BEDDINGS

Bed Making

Definition: The process of preparing hospital bed for effective patient care.

Scientific Principles: -

As a Nurse prepares a bed she considers the hard and soft tissues of the patient resting
against the mattress.

The body exerts uneven points of pressure against the mattress and the greatest
pressure is made at points of prominence or of greater weight. The pressure may be so
great or prolonged that the blood supply is cut off and the part becomes gangrenous.

The means of stimulating circulation such as exercises should be encouraged while on

bed as circulation is slower while in lying position. These exercises also maintain muscle
tone; and as muscle tone improves the joints assume their proper position. When a
person lies in bed his body position should approximate to standing position as nearly as
possible.

Bedclothes also need to be changed as often as possible as a result of moisture and in

order to protect the patient and prevent transfer of infection from one patient to
another.

A well-made bed also aids establishing good rapport in meeting the psychosocial needs
of the patient and also encourages him to do the same while at home.

Purposes

To make patient comfortable and safe

To prevent pressure sores

For treatment purposes

To prevent cross infection

For aesthetic reasons

Principles of Bed Making

Two Nurses procedures

Assemble all requirement before starting

Beds should be made as often as necessary

All worn out materials should be replaced as soon as possible

Bed clothes to be placed on striper or 2 chairs

Patient should never be left uncovered or unsupported

Communicate with patient as much as possible during procedure

The Basic Hospital Bed should have the following:

Bed stead

Tarpolin cover (over springs)

Mattress with rubber cover or mackintosh

Pillow with polythene cover

Types of Beds

Unoccupied bed (empty bed or closed)

Occupied bed (open)

Emergency admission bed

Fracture bed

Bed for drying plaster cast

Operation bed (post operative)

Divided bed

Cardiac bed

Cot bed

Unoccupied Bed

Definition: A bed prepared to receive a patient following a plan admission into the
ward.

Requirements on a Trolley

Top shelf

2 clean bed sheets

1 draw sheet

1 clean pillow cover

1blanket or counterpane

Bottom shelf

1 draw mackintosh

1 pillow

Procedure

NB. Two Nurses’ procedure

Explain procedure to patient

Collect all requirements on a trolley and take trolley to the foot of the bed.

Avoid all unnecessary steps and movements.

Move away the locker or any other object obstructing you from free movement.

Place two chairs back to back at the bottom of the bed (or bed stripper)

and place items on them in order of application.

Turn mattress from end to end and pull it tight to the head of the bed (if necessary).

Spread bottom sheet over mattress and tuck it in at the top and beginning from top to
bottom making tight (envelop) corners.

Place draw mackintosh approximately 40cm from the top.

Place draw sheet to cover draw mackintosh and tuck in both sides together.

Spread top sheet on bed allowing a turn over about 50cm at the head end and tuck in at
the bottom and on either sides.

Cover the top sheet with a blanket or counterpane allowing it to hang loosely on either
side of the bed. Fold top sheet over blanket.

Tuck in the bottom with envelop corner to make a neat appearance.

Slip pillow into its cover so that the corners fit well. Place it on the bed with the open
end away from the door.

Put chair under foot of bed, straighten the bed and return locker to its former position
and remove trolley.

Occupied Bed (For Ambulant Patient)

Definition: A bed prepared for already admitted patient for rest and comfort.

Requirements

Same as for an unoccupied bed with the addition of linen bin.

Procedure
Explain procedure to the patient

Set trolley and wheel to bedside and assist patient to sit comfortably on a chair.

Place two chairs back to back (or striper) at the foot of the bed.

Remove pillow and place on a chair.

Strip bed, fold and place blanket and linens on the chairs accordingly or discard in linen
bin if they need to be changed.

Turn mattress from end to end and put it tight on the bed.

Make bed as for unoccupied bed until when draw sheet is in position.

Place pillow in position with open end away from the door.

Place top sheet and truck in at bottom making an envelope corner.

Place blanket on top and tuck at bottom making an envelope corner.

If patient is back on bed cover him with both top sheet and blanket otherwise fold them
threefold.

Place chairs back to their position, straighten bed, return locker to its former position
and remove trolley.

Occupied Bed with Patient on the Bed

There are two known methods, namely:

Method I: Rolling Patient from Side to Side

Explain procedure to the patient.

Set trolley and wheel to bedside.

Screen bed and close nearby windows.

Strip bed loosely, leaving patient with a pillow and covered with a bed sheet.

Roll patient to one side and roll draw sheet and draw mackintosh towards him. If
bottom sheet needs changing roll it also.

Tuck in the clean sheet on one side and roll it to the centre of bed. Unfold draw
mackintosh and draw sheet over the top or the rolled sheet.

Roll patient gently over the bump to the opposite side.

Remove dirty sheets and put into linen bag.

Smoothen the bottom sheet and tuck it in. Do the same with the draw mackintosh and
draw sheet.

If the bottom sheet is not changed it should be un-tucked, brushed clean with a hand
and tucked again. Pull it well up, straighten and smoothen it before tucking in the draw
mackintosh and draw sheet.

Turn patient back to the centre of the bed and support him while his pillows are shaken
and re-arranged.

Place patient in a comfortable position and make up the top of the bed.

If the top sheet needs changing place it over the dirty one and remove the dirty one.

Cover patient with top sheet if necessary.

Ensure that bedclothes are loose over the patient's feet by pulling them loosely.

Straighten bed and replace locker back to position.

If patient is using a bed cradle place it in an appropriate position before the top sheets.

Method II: From Top to Bottom

Observe I - 3 in Method I

Lift patient to the foot of the bed where he can be supported by a Nurse
Straighten or change bottom sheet at the head of the bed. then lift the patient to the
already made up top part of the bed supporting him by one Nurse as the other make the
lower end of the bottom sheet.

Make up the top bedclothes as for method one

NB: The patient must never be uncovered or exposed

Cardiac Bed

Definition: A bed prepared for patients with difficult breathing to ease respiration.

Indications

Patient with congestive heart failure

Patients with severe respiratory disease

Patients with ascitis.

Requirements

Same as for a simple bed with the addition of the following - back rest, bed table with a
soft pillow, sputum mug, 3 - 4 extra pillows, a bed cradle, a bed sheet, sand bags or foot
rest and one air ring with cover.

Procedure

Inform patient, screen bed, close nearby windows.

Wheel trolley to the patient’s bedside.

If patient is ambulant assist him to sit comfortably on a chair otherwise move him to the
foot of the bed as a Nurse supports him in an upright position.

Make up bed as for a simple bed until when draw sheet is in position.

Place backrest in functional position and arrange pillows in order. If patient is on bed
move him towards the head of the bed so that he sits in an upright position.
Place air ring in position.

Support both feet with sand bags at the sole of feet.

Make up top clothes over a cradle and place bed table with a small pillow and sputum
mug in front of patient.

Place chairs under bed, remove screen replace locker back to its former position and
discard trolley.

Emergency Admission Bed

Definition: A bed prepared to receive patient that need immediate attention to ease
patient’s problem

Indications

Patients with road traffic accident.

Acutely ill patients.

Patients that require urgent attention

Requirements

Same as for a simple bed with the addition of the following: - 2 blankets, hot water
bottles, bed blocks or bed elevator, vital signs tray, oxygen cylinder, suction machine
and a drip stand.

Procedure

Make bed as for a single bed until when draw sheet is in position.

Spread first blanket over bed.

Put hot water bottles over bed and spread second blanket in position.

Place top linen and blanket in position leaving the part toward" the main door open.
Arrange oxygen cylinder with its accessories and suction machine by the side of the bed.

Place vital signs tray on a locker.

Divided Bed (Cradle Bed)

Definition: A special bed prepared to aid comfort based on individual’s problem.

Indications

Patient with fracture of the lower limbs,

Patient with lower limb amputation;

Patient with newly applied plaster of Paris on the lower limbs.

Patient with burns.

Patient with abdominal operations.

Requirements

Same as for occupied bed with the addition of the following:

1 Bed sheet

1 Blanket

Bed cradle

Procedure

Make bed as for simple bed until when the draw sheet is in position.

Make top half of bed by spreading a bed sheet over the bed leaving enough at the top
to overlay.

Fold blanket into two and place on it with the lower end at the centre of the bed.

Fold lower end of bed sheet over blankets and then fold top part of the bed sheet.
Make lower half of the bed by spreading the second sheet over bed and tucking it at the
bottom.

Spread second blanket over it, tucking it at the bottom and fold the top part allowing
about th to overlap the top divided part.

Fold upper part of the bed sheet over blanket.

Place bed cradle in position.

Slip pillows in their cases and place in appropriate place.

NB:

If the bed is to be used for a patient with a lower limb amputation the followings are
added.

3 dressing towels and mackintosh

2 Sand bags

1Tourniquet

1 Draw sheet

If the bed is to be used for a patient with newly applied plaster of Paris on lower limbs
the followings are added:-

A dressing mackintosh and a towel

A protected pillow

Fracture boards.

Post Operative Bed

Definition: A bed prepared to receive a patient following surgical intervention to aid

recovery and prevent complications.
Requirements

Same as for a simple bed (Preferably clean sheets) with the addition of the following: -

Protective sheeting and towel.

Oxygen cylinder and attachments.

Tray for intravenous therapy

Suction machine

Post anesthetic tray

Side rails

Resuscitation trolley

Bed blocks or elevator

Hot water bottles if necessary

Drip stand

Vital signs tray

Procedure

Remove pillows and place on chair.

Make foundation bed as usual until when draw sheet is in position.

Place protective sheeting and towel over head of bed and tuck under mattress.

Place the top bed clothes and fold lengthwise into a pack and place on top of the bed.

Leave pillows on a chair and push under patient's bed.

Arrange additional requirements in readiness by the bedside.

Cot Making

Definition: A special bed prepared for babies and other small children to protect them
from falls and injuries.

Trolley procedure

Top Shelf

Two cot sheets

One pillowcase (cot size)

1draw sheet

Cot cover

1 Cot mosquito net

Cot blanket

Bottom Shelfen

1 Mackintosh

I Small pillow

NB: A linen bin should accompany the trolley.

Procedure

Make bed as for a simple occupied bed until when the top bed clothes are in position.
Then spread mosquito net over the cot to protect child from flies and mosquitoes.

Bed Accessories

Definition:

These are equipment used alongside with bed for the added comfort of the patient
according to the type of Nursingcare required.

Bed Cradles: These are made of metals and are used to take the weight of the
bedclothes from the body e.g in cardiac and burnt patients.

Backrest: These are made of wood or steel. Backrests now form part of the bed and can
be adjusted as required. They help to support the patient and aid breathing.

Air Rings: Hollow rubber rings fitted with a valve. They are blown up to form a cushion
on which the patient sits to prevent pressure sore. Rings must be put into a cotton cover
before being placed under the patient. Used on obese and cardiac patients.

Fracture Boards: Used in patients who are in a plaster splint or need firm support after
spinal injuries or operations. They are placed under the mattress to prevent it from
sagging. These are composed of wood pavels, which may or may not be perforated.
They are used under the mattress to prevent sagging and maintain even surface where
fracture beds are not available. Mostly used on patients with fractures.

Bed Blocks: They are used to raise the head or foot of the bed in case of shock or
haemorrhage. Metal elevators which may either be portable or attached to the bed can
also be used for this purpose.

Ripple Bed: This is sometimes called airbed. The bed is covered with a mattress which is
composed of alternating pressure pads, which are alternately inflated and deflated. It is
used for prevention of pressure sores.

Hot Water Bottles: These are rubber bottles, which are filled with hot water and placed
in a patient's bed or over the patient. It should be protected by flannel cover. They are
used to provide warmth to the patient.

Pulleys: Pulleys are crooked bars over the head of beds with suspended chain and
handle to aid patients lifting and for regular active exercise.

Parallel Bars: These are extra appliances made of iron bars. They are attached to the
head and foot of the bed with parallel support. They are used for cross-pelvic tractions
and putting mosquito nets.
Positions Used in Nursing

Recumbent: This is where the patient lies flat on the back with a pillow under the head.
Indication:
To Nurse patient at complete rest as it provides full relaxation

For examination of the front trunk.

Semi-Recumbent: This is where the patient is half propped up with two to three pillows.
Indication:In medical and surgical Nursing e.g. chronic and acute chest conditions
and gastric conditions.

Prone: Patient lies flat on face with a pillow under head (which is turned to outside).
Small pillow is placed under the ankles to prevent toes from pressing on the bed and a
pillow is placed under the chest.

Use:Patient with burns on the back or severe bed sore.

Semi- Prone (SIMS): Patient is placed on one side with the lower arm resting behind the
other in front. The lower leg is stretched behind and the other is bent in front. The chest
and head are positioned so that any secretion from the mouth is drained out.

Use:For unconscious patients and gynaecological examination.

Upright / Fowler’s Sitting: Patient sits upright supported with pillows. Patient may have
cardiac table as dyspnea is relieved by leaning forward and may also require air ring to
relieve pressure.

Use: For patients with chronic heart disease, dyspnea or post-operative chest or
heart condition and for drainage of abdominal cavity.

Dorsal: Similar to recumbent but here the thighs are flexed and knees are abducted.

Use:For abdominal and vaginal examination, bi-manual examination and

catheterization.

Lateral: Patient lies on left or right side with buttocks to the edge of the bed, head is
bent forward and thighs and knees flexed.
 Use:Rectal examination, vaginal and perineal examination, giving of enemas and
suppositories. N.B. Usually the left lateral is the most suitable for enema because
of the anatomical arrangement of the gastro-intestinal tract.

Genupectoral (Knee Chest): Patient kneels on table near the edge, thighs vertical, the
chest rests on a small flat pillow and head bent beyond while arms are flexed round and
over the head.

Use:For vaginal examination, high colonic irrigation and in cases of vesceroptosis

to assist in replacing dropped organs.

Lithotomy: Patient lies in recumbent positions, knees well flexed, abducted and hanged
so as to maintain position.

Use:Commonly used in the theatre for gynaecological and perineal operations/

examinations.

Trendelenburg: Patient lies in recumbent position with thighs abducted and knees
flexed backwards.

Use: Same as for lithotomy.