hair is dry.
12. Comb hair, fasten the gown and leave the patient comfortably and do the after care of the
equipment.
Range of motion exercises are physical movements which help to relieve the stiffness of the joints and
make them flexible. In conditions like rheumatoid arthritis, the joints become inflamed and stiff. Stiffness
of the joints reduces the range of motion. Range of motion indicates the range to which a joint can be
used in a particular direction. It can be estimated with an instrument called goniometer. Limited range of
motion affects daily activities. The aim of the range of motion exercises is to make the joints flexible and
restore the normal range of movements at a joint.
Causes of limited range of motion
A joint is a place where bones meet and are held together by ligaments and other strong tissues. A joint
allows the involved bones to move in certain directions. Sometimes the movement is obstructed by
conditions like

Paralysis

Mechanical problems

Inflammation

Infection

Pain

Injuries

For example in a wrist joint, the lower end of the forearm bones radius and ulna join the carpal bones.
There are four movements possible at this joint flexion, extension, adduction and abduction. With these
movements various activities like holding and lifting objects are done. When the movement is limited,
these activities cannot be done. In patients who are paralyzed, there will be inability to use the limbs. The
range of motion exercises partially restore the motor function in these patients.

Types of range of exercise

There are three types of range of exercise. They are

Active exercise This is done by people who can exercise, use their joint and move their limbs
themselves

Active assistive exercise These patients require additional support from a doctor or a
physiotherapist to move their limbs. Here the people move the limbs and the assistance is
provided by the therapist with hand, bands or special equipments.

Passive exercise The patients do not move the limbs themselves. The therapist moves the
limbs through the entire range of motion themselves.

These exercises should be done gently to avoid injury. To increase the range of motion the affected joint
should be moved slowly to the range just beyond the point of pain. But care should be taken that it does
not exceed this limit or else there will pain persisting even after the exercise. Sustained stretching is
better than momentary stretching. Sustained stretching should be done for at least 20 minutes per day.

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Foot Care Equipment

Foot care equipment is transported in the nurse's carrying bag to the foot care site. The
assembled foot care equipment should contain:
a set of sterilized foot care instruments for each patient/client
disposable paper towel on which to place instruments during procedure
commercial puncture-proof sharps container
skin antiseptic
hand washing soap and disposable towels
waterless hand washing agent
container to transport used instruments
one pair of non-sterile medical gloves (latex, vinyl, nitrile etc.) for each patient/client
foot emollient (lotion or cream)
protective equipment (eye shield, disposable face mask and disposable apron, gown or towel)
sterile gauze or Band-Aid
Cleaning Foot Care Equipment
All items should be washed in warm water with a detergent. Personnel who are cleaning the
equipment should wear general purpose household gloves. Files and hinged instruments should
be cleaned with a small brush (e.g. toothbrush) while the instrument is held under water to
prevent splashing. An ultrasonic cleaning device may be used as an additional step in the
cleaning process. Washed items should be left to dry. Cleaned instruments should be placed in
packaged sets prior to sterilization.

Recommendations
The overall goal of infection prevention practices for foot care is to eliminate the risk of the
transmission of pathogens between clients and between clients and the health care worker. Foot
trauma during the foot care procedure should be avoided to eliminate the client risk of acquiring
infections. The following recommendations should be implemented when providing foot care.
a. All foot care equipment for re-use must be capable of being cleaned in a detergent and water to
remove organic matter.
b. Single-use items such as emery boards, orange sticks and rotary tool disks should be discarded
after use. If a client's own equipment is used, it must be kept clean and dry.
c. All instruments used in foot care must be sterile before use on a client/patient. Instruments that
must be sterilized prior to use, often packaged in sets, may include the following: nail nippers
foot dresser file Black's file rasp scalpel handle (for attachment of blade) nail probe callus parer
d. The recommended methods of sterilization for foot care instruments include dry heat;
autoclave (steam under pressure); or chemisterilant with exposure time as stated on product's
label. Methods of cleaning, disinfection and sterilization are detailed in text and tabular form in
the Health Canada publication Infection Control Guidelines for Cleaning, Disinfection,
Sterilization and Antisepsis in Health Care(17).
e. Glass bead sterilization is not an effective method of sterilization and should not be used(1719).
f. Boiling water(20) and microwave ovens are not effective methods of sterilization and should
not be used(17).
g. Hand washing is the single most important procedure for preventing infections(17). Hands
must be washed with soap and water before beginning the foot care procedure. Hands should be
washed before glove use and after glove removal. Foot care clinics should be arranged with
consideration for the availability of hand washing sinks. Waterless hand washing agents may be
used if a sink is not available(17).
h. Non-sterile medical gloves should be worn throughout the procedure to prevent exposure to
bacteria, fungi and viruses(21).
i. Gloves must be changed for each patient. The hands should not be washed with gloves on.
j. Eye shields or glasses should be worn to protect the health care provider from nail clippings or
debris(17,21).
k. A disposable face mask should be worn to reduce the possibility of inhaling organisms that
may be aerosolized during filing of nails. The inhalation of nail dust has been associated with
conditions such as conjunctivitis, rhinitis, and an occupational lung disease called "podiatrist's
lung"(22-24). Masks should fit snugly and be worn for one patient/client only.
l. If the foot of the person receiving care is positioned on the lap of the health care provider, the
clothing of the health care provider should be protected by a disposable gown, apron, or a clean
towel.
m. The use of a foot soak prior to foot care is controversial(25); however, the feet should be
clean. Feet should be washed with a mild soap and warm water. If the foot basin is used it should
be washed with soap and water, rinsed, and dried thoroughly between clients.
n. A skin antiseptic should be used to wipe areas of the feet that will be touched by a foot care
instrument (e.g., before removing calluses). If cotton balls are used, a disposable container
should be used to wet the cotton balls with the antiseptic. Alternatively, prepackaged swabs

should be used.
o. Emollients, such as lotions/creams, are often used to massage and moisturize the foot(26). It is
desirable to use small, single use lotion bottles that can be left with the client(17). If the bottle
containing the lotion is used on more than one client, care must be taken to keep the contents free
from contaminants. Squeeze the lotion onto the gloved hand without touching the bottle opening.
p. If towels are used during foot care clinics, the towel should be used for one client only. Clients
should not walk with bare feet. Plantar warts are more frequently associated with users of public
showers, sports centres, and gymnasia(27,28).
q. If the integrity of the skin is accidentally breached, the area should be wiped with a skin
antiseptic and covered with a loosely applied sterile gauze or a Band-Aid. Constrictive
adhesive dressings should not be applied to toes(29). A protocol should be developed for the
daily monitoring and documenting of the wound healing process.
r. If used, blades on foot care instruments should be disposed of in appropriate sharps containers
at the completion of each foot care treatment. Blades must not be re-used.
s. All health care workers providing foot care should be aware of protocols for the prevention of
the transmission of bloodborne pathogens, e.g., recommendations for hepatitis B immunization
and management of accidental exposure to blood(30-32).

Overview
Proper hand washing techniques are mandatory in the healthcare and food industries to
prevent the spread of germs and bacteria. Even though there are no regulations
stipulating that you must wash your hands in a certain manner at home, you can benefit
from doing so. Clean hands are an important factor for good health.

Importance
By keeping your hands clean through frequent hand washing, you help prevent the
spread of harmful germs and bacteria. It reduces your chances of getting sick and the
chances of you getting others sick. According to the Centers for Disease Control, hand
washing "is one of the most important ways to prevent the spread of infection and
illness."
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Frequency
You should wash your hands before and after you touch your face, before touching
food, after touching raw food, after using the restroom, after blowing your nose, before
and after touching wounds, after touching anything that is likely to contain bacteria and
whenever your hands are visibly dirty.

Proper Procedure
For clean hands, follow these seven steps:
1. Place your hands underneath a faucet of running water and wet your hands
thoroughly.
2. Apply soap to your hands. Use a liquid antibacterial or antimicrobial soap if you have
been exposed to viral or infectious germs.
3. Rub your hands together vigorously to lather the soap. Lather the soap over your

entire hands and fingers for at least 20 seconds. Pay attention to both sides of your
hands, between your fingers and around your wrists. Scratch your fingernails on the
palms of your hands to get the lather underneath your nails.
4. Remove dirt from underneath your nails, using a clean nail stick. Discard the stick in
a trash receptacle.
5. Rinse your hands under a faucet for 30 seconds.
6. Grab a paper towel. Hold the paper towel while you turn off the water faucet. Use the
paper towel as a barrier between your hand and the water faucet to prevent
contaminating your hands with bacteria from the faucet. Throw the paper towel away.
7. Grab a fresh paper towel and dry your hands with it.

Waterless Hand Washing

An alcohol-based hand sanitizer can be used to clean hands when water is not
available. Rub a generous amount of alcohol-based hand sanitizer over the entire
hands, fingers and wrist, for a minimum of 30 seconds. For best results, repeat the
process a second time.

Soap
Liquid soap is preferred over bar soap, because bar soap often becomes contaminated
with bacteria. Antibacterial or antimicrobial soaps are more effective at removing virus
and infectious germs than bar soap. According to the Centers for Disease Control and
Prevention, plain soap fails to remove infectious bacteria commonly found on the hands
of medical professionals. Plain soap is sufficient for daily use in households.
Households should use antibacterial or antimicrobial soap when members in the
household are sick.
Kelly's pad,
a horseshoe-shaped inflatable rubber drainage pad used in a bed or on the operating table.

Read more: http://www.livestrong.com/article/19170-correct-handwashingprocedures/#ixzz0y4KTJ3Fp

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