King Saud University

College of Nursing
Medical surgical Nursing

Module 2 -122

:Prepared By
Lecturer/ Magda Bayoumi
.HOSPITAL BEDS •
BED MAKING •
.PRACTICE GUIDELINES FOR BEDMAKING •
TYPES OF BED-MAKING •
• IMPLEMENTATION FOR BED-MAKING •
.PROCEDURES

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 Hospital Beds
Hospital beds are designed to easily change the body position of the user. They are electric so the user can ad
their own comfort. Hospital beds are usually 66 cm. high and 0.9 m wide, narrower than the usual bed, so tha
nurse can reach the client from either side of the bed without undue stretching. The length is usually 1.9 m. S
.beds can be extended in length to accommodate very tall clients

A trapeze bar attaches to the headboard of a hospital bed and is helpful in changing positions, for
instance pulling patient up in the bed or sitting up.

.An over bed table rolls under the bed and provides a nice table top for eating, reading, or writing
They are adjustable in height

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A patient lift is used to move a person from their bed to a wheelchair, etc. This would be a person who is
unable to stand or transfer. A sling is used under the patient and is attached to the lift.

Mattresses

A mattress is a piece of bedding on which to sleep or lie. Hospital mattress protectors are suitable for aut
washing and provide optimum sterilization against microorganisms. Many special mattresses are also use
hospitals to relieve pressure on the body's bony prominences, such as the heels. They are particularly helpful
clients confined to bed for a long time. for example: air mattress designed for use by individuals at risk for pr
.sores / decubitis ulcers

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 Commonly Used Bed Positions
,F lat:m attress is co m pletely ho rizo ntal, C lient sleeping in a variety of b ed P ositio ns, S uch as b◙ack-ly in
an
. d p ro n e p osition

Fowler's position: Semi-sitting position in which convenient for eating, reading, visiting, Watching TV, head ◙
of bed is raised to angle of at least 45. Knee may be flexed or horizontal relief from lying positions, to promote lung
. expansion for client Respiratory problem

Semi-Fowler: head of bed is raised only to 30 angle, relief from lying position, to promote lung expansion ◙

Trandelengurg's position: head of bed is lowered and the foot raised in a straight incline, used ◙
.to promote venous circulation in and certain clients to provide postural drainage of basal lung lobes

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 Reverse Trndelenburg's: head of bed raised and the foot lowered. Straight tilt in direction opposite to ◙
trendelenburg's position. Used to promote stomach emptying and prevent esophageal reflex in client with hiatal
.hearia

Side Rails
Safety sides are used on both hospital beds and stretchers. They are of various shapes and sizes and are usuall
.made of metal
Footboard or Footboot
These are used to support the immobilized client's foot is a normal right angle to the legs to prevent planner
.flexion contracture

Bed Cradles
A bed cradle is a device designed to keep the top bedclothes off the feet, legs, and even abdomen of a client.
The bedclothes are arranged over the device and may be pinned in place. Designed to fit under the mattress to

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.form a support to keep bedclothes clear of the feet and legs

Intravenous Rods
Intravenous rods (poles, stands, standards), usually made of metal, support intravenous (IV) infusion containe
.while fluid is being administered to a client. Some hospital units have overhead hanging rods on a track for I

MAKING BEDS

Nurses need to be able to prepare hospital beds in different ways for specific purposes. The be
is occupied or unoccupied, or the purpose for which the bed is being prepared, Certain practic
.guidelines pertain to all bed-making

Practice Guidelines for Bed-Making

.Wash hands thoroughly after handling a client's bed linen •
Linens and equipment that have been soiled with secretions and excretions harbor
.microorganisms that can be transmitted to others directly or by the nurse's hands or uniform
.Hold soiled linen away from uniform •
.Linen for one client is never (even momentarily) placed on another client's bed •
Place soiled linen directly in a portable linen hamper or tucked into a pillow case at the
.end of the bed before it is gathered up for disposal
Do not shake soiled linen in the air because shaking can disseminate secretions and •
.excretions and the microorganisms they contain
When stripping and making a bed, conserve time and energy by stripping and making
.up one side as much as possible before working on the other side
To avoid unnecessary trips to the linen supply area, gather all linen before starting to •
.strip a bed
:Types of bed making procedures
Unoccupied bed, used when the client is able to get out of bed, is left open with the top-1
sheets folded down

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 Postoperative (post op) or surgical bed, used when clients have left for the operating room-2
or procedural area, is left with the top sheets fanfolded lengthwise and not tucked in to
.facilitate the client's return to bed
.Occupied bed, used when the client is not allowed out of bed-3

ASSESSMENT
.Check the activity order, and assess the client's ability to get out of bed-1
.Rationale: This determines whether an unoccupied or occupied bed should be made
.Assess the client's self-toileting ability; note the presence of any wounds, drainage tubes-2
.Rationale: This determines if placement of waterproof pads should be theonbed
.1
PLANNING
.Expected outcomes focus on the client's safety and comfort
Expected Outcomes
.Client has a clean, safe environment throughout hospitalization-1
.Client verbalizes a sense of comfort while in bed-2
.Client's skin remains free of irritation throughout hospitalization-3

Unoccupied Bed making -1

Equipment
Linen bag, matters (change only when soiled ),bottom sheet (flat or fitted), drawsheet (optional), top sheet,
blanket, bedspread, waterproof pads (optional), pillowcases, bedside chair or table, disposable gloves (if linen i
.soiled), washcloth, and antiseptic cleanser

:STEPS
.Determine if client has been incontinent or if excess drainage is on linen. Gloves will be necessary
Assess activity orders or restrictions in mobility in planning if client can get out of bed for procedure.
.Assist to bedside chair or recliner
.Lower side rails on both sides of bed, and raise bed to comfortable working position .3
.Remove solid linen, and place in laundry bag. Avoid shaking or fanning linen .4
Reposition mattress, and wipe off any moisture using a washcloth moistened in antiseptic solution. Dry
.thoroughly
.Apply all bottom linen on one side of bed before moving to opposite side .6
Be sure fitted sheet is placed smoothly over mattress. To apply a flat unfitted sheet, allow about 25 cm
(10 inches) to hang over mattress edge. Lower hem of sheet should lie seam down, even with bottom edge of
.mattress. Pull remaining top portion of sheet over top edge of mattress

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.While standing at head of bed, miter top corner of bottom sheet .8
.Tuck remaining portion of unfitted sheet under mattress .9
Optional: Apply drawsheet, laying center fold along middle of bed lengthwise. Smooth drawsheet over
.mattress, and tuck excess edge under mattress, keeping palms down
Move to opposite side of bed, and spread bottom sheet smoothly over edge of mattress from head to foot
.of bed
.Apply fitted sheet smoothly over each mattress corner .12
.For an unfitted sheet, miter top corner of bottom sheet (see Step 8), making sure corner is taut
Grasp remaining edge of unfitted bottom sheet, and tuck tightly under mattress while moving from head
to foot of bed. Smooth folded drawsheet over bottom sheet, and tuck under mattress, first at middle, then at top
.and then at bottom
.If needed, apply waterproof pad over bottom sheet or draw sheet .14
Place top sheet over bed with vertical center fold lengthwise down middle of bed. Open sheet out from
.head to foot, being sure top edge of sheet is even with top edge of mattress
make horizontal toe pleat; stand at foot of bed and fan fold in sheet 5 to 10cm (2 to 4 inches) across bed. Pull .
.sheet up. From bottom to make fold Approximately 15 cm (6 inches) from bottom edge of mattress
Tuck in remaining portion of sheet under foot of mattress. Then place blanket over bed with top edge parallel to
.top edge of sheet and 15 to 20 cm (6 to 8 inches) down from edge of sheet
.Make cuff by turning edge of top sheet down over top edge of blanket and spread .18
Standing on one side at foot of bed, lift mattress corner slightly with one hand, and with other hand tuck top .19
.sheet, blanket, and spread under mattress. Be sure toe pleats are not pulled out
Make modified mitered corner with top sheet, blanket, and spread. After triangular fold is made, do not tuck .20
.(tip of triangle (see illustration

Go to other side of bed. Spread sheet, blanket, and spread over evenly. Make cuff with top sheet and blanket. .2
.Make modified corner at foot of bed

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 .Apply clean pillowcase .22
Place call light within client's reach on bed rail or pillow, and return bed to height allowing for client transfer. .
.Assist client to bed
.Arrange client's room. Remove and discard supplies. Perform hand hygiene .24

COMMUNICATION TIP

Use an organized approach and reassuring tone of voice so the client feels safe and
. comfortable during bedmaking
Encourage the client to report any discomfort or special requests while the bed is
. being made
When making an occupied bed, ask the client to as sist as able and to report any •
. discomfort or the need to rest
. Interact throughout the entire procedure, even if client is not responsive •

.SURGICAL BED BEDMAKING -2

Steps

.See standard protocol .1

.Postoperative (post op) or surgical bed. Begin with clean unoccupied bed .2
.Rational: Facilitates transfer of postoperative client from stretcher to bed
a-Fold all top linen from foot of bed toward center of mattress. Linen fold should be flush with bottom edge o
.mattress
b. Fold top linen that is hanging down over sides of bed toward center of mattress. Face one side of bed and f
nearest bottom corner back and over toward opposite side of bed, forming a triangle. Repeat for top corner (s
.(illustration
.c. Grasp apex of triangle and fanfold top linen over to far side of bed
.d. Leave bed in high position with side rails down
.R.d.Matches height of stretcher and facilitates client transfer

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-3

:Occupied Bed Making

a-Raise entire bed to comfortable working height. Lower head of bed, if tolerated by client. Lower side rail o
.nurse's side; leave far side rail up
.R. a. It is easier to apply wrinkle-free, tight linens if bed is in the flat position

b. Loosen all top linens. Remove spread and blanket, leaving client covered with top sheet or bath blanket. Fo
spread and blanket in quarters, and place over bottom of bed or on back of chair if they are clean and are to b
.reused
.R.b. Gloves are worn to remove linen only if it is soiled with body secretions

c. Assist client to a side-lying position on far side of bed. Slide pillow over so it remains under client's head.
.Check that any tubing is not being pulled
.R. c. Provides privacy and warmth

d. Roll bottom sheet, drawsheet, and any pads as far as possible toward client. Clean and dry mattress if
.necessary
.R. d. Reduces transmission of organisms and keeps new linen dry
.e. Place clean bottom sheet on bed with seam side down
.Bottom sheets may be fitted (1)
.If flat, center sheet on bed and pull bottom hem to foot end of mattress. Open sheet toward client (2)

.Unfold flat bottom sheet lengthwise to cover mattress. Tuck top of sheet under head end of mattress

.g.Miter top corner of a flat bottom sheet, and tuck in side of sheet under mattress
.R. g. Reduces transmission of organisms and keeps new linen dry

h- Place folded drawsheet and/or waterproof pads on center of bed with seam side down. Fanfold toward clie
.R.h. Provides additional protection to bed linen

i-Cover unoccupied portion of bed with half the material, tucking drawsheet under mattress. Place remaining
.materials as close to client as possible. Keep clean linen and soiled linen separate

j. Place waterproof pads with absorbent side up and plastic side down. Some pads go under cloth drawsheet.
.(Newer, larger absorbent pads go on top of drawsheet or replace it (check agency policy
.R.j. Waterproof absorbent pads protect bedding and keep moisture away from client's skin

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Assist client with logrolling over all linen and facing you. Keep client covered with top sheet or bath
.blanket. Raise side rail on the side client is facing. Go to other side of bed, and lower side rail

Remove soiled linens. Hold them away from uniform. Place on chair seat or in disposable bag or .l
hamper if it is close by. Do not leave client alone with side rail down, even for a moment. Remove gloves if
.worn, and dispose of them properly
.R.l. Reduces transmission of microorganisms

.Gently slide clean linen toward you, and straighten the clean linen out .m
.R.m. Avoids friction of linen being pulled across skin. n.Miter the top corner of bottom sheet as before

.n. Miter the top corner of bottom sheet as before

.o. Grasp side of flat bottom sheet tightly. Keeping it taut, tuck it under mattress. Proceed from head to foot

.p.Repeat by tucking drawsheet, proceeding from middle to top to bottom

.q.Straighten out waterproof pads that are on top of drawsheet

r.Assist client into a supine position; place a clean top sheet, blanket, and spread over client, leaving severa
.inches of sheet at top to be folded down

s. with client grasping clean top linens, slide out used top sheet or bath
.blanket. Cuff top sheet over blanket and spread
R.s. prevent exposure of client. Give a neat appearance to bed and keeps
.client's face off blanket

t. Make a modified mitter corner with linens at foot of be

Miter the corner as before, but donot tuck in lower edge
.tringle

u-Loosen linen at client's feet to client's comfort

R.u. Allows for movement of client's feet, prevents top lin
from forcing feet into plantar flexion, and prevents
pressure ulcers from developing

v. Supporting client's head remove pillow and change

pillowcase

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 Slide out used top sheet while keeping client covered
EVALUATION
.Observe client's linens for cleanliness and tightness .1
.Ask if client is comfortable after bed is made .2
.Observe client's skin for signs of irritation .3
Unexpected Outcomes and Related Interventions

.Client is not comfortable in bed .1

.Check that linens are clean and dry. Tighten them .a
.Assist client with changing position in bed .b

.Client's skin appears red and irritated .2

.Reposition client frequently. Consider use of pressure-relieving mattress .a
.Keep client's bedding clean and dry .b

Recording and Reporting

Bed making is usually not documented. Some agencies require the nurse to check off this activity on a flo
.sheet

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 Lecturer/ Magda Bayoumi Page Bed Making
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