Bed Making Procedures

• Chapter 21 objectives include identifying bed positions, linen handling per standard practice, bed linens used, safety measures for bed making, and differences between open and closed beds

Client Bed Importance

• Clients spend a lot of time in their beds
• Some clients are in and out during the day
• Some clients eat in their beds
• Care is provided in their beds
• Other clients nap or sleep
• PSW care impacts clients' health by keeping beds clear of crumbs, wrinkle-free, and changing wet linens immediately

Types of Beds

• Regular beds might not have the option to raise the head or feet
• Some regular beds are mechanical, so the head of the bed can be raised
• Regular beds cannot be raised to waist level for care
• Special mattresses can be added to regular beds
• Hospital beds can be raised for care
• Hospital bed feet and head can also be raised
• Hospital bed have wheels and brakes
• Hospital beds usually have electric or manual controls
• Hospital beds can sometimes be locked to prevent clients with dementia from raising them

Special Mattresses and Pads

• Air, gel, or water mattresses are used to reduce pressure
• Bottom sheets with elastic or tucked-in sheets can't be used
• No transfer pad is used
• Special slider sheets can be used

Clean Linens

• Perform hand hygiene before collecting clean linens
• Your uniform is considered dirty, so hold linens away from your body
• Clean linen must be placed on a clean surface, not on a patient's bed
• Never place any linens on the floor
• Only take needed linens into the room; if too many are taken, never return them to the linen cart or supply room
• Collect linens in the reverse order of use

Bed Types

• Closed beds are made when the client is not expected to return to bed, and the linens are pulled all the way to the top
• Open beds are made when the client will likely be in and out of bed often, and the top linens are folded back

Dirty Linens

• Used linen is contaminated, and Standard Precautions should be taken
• When handling linens with body fluids, gloves are to be used
• Linens should always be checked for personal belongings like eyeglasses, jewellery etc
• Remove each piece of linen separately, roll it away from you, and place it in the hamper immediately
• Never place used linens on the floor

Pads

• Turning pads are used to assist with moving and aligning clients
• Incontinence pads are used to keep the mattress dry from body fluids

Bed Making Guidelines

• Use good body mechanics
• Do not use torn linen
• Never shake linen
• Follow medical asepsis rules
• Bring enough linen to the client's room
• Hold both clean and dirty linen away from your uniform
• Never put used, soiled or clean linen on the floor
• Perform hand hygiene before and after handling linen
• Have a bag bin ready for disposal of soiled linen and follow employer's policies
• Linen must be straightened whenever loose or wrinkled and at bedtime
• Change wet, damp, or soiled linen right away to help prevent skin breakdown
• Make one side of the bed as much as possible before going to the other side to save time and energy

Occupied Bed Making

• Occupied beds are made while the patient/client is in it when moving the client out of bed is not possible
• Place the client side-lying
• Remove half of the dirty linen
• Place half of the clean linen on the same side
• Client rolls over the linens onto the other side
• Dirty Linens are unrolled on the other side
• Clean linens are unrolled on the other side, and do one side at a time

Mitered Corners

• Mitered corners are a specific way of tucking in top sheets to ensure there are no wrinkles and bumps
• Mitered corners are important for skin integrity

Nutrition/Fluids

• Objectives include explaining the factors that affect eating and nutrition, the role of support workers in meal planning and preparation, special diets, the support worker’s role in assisting clients to eat, how to feed clients, adult fluid requirements and common causes of edema and dehydration, common special fluid orders, and the importance of recording intake and output

Nutrition Importance

• Good nutrition, achieved through food and water, is necessary for life, helps wound healing, maintains body functions, improves mental function, contributes to social and emotional health, and protects against illness
• Poor nutrition can lead to dehydration, death, slow and impaired healing, body systems not functioning properly, impaired mental ability, social relationship issues, depression/anxiety, and increased disease risk

Basic Nutrition

• Nutrition involves ingestion, digestion, absorption, and use of foods and fluids by the body
• Ingestion is the process of taking food and fluid into the body
• Digestion is the breakdown of nutrients so that they can be absorbed by cells
• Absorption is the process by which substances pass through the intestinal wall into the blood, involving physical and chemical breakdown

Nutrient Types

• Nutrients are found in both food and fluids
• These include proteins, carbohydrates, fats, vitamins, minerals, and water

Macronutrients Provide Energy

• Proteins, fats, and carbohydrates each provide different amounts of energy
• Energy is measured in calories
• 1 gram of carbohydrates or protein supplies 4 calories
• 1 gram of fat supplies 9 calories

Proteins

• Needed for tissue growth and repair
• Protein deficiency can result in severe malnutrition
• Protein sources include meat, fish, poultry, eggs, milk and milk products, beans, peas, and nuts
• Animal products are the best source of protein
• People who do not eat animal products must ensure they get enough protein from plant sources

Carbohydrates

• Come mostly from plants and provide fiber to help with bowel elimination
• Main types include simple sugars, starches, and fiber
  • Simple sugars include sweets, fruits, and fruit juices
  • Starches include bread, pasta, rice, and potatoes
  • Fibre includes bran, nuts, seeds, and raw fruits with skins; fiber cannot be digested and are passed through the intestines
• Most carbs are broken down into sugars and absorbed into the bloodstream during digestion

Fats

• Fats help the body use certain vitamins
• There are 3 types of dietary fat
  • Saturated fat can be found in animal and dairy products such as butter, meat, milk, and cheeses
  • Trans fat can be found in margarine, cakes, and fried foods; it is created when liquid oil is chemically altered to form a solid substance, increasing flavor and preserving food
  • Unsaturated fat can be found in fish and many vegetable oils and is the healthiest fat of the three
• Dietary fat is unneeded by the body and stored as body fat

Vitamins

• Vitamins A, E, B12, C, D, E, and K are needed daily for normal function and growth, but do not provide calories
• Each vitamin is needed for specific body function, and a lack of any specific vitamin may result in illness
• older adults are at risk of vitamin deficiencies because the aging process affects the body's ability to absorb vitamins
• Vitamins A, D, E, and K are fat-soluble vitamins; excess doses are stored in the body and can cause complications
• Vitamins C and B are water-soluble vitamins; excess doses are excreted in the urine

Minerals

• Calcium, Phosphorous, Iron, Sodium, Potassium etc. are chemical substances found in plant and animal foods
• Minerals are needed for specific body functions such as calcium and phosphorus, which are used to form strong bones and teeth

Water

• Water is the most important nutrient necessary for life
• The body needs water for maintaining cell function, regulating body temperature, delivering nutrients, removing waste, and other body processes
• Water is lost through urine, feces, the skin as perspiration, and our lungs with expiration
• Death can result from inadequate or excessive water loss
• There must be a balance between the amount of fluid taken in and the amount put out

Canada Food Guide

• Includes vegetables and fruits, protein foods, whole grains, and water

Factors Affecting Eating and Nutrition

• These include personal choices, allergies, food intolerances, culture, religion, finance, appetite, illness, and aging

Nutrition in Late Adulthood

• Physical changes include difficulty swallowing, decreased muscle strength, reduction of taste buds, and impaired vision
• Social factors include difficulty getting groceries, limited support available and residents may not like food being served

Personal Support Worker role in meal planning and preparation

• Depends on the care plan and on your client’s needs 
• There may be Meals on Wheels available
• Assist with preparing light meals such as planning menus and groceries

Planning and Preparation

• Consider special dietary requirements such as allergies and intolerances, and never give food that they are not allowed
• Instructions depend on swallowing ability
• Offer cut up food sitting in high fowler
• Take food preferences and habits into account

Special Diets

• These can treat malnutrition, high iron, low fat etc
• Be sure to make preparations based on special needs if there are allergies or a potential operation

Examples of Special Diets:

• Clear fluids = High Iron
• Full fluids = High Calorie
• Soft diet = Fat controlled
• Fiber and residue restricted = Low sodium
• High fiber = Diabetic Diet
• Bland = Low phosphorus
• Calorie controlled = Low potassium
• Diet as tolerated (DAT) means the client can have a regular diet with no restrictions

Assisting with Feeding Before

• Assess pain, assist with oral hygiene and offer clear briefs and dentures
• Be sure to encourage independence

Before Feeding

• Wash your hands, provide privacy and comfort
• Explain what you will be doing and ensure that clients have the aids to see and hear
• Ensure a comfortable setting and explain the uses of a towel

Feeding During

• Wipe with a napkin
• Face the client and don't force feed
• Observe signs of choking and any issues with swallowing

Assisting Clients with Meals

• Assist with meal choices and involve the client in those decisions
• Prepare food so it is easy to consume

Encourage Clients

• Offer smaller meals with a high calorie count
• Offer soft foods
• Let the client rest before and after the meal
• Use teaspoons and light cups to make meals more manageable

Difficulties

• Swallowing difficulties is known as Dysphasia
• Warning signs are clearing of throat and changes in voice
• There are also time management constraints and you need to manage the feeding schedule accordingly

Feeding Clients with Dysphagia

• Ask clients to lower their chin and offer plenty of fluids
• Be sure to feed the client only a small amount at a time and have the client sit upright after eating it

Fatigue feeding

• Never force to feed a client especially If they are sleepy
• Let a supervisor know of any concerns

Vision Loss

• Help visually challenged clients by preparing the food
• Tell them ingredients and amounts

Feeding a Client

• Keep hand-washing areas nearby
• Ensure there are no spills and the bell is in reach

Balanced Fluids

• This is essential for ensuring electrolyte balance

Dehydration

• This can impact electrolyte balance
• Clients will need a good daily mix of water
• 1500ml to survive and 2000ml for normal operation

Fluid Intake Orders

• Encourage and control amounts of fluids.

Recording Intake An Output

• This should be strictly followed to ensure the client is getting what they need.