Potter/Perry (Marsha)
Ch. 38 Hygiene, Pgs: 854-878
Foot and Nail Care

Should be incorporated into a person’s regular hygiene routine which involves: soaking to soften cuticles, cleansing, drying, and nail trimming; whilst sitting in a chair or in bed

Person’s with diabetes mellitus do not soak their feet (due to risk of infection) and need a Dr’s order to trim toenails

Teaching clients + families proper techniques for foot/nail care and ways to prevent infection and promote circulation is essential

Clients with diabetes mellitus/ peripheral vascular disease are at risk for chronic foot ulcers and other foot/ nail problems because of poor peripheral blood flow to the feet which all heal slowly and are difficult to treat

Those with diabetes mellitus/peripheral vascular disease should do the follow for routine foot/nail care:
 Inspect all parts of the feet daily (top, soles, between toes etc)
 Get a thorough foot examination by a specialist at least once a year depending on the amount of high risk foot conditions – in which case client should go more often
 Wash the feet daily in lukewarm water (do not soak- may cause infection) and then pat dry including drying between the toes
 Do not cut corns/calluses or use commercial removers- consult a Dr for this
 If feet perspire excessively, apply a non-allergenic foot power
 Rub non-allergenic lotion along the sides of feet if dry (do not apply in between toes)
 File toenails straight across and square- do not use scissors or clippers
 Do not use over the counter products to treat athletes foot/ingrown toenails (consult a podiatrist or physician for this)
 Avoid : elastic stockings, knee-high hose, constricting garters and crossing the legs while sitting- impairs circulation to the lower extremities
 Wear clean, dry, socks/ stockings daily- change twice if feet heavily perspire
 Do not walk barefoot or wear high-heels, open toe/pointed toe shoes
 Wear properly fitted shoes with porous uppers. Soles should be flexible/non slipping
 Clients with increased plantar pressure should wear footwear that cushions + redistributes pressure. Clients with bony deformities should wear extra wide/deep shoes with cushioned insoles
 Do not wear new shoes for an extended period of time, allow time to break them in
 Exercise regularly to improve circulation to the lower extremities
 Do not apply hot water bottles/ heating pads to the feet- use extra coverings instead
 Wash minor cuts immediately using mild antiseptics (avoid iodine or merbromin) then dry feet thoroughly – contact Dr to treat cuts or lacerations
 Get help from a care giver/ family member if unable to perform proper foot care

Performing Nail and Foot care (Derived from Table 38-2, pg: 855- 857 Potter/Perry)
1.
Identify if client is at risk for foot/nail problems (particularly if: older adults/diabetes mellitus/heart failure or renal disease/ cerebrovascular accident – stroke)
2.
Assess clients knowledge of foot/ nail care practices – educate them
3.
Ask female clients if they use nail polish/ polish remover often (causes dryness)
4.
Assess clients ability to care for nails/feet: consider visual alterations, fatigue, musculoskeletal weakness (helps show their knowledge level + if help is required)
5.
Discover what home remedies they use: over the counter preps for corn removal, cutting of corns/calluses with razor blades or scissors, use of oval corn pads, use of adhesive tape (Oval pads decrease circulation to surrounding toes. Tape may tear skin of older adults because of its thin/delicate nature)
6.
Assess type + cleanliness of footwear/socks/ garments worn by clients. (Ill-fitting shoes/socks etc predispose clients to a decrease in mobility, infections, + increased risk of amputation
7.
Observe clients gait – structural/painful disorders cause limping/unnatural gait
8.
Help ambulatory client sit in a bedside chair with disposable bath mat under their feet, or if client is bedbound place into a supine position with head of bed elevated and a towel on the mattress under their feet
9.
Explain procedure to client including time needed to soak feet/hands – 10 to 20 minutes(depending on if the client is diabetic or not)
10.
Perform hand hygiene- arrange equipment on bedside table
11.
Fill wash basin with warm water (softens nails, reduces inflammation of the skin, promotes circulation) Place basin on bath mat or towel to avoid spills
12.
Fill emesis basin with warm water and place on paper towels on bedside table
13.
Pull curtain around the bed or close the room door if desired to provide privacy
14.
Inspect all areas of the hand and feet. Check the colour, temperature. Palpate radial/ ulnar pulses of hands + dorsalis pedis pulses of feet. Assess capillary refill
15.
Place clients’ fingers in emesis basin with arms in a comfortable position, help client place feet into the wash basin. Let feet/fingernails soak for 10-20 mins
16.
Re-warm water after 10 mins. Softening of corns/calluses ensures easy removal of dead cells and easy manipulation of cuticles
17.
Use orange stick/ or the wooden end of a cotton tipped swab to gently clean debris under finger nails and then remove from fingers from basin, dry thoroughly
18.
Use clients nail clippers (for infection control purposes) and cut straight across, even with the top of fingers. Use a nail file to shape the nails straight across – if client has circulatory problems, only file the nail, do not cut them *Only cut nails if there is a
Dr’s order to do so*
19.
Push cuticle back gently with the orange stick, dry the hands
20.
Put disposable gloves on and scrub callused areas of the feet with washcloth to remove dead skin layers
21.
Clean under toenails with orange stick. Remove from basin and dry thoroughly

22.
Clean/trim toenails using the same procedures as with the clients hands
23.
Apply lotion to feet and hands, help client back to bed into a comfortable position
24.
Remove disposable gloves and place in proper garbage, put soiled linen in hamper, clean equipment +supplies and return to proper place. Perform hand hygiene
25.
Inspect nails +surrounding skin. Ask client to demonstrate nail care
26.
Observe clients walk after toenail care to ensure they are mobile and comfortable

Unexpected outcomes + Interventions
 There is inflammation and tenderness of cuticles and surrounding tissues:
1.
Repeated soakings may be necessary to relieve inflammation and loosen layers or cells from calluses/corns
2.
If the client is diabetic or has peripheral vascular disease, refer to podiatrist
3.
Antifungal cream may be needed
 There’s localized areas of tenderness on feet , with calluses/ corns at points of friction:
1.
Change in footwear may be needed
2.
Refer to a podiatrist
 Appearance of ulcer between toes or other pressure areas in foot:
1.
Notify physician and refer to podiatrist
2.
Increase frequency of foot assessment + hygiene

When finished, document procedure and observations in appropriate forms

Report any breaks in the skin or ulcerations to the physician or nurse in charge

For home care, educate ambulatory/ non ambulatory patients proper hand/foot hygiene

If client is diabetic or has peripheral vascular disease, alternative foot therapies or foot soaking should only be done after consulting a physician
Oral Hygiene

Proper oral hygiene helps maintain the healthy state of the mouth, teeth, gums, lips and tongue.
It also enhances well being and stimulates appetite

Brushing cleans the teeth of food particles, plaque and bacteria while massaging gums and relieving it of odour and unpleasant tastes

Flossing helps to further remove plaque and bacteria from between the teeth to reduce gum inflammation and infection

Plaque forming foods include: carbonated beverages, breads and starches

Dental check-ups every 6 months is encouraged for clients of all ages

Provide education, methods of prevention and assistance if needed by clients
Brushing and Flossing

Brushing about 4 times a day (after meals + bedtime) is essential for oral hygiene using a fluoride toothpaste

Toothbrushes should have straight handles, soft bristles & should be replaced every 3 months


Older clients with reduced dexterity/ grip may need a larger handle with easier grip or an electric toothbrush

Discourage clients from cross contamination + sharing toothbrushes and mouthwash

Those with threatened integrity of oral mucosa + unconscious clients need more frequent oral care and use anti-infective agents

Clients should floss at least once a day. Chemotherapy/ radiation patients should use unwaxed
 floss and avoid vigorous flossing near the gum line to prevent bleeding
These clients may also suffer from stomatitis which is inflammation of the oral mucosa that can cause burning, pain, and change in food tolerance
Providing Oral Hygiene (Table 38-3, pg: 860-861 Potter/Perry)
1.
Determine client’s oral hygiene practices: how often they brush/floss, type of toothpaste used, last dental visit/frequency, type of mouthwash used
2.
Assess risk for oral hygiene problems and aspiration (impaired swallowing, reduced gag reflex)
3.
Assess client’s ability to hold and use a toothbrush (shows dexterity/strength)
4.
Prepare equipment needed at bedside, wash hands, put on disposable gloves
5.
Inspect integrity of lips, teeth, buccal mucosa, gums, palate and tongue
6.
Identify presence of common oral problems:
 dental caries (chalky white/black/brown discolouration of tooth)
 gingivitis (inflammation of gums)
 periodontitis (receding gum lines, inflammation/gaps between teeth)
 halitosis (bad breath)
 cheilosis (cracking lips)
 stomatitis (inflammation of the mouth)
 dry, cracked, coated tongue
7.
Explain procedure to client, discuss preferences of hygiene aids, prepare bed (raise head, lower side rails)
8.
Place paper towels on table and put equipment within reach, place towel on clients chest
9.
Apply toothpaste on brush, pour small amount of water over toothpaste
10.
Client may assist by brushing. Brush inner/outer surfaces of upper/lower teeth by brushing from gum to crown of each tooth, and sides of teeth by brushing bristles back and forth
11.
Have client brush sides/ surface of tongue. (Microorganisms can collect on tongue and cause bad breath) Avoid initiating gag reflex. Tell client to rinse by taking several sips of water and spitting into emesis bin (removing food particles)
12.
Allow client to gargle with mouthwash if desired, assist in wiping mouth, allow client to floss and then ask if clients oral cavity feels uncomfortable/ irritated.
13.
Help client to comfortable position, put bed back to original position, discard of soiled linen/paper towels, remove soiled gloves + emesis bin and return equipment to proper places
14.
Perform hand hygiene, ask client to describe proper oral hygiene techniques


Unexpected Outcomes and Related Interventions:
 Dryness/ Inflammation of Oral Mucosa
1.
Increase frequency of oral hygiene
2.
Increase client’s hydration
3.
Apply protectant to the client’s lips
 Retraction of Gum Margins From Teeth, Localized Areas of Inflammation, and Bleeding
Around Gum Margins
1.
Find out if client has underlying bleeding tendency (anticoagulant therapy)
2.
Report findings to physician
3.
Use a soft-bristled toothbrush
4.
Increase frequency of oral hygiene
 Signs of Dental Caries
1.
Refer client to dentist
2.
Teach client oral hygiene techniques

Record procedures and findings and teach client + caregiver hygiene techniques for home care
Performing Mouth care for an Unconscious or Debilitated Client (Table 38-4, pg: 862-863 Potter/Perry)
1.
Assess client’s risk for oral hygiene problems, explain procedure to client (unconscious clients can still hear, this will reduce anxiety)
2.
Test the presence of a gag reflex by placing a tongue blade on back half of the client’s tongue
3.
Prepare bed positioning. Lower head of bed + side rail, pull curtains or close the room door
4.
Wash hands, put on disposable gloves, arrange equipment, if needed, turn on suction machine + connect tubing to the suction catheter. Put towel under clients head + emesis bin under chin
5.
Position client on side (Sim’s position) with head turned, move client to the side of the bed
6.
Carefully separate upper/lower teeth with padded tongue blade by inserting quickly but gently between back molars ( never use fingers to separate teeth)
7.
Inspect condition of oral cavity, clean mouth using brush/sponge. Clean chewing and inner/ outer tooth surfaces. Swab roof of mouth, gums and inside cheeks. Gently swab/brush tongue
8.
Moisten clean swab/toothette swab w/ water or use bulb syringe to rinse, repeat several times
9.
Suctions secretions as they accumulate if needed
10.
Apply a thin layer of water-soluble jelly to lips to prevent dryness/cracking
11.
Inform client procedure is done, put on clean gloves, inspect oral cavity, ask client if their mouth feels clean, reposition client, and return bed to original position
12.
Clean equipment and return to their proper places, place soiled linen in proper receptacle, remove and discard gloves, wash hands
13.
Assess client’s respirations on an ongoing basis

Unexpected Outcomes and Related Interventions
 Secretions or Crusts Remaining on Oral Mucosa, Tongue or Gums
1.
Increase frequency of oral hygiene
2.
Try using pediatric-sized toothbrush- it may provide better hygiene
 Localized Inflammation of Gums or Mucosa

1.
Increase frequency of oral hygiene with a soft-bristled tooth brush
2.
Apply moisturizing gel on the oral mucosa
3.
Chemotherapy/radiation can cause stomatitis. To provide relief + promote oral hygiene: topical anti-inflammatory and anaesthetics may be prescribed by Dr
 Aspiration of Secretions
1.
Suction oral airway
2.
Perform tracheal bronchial suctioning
3.
Notify the physician

Record the procedure and include observations and unusual findings

Give home care advice to caregiver: cavity should be irrigated w/ syringe, mouth care should be given twice a day, educate on proper positioning of client to prevent aspiration
Focusing on Older Adults (Box 38-12, pg: 858 Potter/Perry)

Many older adults are edentulous (without teeth) and the ones they do have are often diseased/decayed

Periodontal membrane weakens making it prone to infection, chronic illnesses such as diabetes increase risk for periodontal disease

Dentures/partial plates should fit properly, otherwise it will cause pain

Weaker jaw muscles makes it harder to chew food and leads to fatigue

Dry mouth is caused by age related decrease in saliva secretion as well as medications

Poor nutritional status leads to increased risk and severity of dental problems

Some older adults think tooth loss is a natural outcome of aging so they do not seek dental care

Financial limitations and belief that use of dentures eliminates need for dental care are also reasons why older adults do not seek dental care
Clients with Special Needs

Unconscious clients are susceptible to drying of mucous-thickened salivary secretions because they’re unable to eat/drink through mouth and often receive 02 therapy

While providing hygiene to unconscious clients (every 2 hours), protect them from choking and aspiration

Always explain the steps of mouth care, sensations the client will feel during the procedure

Clients with diabetes mellitus frequently have periodontal disease and should visit the dentist every 3-4 months. All tissues should be handled gently to prevent trauma
Denture Care



Dentures should be cleaned on a regular basis to avoid gingival infection and irritation
They should be handled with care because they’re easily broken
Must be removed at night to give the gums a rest and prevent bacterial build up. They should be placed in water in an enclosed labelled cup beside clients bedside to prevent warping

Care of Dentures (Box 38-13, pg: 864 Potter/Perry)
1.
Ask client whether gums/ mucous membranes are tender/irritated
2.
Find out if client has preference for denture care + products used
3.
Fill emesis basin with tepid water, ask client to remove dentures - if unable to do this independently then wash hands, put gloves on and gently remove top + bottom dentures and place in emesis bin or sink
4.
Apply cleaning agent and brush surfaces of dentures, rinse thoroughly
5.
Apply adhesive to seal dentures if needed, and reinsert clients dentures, press firmly to seal it in place after moistening upper/lower denture or have them do this if capable
6.
Dentures should be removed at night and gums cleaned gently. Remove gloves, wash hands
Hair and Scalp Care

Proper and routine hair care contributes to a clients well being and appearance

Brushing, combing, shampooing are basic hygiene measures for proper hair care
Brushing and Combing

Frequent brushing helps keep hair clean and distributes oil evenly along hair shafts and keeps hair from tangling. Brush hair in small sections, moisten if needed to free tangles

Assist those with limited mobility and weakness with their hair care, take cultural preference into consideration as well (might want certain styles)

Braiding hair helps prevent tangles however unbraid these periodically for good hygiene and obtain consent before braiding hair (also get written consent for cutting hair)

Bright lights or natural light is needed to spot head lice (size of a sesame seed)

If infested do the following:
1.
Wear disposable gown and gloves, then use a comb or hairbrush to remove tangles
2.
Section clients hair, comb from the scalp to the end of hair and dip comb in a cup of water or wipe with paper towel to remove nits (empty eggshells) each time
3.
Look through hair for live lice, if visible, catch with tweezers or comb

4.
Instruct family/client to clean comb thoroughly or discard after each use and to screen for lice daily
5.
Family should contain the clients clothes and wash them in hot water
6.
Give instructions to prevent lice transmission:
 Do not share bed linens
 Avoid placing bare hand on clients head
 Immediately wash hands after providing hair care and contain all hair care products
Pediculicidal shampoo helps get rid of lice. May have neurological side effects mostly on the very young and very old which may lead to seizures, dizziness, headaches, paraesthesia and death. This shampoo should never be used on HIV+ clients, clients with neurological conditions, neonates, or clients who weigh less than 50kg

Shampooing

Frequency of shampooing depends on condition of hair and clients daily routine

Shower or tub chair can be used for clients that are tired or faint. Hand held shower nozzles allow clients to easily wash hair

If clients can’t sit but can be moved, place on stretcher and take them to a sink or shower

If clients can’t be transferred to stretcher either, hair must be washed at bedside using trough that is placed under clients head. Dry shampoos can be used as well but aren’t as effective
Shampooing the Hair of a Bed-Bound Client (Box 38-14, pg: 865 Potter/Perry)
1.
Before washing client’s hair, make sure it is not contraindicated for client (medical conditions like head/neck/spinal cord injuries may not allow this due to positioning of head + neck)
2.
Wear gloves if needed, inspect hair/scalp before starting to determine if there are conditions present which require use of special shampoos or treatments (removal of dandruff/dried blood)
3.
Put waterproof pad under client’s shoulders/head/neck, position them supine + put a trough under client’s head to catch water, put a rolled towel under client’s neck and towel on shoulders
4.
Brush + comb client’s hair, get warm water, offer client a towel to cover eyes
5.
Slowly pour water from pitcher over hair until wet, apply a small amount of shampoo, lather with both hands starting at the hairline and work toward the back of neck, massage scalp
6.
Rinse hair with water until free of soap, apply conditioner or cream rinse then rinse thoroughly
7.
Wrap client’s head in bath towel, dry client’s face + moisture on neck/shoulders
8.
Dry client’s hair and scalp, come hair to remove tangles, apply oil prep or conditioning product if desired by client, help them into a comfortable position and complete styling of hair
Shaving

Shaving facial hair can be done after bath/shampoo. Women prefer to shave legs/axillae while bathing

Clients receiving anticoagulants, high doses of aspirin or those with low platelet counts bleed easily and should therefore receive careful care and should always use an electric razor

To prevent pulling, scraping or cuts, place warm washcloth over male clients face, then apply shaving cream or lather a mild soap to soften skin (Nurse to do task if client is unable)

Shave in direction of hair growth using short strokes
Moustache and Beard Care

Daily grooming required by client or nurse to prevent food particles/mucus from collecting

Trimming or shaving a clients beard must only be done after obtaining consent from client or family (cultural or religious reasons)
Hair and Scalp Health

Hair should be kept clean, combed and regularly brushed


Instruct client to inform primary caregiver if there are changes in the texture and distribution of hair (could be a serious systemic problem)
Basic Eye Care

Wash each eye with a different section of a moistened wash cloth from inner to outer canthus

Secretions may collect along lid margins + inner canthus when blink reflex is absent or eye does not close fully, an eye patch or lubricating eye drops may be needed

For eyeglasses, use extra care when handling or cleaning to prevent damage/breaking. Use cool water and a soft cloth to clean lens. Then label with name and place inside case in bedside table

For contacts, remove periodically to prevent ocular infection and corneal ulcers or abrasions.
They should be thoroughly cleaned/disinfected to get rid of foreign matter + secretions

Contacts come in daily-wear, extended-wear and disposable varieties

Daily wear lenses should be removed overnight for cleaning and disinfecting. Extended wear lenses can be worn up to 30 days without being removed.

Pain, discomfort and redness of the conjunctivae might be symptoms of over wear

Clients with artificial eyes have had an enucleation (removal of an entire eyeball) as a result of a tumour growth, severe infection or eye trauma- some are permanent, some can be removed

Only help clients if they need assistance in prosthesis removal and cleansing. To remove, retract lower eyelid and exert slight pressure just below the eye which lifts the eye from the socket. To reinsert artificial eye, retract upper and lower lids and gently slip the eye into socket

Use warm normal saline to cleanse the prosthesis, also cleanse edges of eye socket and surrounding tissues with soft gauze moistened in saline/ clean tap water. Eye may be stored in container filled with saline or tap water
Contact Lens Care (Box 38-15, pg: 867 Potter/Perry)

Use special cleaning solutions when cleaning/disinfecting contact lens

Never use fingernails on a lens to remove dirt/debris

Remember the mnemonic “RSVP” : Redness, Sensitivity, Vision problems, Pain – if one of these symptoms occurs, remove contacts immediately, if worsens, contact vision care specialist

If a lens is dropped on a hard surface, moisten finger, gently touch lens to pick up and re-clean and disinfect (do not wipe lens with a tissue/towel)

Lens should be kept moist and wet when not worn using fresh solution

Throw away disposable or planned replacement lenses after prescribed wearing period

To avoid mix ups, always start with the same lens when removing/inserting lenses
Ear Care

Routine ear care involves cleansing the ear with the end of a moistened washcloth rotated gently into the ear canal- if cerumen (wax) is visible, a downward retracted at the entrance of the ear canal may cause it to loosen + slip out


Using objects like Q-tips, bobby pins, paper clips can be traumatic to the ear canal, can rupture the tympanic membrane + impact cerumen in the canal (this can be removed by irrigation)

To irrigate, put 3 drops of glycerine at bedtime to soften wax + 3 drops of hydrogen peroxide twice a day to loosen wax. Client should sit or lay on their side with affected ear up, put a small basin under ear to catch fluid. Use a bulb-irrigating syringe. Direct gentle irrigation at the top of the canal will loosen the cerumen. Wipe off any moisture from the ear, check it canal’s clear

Hearing aids amplify sounds and reduce background noise interference and are used by both hard of hearing and deaf individuals

3 types of hearing aids are:
 In-the-canal (ITC) aid: fits entirely in the ear canal, easy to manipulate, doesn’t interfere with wearing glasses, using the phone etc. However does not accommodate progressive hearing loss and requires manual dexterity to operate, insert, remove etc.
 In-the-ear (ITE) aid: fits into external auditory canal and allows for better fine-tuning, more powerful and stronger than ITC therefore more useful for wider range of hearing loss. Not recommended for people with moisture or skin problems in the ear canal
 Behind-the-ear (BTE) aid: hooks around and behind the ear and is connected by a short clear, hollow, plastic tube to an ear mould inserted into the external auditory canal.
Useful for clients with progressive hearing loss, manual dexterity issues. Disadvantages include that it interferes with wearing glasses, more visible and difficult to keep in place
Care and Use of Hearing Aids (Box 38-16, pg: 869 Potter/Perry)

Begin with wearing hearing aid for short periods of times, then gradually increase

Slowly increase volume from one third to one half- adjust to a comfortable volume

Whistling sound indicates too high a volume, incorrect ear mould insertion, an improper fit of the aid, or a buildup of earwax or fluid

Do not wear aids while under heat lamps, using a hair dryer, or in very wet/cold weather

Batteries usually last 70-85 hours, remove/disconnect battery when not in use. Routinely check battery compartment for cleanliness, inserted properly etc

Clean with a soft cloth and warm soapy water as per manufacturer’s instructions

Replace ear moulds every 2-3 years

Do not put aid in water, and do not use hairspray of perfume near aid to avoid greasiness

Follow up with audiologist to routinely evaluate effectiveness of aid
Nasal Care

Secretions can usually be removed from the nose by gentle blowing into a tissue, harsh blowing can cause bleeding and create pressure capable of injuring eardrum + nasal mucosa

If client is unable to remove, assist by using a wet washcloth/ cotton-tipped applicator moistened in water or saline. Excessive secretions can be removed by gentle suctioning


If client has a nasogastric, feeding, or endotracheal tube inserted thru nose, change the tape anchoring the tube at least once a day. After removing tape, maintain hold of tubing and thoroughly cleanse and dry the nasal surface
Client’s Room Environment

Client’s room should be comfortable, safe, neat and large enough to allow client + visitors to move about freely. Noise level + odours should be controlled as well
Maintaining Comfort

Comfortable environment depends on client’s age, severity of illness, and level of daily activity

Room temperature should be cooler unless client is acutely ill or is an infant

Good ventilation keeps stale air/odours (such as bowel movements, wound drainages etc) from lingering. Room deodorizers can be used as long as client is not allergic or sensitive to it

Acutely ill + infants should be dressed warm and covered in a light blanket

Proper lighting is necessary for safety + comfort, bright lights are stimulating, dim lights are good for rest and sleep- do not abruptly turn light on in client’s room unless necessary
Room Equipment


Typical hospital room contains: overbed table, bedside stand, chairs and a bed
Overbed table has wheels, can be adjusted in height, provides surface to put meal trays, equipment, toiletry items and provides a working space

Bedside stand is used to store client’s personal things, hygiene equipment, phone, water, cups

Straight-backed chair is useful to temporarily transfer client from bed during bed making whereas lounge chairs are good for clients who are able to sit for extended periods of time

Other equipment includes: call bell, wall-mounted blood pressure gauge, oxygen and vacuum wall outlets and a TV depending on the facility
Beds

Typical hospital bed has a firm mattress on a metal frame that can be raised/lowered horizontally- different bed positions are used to promote client comfort, minimize symptoms, promote lung expansion + improve access during certain procedures

Positions can be changed by electronic controls on the side or foot of bed

Beds have safety features such as locks on the wheels, casters and alarms. Wheels should be locked when bed is stationary, alarms should be turned on to protect at-risk-for-falling clients and side rails should be raised up to protect client from falling out of bed
Common Bed Positions (Table 38-6, pg: 870 Potter/Perry)

Fowler’s: head of bed raised to angle of 45 degrees or more
 Used while client eats + promotes lung expansion
 Used during nasogastric tube insertion and nasotracheal suction


Semi-Fowler: head of bed raised approx 30 degrees
 Promotes lung expansion
 Used when clients receive gastric feedings to reduce regurgitation + aspiration

Trendelenburg’s: entire bed frame tilted with head of bed down
 Used for postural drainage
 Facilitates venous return in clients with poor peripheral perfusion

Reverse Trendelenburg’s: entire bed frame tilted with foot of bed down
 Used infrequently
 Promotes gastric emptying
 Prevents esophageal reflux

Flat: Entire bed frame horizontally parallel with floor
 Used for clients with vertebral injuries and in cervical traction
 Used for clients who are hypotensive
 Generally preferred for clients who are sleeping
Bed Making

Ensure the linen is clean, dry, free of wrinkles, food particles, and wetness from soiling

Bed is usually made in the morning after client’s bath, during meals (when in chair) or when the client is out for a procedure or test

Medical asepsis should be followed to keep soiled linen away from your uniform; soiled linen should be placed in special bags before discarding in a hamper. Linens should not be shaken.
This prevents spread of microorganisms

Use proper body mechanics while bed making, raise bed to appropriate height to prevent strain.
After bed is made, return it to lowest horizontal position to prevent accidental falls

Make bed when it’s unoccupied whenever possible. Can be open: top covers are folded back so client can easily get in. Can be closed: top sheet, blanket and bedspread are drawn up to the head of the mattress and under pillows- done when a new client is arriving

For a surgical, recovery, post-op bed: top sheets + bedspread are not tucked at the corners, instead are folded to one side or to the bottom third of the bed (allows for easier transfer of the client from stretcher to bed)
Making an Occupied Bed (Table 38-5, pg: 871-875 Potter/Perry)
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Refer to textbook 
Making an Unoccupied Bed (Table 38-17, pg: 876 Potter/Perry)
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Refer to textbook 
Linens
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Adequate supply is needed to care for client. “Nurse servers”/ cart with linen are usually placed within or outside clients rooms

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Collect necessary bed linens before bed making. Sheet, blanket and bedspread may be reused for the same client if they are not wet or soiled
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Disposal of linen must be done to minimize the spread of infection as per agency’s guidelines
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After client is discharged, all bed linen is sent to laundry, mattress + bed are cleaned by housekeeping and new linen is applied
Client Care and Expectations
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Evaluation of hygiene measures occurs both during and after each skill. Look for changes in the clients behaviour: client free of odour, in a relaxed position, facial expression showing comfort
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Critical thinking is necessary to ensure hygiene care is effective, if not, revise the plan
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Ask the patient if their expectations have been met for hygiene care using a caring approach