Bed making and Bed bath ppt.pptx

bed making

1. FUNDAMENTALS OF NURSING II Meeting Client’s Needs and Basic Nursing Skills.

2. OBJECTIVES OF THE COURSE: At the end of the module the students should be able to: Define the key words related to nursing profession. Demonstrate different techniques of bed making. Define complete bed bath. Differentiate between complete bed bath and partial bed bath. Identify the purpose in complete bed bath. Identify the indications associated to complete bed bath Perform the procedure in complete bed bath.

3. Definitions of the key concepts A nurse is a person educated and trained to care for sick or disabled persons. A nurse is a health care professional, who is engaged in the practice of nursing. Nurses are responsible (with others) for the safety and recovery of acutely ill or injured people, maintenance of the healthy, and treatment of life-threatening emergencies in a wide range of health care settings.

4. Con’t Nursing is to care of people who are healthy as well as those who are sick, and of groups of people as well as individuals. Nursing is the use of clinical judgment in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.

5. Con’t Nursing is a combination of three factors: art, science and the spirit of unselfish devotion to a cause primarily concerned with helping those who are physically, mentally, or spiritually ill. Nursing as an art means that the nurse must develop skilled techniques in the performance of the various procedures required for giving adequate care to the patient.

6. Con’t Nursing as a science means that the underlying principles of nursing care depend on knowledge of biological sciences such as anatomy, physiology, microbiology and chemistry. Nursing as a spiritual quality means that the primary aim is to serve humanity, not only by giving curative care to the bodies of the sick and injured, but by serving the needs of the mind and the spirit as well”.

7. MAKING BEDS IN NURSING 1 st presentation

8. MAKING BEDS IN NURSING Introduction Bed making is a technique in which different types of beds are prepared to make a client or patient comfortable according to the situations and procedures. Bed making is an essential procedure in nursing in which nurses prepare and arrange different types of beds for the client's comfort in the hospital or other health care institutions. Bed making procedure ensures the patient's comfort according to the situation. It may vary on the client's conditions, purposes and procedures such as open bed, closed bed, occupied bed, cardiac bed, fracture bed etc. Nurses have a major role in bed making procedure in hospital. So, a nurse should learn and follow the proper and standard techniques of bed making procedure.

9. Purposes of bed making To provide a safe and comfortable bed to the clients or patients. To maintain a clean environment and neat appearance to the unit. To reduce transmission of microorganisms, To economize time, materials and effort, To promote neat appearance and cleanliness. To observe patient and to prevent complications, To ambulate the patient, To provide smooth, wrinkle free bed thus minimizing sources of skin irritation. To organize a specific ward. To be prepared for any critical or emergency condition. To prevent bedsores. To teach the relatives to take care of the sick at home.

10. Guidelines for bed-making Gather all the required linens and accessories before making the bed: Beds Trolley Mattress Non sterile gloves Top sheet and bottom sheet Kidney dish Cotton draw sheets Dry rag/ duster Mackintosh Chair (1 or 2) Pillows Hand sanitizer/ source of water Pillowcases Dust bins Blankets / bed cover Chair or stool Avoid shaking the linen to prevent the spread of microorganisms and dust particles. Avoid placing linen, clean or dirty, on another patient's bed. Do not put the dirty linens on the floor. Do not hold dirty linen against your uniform.

11. Con’t 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. Observe the patient and document any nursing observations: Check for areas of redness that may lead to decubitus ulcer formation (bed sores ). 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. Always, use good body mechanics; raise the bed to its highest position to make bed-making easier.

12. Precautions to be taken during bed making: Wash hands properly before and after the procedure. Do not expose the client unnecessarily. Do not keep clean linen with soiled linen. Soiled linen should not be thrown on floor. Do not place the wool blanket directly to the client's body without the top sheet. Always ensure that the client should not lie down on the Macintosh without a cotton draw sheet. Shake the linen gently. Maintain a distance so that the linen should not touch your body or uniform. Always maintain good body mechanics so as prevent extra workload. Make the bed comfortable, smooth and unwrinkled. To prevent the cross-infection maintain reasonable distance with the patient. The open end of the pillow should not face to the entrance of ward. The beds should be in one line for better look.

13. Types of bed making Unoccupied (Closed) Bed: is one that is made when not occupied by a patient. Occupied (Open) Bed: is one that is made while occupied by a patient. Admission bed Cardiac bed Cradle bed Operation bed or post- anaesthetic bed or recovery bed: is a bed that is prepared to receive a patient from the operating room.

14. Closed bed: The closed bed is an empty bed, which is covered with the top linen so that all linen under the linen is fully protected from dust and dirt while waiting for the patient admission. Open bed: The term open bed is used to describe the hospital bed when it is about to be occupied by a client. It is made either for a new client or an ambulatory client. Admission bed: The admission bed is made as an open bed. The client gets into the bed after a bath and changing into a hospital dress if it is a custom in the hospital. Occupied bed: This is to make a bed with the client in. This is made for a client who cannot get out of bed.

15. Operation bed or post- anaesthetic bed or recovery bed: It is prepared for a client who is recovering from the effects of anaesthesia following a surgical operation. Cardiac bed: A cardiac bed is used to help the client to assume a sitting position that can afford him the greatest amount of comfort with the least strain. The main purpose of the cardiac bed is to relieve dyspnoea caused by cardiac disease. Cradle bed: It is a curved, semi-circular device made of metal that can be placed over a portion of the patient’s body. It is sometimes called an Anderson frame, is a device designed to keep the top bed clothes off the feet, legs, and even abdomen of a client. Used for burns, skin ulcers, lesions, blood clots, fractures or surgery.

16. U noccupied bed, without changing bed sheets: two nurses Materials: Chair Dry rag and kidney dish Preparation: A. Data collection:   Identification of the client Assess physical and psychological status of the patient Assess cleanliness or condition of the bed. Environment control.

17. B. Nurse: Should appear professional Tie the long hair at the back Remove the watch, jewels, etc. Wash the hands. C. Patient:   Respect the privacy of the patient, Assess levels of comprehension and collaboration of the patient. Provide care information and advisory lines to the patient/ family: goal, procedure. Adjust the environment of the patient as necessary.( move furniture away from the bed: provide adequate space for nurse to move ).

18. Procedure/ Implementation Never put the linens on the floor Avoid cooling the patient throughout care Install the patient comfortably on a chair so as to observe him/her carefully (if not contraindicated ). Provide a chair at the foot of the bed Untuck the bed, while starting from the head and going towards the foot( sens des aiguilles d’une montre ). Fold separately and into three, bed-covers, blanket and superior bed-sheet; starting from the upper part of the sheet, and finishing with the lower part, deposit them on the chair. Put the pillow on the chair. Remove the cotton and the rubber draw-sheets separately, folding them into 2, and deposit them on the chair. Fold the bottom sheet into three, starting with the lower part and finishing by the upper part . Put it on the chair. Clean top of mattress with a dry duster from head end to foot end and collect into kidney dish. Adjust the mattress and the cover properly.

19. Con’t Open up the bottom sheet, make mitered corners, first at the head end then at the foot end and tuck on that side moving from head to foot(making mitered corners and tucking prevents slipping of sheet and keeps bed firm). While tucking, keep palms down wards in order to get even appearance Spread mackintosh and place draw sheet over it, tuck them together, tuck the middle portion first, then head and followed by foot end (mackintosh prevents soiling off bottom sheet. Draw sheet avoids direct contact of mackintosh with the skin) Place the top bed-sheet, unfold it and make the inferior corners, and tuck in. Place blanket and bed-cover separately, unfold them and make the inferior corners, don’t tuck them in. Fold the higher part of the bed-sheet over the bedcover and blanket Replace the pillow at the head of the bed Fold the bed-cover, blanket and the top bed-sheet in an accordion or triangle at the foot of the bed. Help the patient to return to bed

20. Finishing A. Patient:   Position the patient comfortably and appropriately Arrange personal effects and objects of the patient within his/her range. Air/ vantilate the room Thank the patient for his/her collaboration B. Materials: Put materials in order C. Nurse: Provide the health education / care-related guidance Wash hands Make a verbal and written report of care provided.

21. UNOCCUPIED BED WITH CHANGING THE BED SHEETS: TWO NURSES Preparation: A. Data collection:   I dentification of the patient Physical and psychological status of the patient Cleanliness or condition of the bed Environment control.   B. Nurse: Should appear professional Tie the long hair at the back Remove the watch, jewels, etc. Wash the hands.   C. Patient:   Respect the privacy of the patient Assess levels of comprehension and collaboration of the patient Provide care information and advisory lines to the patient/ family: goal, procedure Adjust the environment of the patient as necessary.

22. D. Materials: Trolley Individual blanket Bottom bed sheet Top bed sheet Pillow and pillow cover/case Draw-sheet in cloth Laundry Bag / bucket for soiled linen Chair Dry rag and kidney dish. Clean gloves (optional) Basin with disinfectant solution

23. Procedure/ Implementation Never put linen on the floor Clean linen has not to be folded in a specific way on forehand, use it as folded in the cupboard Avoid cooling the patient throughout care Place the patient comfortably on a chair so as to observe him carefully Provide a chair at the foot of the bed Leave the material on the trolley Untuck the linens starting from the head and going towards the foot of the bed Remove the pillowcase Place the pillow on the chair Fold separately and into three, bed cover and blanket, starting from the upper part of the sheet , and finishing with the lower part, deposit them on the chair Remove the top bed sheet, without passing above the bed, and place in the bag for soiled linen . Remove the cotton draw-sheet and put it in the bag for soiled linen, without passing above the bed.

24. Con’t Clean the rubber draw-sheet, fold it in two and place it on the chair . Remove the bottom bed sheet and put in the bag for soiled linen without passing above the bed. Clean the mattress if necessary op change the side of this one Place a clean bottom bed-sheet, unfold it and tuck it in commencing from the upper corners. Place the two draw-sheets, the rubber and a cotton (clean one), and tuck them in. Place the clean top bed-sheet, unfold it, make the lower corners , tuck in. Place blanket and bed-cover separately, make the lower corners, don’t tuck them in. Fold up the upper part of bed-sheet over the bed-cover and blanket to make an edge. Change the pillowcase. Place the pillow at the head of the bed Fold the bed-cover, blanket and the top bed-sheet in an accordion or triangle at the foot of the bed. Help the patient to return to bed.

25. Finishing A. Patient: Position the patient comfortably and appropriately Arrange personal effects and objects of the patient within his range Ventilate the the room Thank the patient for his collaboration B. Materials: Put materials in order C. Nurse: Provide the health education/ care-related guidance Wash hands Make a verbal and written report of care provided.

26. UNOCCUPIED BED WITHOUT CHANGING BED SHEETS: 1NURSE Preparation A. Data collection:   Identification of the patient Physical and psychological status of the patient Cleanliness or condition of the bed Environment control   B. Nurse : Should appear professional Hair tied back Remove watch, jewels, etc. Wash hands.

27. C. Patient:  Respect the privacy of the patient. Assess the levels of comprehension and collaboration of patient. Provide the care information and advisory lines to the patient/ family: goal, procedure. Adjust the environment of the patient as necessary.   D. Materials: Trolley Individual blanket Bottom sheets Top sheets Pillow and pillow cover Draw-sheet in cloth Chair Dry rag and kidney basin

28. Procedure/ Implementation Place the patient comfortably on a chair so as to observe him carefully. Provide a chair at the foot of the bed. Untuck all bed linen, starting from the head and moving towards the foot of the bed. Fold separately and into three, bed-covers, blanket and upper bed-sheets, starting from the upper part of the sheet, and finishing with the lower part. Draw towards oneself, fold them into two, seize on the fold level and deposit on the chair. Place the pillow on the chair Fold them separately into two, rubber/ mackintosh and cotton draw-sheets. Draw towards oneself, fold into 2, seize on the level of the fold and deposit on the chair. Fold the bottom bed-sheet into 3, starting from the lower part and finishing with the upper part. Draw towards oneself, fold into 2, seize on the fold level and deposit on the chair and clean the mattress.

29. Con’t Adjust the mattress and its protection properly. Place the bottom bed-sheet with the fold on the middle of the bed. Unfold and fix it, starting from the superior corner, then inferior corner and tuck them in. Replace the draw-sheets (cotton and mackintosh) with the fold on the middle of the bed, unfold them and tuck them in. Replace the top bed-sheet with the fold on the middle of the bed, unfold it, make the inferior corners, tuck them in. Replace the blanket and bed-cover separately with the fold on the middle of the bed, unfold them, make the inferior corner, and don’t tuck them in. Go to the other side of the bed. Fold back the blanket, top sheet and draw sheets.

30. Con’t Make first the superior corner, then the inferior corner of the bottom bed-sheet. Smooth the rubber/mackintosh and cloth draw-sheet, and tuck in. Smooth the top bed-sheet, make the lower corners and tuck in. Smooth the blanket and bed-cover separately, make the inferior corners don’t tuck in. Fold up the upper part of the bed-sheet over the blanket and bed-cover to make an edge or cuff the top of the sheet over the blanket(smooth cuff protects patient’s skin from irritation caused by the blanket). Place the pillow at the head of the bed. Fold the bed-cover, blanket and the top bed sheet in an accordion or triangle form at the foot of the bed. Help the patient to return to the bed.

31. Finishing A. Patient:  Position the patient comfortably and appropriately Arrange the personal effects and objects of the patient within his range. Ventilate/Air the room Thank the patient for his collaboration.   B. Materials: Put the materials in order.  C. Nurse: Provision of health ducation / care-related guidance Wash the hands Make a verbal and written report of care provided.

32. D. Special considerations Assess the patient’s pulse, respiration and blood pressure before ambulating. Any comfort device used by the patient should be replaced. The patient should be assisted back to bed. The whole unit of the patient must be made smart and well organized. The used dusters/ dry rugs must be disinfected, washed and dried. If the linen is soiled with feces, urine or any other body fluids, segregate such linen for laundry as per the hospital.

33. UNOCCUPIED BED WITH CHANGING BED SHEETS: ONE NURSE Preparation: A. Data collection: Identification of the patient Physical and psychological status of the patient Cleanliness or condition of the bed Environment control B. Nurse: Should appear professional Hair tied back Remove the watch, jewels, etc. Wash hands.

34. C. Patient:  Respect the privacy of the patient. Assess the levels of comprehension and collaboration of the patient. Provide the care information and advisory lines to the patient/ family: goal, procedure. Adjust the environment of the patient as necessary. D. Materials: Non sterile gloves Chair Dry rag and kidney dish.

35. Procedure/ Implementation Place the patient comfortably on a chair so as to observe him carefully. Provide a chair at the foot of the bed. Leave the material on the trolley Untuck them starting from the head and moving towards the foot of the bed Remove the pillowcase Place the pillow on the chair. Fold separately and into three, bed cover and blanket, starting from the upper part of the sheet, and finishing with the lower part. Draw towards one self, fold into two, seize on the fold level and deposit on the chair. Remove the top bed sheet, without passing above the bed, and place it in the laundry bag for the soiled linens.

36. Con’t Remove the cotton draw-sheet and put it in the bag for soiled linen, without passing above the bed. Clean the mackintosh, fold it in two and place it on the chair. Draw towards oneself, fold it into 2, seize on the level of the fold and deposit it on the chair. Remove the bottom bed sheet and put in the bag for soiled linen without passing above the bed. Clean the mattress if necessary and adjust it properly. Place the clean bottom bed sheet with fold on the middle of the bed Unfold and fix it, starting from the superior corner, then inferior corner and tuck it in. Place the mackintosh and cotton draw sheet with the fold on the middle of the bed, unfold them and tuck them in. Place the clean top bed sheet with the fold on the middle of the bed, unfold it, make the inferior corners, and tuck them in.

37. Con’t Replace the blanket and bed-cover separately with the fold on the middle of the bed, unfold them, make the inferior corner, and don’t tuck them in. Go to the other side of the bed. Fold back the blanket, top sheet and draw sheets Make first the superior corner, then the inferior corner of the bottom bed sheet.  Smooth the rubber and cloth draw sheet, and tuck in Smooth the top bed sheet, make the inferior corners don’t tuck in. Fold up the upper part of the bed sheet over the blanket and bed-cover. Place the pillow at the head of the bed Fold the bed-cover, blanket and the top bed sheet in an accordion or triangle at the foot of the bed. Help the patient to return to bed.

38. Finishing A. Patient  Position the patient comfortably and appropriately. Arrange personal effects and objects of the patient and to put them within his Ventilate the room Thank the patient for his collaboration.   B. Materials: Put materials in order   C. Nurse: Provision of health education/care-related guideline, Wash the hands Make a verbal or written report of care provided.

39. BEDMAKING FOR OCCUPIED BED A. Preparation (see unoccupied bed) B. Procedure/ Implementation Explain procedure to client. Remove top sheet and blanket and client may be covered with a personal blanket to prevent exposure during bed making. Position client on side, facing away from you. Roll bottom linens close to client toward the center of the bed. Place clean bottom linens with the center fold nearest the client. Tuck clean bottom sheet at head of bed till to the foot of bed. Place clean draw sheet, roll it closest to client and tuck it. Draw sheet should be positioned under the lower back and buttocks. Turn the client to the side facing you. Move to other side of bed.

40. Con’t Remove soiled linens, and place them in the bag for soiled linen without touching uniform. Unroll bottom sheet; then draw sheet and tuck them. Client may be positioned on supine position. Place top sheet then blanket over client with center of sheet in middle of bed. Unfold top sheet and blanket over client. Remove personal blankets. Raise foot of mattress and tuck the corner of the top sheet and blanket under. Repeat with other side of mattress. Change pillow case and replace pillow with free end facing away from the entrance of the room or door.

41. Finishing (see unoccupied bed) Special points:  Patients with respiratory and cardiac disorders may be unable to tolerate lying flat during bed making. Top bottom method of occupied bed making can be used for such patients.

42. Infection control: Important to limit the movement of organisms and spread of infection while in bed. Roll the dirty or soiled linen while removing it from bed. Hold dirty linen away from your body. Place dirty linen in the hamper/ bag immediately. Never place the linen on the floor, Wash the hands after handling the dirty linen. Never bring extra linen into a patient’s room. Linen is considered contaminated once it is in a room and can not be used for another person. Avoid shaking the clean sheets to place them on the bed. Unfold them gently to inhibit the flow of microorganisms. Place the open end of pillowcase away from the door.

43. CLIENT/ PATIENT TOILET OR WASHING OR BATHING OR HYGIENE 2 nd Presentation

44. BED BATH Introduction A nurse, in her/his career will deal with several patients, some of them having a need of assistance. While providing assistance to ill patients, the nurse will have a duty to provide body hygiene to some patients, by specifically doing toilet to those patients or assisting them in their toilet. The bed bath/toilet is a daily care for a sick person and for a healthy person. A sick person is some who is incapable to satisfy his needs. It is important to manage his cares to allow skin to assure its functions.

45. Con’t Bed bath means bathing a patient who is confined to bed and cannot have the physical and mental capability of self-bathing Bath is the act of cleaning the body. Baths are given for therapeutic purposes. A complete bed bath: It is a bath given for patients who are totally dependent while lying on bed. Maintenance of personal hygiene is necessary for an individual’s comfort, safety, and sense of wellbeing. Complete bed bath involves washing the entire body, & Partial bed bath: involves washing the face, hand, leg, under arms, genitals/perineal area.

46. Goals of the patient hygiene/toilet To permit the skin to accomplish its functions: Protective role Elimination role Temperature regulation Sensory role To stimulate the blood circulation by: Friction, massage Patient movement Hot water To maintain the image value: the bath encourages the relaxation and gives a feeling to be well and of freshness. To clean the skin: the bath permits to remove sweat, some bacteria, sebum and the dead cutaneous cells.

47. Con’t Reduction of body odors: excessive secretions of sweat from apocrine glands located in the axilla and pubic areas cause unpleasant body odors. Bathing and use of antiperspirant minimizes odors. Promotion of Range of motion: The movement of the extremities during bathing maintains the joint function. Psychological effect: by being in contact with patient. Cleansing the skin: This removes perspiration, some bacteria, sebum and dead cells which minimizes skin irritation and reduces chance of infection. Stimulation of circulation: Good circulation is promoted through the warm water and gentle stroking in the extremities. Improved Self Image: Bathing promotes relaxation and a feeling of being refreshed and comfortable.

48. Purposes To cleanse body of dirt, debris and perspiration To refresh To stimulate circulation To provide comfort and relaxation To enhance self-concept To provide tactile stimulation To facilitate head to be assessment To regulate body temperature To induce sleep To prevent pressure sore To remove toxic substances from body surface To maintain an effective nurse-patient relationship To give health instruction to patient To remove unpleasant odors due to perspiration To relieve fatigue To prevent contractures by giving exercises To minimize the skin irritation

49. Indications of bed bath: Unconscious/ coma or semiconscious patients. Postoperative patients, Patients with strict bed rest/ Bed ridden patients. Paraplegic patients, Orthopedic patients in plaster – cast and traction or with surgery. Seriously ill patients, Patients with amputation surgery, Mentally ill patients.

50. Factors determining the patient hygiene Appearance: This reveals how the patient carries out to his/her hygiene. The bodily picture is the subjective idea that a person makes of his physical appearance. This picture can often change. It has an impact on hygiene practices. If the patient has a negligence or does not show the interest to hygiene, the nurse will teach him the importance of a good hygiene. Socio - economic factors:  Socio - economic situation of a person shows the patient’s hygiene habits. The nurse must know if the patient is able to buy hygiene products, deodorants, the shampoos, toothpaste and cosmetic of which he has needs. Knowledge: The fact to know the importance of hygiene and its effects on the well-being influences on the habits of hygiene. Some times, the knowledge itself is not sufficient; the client must also have motivation to take care for his hygiene.

51. Con’t Cultural factors: The cultural beliefs and the personal values also have their influence on hygiene. Personal preference:  Some people have their preferences as for the moment to bathe, to shave or to buy some products like soap, the shampooing, deodorizing, toothpaste, and different ways to perform their hygiene. For example some men prefer to shave before their bath, whereas others shave after bath. Physical condition: People who suffer from some illnesses or having undergone a surgical intervention miss physical energy to perform their hygiene.

52. Factors affecting the skin Impaired self-care Immobilization Exposure to pressure and moisture Vascular insufficiency Reduced sensation Nutritional alternation Constrictive external devices.

53. Types and techniques of patient hygiene Types of patient toilet/ cleansing bath: Bed bath : it is the bathing of a patient who is confined to bed. I. Complete (general) patient toilet/washing: the entire body is washed.   Indications of complete patient washing: Patients who are not able to take bath: Caesarean section Patient who has undergone an operation Patient with cast, traction. Weak patients Febrile, cardiac patients etc II. Partial (local) patient toilet/washing / hygiene: Some parts of the body are only washed: face, head, armpit, perinea, etc. Indications of partial patient washing: Patient who remains confined to bed because of their physical handicap: Patient with splint, cast, traction

54. Therapeutic bath: doctor specifies the temperature of the water, medications to be added and the body part to be treated Partial bath: it is the act of cleaning particular areas in the body part. They are face, axilla , and genitalia, upper and lower-limbs Self-administered bath: this is same as in bed bath except the patient is assisting in taking bath

55. General Instructions Explain the procedure to the patient Maintain privacy of the patient Put off the fans and close the windows and doors to avoid chill Do not give bath immediately after the lunch Cleaning is to be done from the cleanest area to the less  clean area The temperature of the water should be 110 – 115 degree F A thorough inspection of the skin and back is necessary to find out early signs of pressure sore Use soap which contains less alkali Special attention must be given to the creases and folds and bony prominences between fingers and toes and pubic region Remove the soap completely to avoid the drying effect of the soap on the skin Do not touch the body with wet hands it is unpleasant to the patient Creams or oils used to prevent drying or excoriation of the skin The nurse should maintain good posture and balances of the body during bed bath

56. Preliminary Assessment Identify the patient and assess the need Check the physician’s order for any specific precautions Assess the general condition of the patient Assess the patient’s ability of self-help Assess the patient’s mental status to follow directions Check the patient’s preference for soap, powder, etc Check whether the patient has taken the meal in the previous one hour Find out the available articles in the unit Provide privacy avoid draught and maintain proper light Teach the patient and relatives about personal hygiene

57. Con’t Check the patient’s hygiene practices: frequency, time of day, and type of hygiene products. Assess for any physical-activity limitations. Assess the patient’s ability to bathe him or herself. Allow the patient to do any part of the bath that he or she can do. For example, the patient may be able to wash the face, while the nurse does the rest. Assess the patient’s skin for dryness, redness, or areas of break down, and gather any other appropriate supplies that may be needed as a result.

58. Preparation of the Patient and Environment Explain the sequence of the procedure to the patient Close the windows and doors to prevent draught put off the skin. Arrange the necessary articles at the bedside Maintain the room temperature which will be must comfortable for patient Adjust the height of the bed to the comfortable work of the nurse Bring the patient to the edge of the bed and towards the nurse to prevent over reaching. Provide privacy by means of curtains Offer bed pan or urinals if necessary Keep the patient flat if the condition permits remove extra pillows and back rest Remove the personal clothing and cover the patient with the bath blankets.

59. Equipment Warm water Basins: 2 (1 big and 1 small) Soap and soap dish Wash cloth: 2 Bath towels: 2 Face towel: 1 Bath blanket/ bed sheet: 1 Surgical spirit and powder Nail cutter Nail brush Kidney dish and Tray or trolley Comb and oil/ lotion Jugs: 2 Bucket: 1 Clean bed linen Clean dress to patient/ Clean hospital gown Bucket or a laundry bag Bath thermometer: 1 Bath blanket Non sterile gloves Personal hygiene supplies (lotion, deodorant, ect )

60. Techniques of patient hygiene: Equipments and materials: Washbasin and warm water Personal hygiene supplies (deodorant, lotion, others) Skin-cleaning agent (soap) Towels (2) Washcloths (2) Bath blanket Gown or pyjamas Bedpan or urinal Laundry bag (for soiled linens) Trolley No sterile gloves, and others as indicated

61. Procedure Explain the procedure Remove the patients dress, cover with bath sheet while removing top sheet and dress Mix hot and cold water in basin half full and check the temperature on the back of your hand. Spread face towel around neck Wet sponge towel and form mitten around gingers after removing excess water. Clean body in following

62. Face: Wet and apply soap to forehead, face, over and behind ear and neck. Clean eyes from inner to outer canthus . Rinses sponge towel and allow patient to wipe face. Dry with face towel, replace at head end of bed. Arms: Place towel lengthwise under the farthest arm if there is IV do not disturb it. Take soapy bath mitt and soap the arm and axilla Massage the pressure areas Place the hand in basin of water to wash Rinse and dry well, paying attention to skin under breast. Recover with towel.

63. Chest: Avoid unnecessary exposure Cover chest with towel and turn bath sheet down to abdomen Wet chest and apply soap in rotatory movement, paying attention to skin creases Remove soap thoroughly by wiping from neck to check Dry with bath towel. Abdomen: Fold top sheet up to supra pubic region cover the chest with bath towel Wet and clean abdomen with soap Clean umbilicus and dry with bath towel Cover the patient with top water and remove towels

64. Back : Turn the patient on side or left lateral position. Close to edge of bed, with back towards nurse. Expose back including buttocks, spread bath towel on bed, close the patients back. Wet the area and apply soap with rotatory movements clean and remove soap and dry the area Give massage by applying firm pressure with palms and fingers from sacrum to shoulder in sequence, covering whole back. Help the patient to return to supine position. Legs : Uncover the farthest leg and place towel under leg. Apply soap to the leg and give special attention to the groin Massage the pressure points, Place foots in basin of water to wash. Rinse and dry well, paying special attention in between the toes Repeat the procedures on the near leg.

65. Pubic Region: Clean pubic region with wet large rag piece (for helpless patient). Permit patient to clean if so desired Discard rag pieces into large Kidney basin Give perineal care for helpful patient.

66. Procedure/ Implementation Preparation: (See bed making) Procedure: Bring the necessary equipment to the bedside stand or over bed table. Discuss the procedure with patient and assess patient’s ability to assist in the bathing process, as well as personal hygiene preferences. Close curtains around the bed and close the door. Adjust the room temperature if necessary. Offer patient bedpan or urinal. Have the patient lie on his or her back. Put on your non sterile gloves, Loosen top covers and remove all except the top sheet. Place the bath blanket over patient and then remove the top sheet. If the linen is to be reused, fold it over a chair. Place the soiled linen in laundry bag. Remove the patient’s gown and keep the bath blanket in place. Put on the washcloth

67. Con’t Lay a towel across the patient’s chest and on top of bath blanket. With no cleanser (soap) on the washcloth, wipe one eye from the inner part of the eye, near the nose, to the outer part. Rinse or turn the cloth before washing the other eye. Bathe patient’s face, neck, and ears. Apply appropriate cleanser (soap). Expose patient’s far arm and place towel lengthwise under it. Wash hand, arm, and axilla , lifting the arm as necessary to access axillary region. Rinse, if necessary, and dry. Repeat actions for the arm nearer you. Lower bath blanket to patient’s umbilical area. Wash, rinse, if necessary, and dry chest. Keep chest covered with towel between the wash and rinse.

68. Con’t Wash; rinse, if necessary; and dry abdomen. Expose far leg and place towel under far leg. Wash; rinse, if necessary; and dry leg from near groin area to knee and knee to ankle. Wash, rinse if necessary, and dry the far foot. Repeat the same actions for the nearer leg and foot. Make sure patient is covered with bath blanket. Change water at this point or earlier if necessary. Assist patient to prone or side-lying position. Position bath blanket and towel to expose only the back and buttocks. Wash; rinse, if necessary; and dry back and buttocks area. Change water, washcloth and towel. Set up patient so that he or she can complete perineal self-care. If the patient is unable, you complete perineal care.

69. Providing the perineal care Wash and rinse the groin area (both male and female patients). For a female patient, spread the labia and move the washcloth from the pubic area toward the anal area to prevent carrying organisms from the anal area to the genital area. Always proceed from the less contaminated area to the most contaminated area, and use a clean portion of the washcloth for each stroke.  For a male patient, clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward. Wash the shaft of the penis using downward strokes toward the pubic area. In an uncircumcised male patient retract the foreskin (prepuce), and wash inner part. Wash and rinse the male patient’s scrotum.

70. Con’t Turn the patient on his or her side and continue with cleansing the anal area. In the female, clean from the vagina toward the anus. In both female and male patients, change the washcloth with each stroke until the area is clean. Rinse and dry the area. Remove gloves and perform hand hygiene. Continue with additional care as necessary. Assist with the use of other personal toiletries, such as deodorant or cosmetics and help patient put on a clean gown. When finished, make sure the patient is comfortable, with the side rails up and the bed in the lowest position. Finishing: (refer to bed making).

71. Common local baths Mouth hygiene : 1. Definition It is a care of hygiene applied to the level of the mouth. 2. Goals To prevent the illnesses of the mouth and teeth  To keep healthy teeth To promote the cleanliness of the mouth To prevent the proliferation of microbes To prevent the local and general infections of the mouth To preserve the hydration of the oral mucous membrane To remove the food rest accumulated in the mouth. 3. Materials Basin or sterile pot (clean water, bicarbonate water, sterile water), A basin Impermeable protection Sterile gauze and forceps Haemostatic forceps, serving forceps Toothpaste and pronged brush Tray/ Trolley

72. Technique Outside cleaning of the mouth: Ask the patient to close the mouth, With gauze clean the superior lips and finishing the corner of the lips Change the face of the compress and proceed in the same way for the lower lip To clean the superior jaw with a compress To clean the internal part of the lower lip, gum, and the internal face of the cheeks With another compress, clean the outside of the teeth of superior jaw from top to base To clean the superior jaw: with a compress to clean the internal face of the inferior lip, inferior gum, Clean the lower teeth with another compress

73. Con’t With other compress, clean arch palace and the internal face of the teeth of the superior jaw, Change the compress and to clean the superior face of the tongue Change the compress and clean the lower face of the tongue and internal face of the teeth. Rinse the mouth with the solution Make the oral and written report Arrange the materials

74. Feet bath Materials: A basin The necessary of toilet Scissors, cut-nail or razor blade Kidney dish Protective material for the bed and soil Individual cover so necessary

75. Technique Client in the bed To undo the lower sheets and fold back until the knees or to place the individual cover and to remove the lower furniture entirely or bend it in accordion to the foot of the bed To protect the bed under the legs and the feet Wash the legs and the feet (to soap only) To place the basin in the bed and impermeable protection under the basin and to place this one the closer to the patient's seat Bend the patient's knees Place the feet in the basin Cover the legs and basin Then let the bath during at least 10 minutes Remove the basin, to wipe the legs and the feet, cut the nails, Rub the heel Reinstall the patient comfortably and to finish as usual.

76. Client out of the bed: Install the patient comfortably on a chair (armchair) or on the side of the bed. Protect him against the cooling Protect the soil Install the basin possibly on a chair or a shelf If necessary help the patient and observe him attentively Other points (see feet bath with patient in the bed). Finish the technique as usual Bath of head or head washing or Shampooing Indications Hygiene measures Therapeutic goal

77. Contra- indications Scalp wound Scalp operations and traumatism Coma Precautions: Avoid the alkali soaps Protect the neck with impermeable protection and the ears with cotton wool, Fix well around the neck the protection to protect falling drops.

78. Materials: A basin with water Another basin without water A cup A towel Protective materials 2 mackintoshes 2 pieces of clothes A band to cover the eyes The pillows to raise the patient Cotton wool to protect the ears Comb for hair: so necessary.

79. Technique: Straighten the pillow if necessary the head in hyperextension Place the basin on the protection and entire neck and put the head in a basin Wash by circular movements of the finger tip while starting with the middle and rub the head with soap. Restart so much as it is necessary Rinse and to wipe carefully Remove protective materials Comb the client if necessary Reinstall the patient in a comfortable position according to his/her state Repair the bed Clean and arrange the used materials

80. Seat bath: A special care that consists of placing patient’s seat in a hot and disinfecting solution Objectives of care: To calm the pain To disinfect a wound To stimulate the local circulation To soften the secretion and to encourage the recovery To loosen the urinary sphincter Indications: After operation of the genito -urinary region Post hemorrhoidectomy Childbirth with episiotomy Infections

81. Materials: A pan -Hot water -Piece of gauzes Disinfectant (permanganate of potassium 0.25%, dettol 0. 01%) Technique: 3 to 4 L of hot water (but not very hot to burn) Add a small quantity of disinfectant if is not available use spoon kitchen salt. Place the basin if possible on a small bench After assessing the temperature of water, help the patient to sit in water. The patient soaks his seat during 15 to 20 minutes Help the patient to come out of water and to stand up, to wipe with very clean linen or sterile gauze if he has a wound, it will also be the good moment to examine the state of the wound. Note the cares and the observation in the file of the patients.

82. After Care: Provide clean gown and pajama Replace articles after cleaning Discard dirty water in sluice room Clean the bed linen if needed Offer a hot drink (coffee or tea) if permitted Position the patient for comfortable and proper alignment Cut short the finger nails and toe nails Comb the hair and arrange the hair Hand wash Record the procedure in the nurse’s record with time, date, type and abnormalities noticed.

83. References: https://nurseinfo.in/bed-bath/ https://www.youtube.com/watch?v=VPGLhcM7r94&t=3s https://www.youtube.com/watch?v=VPGLhcM7r94&t=3s https://www.youtube.com/watch?v=ioxDUkbV5z4&t=66s https://www.powershow.com/view1/25cb21-ZDc1Z/BEDMAKING_powerpoint_ppt_presentation https://www.coursehero.com/file/70545183/BED-MAKINGppt/ https://www.youtube.com/watch?v=kC8vqZuq-L4 https://www.youtube.com/watch?v=LcaiMHduqPc&t=8s