ObjectivesObjectives

Position, Turn, and Transfer patientsPosition, Turn, and Transfer patients Make a bedMake a bed Administer personal care and apply restraintsAdminister personal care and apply restraints

Positioning, Turning, Moving Positioning, Turning, Moving and Transferring Patientsand Transferring Patients

Must use correct body mechanicsMust use correct body mechanics

Alignment = Positioning body parts in relation Alignment = Positioning body parts in relation to each other to maintain correct body postureto each other to maintain correct body posture

Correct alignment helps pt. feel comfortable; Correct alignment helps pt. feel comfortable; prevents fatigue, Decubitus ulcers and prevents fatigue, Decubitus ulcers and contracturescontractures

Decubitus UlcerDecubitus Ulcer Pressure sore or bed sorePressure sore or bed sore

Caused by pressure that interferes with Caused by pressure that interferes with circulationcirculation

Usually at bony prominences – coccyx, hips, Usually at bony prominences – coccyx, hips, knees, heels, and elbowsknees, heels, and elbows

First sign is a pale or reddened area on the skinFirst sign is a pale or reddened area on the skin

Decubitus Ulcer Cont.Decubitus Ulcer Cont.

Vesicle or blister may for at the siteVesicle or blister may for at the site

Cells die, skin breaks down and open sore Cells die, skin breaks down and open sore (ulcer) develops(ulcer) develops

EASIER TO PREVENT THAN TO TREATEASIER TO PREVENT THAN TO TREAT

Prevent Decubitus Ulcers by:Prevent Decubitus Ulcers by:

Good skin careGood skin care Prompt cleaning of urine and feces from skinPrompt cleaning of urine and feces from skin Massage in circular motion around reddened Massage in circular motion around reddened

areaarea Light dusting of powder to prevent frictionLight dusting of powder to prevent friction Frequent turning and positioningFrequent turning and positioning Linen dry and free from wrinklesLinen dry and free from wrinkles Use of pressure-relieving surfacesUse of pressure-relieving surfaces

Carefully observe the skin during Carefully observe the skin during bathing for evidence of pressure bathing for evidence of pressure soressores

ContracturesContractures Tightening or shortening of muscle due to lack Tightening or shortening of muscle due to lack

of movement or usageof movement or usage Foot drop common contractureFoot drop common contracture

Prevented by keeping foot at right angle to legPrevented by keeping foot at right angle to leg ROM will help prevent contracturesROM will help prevent contractures

Contractures Cont.Contractures Cont.

Weakened body parts must be supported with Weakened body parts must be supported with pillows, bed cradles, footboards, rolled pillows, bed cradles, footboards, rolled blankets or towelsblankets or towels

Pt must be turned frequentlyPt must be turned frequently

Turning, Moving, andTurning, Moving, and Transferring Transferring

DanglingDangling Sitting on side of bed prior to standingSitting on side of bed prior to standing Allows patient time to adjustAllows patient time to adjust If the patient c/o vertigo, weakness or diaphoresis If the patient c/o vertigo, weakness or diaphoresis

– return pt. Immediately to supine position– return pt. Immediately to supine position Mechanical LiftsMechanical Lifts

Used to transfer weak or paralyzed patients Used to transfer weak or paralyzed patients Be sure you have been instructed on proper useBe sure you have been instructed on proper use Reassure patient during transferReassure patient during transfer

Turning, Moving, andTurning, Moving, andTransferring Cont.Transferring Cont.

TransferringTransferring Be sure to protect patient and health care Be sure to protect patient and health care

workerworker Be sure you know how to operate the Be sure you know how to operate the

wheelchair/stretcherwheelchair/stretcher Lock the wheelsLock the wheels

When turning and TransferringWhen turning and Transferring

Before moving patient, obtain proper Before moving patient, obtain proper authorization from immediate supervisorauthorization from immediate supervisor

Watch the patient closely – pulse rate, Watch the patient closely – pulse rate, respirations and colorrespirations and color

Observe for weakness, dizziness, increased Observe for weakness, dizziness, increased perspiration or discomfortperspiration or discomfort

If you note abnormal changes, return the If you note abnormal changes, return the patient to a safe and comfortable position and patient to a safe and comfortable position and notify your supervisornotify your supervisor

Moving the Pt. Up in BedMoving the Pt. Up in Bed

Lower the head of the bedLower the head of the bed Place the pillow against the bed frame to Place the pillow against the bed frame to

protect the pts. Headprotect the pts. Head If pt. has trouble breathing, raise the head of If pt. has trouble breathing, raise the head of

the bedthe bed Ask the pt. to flex the knees and brace the feet Ask the pt. to flex the knees and brace the feet

on bedon bed

Place one arm under the pts. Head and Place one arm under the pts. Head and shouldersshoulders

If the patient is unable to help, get someone to If the patient is unable to help, get someone to assist youassist you

Get a broad base of support and as close to the Get a broad base of support and as close to the bed as possiblebed as possible

Arrange a signal – “On the count of three, Arrange a signal – “On the count of three, push with your feet”push with your feet”

On the signal, shift your weight forwardOn the signal, shift your weight forward Two people can use a draw sheet or lift sheetTwo people can use a draw sheet or lift sheet

Turning the Pt.Turning the Pt.

Lower the side rail nearest you – be sure the Lower the side rail nearest you – be sure the opposite side is upopposite side is up

If the pt. is lying in the center of the bed, place If the pt. is lying in the center of the bed, place hands under the pts. Head and shoulders and hands under the pts. Head and shoulders and slide the pt toward youslide the pt toward you

Place both hands under the hips and slide the Place both hands under the hips and slide the hips toward youhips toward you

Turning the Pt. Cont.Turning the Pt. Cont.

Place both hands under the legs and slide the legs Place both hands under the legs and slide the legs toward youtoward you

Cross the pts. arms across his/her chestCross the pts. arms across his/her chest Move the leg closest to you over the other legMove the leg closest to you over the other leg Get close to the pt. and roll the pt. away from youGet close to the pt. and roll the pt. away from you Explain what you are doing to the pt.Explain what you are doing to the pt. Place your hands under the head and shoulders, then Place your hands under the head and shoulders, then

the hips, drawing the pt. to the center of the bedthe hips, drawing the pt. to the center of the bed

BedmakingBedmaking

Linen must be free of wrinkles as they could Linen must be free of wrinkles as they could cause discomfort and lead to Decubitus ulcerscause discomfort and lead to Decubitus ulcers

Closed BedClosed Bed Made after the pt. is discharged and after terminal Made after the pt. is discharged and after terminal

cleaning of unitcleaning of unit Purpose: keep bed clean until new pt. comesPurpose: keep bed clean until new pt. comes

Open BedOpen Bed Fanfold top sheets to welcome new pt. or for Fanfold top sheets to welcome new pt. or for

ambulatory pts.ambulatory pts.

Bedmaking Cont.Bedmaking Cont.

Occupied BedOccupied Bed Bed made while pt. is in itBed made while pt. is in it

Bed with CradleBed with Cradle Cradle is placed under top sheets to prevent linen Cradle is placed under top sheets to prevent linen

from touching parts of the pts. Body. Used for pts. from touching parts of the pts. Body. Used for pts. With burns, skin ulcer, blood clots, fractures, and With burns, skin ulcer, blood clots, fractures, and other similar conditionsother similar conditions

Bedmaking TipsBedmaking Tips

Observe correct body mechanicsObserve correct body mechanics Keep linen arranged in the order of useKeep linen arranged in the order of use Make one side of the bed completely, then on Make one side of the bed completely, then on

the other sidethe other side Roll dirty linens away from your body and Roll dirty linens away from your body and

place in hamper immediatelyplace in hamper immediately

Do not shake clean or dirty linen.Do not shake clean or dirty linen. Place open end of the pillowcase away form Place open end of the pillowcase away form

the doorthe door Wear gloves while handling dirty or Wear gloves while handling dirty or

contaminated linencontaminated linen

Oral HygieneOral Hygiene

Benefits:Benefits: Provides comfortProvides comfort Stimulates the appetiteStimulates the appetite Prevents disease and dental cariesPrevents disease and dental caries Helps to prevent bad breath (halitosis)Helps to prevent bad breath (halitosis) Stimulates saliva production which contains Stimulates saliva production which contains

digestive enzymes and promotes digestiondigestive enzymes and promotes digestion

Routine Oral HygieneRoutine Oral Hygiene

Involves tooth brushing and flossingInvolves tooth brushing and flossing Should be done at least three times a dayShould be done at least three times a day Provide necessary equipment such as Provide necessary equipment such as

toothbrush, toothpaste, dental floss, toothbrush, toothpaste, dental floss, mouthwash, emesis basin, cup, and watermouthwash, emesis basin, cup, and water

Assist the patient as neededAssist the patient as needed

Denture CareDenture Care

Proved privacy for the pt.Proved privacy for the pt. Have pt. remove dentures if ableHave pt. remove dentures if able Place dentures in a denture cup to carry to sinkPlace dentures in a denture cup to carry to sink Use warm water to clean denturesUse warm water to clean dentures Hold dentures securely. Let pt rinse mouth and Hold dentures securely. Let pt rinse mouth and

brush gumsbrush gums Store dentures in a denture cup labeled with Store dentures in a denture cup labeled with

the pts. namethe pts. name

Special Oral HygieneSpecial Oral Hygiene

Usually given to unconscious or semiconscious ptsUsually given to unconscious or semiconscious pts Tell the pt. what you are doingTell the pt. what you are doing Turn pt. what you are doingTurn pt. what you are doing Turn pts. Head toward youTurn pts. Head toward you Use a very small amt. of liquidUse a very small amt. of liquid Clan all areas of mouth:Clan all areas of mouth:

Teeth, Gums, Tongue, Roof of MouthTeeth, Gums, Tongue, Roof of Mouth Apply lubricant to tongue and lipsApply lubricant to tongue and lips

BathingBathing

Types of BathsTypes of Baths Complete Bed Bath (CBB)Complete Bed Bath (CBB)

Pt. is usually confined to bed and the health care worker Pt. is usually confined to bed and the health care worker must bathe all parts of the pts. bodymust bathe all parts of the pts. body

Partial Bed BathPartial Bed Bath Pt. washes some of the parts of their body and the health Pt. washes some of the parts of their body and the health

care worker washes the parts of the body the pt. cannot care worker washes the parts of the body the pt. cannot reachreach

Bathing Cont. Bathing Cont.

Tub Bath or ShowerTub Bath or Shower Health care worker prepares the tub or shower area and Health care worker prepares the tub or shower area and

assists pt. as neededassists pt. as needed

Complete Bed BathComplete Bed Bath

Use standard precautionsUse standard precautions

Provide privacy, comfort, and safetyProvide privacy, comfort, and safety

Fill basin 2/3 full with warm water at a temp. Fill basin 2/3 full with warm water at a temp. of 105-110 Fof 105-110 F

Form a mitten around your hand with the clothForm a mitten around your hand with the cloth

CBB Cont.CBB Cont.

Wash body parts in this order:Wash body parts in this order: Face, ears, and neck -> axilla, arms, and hands Face, ears, and neck -> axilla, arms, and hands

(apply deodorant) -> chest, breast, and abdomen -> (apply deodorant) -> chest, breast, and abdomen -> thighs, legs, and feet (change water) -> back, thighs, legs, and feet (change water) -> back, buttock, and back of perineum (give back rub) -> buttock, and back of perineum (give back rub) -> perineum areaperineum area

Change water when it becomes too cool, dirty or Change water when it becomes too cool, dirty or soapysoapy

Tub Baths and ShowersTub Baths and Showers

Usually require a physician’s orderUsually require a physician’s order Make sure tub or shower is cleanMake sure tub or shower is clean Put rubber mat in tub or showerPut rubber mat in tub or shower Full tubs half full with water at 105 FFull tubs half full with water at 105 F Help pt. into the tub or shower (Use the Help pt. into the tub or shower (Use the

shower chair for pt. who cannot stand)shower chair for pt. who cannot stand) Assist pt. as neededAssist pt. as needed

Tub Baths and Showers Cont.Tub Baths and Showers Cont.

Stay with pt. or make sure pt. can use the Stay with pt. or make sure pt. can use the emergency call systememergency call system

After bath or shower, cover pt. with a towel or After bath or shower, cover pt. with a towel or bath blanketbath blanket

Clean the tub or shower with a disinfectant Clean the tub or shower with a disinfectant after each useafter each use

Measuring and Recording Measuring and Recording Intake and OutputIntake and Output

Amount of fluid taken into the body should equal the Amount of fluid taken into the body should equal the amount of fluid lost from the body.amount of fluid lost from the body.

Excessive fluid retained by body=edema Excessive fluid retained by body=edema (swelling)(swelling)

Excessive fluid lost by body=Excessive fluid lost by body= What do you measure?What do you measure?

IntakeIntake OutputOutputOralOral BowelBowel

IVIV EmesisEmesis

IrrigationIrrigation UrineUrine

IrrigationIrrigation

IntakeIntake

OralOral Includes liquids taken by mouthIncludes liquids taken by mouth Also includes foods that are liquid at room temp. Also includes foods that are liquid at room temp.

such as soup, jell-o, ice cream, pudding, and such as soup, jell-o, ice cream, pudding, and Popsicle’sPopsicle’s

Tube feeding is usually recorded under oral intakeTube feeding is usually recorded under oral intake Fluids are measured in metric unitsFluids are measured in metric units

Intake Cont.Intake Cont.

1 Cubic Centimeters (cc) = 1 Millimeter (ml)1 Cubic Centimeters (cc) = 1 Millimeter (ml) Memorize these equivalentsMemorize these equivalents

1 ml or cc =15gtts (drops)1 ml or cc =15gtts (drops) 5ml or cc = 1 tsp (teaspoon)5ml or cc = 1 tsp (teaspoon) 15 ml or cc = 1 tbsp (tablespoon)15 ml or cc = 1 tbsp (tablespoon) 30 ml or cc = 1 (oz) ounce30 ml or cc = 1 (oz) ounce 240 ml or cc = 1 cup (8 oz)240 ml or cc = 1 cup (8 oz) 500 ml or cc = 1 pint (16 oz)500 ml or cc = 1 pint (16 oz) 1000 ml or cc = 1 quart (32 oz)1000 ml or cc = 1 quart (32 oz)

Measuring IntakeMeasuring Intake

Fred is on I & O. When you go into his room Fred is on I & O. When you go into his room after lunch, you examine his lunch tray and after lunch, you examine his lunch tray and find he consumed the following:find he consumed the following:1 hamburger, ½ bowel of chicken broth (1 soup 1 hamburger, ½ bowel of chicken broth (1 soup

bowl=200cc), 4 soda crackers, 1 cup of tea, ¾ bowl=200cc), 4 soda crackers, 1 cup of tea, ¾ carton of milk (1carton=8 oz), ½ bowel of jello (1 carton of milk (1carton=8 oz), ½ bowel of jello (1 small bowl=120cc)small bowl=120cc)

What was Fred’s fluid intake?What was Fred’s fluid intake?

Measuring OutputMeasuring Output

Output = all fluids eliminated by the pt.Output = all fluids eliminated by the pt. BMBM

Liquids BMs are measured and recordedLiquids BMs are measured and recorded Solid or formed BM is usually noted under feces Solid or formed BM is usually noted under feces

or the remarks columnor the remarks column EmesisEmesis

Measure anything that is vomitedMeasure anything that is vomited Also not color, type, and other facts in the remarks Also not color, type, and other facts in the remarks

columncolumn

Measure Output Cont.Measure Output Cont.

UrineUrine Measure all urine voided or drained via a catheterMeasure all urine voided or drained via a catheter Men can collect their urine in a urinal and women Men can collect their urine in a urinal and women

can collect their urine in a bedpan or a special can collect their urine in a bedpan or a special urine collector that can be placed under the seat of urine collector that can be placed under the seat of the toiletthe toilet

IrrigationIrrigation Measure any drainage from nasogastric tubes, Measure any drainage from nasogastric tubes,

hemo-vacs, chest tubes or other drainage tubeshemo-vacs, chest tubes or other drainage tubes These measurements are usually done by the nurseThese measurements are usually done by the nurse

Measuring OutputMeasuring Output

Jennifer is on I & O. A the end of an 8 hour Jennifer is on I & O. A the end of an 8 hour shirt, you note the following:shirt, you note the following:

0800 she voided 400 cc of urine0800 she voided 400 cc of urine1000 she vomited 200 cc of thick yellow emesis with 1000 she vomited 200 cc of thick yellow emesis with

food particles in itfood particles in it1130 she had one formed green BM1130 she had one formed green BM1315 she voided 350 cc of urine1315 she voided 350 cc of urine

What was Jennifer’s output for the 7-3 shift?What was Jennifer’s output for the 7-3 shift?

Feeding the Pt.Feeding the Pt.

Prior to meal:Prior to meal: Provide privacyProvide privacy Help pt. use the bedpan or urinal if neededHelp pt. use the bedpan or urinal if needed Provide oral hygiene if desiredProvide oral hygiene if desired Remove emesis basins or bedpans for sightRemove emesis basins or bedpans for sight Position pt. in a sitting position if allowedPosition pt. in a sitting position if allowed Wash pts. hands and faceWash pts. hands and face

Feeding Cont.Feeding Cont.

Put over bed table in positionPut over bed table in position Check to make sure the pt. is not NPOCheck to make sure the pt. is not NPO Make sure the diet is correct for the pt.Make sure the diet is correct for the pt. Place a towel or napkin under pts. ChinPlace a towel or napkin under pts. Chin Open packages and cartoons; season and cut Open packages and cartoons; season and cut

foods if necessaryfoods if necessary

Steps for feeding pt.Steps for feeding pt.

Test temperature of hot foods by placing small Test temperature of hot foods by placing small amount on wristamount on wrist

Feed pt. slowly and allow them time to chewFeed pt. slowly and allow them time to chew Use separate straw for each liquidUse separate straw for each liquid Hold utensil at a 90 degree angle to the pt. Hold utensil at a 90 degree angle to the pt.

mouthmouth Give small bitesGive small bites

Steps for Feeding Pts. Cont.Steps for Feeding Pts. Cont.

Alternate the foods and liquidsAlternate the foods and liquids Allow pt. to help as much as they are able toAllow pt. to help as much as they are able to Offer choices to the pt.Offer choices to the pt. Wipe the pts. mouth as necessaryWipe the pts. mouth as necessary Encourage pt. to each as much as possibleEncourage pt. to each as much as possible

After the MealAfter the Meal

Allow pt. to wash their face and handsAllow pt. to wash their face and hands Provide oral hygieneProvide oral hygiene Position pt. in correct body alignmentPosition pt. in correct body alignment Clean areaClean area Note how much food was eatenNote how much food was eaten Calculate I & O if this is ordered for pt.Calculate I & O if this is ordered for pt.

Bed Pans and UrinalsBed Pans and Urinals

Urinate, micturate, or void – terms for Urinate, micturate, or void – terms for emptying of the bladder, which stores urineemptying of the bladder, which stores urine Urinals are used by male pts. when they need o Urinals are used by male pts. when they need o

micturatemicturate A bedpan is used by females when they need to A bedpan is used by females when they need to

micturatemicturate Defecate – having a bowel movementDefecate – having a bowel movement

Both men and women must use a bedpan when Both men and women must use a bedpan when they need to defecatethey need to defecate

Bedpans and Urinals Cont.Bedpans and Urinals Cont.

Two main types of bedpansTwo main types of bedpans Fracture or orthopedic bedpanFracture or orthopedic bedpan Standard bedpanStandard bedpan

Many patients are sensitive about using the Many patients are sensitive about using the bedpan. Always provide privacy and make bedpan. Always provide privacy and make them as comfortable as possible.them as comfortable as possible.

Assisting with a BedpanAssisting with a Bedpan

Use standard precautions and wear glovesUse standard precautions and wear gloves Provide privacy for the ptProvide privacy for the pt Warm bedpan by running warm water over itWarm bedpan by running warm water over it There are two positions to place the pan under There are two positions to place the pan under

the pt.the pt. Pt. flexes knees and puts weight on heels. They Pt. flexes knees and puts weight on heels. They

then lift their hips upthen lift their hips up Pt. is turned to one side and the pan is placed Pt. is turned to one side and the pan is placed

against the buttock and the pt is rolled back on the against the buttock and the pt is rolled back on the panpan

Assisting with a Bedpan cont.Assisting with a Bedpan cont.

The pts. Buttock should rest on the rounded The pts. Buttock should rest on the rounded portion of the panportion of the pan

Place call bell and tissue within the pts. reachPlace call bell and tissue within the pts. reach Raise siderail before leaving the pt.Raise siderail before leaving the pt.

All DoneAll Done

Answer call bell immediately Answer call bell immediately Use the same positions to get pt. off the pan, Use the same positions to get pt. off the pan,

but hold pan firmlybut hold pan firmly Cover the bedpan and place on nearby chair or Cover the bedpan and place on nearby chair or

tabletable Make sure perineum is clean and dryMake sure perineum is clean and dry Assist pt. in washing handsAssist pt. in washing hands Clean bedpan and note any abnormalities of Clean bedpan and note any abnormalities of

urine or BMurine or BM

Assisting with UrinalAssisting with Urinal

Use standard Precautions and wear glovesUse standard Precautions and wear gloves Provide privacy for pt.Provide privacy for pt. Assist with placement of the urinal if neededAssist with placement of the urinal if needed Leave the call bell and toilet tissues near the Leave the call bell and toilet tissues near the

patientpatient Answer the pts. call bell immediately Answer the pts. call bell immediately

All finishedAll finished

Avoid exposing the pt.Avoid exposing the pt. Have pt. hand you the urinal if they are ableHave pt. hand you the urinal if they are able Close the lid or cover the top of urinalClose the lid or cover the top of urinal Assist pt. with washing handsAssist pt. with washing hands Assister pt. with washing perineum if neededAssister pt. with washing perineum if needed Measure contents of pts. I & OMeasure contents of pts. I & O Empty urinal and cleanEmpty urinal and clean Report abnormalities related to urineReport abnormalities related to urine

RestraintsRestraints

May be used only to protect pts. from harming May be used only to protect pts. from harming themselves or othersthemselves or others

Must have doctor’s order to use restraintsMust have doctor’s order to use restraints Conditions that may require restraintsConditions that may require restraints

Irrational or confused pts.Irrational or confused pts. Skin conditionsSkin conditions Paralysis or limited muscular conditionsParalysis or limited muscular conditions

Restraints Cont.Restraints Cont.

Types of restraintsTypes of restraints Straps or safety beltsStraps or safety belts Limb restraintsLimb restraints Leather Cuffs or locksLeather Cuffs or locks Restraint jacketsRestraint jackets

Restraint applied unnecessarily=false Restraint applied unnecessarily=false imprisonmentimprisonment

When using restraintsWhen using restraints

Use only when other alternatives failUse only when other alternatives fail Allow pt. to move as much as possibleAllow pt. to move as much as possible Always tell pt. why they are being restrainedAlways tell pt. why they are being restrained Reassure pt. frequentlyReassure pt. frequently Check circulation below limb restraints every Check circulation below limb restraints every

15 minutes15 minutes All restraints must be removed every 2 hours All restraints must be removed every 2 hours

and skin color care givenand skin color care given

Complications from RestraintsComplications from Restraints

Physical and mental frustrationPhysical and mental frustration Impaired circulationImpaired circulation Decubitus ulcersDecubitus ulcers Loss of muscle toneLoss of muscle tone Joint stiffnessJoint stiffness Respiratory or breathing problemsRespiratory or breathing problems