Fine sealpel Curved cutting needle iv. Nylon thread or silk worm gut v. Needle holder vi. 2 pairs of scissors-one of whiet fine and sharp p Vii. 2 pairs of mosquito forceps vit 2 pairs of dissecting foreeps - | plain, {toothed ix. Ancurism needle x Blunt hook retractor Also on the Trolley ‘= Tray with local anesthetic agent ‘© Receiver with syringe and 2 needles “Additional requirement for scalp vein ‘Tray for shaving hairs Shave hair, wash and dry shaved part of the had (On the top shelf + Dressing towel in a bow! + Scalp vein needles this Method: ‘Same as intravenous infusion ‘Additional requirements for blood transfusion + Blood grouped and eross matched + Blood form for identifying blood group, bag (bottle) number + Sterile blood giving set * Blood book for cross checking blood group and expiration date ee, placed on bottom shelf oftolley “Method: Same for intravenous infusion except for the observation of patient before, during and afler the transfusion. 14, BED-MAKING Definition: Bed making is the act of making tp a bed according to patient's condition using adequate equipment and nursing technique. Principles of bed-making Principles of bed making are those guidelines ‘and precautions that must be followed carefully to ensure the greatest outcome possible, They include: ‘© Ensure safety. comfort, cleanliness of the patient and attractiveness of his environment ‘© Ensure economy of equipment, nurses! time and energy during bed making, © Good body mechanics must be used to prevent undue fatigue and strain to the B ‘© Any damaged equipment or tom finen ‘hould not be used but is sent for mending or repairs according to ward procedure. ‘s There should be no jaring of beds No bed linens and accessories should be allowed to touch the oor. ‘any conversation going on during bed making must iavolve the patient «The procedure should be explained to the patient and consent obtained before commencing ‘Assess patient prior tot ‘All needed requiterents ru before starting. = Two nurses should harmony, one on either sis © The ward should be prepa aking ie. no feeding oF teat be + goingon ‘© The patient ‘unnecessarily. ‘© The patients’ face should never be covered ‘with bed cloths © Call for help when necessary to move heavy or very ill patient. +. Avoid flapping of bed linens to minimize the risk of eross infection. + Pillows should be placed with open end away from the main door. + The murse should tum away from the patient while shaking the pillows. ‘+ When replacing top sheet, allow room for patient's fet. ‘+ If any linen needs to be sluiced before sending to the laundry, place directly in a bucket with lid, not in linen bin/hamper. ‘© Keep patient in required position for his treatment throughout the petiod of bed © making, ‘© The bed, ifto be stripped, must be stripped unto twa chairs placed back to back at t Ihebottom of the bed. Hands should be washed before and after ‘bed making. the procedure. st be collected work together in ide ofthe bed. wed for bed- tment should should not be exposed ‘TYPES OF BED 1. Simple bed (occupied and uncecupied) 2 Operation bed 3. Cardiac bed 44. Fracture bed 5. Divided bed 6 Plater bed 7. Amputation bed4 npprcue ne 8. Emergency bed 3 Method of stripping an unoccupied bed Reaqirements 1. Two chairs 2 Soiled linen coatainerinen barpe" 3. Clean bed linen Stripping «Place 2 chars back to back atthe foot of the bed Remove pillows and place on chairs © Untuck the shects and counterpane from teat the fot ofthe De Take off the bod-lohes separately, fold cach actin thre illustrated «© Place articles oa the chairs making an txts pleat 10 the seat of the chai 1 ep the Bed clothes well away from the floor fa draw shoot is used, gather the draw sheet neatly and shake gently «Place on he chair © Repeat with draw mackinosh folding as usual ‘© Brush off crumbs from bottom shee, fold int three as above ‘© Brush off crumbs and remove long smackintosh + Tum matress where applicable and pull to the head ofthe bed, 18, SIMPLE BED ‘Simple unoccupied! Admission/Vacant bed Definition: This isa bed which has been made ‘up and a patient isnot admited on it. Iisa wolley procedure Requirements: ‘Top Shelf: 2 large sheets 1 draw sheet | counterpane blanket Bottom Shelf 1 draw mackintosh 1 Tong mackintosh if mattress is not ‘covered with mackintosh 2 chairs placed back to back Dusting brush in a receiver Disposable gloves Procedure: 1. Wash hands and collect requirements. 2. Place two chairs hack wo hack 3. Place linen in order of use on the wwolley 16. “ Put om gloves Pl be from wall Remove debris and crumbs from mattress with dusting brush ‘Tum mattress and dust as above $. Cover mattress with long mackintosh i 9, Place bottom sheet and spread evenly con bed with aight side uppermost to. Tuck in at the top and bottom usin envelop comers then tuck in sides neatly and firmly 11Place draw mackintosh across. the entre ofthe bed and tck in both ses ly 12 Cover the draw mackintosh with draw sheet, tuck in one side, pull excess 10 the others, tuck in neatly in pleats 13, Spread top sheet centrally of the bed with ight side downwards 14 Tuck in bottom end of the shect in envelope comer. 15. Spread blanket on top of the sheet with side uppermost. and tuck in botior inenvelp comer. 16.Fold the top pat of the blanket outwardly. The top part of the top sheet is broughulown over the folded blanket to look like an ordinary cverlay. Tuk in both sides 17. Pace the counerpane, tuck in bottom in emelop comer, allow the sides to ft 18, Push bed back its proper poston 19, Amange lockers a bed tables. 20. Takeaway wlley 21, Remove gloves 22! Wash hands. SIMPLE OCCUPIED BED Definition Simple occupicd bed is a bed to which a patient is admitted but may be out of bed during bed making I the condition of the patient does not allow him or her to sit out of bed, the bed is made using turing of the patient from side to side or “lifting the patient from top 0 bottom metho Requirements: Sane as for simple unoccupied bod with the following extra requirements Dirty linen binyhampe. © Bucket with ld for soiled linen ‘+ Clean patients gownvr + Pillow * Pillow slip + Two chairs placed back to back ‘rocedure 1. Explain procedure to the patent and obtain informed consent 2. Wash hands & put on gloves 3. Clean trolley by using sprit with cotton wool swab 4, Remove gloves 3. Wash hands and set requirements 6, Take trolley othe bedside 7. Sot two chairs back to back a the foot ofthe bed (sipper) comer 8. Pace pillows onthe char 9, Where patient can sit out of bed, Yoosen all bed clothes from top. to bottom. Strip off had clothes and fold coch article in shape from top 10 bottom, 10, Soiled tnens sre placed in the ‘cet with ld tobe suicd, otherwise diy linens are placed dircly into linen bin 11. Tt there are any crumbs or debris, brash out with dusting brash into @ Kidney dish 12 TF the matress cover is not of ‘mackintosh material, the long ‘mackintosh is placed and tucked in 13. Do. mumbers. 8-14 in simple ‘unecupied bed 14, Place the eounterpane and fld the per side inwardly and tuk in bottom inenvelop 15. Fold the Blanket and top shest separately over the folded countepane 16. Tuck in the lef side, then open up fiom the right side of the patient in a triangular form. This is for easy reception ofthe patient 17. Push bed back to its proper pesition 1S. Arrange bed tables and lockers. 19, Take aay wll, 20, Remove loves & wash hands u NB: Ifthe patent cannot sit out of bed, the boom shes, draw mackiniesh and draw sheet ce made using the following methods ‘Changing bottom sheet (From side to side) This method is used for patients who can lie Maton bod 8 1. Explain procedure to the patent and obtain informed consent 2. Provide privacy by screening the bed 3. Wash hands and put on gloves and clean trolley 4, Remove gloves and wash hands 5. Collet requirements 6, Puton gloves 7-Pull bed out fom the wall §. Place chairs bac to back at the foot ‘ofthe bed or (stripper) 9, Loosen sides of the bed clothes stating fom top to bottom, 10. Remove counterpane and blanket, fold as usual and place on the huivstipper leaving patient covered with tp shoe 11, Remove all bat one pillow. 12, Tum patient to lateral position or near the eige of one side of the bed, moving the pllow tothe patients head. 13. Nurse supports the patient if be is unable to support himself 14. The second nurse rolls draw sheet, raw smackntosh and otom sheet towards the paints back. 15. Clean and straighten the matress, 1. Insert clean bottom sheet, draw ‘mackintoh and draw sheet. 17. Roll remaining pars against or towards patient 18, Tuck inthe tp, bottom in envelope camer 19. Ensue smooth and fim surface 20, Tuck nthe sides 21 Treat pressure areas necessary 22. Tun paint 10 the opposite side ‘ving thi to he patient’ head, 28. The second murse removes the Sei or diy sheets and puts them in ‘he dit inn bin or backet with i 24 Straighten the matress cover 25, Uno the clean botiom sheet fom entre of he bd 26. Tuck in top and bottom using ‘velop comers, then he side 27 Ensure a smooth and firm suriee 28, Uno the dea’ mackish fom the cent, pl ily and tack in. 29. Uno the clean da sheet from she ent, ack the ed i pleats 3M. Make up top shost as where the patient can it ot of ba31. Place top Tinens in usual mannes, ‘and tuck in Precautions: © The tuming should not unnecessary strain to the patient. = The nurses should work smoothly, {quickly and without wasted motion. +The nurse should be sure to maintain proper posture * Sheets must be wrinkle fre: ++ Observation of the patient should be made considering his diagnosis and mera condition ‘© Pressure areas should be treated while patient ison side. + TP the patient is helpless and requires passive change of position, his position ‘Should be changed from that which he ‘vas in at the start of the procedure Changing bottom sheet (from top to bottom) This method is used for patients who cannot 4. The P* nurse support the patient while the 2 muse icks in her own side of the sheets oth nurses it the patient up in bed wsing the ‘method described above, ‘i 8. Now both nurses smoothen, tighten and tuck in bottom bedding 9. Replace bolster to support the feet and prevent foot drop. 10. Arrange top bed clothes. 1, Arrange locker, bed and chair in a tidy, convenient position. 12, Replace chart, remove sereen, linen bin and other equipments used, 13, Leave patie 14. Remove gloves. Precautios comfortable, id wash hands, ‘Be sure that patient does not try o lift himself during this procedure as this could be detrimental to his condition Jie flat in bed. fo It treatment of pressure area is to be Extra requirements done on patient; it should be done Bolster before replacing top bedding, © Extra pillows and pillow slips if 17. OPERATION BED necessary Definition: Procedure ‘This isthe type of bed made for reception of a 1, Do numbers I to 6 above 2. Screen the bed 3, Remove all top bedding except tp sheet 4. Remove bolster and loosen botwom bed linens 5. Lift patient down in bed in the following i, Cross patient's hand over chest ii, Nurses lock their wrists behind patient's shoulder and under the thighs. iii, On the count oF 3, ift patient down, 6. One nurse remains with the patient, supporting him in comlortable postion while the other nurse does the following i, Removes pillows and back rest ii, Folds down soiled sheets from head ‘of bed to patient's back iii, Places bottom she towards the patient's back iv, Places draw mackintosh, if fresh ‘one is to be used, or draws up the one in position, smoothens and tucks it in, Y. Places draw sheet and tucks it in on her side. +i, Places back rest and pillows, and rolls 16 patient after surgery Uses: For close observation of postoperative patients. For quick resuscitation in ease of post- ‘operative shock. ‘To monitor progress of recovery from anesthesia Requirements Same as for simple occupied bed with the addition ofthe following Dressing mackintosh and towel Drip stand Oxygen apparatus Suction machine Vital signs tray Resuscitation tay containing: Long artery forceps Dissecting forceps Tongue holding forceps le depressor Gallipot of gauze swabs Receiver for used swabs icy drugsVomit bow! by the bed side Mouth gag Procedure 1. Wash hands and put on gloves 2. Clean trolley by using. spi cotton woo! swab 3. Remove gloves and wash hands 4, Set vital signs and resuscitation tray 5. Collet requirements {6 Make Foundation of bed in the usual 7. Place dressing mackintosh and dressing towel atthe head ofthe bed 8, Place top linens. 9, Fold the top linens into a pack oF fold over the bed to the edge of the mattress opposite the side from whi the patient enters the bed and tuck in the left side 10, The vital signs tray is left on the bed table while the resuscitation tray is Ieft on top of the bed side locker. TT. Place the drip stand appropriately 12. Check if oxygen and sunction apparatus are functioning well and place at convenient and appropriate positions T3. Clear away the trolley and wash hands. and N. B. The nurse making this type of bed should have a thorough knowledge of: i, Rules of bed making Post-operative care of patients who have had general anaesthesia ii, Oxygen therapy Intea-venous therapy Suctioning 18, EMERGENCY BED Definition: This is the type of bed made for emergency reception of a patient for admission. Uses: = For easy reception ofthe patient * To feilitte bathing the patient if necessary without undue disturbance, Requirements: Same as for simple unoccupied bed with the following extra requirements: 1. Tong mackintosh 2 Dlarge towels 3. Vital signs tray ” 4, Resuscitation tay N.B: Bed bath trolley and other requirements may be added according to patien's condition Procedure: {. Wash hands and put on gloves 2 Clean Trolley using spinit and cotton ‘wool swabs. 3 Remove gloves and wash hands 4 Collect requirements, place linen i order of use on trolley '5 Pull bed from wall 6. Place hair back 10 back 7. Remove debris and crumbs from mattress with dusting brush 8 Turn mattress and dust, 9, Cover mattress rmackintosh ifnecessary. 10. Place bottom sheet with right side uppermost and place evenly on hed 11 Tuek inat the top and bottom using. envelope comer, then sides neatly and firmly. 12. Cover the draw mackintosh with draw sheet, 13. Tuck in one side and excess to the other side and tuck in neatly and in pleats. 114, Place Long mockintosh on bed, 15. Place the wo towels on the long mackintash 16. Place the top sheet, leaving it hanging. 17, Place the blanket followed by the counterpane, all hanging 18, Make a pack using top linens with lup bath towel 19, Push back bed to its former position 20, Clear away trolley 21, Wash and dry hands with long CARDIAC BED Definition ‘A cardige bed is a bed made for patient with cardiac and respiratory problem for whom w ‘more upright position is most comfortable Requirements: Same as for simple bed with the following ‘added Back test, Six pillows with sips Linen for making of holster or foot rest Airing with cover Bed cradle 0.Sputum mug, Oxygen cylinder Bed table Call bell Procedure: * Explain procedure and reason for extra requirements o patient ‘Wash hands, dry and put on gloves Clean trolley using spirit and cotton wool swab Remove gloves and wash hands Set requirements and take to bed side Don your gloves Make the bed as for simple occupied bed up to the foundation (upto draw sheet) * Put the back rest in position at top of bed + Arrange the pillows in an arm chair fashion to suppor patient Place the covered air ring atthe centre for buttocks Secure bolster oF foot rest in positon ‘This support patents feet and prevents foot drop Place bed cradle if lower extremities are oedematous + Place top beddings as for simple bed * Place a soft pillow over a bed table foe the patient’ who finds it more comfortable to lean slightly forwards resting his arms and head on the bed table which is drawn up as near to the patient as possible. This position may ease the difficulty in breathing and + also give the patent a slight change of position * Place the sputum mug and bell on top ‘of bedside locker. + The oxygen eylinder stands by the bedside if needed At the end of the procedure clear away the twolley and leave patient comfortable in bed, 20, FRACTURE BED Definition: ‘A fracture bed is a type of bed made to provide a firm base to prevent sagging of the mattress Uses: a. 18 To ensure level support ofa fracture the spine, pelvis, lower limbs. ang slipped disc ‘Requirements: Sa a for simple occupied bed with the following additions: Fracture board Abed cradle Mackintosh covered pillow (incase of drying of P.O.P) 2 Sandbags for immobilization Other special orthopedic beds/appliances may be used according to doctor's instructions and patient's condition Procedure Defini Place fracture board under the mattress, Place bed cradle over affected limb (s) Clear away trolley. Make up bed as for simple bed until the draw sheet has been laid. Place top bedding in usual manner and tuck in the bottom end AMPUTATION BED ‘This isthe type of bed made for patients with lower knee amputation, Uses: For easy observation of the stump for hhaomorthage and quivering. To facilitate dressing ofthe stump. ‘To make patient comfortable, Requirements: Same as for simple bed with the following extra requirements; S8888 8 I dressing towels, 2 sandbags 1 bed cradle pillow with slip if necessary 1 roller cloth (draw sheet) Dressing mackintosh and all. other ‘post-operative equipments or gadgets Procedure: ‘Make up to foundation of the bed Dress pillow and place on bed if necessary Place dressing mackintosh and towel where the stump will rest under the cradle fpatient is in bed, place the bed eradle over the affected part.y Place the top sheet on top ofthe erale ‘being careful not cover the patients face > Place the blanket > Place the counlerpane on the blanket > Fold the top part of the courterpane inwardly > The top pat of the blanket is brought own over the counterpane then overap with the top shee. > The bottom part of the top linens are folded as above, make ito hang athe ‘ge of the eral, This exposes the stump for esy viewing. 'N.B. If amputation is at thigh level (above the knee) make a divided bed. patient isnot in bed, make top linens into @ pack, Pillow should not be used if patient has ‘ot recovered ftom anaesthesia 2. DIVIDED BED Definition: ‘This is the ype of bed made wih top linens in 2 parts with a division in the centre to facilitate etter observation, treatment, nursing care, less disturbance and less exposure of patient Indications: ‘To avoid over exposure of the patient while carrying out certain procedures like: > Examination of the lower part of the abdomen > Examination of the rectam and vagina > Treatment of fracture of the femur > Dressing of wounds in the perineal region ¢z burs Requirements: Same as for simple bed with these extra tems; + Two sandbags + Roller doth Dressing towel and mackitosh * Cradle Two sets oftop bed nen. Procedure: Male up tothe foundation of bed Dies up pillow and place atthe top ¥ Place dressing mackintosh and towel under the stump 4 Roll up the two sandbags with the roller lth nd ue ito immobilize the ‘sump, Pi 2B. ry Place in such a way that the end of stump is exposed Place cradle over the affected limb ‘To make up the upper half of the bed, the top sheet is spread over the bed leaving enough at top to overlay. A blanket folded in to is placed over this the lower edge lying at the centre of the bed, “The counterpane is folded as above and paved over the folded blanket. ‘The top sheet is brought down over the ‘blanket and counterpane and the excess folded in ‘To make the lower half of the bed, the ‘nd sheet is spread aver the bed and tucked in atthe bottom with envelope ‘The 2 blanket is placed then the 2” counterpane is placed and folded inwards, the blanket and top sheet are brought down to overlay the eunterpane. ‘The lower half should overlap the upper half by the least Sem (Ginches). “Tuck in at theses. ‘The two parts may be folded slightly bacovards at the affected side fo inspection when necessary 1. B. Where the patient is ot in bed, fold the ‘upper and lower halves ofthe top ines into 2 pocks and place on a cha. POSITIONS USED IN NURSING “Thote are many positions used in nursing. The position used should meet the needs of the patients, make patient comfortable and enable ‘he patients organs to function maximally. 1, RECUMBENT: Patient lies fat on his back with a pillow under his head and his hands by the sie. Uses For complete relaxation and rest For examination ofthe trunk and abdomen 2. SEMERECUMBENT: Same as former except that patent ies with two or more pillows ‘Uses Used for nursing convalescent patient Aer abdominal or pelvic operations except if dose itisesoervie. a 3, SUPINE: Patient lies with his back without 1 pillow and head tumed to one side, hands by the side Uses; In shock and unconsciousness4. UPRIGHT POSITION (Cardiae position) Patient lies in a sitting position with his hack supported with pillows arranged in an armchair fashion on a back’bod rest. Uses ¥ Cardiac conditions eg cardiae failure Y Other respiratory condition that ean ‘cause dyspnoea eg. asthma. For drainage of abdominal cavity 5. DORSAL: Patient lies on his back with Pillow, knee flexed, heels together and thighs par. Uses: ¥ Forcatheterization Vaginal examination 6. PRONE POSITION: The patient lies at fon the face, head tumed to one side with 3 pillow under the head, one arm by the side and the other across his head resting onthe pillow A soft pillow may be placed under the ankles to prevent toes fom pressing onthe bed Uses: ¥ For change of position in order relieve pressure ¥ Patients with back or heal injuries ¥ To. feclitate drainage, from the anterior aspect of the body or after ‘operation ofthe spine. congestive 7. LERT LATERAL POSITION: Patient lies om the lft side, butocks tothe edge of the bed, and head forward on the pillow, thighs and knees flexed Uses: Y For giving enema and insertion of suppositories. ¥ For checking rectal temperature ¥ For the examination of treatment of the perincal region ¥ For change of positions SIMS POSITION: (May be called semi prone or exaggerated left lateral position) ‘The patient lies partly on her left side, right arm Ties on the bed in front ofthe patient and the left arm lies bebind the patient on the be both knees are drawn up but the right one is more flexed than the left. The left side of the face rest on the pillow placed under the check, ‘The anterior aspect of the ileum, humerus and clavicle bears the patient's weight Uses: um, 20 4 ory din fm = ¥ For examination/reatment of cer ig, vagina and rectum ¥ Post tonsillectomy 9,GENU-PECTORAL (knee-chest)> Patien, kneels on the bed thighs upright, bends forward util his ebest rests on small pillow and the head lies just beyond and the arms Nlexed around the head. Uses: ¥ For vaginal examination ¥ Forhigh colonic lav ¥ Forsigmoidoscopy ¥ In cases of visceroplosis (10 replace prolapsed abdominal organs) ¥_ For post partum exercises 10, LITHOTOMY POSITION Patient lies on her back with the legs raised and stretched. The legs are tied to the stimup of the poles on the special bed. The leys should be removed simultaneously at the end of procedure to avoid injury tothe hip. Uses: ¥ For evacuationdilatation and curetag ¥ Examination of uterus and fullopian tubes (gyneacological exmainations) 11. TRENDELENBURG POSITION: ‘This is almost lithotomay with head lowered 10 allow upward displacement of the abxlominal ‘organs. Shoulder support may be provided, LIFTING A PATIENT. Many nurses suller injury to their backs through bad methods of lifting, Those injuries are avoidable. ‘The spine itself should not be used in lifting. It should be locked straight by fensing the back muscles. The lift should be Performed by the use of the powerful ley and hip muscles. Ia nurse lifts a patient with her back in flexed position, she will almost certainly injure her back as well as failing to Jit the patient, points when lifting Preparation for lifting 11s important that Titers prepare to Ti and are not tensed when the lift is made Position of feet ‘This is very important in all Ling: —=—