Bedmaking, Moving and Positioning 2025 PDF

PNE 118 BEDMAKING, MOVING AND POSITIONING, Reference  Perry, A.G., Potter, P.A, Ostendorf, W., Cobbett, S. (2025). Canadian Clinical Nursing Skills + Techniques (2nd ed.). Elsevier: Toronto Bedmaking Safety and comfort are primary considerations when making a bed Not automatically ch...

PNE 118 BEDMAKING, MOVING AND POSITIONING, Reference  Perry, A.G., Potter, P.A, Ostendorf, W., Cobbett, S. (2025). Canadian Clinical Nursing Skills + Techniques (2nd ed.). Elsevier: Toronto Bedmaking Safety and comfort are primary considerations when making a bed Not automatically changed every day as it costs money to launder, as well as nursing time. Usually 2x/week. Change the sheets when soiled, EVERY time they are soiled. Can change just the part that is soiled. Changed more frequently for comfort for a client for a client on bedrest. For longterm care usually changed on bath days 2x/week. Unoccupied Bed Always preferred as easier on client and nurses. Excellent opportunity to encourage client mobility and ambulation Occupied Bed Client remains in bed while bed is made. Only used if client absolutely can not get out of bed. Watch for client comfort, privacy and safety at all times. Siderail up – on opposite side of bed Client is always covered Tubings and drains not entangled Safe position for comfort but also positioned properly Needs to be done in a manner that conserves time and client’s energy. Consider analgesics before. Still encourage self help as much as possible. Types of Bedmaking Open bed: sheets folded down to bottom to allow client ease of getting in. Most common in hospital Closed bed: sheets pulled up. Used for an unassigned bed in hospital, but for day time use in longterm care. Recovery bed: top sheet not tucked in, folded to side to allow transfer of client into bed from stretcher. Rarely used. Beds Designed for comfort and safety. Height adjustable. Usually not on the client controls. Head and foot/knee position changes Mattress are increasingly adjustable for client comfort and pressure reduction. Brakes, on at all times. Siderails- adjust as needed Headboards – often removable Linens Must be wrinkle free. Tighten sheets several times a day for clients on bedrest. Otherwise 2x/day (morning and at bedtime) and as needed. Consider soap allergies for clients with rashes. Most facilities have an alternative available. Many facilities use fitted sheets now. If using flat sheets, seams are always away from the client. Minimize layers on a bed. Waste money because of extra laundry, and may increase skin irritation as they form wrinkles. Linens Bring minimum into the room. Can not be returned to linen cart after. Must be laundered even if unused. Be organized. Gather all equipment/linens ahead of time. Usually bathing at same time. Think about contamination of linens from other clients. Handwashing, linen storage, dirty linen disposal. Assessment Consider cause of soiling and determine Determine if bed linens what needs to be are soiled , or client is changed, as well as need uncomfortable and to change bed linen would benefit from fresh types to contain future linens. soiling ie. a waterproof pad to contain incontinence or drainage. Delegation and Collaboration Make sure PSW knows Clients position or activity restrictions What to do if client becomes SOB or fatigued Instruct to report unusual drainage or unexpected concerns. Procedure and evaluation Review checklist Try to conserve patients energy Procedure Safe patient handling techniques Often completed with 2 people Observe clients linen’s for cleanliness and tightness Evaluation Ask if client is comfortable after the bed is made Observe client’s skin for signs of irritation Not usually documented except on flowsheet. Documentation Do need to document unexpected outcomes. Document skin assessment Unexpected outcomes Client is not comfortable in bed Check that linen is clean and dry Assist client to change position Client’s skin appears red and irritated Reposition frequently. Consider pressure relieving mattress. Consider allergy Keep bedding clean and dry Across the Lifespan Pediatric:  Check age policy for age restrictions and bed type - regardless of bed type used at home. Geriatric:  At extra risk due to fragile skin. Assess more frequently. Tighten sheets more frequently Home:  Does the home have facility to manage an increased burden of laundry (washer/dryer, extra linens  Assess caregivers ability to cope with extra workload. Teach importance of clean dry linens for prevention of skin irritation What is wrong with this picture? MOVING AND POSITIONING Mobility Ability to move easily and independently. Musculoskeletal and nervous systems must be normal. MOVING & POSITIONING CLIENTS Moving & positioning client’s with impaired physical mobility requires the nurse to use ergonomics. Apply principles of safe patient lifts, transfers and positioning. Frequent skin assessments and use of repositioning devices (eg wedges). Body mechanics are critical in repositioning clients in bed. Safety of staff and client Use assistive devices, Have client help as Elevate the bed Have assistance glide sheets, much as possible mechanical lifts, Positioning Done to reduce risks related to immobilization Must be done so that correct body alignment is maintained as much as possible throughout. Final position must be correctly aligned in order to prevent strain on joints, tendons, ligaments, muscles. Be aware of potential pressure points with each position Must be repositioned AT LEAST every 2 hours in bed and every 20-30 minutes in a chair. Consider special mattresses Logrolling Maintains neck and spinal alignment following injury or certain surgeries. Minimum of 3 people. Designate a leader/ counter. Usually the one with the heaviest weight. Bed flat Pillow between knees One smooth, continuous motion on count of three. Bed Positions Fowlers Flat Semi-Fowlers Chair Trendelenburg Knee Gatch up Reverse Foot elevations trendelenburg Trendelenburg and Reverse Body positions Supported Fowlers or Semi- Fowlers Supine Prone Lateral Sims or semi-prone Dorsal recumbent Lithotomy Positions Semi Fowlers – 30 Fowlers- 45 degrees degrees or more High Fowlers – 90 degrees Positions Supine, Lateral, Prone Positions Lateral Sims – Semi-prone Positions Dorsal Recumbent Lithotomy Foot drop: Use footboard, high top sneakers or splints to prevent foot drop on clients at risk. Positioning Reposition every 2 hours maximum in bed. Every 20-30 minutes in a chair. Influenced by comfort, level of independence, presence of edema, loss of sensation. At risk clients Some clients are at greater risk of tissue, joint damage due to positioning concerns. Immobility is of concern for all clients. Clients with immobility concerns of any body part including paralysis & LOC. Frail, poorly nourished, obese, Presence of edema or decreased Pressure points Internal or external pressure compromises skin and tissue integrity. If low pressure over long periods of time, or high pressure for short periods of time occurs, tissue damage may occur. You must know the pressure points; assess them every time you reposition a client for pressure reduction; and assess frequently for any evidence of pressure damage occurring. Stage 1 pressure ulcer. Skin is reddened and does not blanch when pressed. Stage 2 pressure ulcer : the skin forms a blister or open area. Area around may be red or irritated. Stage 3 : the ulcer looks like a crater with tissue damage below the skin Stage 4 : damage is so deep that muscles, bones, tendons, ligaments and joints can be affected, Deep tissue injury: localized, discolored (red, maroon) intact skin. May be painful, mushy, boggy, warmer or cooler then adjacent skin. Unstageable ulcers: slough(yellow, tan, grey, green brown) or eschar(tan, brown or black) Friction vs Shearing Safe Patient Handling Reducing friction and risk of shearing reduces the work and risk of movement Use a slide sheet (Maxi slide). Client crosses arms on chest. Client assist with movement Synchronize movements Gives client a sense of accomplishment Devices to help Special mattresses Pressure reduction: Pillows; foam devices, Trapeze, siderail, head Mobility in bed aides and foot controls. Assessment for Risk of Pressure Ulcers Braden scale: most commonly used. Easy and quick to do Often done at time of admission and repeated periodically and prn. See handout Moving and positioning Assessment Weight, age, level of consciousness, disease process, ability to cooperate, strength of muscles, joint mobility Assess for need for analgesics 30-60 minutes before Assess for tubes, incisions, equipment needed. Review physicians orders Determine means of positioning, planned position and number of personnel needed to assist Delegation & Collaboration Assessment can not be delegated. Acute spinal cord or neurological trauma clients can not be delegated. Direct personnel about: Allowing client to assist Number of personnel needed, and method used Positions to use Reporting reddened areas, client comfort, client ability to assist. Evaluation Inspect Inspect skin for erythema and blanching Ask Ask client re comfort Observe Observe body alignment and position Ask client to identify benefits of position changes and Ask proper body alignment Unexpected outcomes Develops areas of abnormal reactive hyperemia (increased blood) Change positions more frequently Avoid prolonged pressure on any one pressure area Consider applying pressure relief support surfaces Client reports discomfort or respiratory distress Reposition according to comfort level Client turns back to same position frequently and expresses discomfort with alternative positions Reinforce rationale for position changes Provide diversional activities in various positions Identify clients perception of position preference and create incentive for compliance Across the Lifespan Geriatric Immobilized elderly at high risk for complications: muscle atrophy, contractures, pressure ulcers, blood clots, pneumonia, constipation, urinary stasis, depression, mental confusion Activity helps maintain functional status Lubricants and protective films reduce friction injuries in clients with fragile skin and/or nutritional compromise. Communication and Documentation Document times and position changes of patient throughout the shift. Document observations (e.g., condition of skin, joint movement, patient’s ability to assist with positioning), and whether positioning devices are needed. Communicate observations during hand-off and document in nurses’ notes. Communicate skin or joint complications to the health care provider. Review Know each body position and placement of pillows and limbs To keep the spine mobilized – logroll Assess for pain medication prior to repositioning Know the steps in making an occupied bed How to prevent footdrop