2. Objectives Position, Turn, and Transfer patients Position, Turn, and Transfer patients Make a bed Make a bed Administer personal care and apply restraints Administer personal care and apply restraints

3. Positioning, Turning, Moving and Transferring Patients Must use correct body mechanics Must use correct body mechanics Alignment = Positioning body parts in relation to each other to maintain correct body posture Alignment = Positioning body parts in relation to each other to maintain correct body posture Correct alignment helps pt. feel comfortable; prevents fatigue, Decubitus ulcers and contractures Correct alignment helps pt. feel comfortable; prevents fatigue, Decubitus ulcers and contractures

4. Decubitus Ulcer Pressure sore or bed sore Pressure sore or bed sore Caused by pressure that interferes with circulation Caused by pressure that interferes with circulation Usually at bony prominences – coccyx, hips, knees, heels, and elbows Usually at bony prominences – coccyx, hips, knees, heels, and elbows First sign is a pale or reddened area on the skin First sign is a pale or reddened area on the skin

5. Decubitus Ulcer Cont. Vesicle or blister may for at the site Vesicle or blister may for at the site Cells die, skin breaks down and open sore (ulcer) develops Cells die, skin breaks down and open sore (ulcer) develops EASIER TO PREVENT THAN TO TREAT EASIER TO PREVENT THAN TO TREAT

6. Prevent Decubitus Ulcers by: Good skin care Good skin care Prompt cleaning of urine and feces from skin Prompt cleaning of urine and feces from skin Massage in circular motion around reddened area Massage in circular motion around reddened area Light dusting of powder to prevent friction Light dusting of powder to prevent friction Frequent turning and positioning Frequent turning and positioning Linen dry and free from wrinkles Linen dry and free from wrinkles Use of pressure-relieving surfaces Use of pressure-relieving surfaces

7. Carefully observe the skin during bathing for evidence of pressure sores Carefully observe the skin during bathing for evidence of pressure sores

8. Contractures Tightening or shortening of muscle due to lack of movement or usage Tightening or shortening of muscle due to lack of movement or usage Foot drop common contracture Foot drop common contracture Prevented by keeping foot at right angle to leg Prevented by keeping foot at right angle to leg ROM will help prevent contractures ROM will help prevent contractures

9. Contractures Cont. Weakened body parts must be supported with pillows, bed cradles, footboards, rolled blankets or towels Weakened body parts must be supported with pillows, bed cradles, footboards, rolled blankets or towels Pt must be turned frequently Pt must be turned frequently

10. Turning, Moving, and Transferring Dangling Dangling Sitting on side of bed prior to standing Sitting on side of bed prior to standing Allows patient time to adjust Allows patient time to adjust If the patient c/o vertigo, weakness or diaphoresis – return pt. Immediately to supine position If the patient c/o vertigo, weakness or diaphoresis – return pt. Immediately to supine position Mechanical Lifts Mechanical Lifts Used to transfer weak or paralyzed patients Used to transfer weak or paralyzed patients Be sure you have been instructed on proper use Be sure you have been instructed on proper use Reassure patient during transfer Reassure patient during transfer

11. Turning, Moving, and Transferring Cont. Transferring Transferring Be sure to protect patient and health care worker Be sure to protect patient and health care worker Be sure you know how to operate the wheelchair/stretcher Be sure you know how to operate the wheelchair/stretcher Lock the wheels Lock the wheels

12. When turning and Transferring Before moving patient, obtain proper authorization from immediate supervisor Before moving patient, obtain proper authorization from immediate supervisor Watch the patient closely – pulse rate, respirations and color Watch the patient closely – pulse rate, respirations and color Observe for weakness, dizziness, increased perspiration or discomfort Observe for weakness, dizziness, increased perspiration or discomfort If you note abnormal changes, return the patient to a safe and comfortable position and notify your supervisor If you note abnormal changes, return the patient to a safe and comfortable position and notify your supervisor

13. Moving the Pt. Up in Bed Lower the head of the bed Lower the head of the bed Place the pillow against the bed frame to protect the pts. Head Place the pillow against the bed frame to protect the pts. Head If pt. has trouble breathing, raise the head of the bed If pt. has trouble breathing, raise the head of the bed Ask the pt. to flex the knees and brace the feet on bed Ask the pt. to flex the knees and brace the feet on bed

14. Place one arm under the pts. Head and shoulders Place one arm under the pts. Head and shoulders If the patient is unable to help, get someone to assist you If the patient is unable to help, get someone to assist you Get a broad base of support and as close to the bed as possible Get a broad base of support and as close to the bed as possible Arrange a signal – “On the count of three, push with your feet” Arrange a signal – “On the count of three, push with your feet” On the signal, shift your weight forward On the signal, shift your weight forward Two people can use a draw sheet or lift sheet Two people can use a draw sheet or lift sheet

15. Turning the Pt. Lower the side rail nearest you – be sure the opposite side is up Lower the side rail nearest you – be sure the opposite side is up If the pt. is lying in the center of the bed, place hands under the pts. Head and shoulders and slide the pt toward you If the pt. is lying in the center of the bed, place hands under the pts. Head and shoulders and slide the pt toward you Place both hands under the hips and slide the hips toward you Place both hands under the hips and slide the hips toward you

16. Turning the Pt. Cont. Place both hands under the legs and slide the legs toward you Place both hands under the legs and slide the legs toward you Cross the pts. arms across his/her chest Cross the pts. arms across his/her chest Move the leg closest to you over the other leg Move the leg closest to you over the other leg Get close to the pt. and roll the pt. away from you Get 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 the hips, drawing the pt. to the center of the bed Place your hands under the head and shoulders, then the hips, drawing the pt. to the center of the bed

17. Bedmaking Linen must be free of wrinkles as they could cause discomfort and lead to Decubitus ulcers Linen must be free of wrinkles as they could cause discomfort and lead to Decubitus ulcers Closed Bed Closed Bed Made after the pt. is discharged and after terminal cleaning of unit Made after the pt. is discharged and after terminal cleaning of unit Purpose: keep bed clean until new pt. comes Purpose: keep bed clean until new pt. comes Open Bed Open Bed Fanfold top sheets to welcome new pt. or for ambulatory pts. Fanfold top sheets to welcome new pt. or for ambulatory pts.

18. Bedmaking Cont. Occupied Bed Occupied Bed Bed made while pt. is in it Bed made while pt. is in it Bed with Cradle Bed with Cradle Cradle is placed under top sheets to prevent linen from touching parts of the pts. Body. Used for pts. With burns, skin ulcer, blood clots, fractures, and other similar conditions Cradle is placed under top sheets to prevent linen from touching parts of the pts. Body. Used for pts. With burns, skin ulcer, blood clots, fractures, and other similar conditions

19. Bedmaking Tips Observe correct body mechanics Observe correct body mechanics Keep linen arranged in the order of use Keep linen arranged in the order of use Make one side of the bed completely, then on the other side Make one side of the bed completely, then on the other side Roll dirty linens away from your body and place in hamper immediately Roll dirty linens away from your body and place in hamper immediately

20. Do not shake clean or dirty linen. Do not shake clean or dirty linen. Place open end of the pillowcase away form the door Place open end of the pillowcase away form the door Wear gloves while handling dirty or contaminated linen Wear gloves while handling dirty or contaminated linen

21. Oral Hygiene Benefits: Benefits: Provides comfort Provides comfort Stimulates the appetite Stimulates the appetite Prevents disease and dental caries Prevents disease and dental caries Helps to prevent bad breath (halitosis) Helps to prevent bad breath (halitosis) Stimulates saliva production which contains digestive enzymes and promotes digestion Stimulates saliva production which contains digestive enzymes and promotes digestion

22. Routine Oral Hygiene Involves tooth brushing and flossing Involves tooth brushing and flossing Should be done at least three times a day Should be done at least three times a day Provide necessary equipment such as toothbrush, toothpaste, dental floss, mouthwash, emesis basin, cup, and water Provide necessary equipment such as toothbrush, toothpaste, dental floss, mouthwash, emesis basin, cup, and water Assist the patient as needed Assist the patient as needed

23. Denture Care Proved privacy for the pt. Proved privacy for the pt. Have pt. remove dentures if able Have pt. remove dentures if able Place dentures in a denture cup to carry to sink Place dentures in a denture cup to carry to sink Use warm water to clean dentures Use warm water to clean dentures Hold dentures securely. Let pt rinse mouth and brush gums Hold dentures securely. Let pt rinse mouth and brush gums Store dentures in a denture cup labeled with the pts. name Store dentures in a denture cup labeled with the pts. name

24. Special Oral Hygiene Usually given to unconscious or semiconscious pts Usually given to unconscious or semiconscious pts Tell the pt. what you are doing Tell the pt. what you are doing Turn pt. what you are doing Turn pt. what you are doing Turn pts. Head toward you Turn pts. Head toward you Use a very small amt. of liquid Use a very small amt. of liquid Clan all areas of mouth: Clan all areas of mouth: Teeth, Gums, Tongue, Roof of Mouth Teeth, Gums, Tongue, Roof of Mouth Apply lubricant to tongue and lips Apply lubricant to tongue and lips

25. Bathing Types of Baths Types of Baths Complete Bed Bath (CBB) Complete Bed Bath (CBB) Pt. is usually confined to bed and the health care worker must bathe all parts of the pts. body Pt. is usually confined to bed and the health care worker must bathe all parts of the pts. body Partial Bed Bath Partial Bed Bath Pt. washes some of the parts of their body and the health care worker washes the parts of the body the pt. cannot reach Pt. washes some of the parts of their body and the health care worker washes the parts of the body the pt. cannot reach

26. Bathing Cont. Tub Bath or Shower Tub Bath or Shower Health care worker prepares the tub or shower area and assists pt. as needed Health care worker prepares the tub or shower area and assists pt. as needed

27. Complete Bed Bath Use standard precautions Use standard precautions Provide privacy, comfort, and safety Provide privacy, comfort, and safety Fill basin 2/3 full with warm water at a temp. of 105-110 F Fill basin 2/3 full with warm water at a temp. of 105-110 F Form a mitten around your hand with the cloth Form a mitten around your hand with the cloth

28. CBB Cont. Wash body parts in this order: Wash body parts in this order: Face, ears, and neck -> axilla, arms, and hands (apply deodorant) -> chest, breast, and abdomen -> thighs, legs, and feet (change water) -> back, buttock, and back of perineum (give back rub) -> perineum area Face, ears, and neck -> axilla, arms, and hands (apply deodorant) -> chest, breast, and abdomen -> thighs, legs, and feet (change water) -> back, buttock, and back of perineum (give back rub) -> perineum area Change water when it becomes too cool, dirty or soapy Change water when it becomes too cool, dirty or soapy

29. Tub Baths and Showers Usually require a physician’s order Usually require a physician’s order Make sure tub or shower is clean Make sure tub or shower is clean Put rubber mat in tub or shower Put rubber mat in tub or shower Full tubs half full with water at 105 F Full tubs half full with water at 105 F Help pt. into the tub or shower (Use the shower chair for pt. who cannot stand) Help pt. into the tub or shower (Use the shower chair for pt. who cannot stand) Assist pt. as needed Assist pt. as needed

30. Tub Baths and Showers Cont. Stay with pt. or make sure pt. can use the emergency call system Stay with pt. or make sure pt. can use the emergency call system After bath or shower, cover pt. with a towel or bath blanket After bath or shower, cover pt. with a towel or bath blanket Clean the tub or shower with a disinfectant after each use Clean the tub or shower with a disinfectant after each use

31. Measuring and Recording Intake and Output Amount of fluid taken into the body should equal the amount of fluid lost from the body. Amount of fluid taken into the body should equal the amount of fluid lost from the body. Excessive fluid retained by body=edema (swelling) Excessive fluid retained by body=edema (swelling) Excessive fluid lost by body= Excessive fluid lost by body= What do you measure? What do you measure? IntakeOutput OralBowel IVEmesis IrrigationUrine Irrigation

32. Intake Oral Oral Includes liquids taken by mouth Includes liquids taken by mouth Also includes foods that are liquid at room temp. such as soup, jell-o, ice cream, pudding, and Popsicle’s Also includes foods that are liquid at room temp. such as soup, jell-o, ice cream, pudding, and Popsicle’s Tube feeding is usually recorded under oral intake Tube feeding is usually recorded under oral intake Fluids are measured in metric units Fluids are measured in metric units

33. Intake Cont. 1 Cubic Centimeters (cc) = 1 Millimeter (ml) 1 Cubic Centimeters (cc) = 1 Millimeter (ml) Memorize these equivalents Memorize 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) ounce 30 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)

34. Measuring Intake Fred is on I & O. When you go into his room after lunch, you examine his lunch tray and find he consumed the following: Fred is on I & O. When you go into his room after lunch, you examine his lunch tray and find he consumed the following: 1 hamburger, ½ bowel of chicken broth (1 soup bowl=200cc), 4 soda crackers, 1 cup of tea, ¾ carton of milk (1carton=8 oz), ½ bowel of jello (1 small bowl=120cc) What was Fred’s fluid intake?

35. Measuring Output Output = all fluids eliminated by the pt. Output = all fluids eliminated by the pt. BM BM Liquids BMs are measured and recorded Liquids BMs are measured and recorded Solid or formed BM is usually noted under feces or the remarks column Solid or formed BM is usually noted under feces or the remarks column Emesis Emesis Measure anything that is vomited Measure anything that is vomited Also not color, type, and other facts in the remarks column Also not color, type, and other facts in the remarks column

36. Measure Output Cont. Urine Urine Measure all urine voided or drained via a catheter Measure all urine voided or drained via a catheter Men can collect their urine in a urinal and women can collect their urine in a bedpan or a special urine collector that can be placed under the seat of the toilet Men can collect their urine in a urinal and women can collect their urine in a bedpan or a special urine collector that can be placed under the seat of the toilet Irrigation Irrigation Measure any drainage from nasogastric tubes, hemo-vacs, chest tubes or other drainage tubes Measure any drainage from nasogastric tubes, hemo-vacs, chest tubes or other drainage tubes These measurements are usually done by the nurse These measurements are usually done by the nurse

37. Measuring Output Jennifer is on I & O. A the end of an 8 hour shirt, you note the following: Jennifer is on I & O. A the end of an 8 hour shirt, you note the following: 0800 she voided 400 cc of urine 1000 she vomited 200 cc of thick yellow emesis with food particles in it 1130 she had one formed green BM 1315 she voided 350 cc of urine What was Jennifer’s output for the 7-3 shift?

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

39. Feeding Cont. Put over bed table in position Put over bed table in position Check to make sure the pt. is not NPO Check 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. Chin Place a towel or napkin under pts. Chin Open packages and cartoons; season and cut foods if necessary Open packages and cartoons; season and cut foods if necessary

40. Steps for feeding pt. Test temperature of hot foods by placing small amount on wrist Test temperature of hot foods by placing small amount on wrist Feed pt. slowly and allow them time to chew Feed pt. slowly and allow them time to chew Use separate straw for each liquid Use separate straw for each liquid Hold utensil at a 90 degree angle to the pt. mouth Hold utensil at a 90 degree angle to the pt. mouth Give small bites Give small bites

41. Steps for Feeding Pts. Cont. Alternate the foods and liquids Alternate the foods and liquids Allow pt. to help as much as they are able to Allow 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 necessary Wipe the pts. mouth as necessary Encourage pt. to each as much as possible Encourage pt. to each as much as possible

42. After the Meal Allow pt. to wash their face and hands Allow pt. to wash their face and hands Provide oral hygiene Provide oral hygiene Position pt. in correct body alignment Position pt. in correct body alignment Clean area Clean area Note how much food was eaten Note how much food was eaten Calculate I & O if this is ordered for pt. Calculate I & O if this is ordered for pt.

43. Bed Pans and Urinals Urinate, micturate, or void – terms for emptying of the bladder, which stores urine Urinate, micturate, or void – terms for emptying of the bladder, which stores urine Urinals are used by male pts. when they need o micturate Urinals are used by male pts. when they need o micturate A bedpan is used by females when they need to micturate A bedpan is used by females when they need to micturate Defecate – having a bowel movement Defecate – having a bowel movement Both men and women must use a bedpan when they need to defecate Both men and women must use a bedpan when they need to defecate

44. Bedpans and Urinals Cont. Two main types of bedpans Two main types of bedpans Fracture or orthopedic bedpan Fracture or orthopedic bedpan Standard bedpan Standard bedpan Many patients are sensitive about using the bedpan. Always provide privacy and make them as comfortable as possible. Many patients are sensitive about using the bedpan. Always provide privacy and make them as comfortable as possible.

45. Assisting with a Bedpan Use standard precautions and wear gloves Use standard precautions and wear gloves Provide privacy for the pt Provide privacy for the pt Warm bedpan by running warm water over it Warm bedpan by running warm water over it There are two positions to place the pan under the pt. There are two positions to place the pan under the pt. Pt. flexes knees and puts weight on heels. They then lift their hips up Pt. flexes knees and puts weight on heels. They then lift their hips up Pt. is turned to one side and the pan is placed against the buttock and the pt is rolled back on the pan Pt. is turned to one side and the pan is placed against the buttock and the pt is rolled back on the pan

46. Assisting with a Bedpan cont. The pts. Buttock should rest on the rounded portion of the pan The pts. Buttock should rest on the rounded portion of the pan Place call bell and tissue within the pts. reach Place call bell and tissue within the pts. reach Raise siderail before leaving the pt. Raise siderail before leaving the pt.

47. All Done Answer call bell immediately Answer call bell immediately Use the same positions to get pt. off the pan, but hold pan firmly Use the same positions to get pt. off the pan, but hold pan firmly Cover the bedpan and place on nearby chair or table Cover the bedpan and place on nearby chair or table Make sure perineum is clean and dry Make sure perineum is clean and dry Assist pt. in washing hands Assist pt. in washing hands Clean bedpan and note any abnormalities of urine or BM Clean bedpan and note any abnormalities of urine or BM

48. Assisting with Urinal Use standard Precautions and wear gloves Use standard Precautions and wear gloves Provide privacy for pt. Provide privacy for pt. Assist with placement of the urinal if needed Assist with placement of the urinal if needed Leave the call bell and toilet tissues near the patient Leave the call bell and toilet tissues near the patient Answer the pts. call bell immediately Answer the pts. call bell immediately

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

50. Restraints May be used only to protect pts. from harming themselves or others May be used only to protect pts. from harming themselves or others Must have doctor’s order to use restraints Must have doctor’s order to use restraints Conditions that may require restraints Conditions that may require restraints Irrational or confused pts. Irrational or confused pts. Skin conditions Skin conditions Paralysis or limited muscular conditions Paralysis or limited muscular conditions

51. Restraints Cont. Types of restraints Types of restraints Straps or safety belts Straps or safety belts Limb restraints Limb restraints Leather Cuffs or locks Leather Cuffs or locks Restraint jackets Restraint jackets Restraint applied unnecessarily=false imprisonment

52. When using restraints Use only when other alternatives fail Use only when other alternatives fail Allow pt. to move as much as possible Allow pt. to move as much as possible Always tell pt. why they are being restrained Always tell pt. why they are being restrained Reassure pt. frequently Reassure pt. frequently Check circulation below limb restraints every 15 minutes Check circulation below limb restraints every 15 minutes All restraints must be removed every 2 hours and skin color care given All restraints must be removed every 2 hours and skin color care given

53. Complications from Restraints Physical and mental frustration Physical and mental frustration Impaired circulation Impaired circulation Decubitus ulcers Decubitus ulcers Loss of muscle tone Loss of muscle tone Joint stiffness Joint stiffness Respiratory or breathing problems Respiratory or breathing problems