1. 1. Explain why a comfortable environment is important for the resident’s well-being
REMEMBER: NAs can help residents feel at home and possibly even improve their health by maintaining a clean and comfortable environment.

2. 1. Explain why a comfortable environment is important for the resident’s well-being
NAs should remember the following guidelines for promoting comfort in the resident’s unit:
Help keep the noise level low.
Don’t bang equipment or meal trays.
Keep voice low.
Answer phones and call lights promptly.
Close doors when asked to do so.
Turn off televisions when not in use.

3. 1. Explain why a comfortable environment is important for the resident’s well-being
Guidelines for promoting comfort in the resident’s unit (cont’d):
Control odors.
Clean up promptly after incontinence.
Change incontinence briefs promptly and dispose of them properly.
Empty and clean bedpans, urinals, commodes, and emesis basins promptly.
Change soiled linens and clothing as soon as possible.
Give regular oral care and personal care.

4. 1. Explain why a comfortable environment is important for the resident’s well-being
Guidelines for promoting comfort in the resident’s unit (cont’d):
Help residents feel comfortable. OBRA requires facilities maintain temperature range of 71-81°F.
Layer clothing and bed covers.
Keep residents away from drafts.
Offer blankets to residents in wheelchairs.
Keep residents covered while giving personal care.

5. 1. Explain why a comfortable environment is important for the resident’s well-being
Guidelines for promoting comfort in the resident’s unit (cont’d):
Provide appropriate lighting and keep lighting controls within resident’s reach.
Report resident complaints about food to the nurse.
Be aware that caffeine may need to be decreased to promote better rest.
Listen to residents’ concerns and provide emotional support. Report to nurse if resident seems to need more assistance than you can give.

6. 2. Describe a standard resident unit
REMEMBER: A resident’s room is her home. Residents’ living spaces and their personal possessions must be respected.

7. 2. Describe a standard resident unit
The following equipment is usually found in a resident’s unit:
Bed
Bedside stand (which may contain the following items):
Urinal/bedpan
Wash basin
Emesis basin
Soap dish and soap
Bath blanket
Toilet paper
Personal hygiene items
Overbed table

8. 2. Describe a standard resident unit
Equipment usually found in a resident’s unit (cont’d):
Chair
Bath basin
Call light
Privacy curtain

9. 2. Describe a standard resident unit
REMEMBER:
Soiled items, bedpans, and urinals should never be placed on the overbed table.

10. 2. Describe a standard resident unit
REMEMBER:
Privacy curtains should be pulled every time NAs give care.

11. 3. Discuss how to care for and clean unit equipment
REMEMBER:
Infection prevention measures must be followed when cleaning a resident’s unit.

12. 3. Discuss how to care for and clean unit equipment
Think about this question:
What types of equipment in a resident’s unit will need to be cleaned after each use?

13. 3. Discuss how to care for and clean unit equipment
NAs should remember these guidelines for the resident’s unit:
Clean the overbed table after each use.
Keep call light within reach.
Keep equipment clean and in good condition. Report problems with equipment to nurse or according to facility guidelines.
Remove meal trays promptly, then remove crumbs and straighten linen. Change linen if it is wet, soiled, or wrinkled.

14. 3. Discuss how to care for and clean unit equipment
Guidelines for the resident’s unit (cont’d):
Re-stock personal supplies as needed. Keep water pitchers filled.
Notify housekeeping department if trash needs to be emptied.
Report signs of insects or pests immediately.
Do not move residents’ belongings.
Clean equipment and return it to proper storage. Tidy the area.

15. 4. Explain the importance of sleep and factors affecting sleep
Define the following terms: circadian rhythm the 24-hour day-night cycle. insomnia inability to fall asleep or remain asleep.

16. 4. Explain the importance of sleep and factors affecting sleep
Lack of sleep can cause the following problems:
Decreased mental function
Reduced reaction time
Irritability
Decreased immune system function

17. 4. Explain the importance of sleep and factors affecting sleep
The following factors can affect sleeping patterns:
Fear
Stress
Noise
Diet
Medications
Illness
Sharing a room with another person

18. 4. Explain the importance of sleep and factors affecting sleep
NAs should observe for the following when a resident is not sleeping well:
Sleeping too much during the day
Drinking too much caffeine
Dressing in night clothes during the day
Eating too late at night
Refusing prescribed medications
Taking new medications
Having TV, radio, computer, or light on late at night
Pain

19. 5. Describe bedmaking guidelines and perform proper bedmaking
Define the following terms: occupied bed a bed made while a person is in the bed. unoccupied bed a bed made while no person is in the bed. closed bed a bed completely made with the bedspread and blankets in place. open bed a bed made with linen folded down to the foot of the bed. surgical bed a bed made to accept residents who are returning to bed on stretchers.

20. 5. Describe bedmaking guidelines and perform proper bedmaking
Proper bedmaking is important for the following reasons:
Damp and wrinkled sheets are uncomfortable and may keep the resident from sleeping well.
Microorganisms thrive in moist, warm places, and damp, unclean bedding may cause infection or disease.
Sheets that are not flat increase risk for pressure ulcers.

21. 5. Describe bedmaking guidelines and perform proper bedmaking
NAs should remember these guidelines for bedmaking:
Keep linen wrinkle-free and tidy.
Wash hands before handling clean linen.
Place clean linen on clean surface, such as chair, overbed table, or bedside stand.
Don gloves before removing bed linen.
Look for personal items before removing linen.
When removing linen, fold or roll linen so the dirtiest area is inside.

22. 5. Describe bedmaking guidelines and perform proper bedmaking
Guidelines for bedmaking (cont’d):
Do not shake linen or clothes.
Bag soiled linen at point of origin, and do not take it to other residents’ rooms.
Sort soiled linen away from care areas.
Place wet linen in leakproof bags.
Wear gloves when handling soiled linen. Hold soiled linen away from your body. If dirty linen touches your uniform, your uniform becomes contaminated.
Disposable bed protectors or pads are used for incontinent residents. Change them as soon as they are soiled or wet, and dispose of them properly.

23. Identify yourself by name. Identify the resident by name.
Making an occupied bed
Equipment: clean linen— mattress pad, fitted or flat bottom sheet, waterproof bed protector if needed, cotton draw sheet, flat top sheet, blanket(s), bath blanket, pillowcase(s), gloves
Identify yourself by name. Identify the resident by name.
Wash your hands.
Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.

24. Provide for the resident’s privacy with curtain, screen, or door.
Making an occupied bed
Provide for the resident’s privacy with curtain, screen, or door.
Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair).
Adjust bed to a safe working level, usually waist high. Lower head of bed. Lock bed wheels.
Put on gloves.
Loosen top linen from the end of the bed on the working side.

25. Making an occupied bed
Unfold bath blanket over the top sheet to cover the resident, and remove the top sheet. Keep the resident covered at all times with the bath blanket.
You will make the bed one side at a time. Raise side rail (if bed has them) on far side of bed. This protects the resident from falling out of the bed while you are making it. After raising side rail, go to the other side of the bed. Help resident to turn onto her side, moving away from you, toward the raised side rail.

26. Making an occupied bed
Loosen bottom soiled linen, mattress pad, and protector, if present, on the working side.
Roll bottom soiled linen toward resident, soiled side inside. Tuck it snugly against the resident’s back.
Place the mattress pad (if used) on the bed, attaching elastic at corners on working side.

27. Making an occupied bed
Place and tuck in clean bottom linen. Finish with bottom sheet free of wrinkles. If you are using a flat bottom sheet, leave enough overlap on each end to tuck under the mattress. If the sheet is only long enough to tuck in at one end, tuck it in securely at the top of the bed. Make hospital corners to keep bottom sheet wrinkle-free.

28. Making an occupied bed
Smooth the bottom sheet out toward the resident. Be sure there are no wrinkles in the mattress pad. Roll the extra material toward the resident. Tuck it under the resident’s body.
If using a waterproof bed protector, unfold it and center it on the bed. Tuck the side near you under the mattress. Smooth it out toward the resident. Tuck as you did with the sheet.

29. Making an occupied bed
If using a draw sheet, place it on the bed. Tuck in on your side, smooth, and tuck as you did with the other bedding.
Raise side rail nearest you. Go to the other side of the bed and lower the side rail on that side. Help resident turn onto clean bottom sheet. Explain that she will be rolling over a pile of linen. Protect the resident from any soiled matter on the old linens

30. Making an occupied bed
Loosen the soiled linen. Check for any personal items. Roll linen from head to foot of the bed. Avoid contact with your skin or clothes. Place it in a hamper or bag. Never put it on the floor or furniture. Never shake it. Soiled bed linens are full of microorganisms that should not be spread to other parts of the room.

31. Making an occupied bed
Pull the clean linen through as quickly as possible. Start with the mattress pad and wrap around corners. Pull and tuck in clean bottom linen just like the other side. Pull and tuck in waterproof bed protector and draw sheet if used. Finish with bottom sheet free of wrinkles.
Ask resident to turn onto her back. Help as needed. Keep resident covered and comfortable, with a pillow under her head. Raise the side rail.

32. Making an occupied bed
Unfold the top sheet. Place it over the resident and center it. Ask the resident to hold the top sheet. Slip the bath blanket or old sheet out from underneath. Put it in the hamper or bag.
Place a blanket over the top sheet, matching the top edges. Tuck the bottom edges of top sheet and blanket under the bottom of the mattress. Make hospital corners on each side. Loosen the top linens over the resident’s feet. This prevents pressure on the feet. At the top of the bed, fold the top sheet over the blanket about six inches.

33. Remove and discard gloves. Wash your hands.
Making an occupied bed
Remove the pillow. Do not hold it near your face. Remove the soiled pillowcase by turning it inside out. Place it in the hamper or bag.
Remove and discard gloves. Wash your hands.

34. Making an occupied bed
With one hand, grasp the clean pillowcase at the closed end. Turn it inside out over your arm. Next, using the same hand that has the pillowcase over it, grasp one narrow edge of the pillow. Pull the pillowcase over it with your free hand. Do the same for any other pillows. Place them under resident’s head with open end away from door.

35. Make resident comfortable.
Making an occupied bed
Make resident comfortable.
Return bed to lowest position. Leave side rails in the ordered position. Remove privacy measures.
Place call light within resident’s reach.
Take laundry bag or hamper to proper area.
Wash your hands.
Report any changes in resident to the nurse.
Document procedure using facility guidelines.

36. Making an unoccupied bed
Equipment: clean linen— mattress pad, fitted or flat bottom sheet, waterproof bed protector if needed, blanket(s), cotton draw sheet, flat top sheet, pillowcase(s), gloves
Wash your hands.
Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair).
Adjust bed to a safe working level, usually waist high. Put bed in flattest position. Lock bed wheels.
Put on gloves.

37. Making an unoccupied bed
Loosen soiled linen. Roll soiled linen (soiled side inside) from head to foot of bed. Avoid contact with your skin or clothes. Place it in a hamper or bag. Do not put it on the floor or furniture.
Remove and discard gloves. Wash your hands.
Remake the bed. Start with the mattress pad and wrap around corners. Place bottom sheet, tucking under mattress. Make hospital corners to keep the bottom sheet wrinkle-free. Put on waterproof bed protector and draw sheet, if used, smooth, and tuck under sides of bed.

38. Making an unoccupied bed
Place top sheet and blanket over bed. Center these, tuck under end of bed and make hospital corners. Fold down the top sheet over the blanket about six inches. Fold both top sheet and blanket down so resident can easily get into bed. If resident will not be returning to bed immediately, leave bedding up.
Remove pillows and pillowcases. Put on clean pillowcases. Replace pillows.
Return bed to lowest position.

39. Making an unoccupied bed
Take laundry bag or hamper to proper area.
Wash your hands.
Document procedure using facility guidelines.

40. Remove and discard gloves. Wash your hands.
Making a surgical bed
Equipment: clean linen (see procedure: Making an unoccupied bed), gloves
Wash your hands.
Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair).
Adjust bed to a safe working level, usually waist high. Lock bed wheels.
Put on gloves.
Remove all soiled linen, rolling it (soiled side inside) from head to foot of bed. Avoid contact with your skin or clothes. Place it in a hamper or bag.
Remove and discard gloves. Wash your hands.

41. Put on clean pillowcases. Replace pillows.
Making a surgical bed
Make an unoccupied, closed bed. See procedure: Making an unoccupied bed.
Loosen linens on the side of bed that is away from the door (where the stretcher will be).
Fanfold linens lengthwise to the side away from door. Fanfolded means folded several times into pleats.
Put on clean pillowcases. Replace pillows.
Leave bed in its locked position with both side rails down.
Make sure the pathway to the bed is clear.

42. Take laundry bag or hamper to proper area. Wash your hands.
Making a surgical bed
Take laundry bag or hamper to proper area.
Wash your hands.
Document procedure using facility guidelines.

43. Exam Multiple Choice. Choose the correct answer.
What can an overbed table be used for?
(A) Placement of dirty linens
(B) Placement of bedpans
(C) Placement of meals
(D) Placement of urinals
How should a nursing assistant enter a resident’s room?
(A) Knock and wait for permission to enter
(B) Walk in if the door is open
(C) Say her name as she walks in
(D) Call the resident first to make sure he or she is alone

44. Exam Which of the following is a type of disposable equipment?
(A) An autoclave
(B) An electric razor
(C) A bedpan
(D) Gloves
When leaving a resident’s room, a nursing assistant should
(A) Leave the call light within the resident’s reach
(B) Move the resident’s belongings
(C) Leave spills for the next shift
(D) Remind the resident not to call her again because she’ll be busy with other residents

45. Exam How can a nursing assistant help control odors in a facility?
(A) He can ask the resident to clean up if he soils his linens.
(B) He can clean up within an hour after episodes of incontinence.
(C) He can ask residents to use the toilets in the reception area instead of in their units.
(D) He can empty and clean bedpans immediately after use.
Which of the following is true of sleep?
(A) The elderly usually go to sleep faster than other groups.
(B) The elderly are more able to tolerate sleep deprivation than other groups.
(C) Lack of sleep can cause decreased mental function.
(D) People can live in good health even without much sleep.

46. Exam Lack of sleep can cause (A) Increased mental function
(B) Increased reaction time
(C) Increased immune system function
(D) Increased irritability
The bedside stand is used for
(A) Linen storage
(B) Serving meals
(C) Storing equipment
(D) Storing valuables

47. Exam What should be done with soiled bed linens?
(A) They should be shaken out to be sure none of the residents’ personal belongings are put in the wash.
(B) They should be rolled up with the dirty side in.
(C) They should be rolled up with the clean side in.
(D) They should be left in a pile outside the resident’s door for housekeeping to pick up.
When should sheets be changed?
(A) Daily
(B) Twice a week
(C) Every other day
(D) When they are soiled, wrinkled, or damp

48. Exam
According to OBRA, what temperature range must long-term care facilities maintain?
(A) 61-71°F
(B) 71-81°F
(C) 81-91°F
(D) °F
Which of the following statements is true of linen?
(A) Linen should be carried close to the NA’s uniform.
(B) Linen should be shaken to remove
wrinkles.
(C) Dirty linen should be removed by rolling it away from the NA.
(D) Linen can be taken from one resident’s room into another resident’s room.

49. Exam
Which of the following terms describes a bed that is completely made, with the bedspread and blankets in place?
(A) Closed bed
(B) Open bed
(C) Occupied bed
(D) Unoccupied bed
In which type of environment do microorganisms thrive?
(A) Cool, dry environments
(B) Clean, cold environments
(C) Dry, hot environments
(D) Warm, moist environments

50. Exam
Where should the call light be placed when a nursing assistant leaves a resident’s room?
(A) On the bedside table beside the telephone
(B) Next to the television remote
(C) Within the resident’s reach
(D) On a chair next to the resident’s bed
The circadian rhythm is
(A) The 24-hour day-night cycle
(B) The lack of ability to fall asleep or stay asleep
(C) Deep sleep that helps the body to renew
(D) The habit of taking short naps throughout the day

51. CHAPTER 12 PRACTICE
1. According to OBRA, what temperature range must long-term care facilities maintain? (A) 61-71°F (B) 71-81°F (C) 81-91°F (D) °F 2. The circadian rhythm is (A) The 24-hour day-night cycle (B) The lack of ability to fall asleep or stay asleep (C) Deep sleep that helps the body to renew (D) The habit of taking short naps throughout the day 3. When should sheets be changed? (A) Daily (B) Twice a week (C) Every other day (D) When they are soiled, wrinkled, or damp 4. How can a nursing assistant help control odors in a facility? (A) He can ask the resident to clean up if he soils his linens. (B) He can clean up within an hour after episodes of incontinence. (C) He can ask residents to use the toilets in the reception area instead of in their units. (D) He can empty and clean bedpans immediately after use. 5. Lack of sleep can cause (A) Increased mental function (B) Increased reaction time (C) Increased immune system function (D) Increased irritability

52. CHAPTER 12 PRACTICE ANSWERS
B-71* TO 81*
A-THE LACK OF ABILITY TO FALL ASLEEP OR STAY ASLEEP
D-GLOVES
D-EMPTY AND CLEAN BEDPANS IMMEDIATELY AFTER USE
D- INCREASED IRRATIBILITY