POINTS TO REMEMBER ON BECOMING A

STUDENT NURSE
 Know that you are needed and wanted in this  Nursing is an important job. It calls for
work. persons who want to grow in the process of
 When you desire to do your best, you will caring others.
always have pride in your work. This in turn - As student nurses always think that nursing
make the dull moments less frequent. is an important job. It requires people who is fully
- The work “nursing” is very demanding. equipped with the necessary skills, knowledge and
- It is not easy because they have different attitude.
needs and different conditions. - If you want to improve yourself, always be
- Has a lot of requirements receptive.
 Understand what your assignment is; ask - Receptive - willing to consider or accept
about it, if it is not clear. new suggestions and ideas.
- Always ask the CI or the other nurses
around if you need help to prevent hurting/killing
the patient.
 Make a WORK PLAN (Timetable)
- Importance/benefits of planning is for us to
be organize.
- Making a work plan at the same time will
provide you with the opportunity to determine what
will be the priority activities that has to be done to
your patient.
 Be willing to accept changes in workload and
assignment when necessary.
 Report to the Nurse or CI the following:
a) A patient’s request or complaint which
calls for a professional nurse’s decision.
b) Changes in patient’s condition or
something which seems unusual to you.
c) A problem or question about your work.
 As a nursing student, you are called upon to
be dependable. This means:
a) Being on the job and being there on
time.
b) Doing an assigned task and finishing it
on time; and
c) Keeping promises after telling anyone
particularly a patient, that you will do
something.
 As a nursing student, you are called upon to
be trustworthy. This means that;
a) When accident occur or errors are made,
you must report them at once.
b) When personal experiences are shared
to you, keep these in confidence.
 Try to be mindful of the feelings of others and
try to show consideration by controlling your
emotion.
- Always control your emotion
- Be tactful
- Example: When you are angry, you
need to control and tone down your voice
 PRESENTING GOOD APPEARANCE
1. When you feel good about your appearance, your
work, and your personal relationships, your whole
day is likely to go better, because you think well of
yourself.

2. If possible, give yourself the mirror test before

reporting for duty. Look at yourself in a full length
mirror.

3. Start the day in spotlessly clean, well-fitting

uniform.

4. Be clean, look clean and feel clean

5. Check the way you stand and how you walk. Set
out to correct faulty posture habits.

6. Bathe daily and use an effective deodorant.

7. Give the face special skin care. It should be

impressively clean.

8. Use cosmetics with restraint. Apply lipstick and

use only mild colognes.

9. Keep hair neat arrangement and in keeping with

good taste for work. The nurse’s hair should be in
keeping with the practices of the particular hospital
or agency.

10. Take particular care of your hands as health

reasons as well as appearance.

11. Wear well-fitting shoes. Wear clean hose or socks

daily.

12. Earrings, rings, and other forms of jewelry should

not be worn while on duty.

13. Gum chewing makes an unfavorable impression

with patients, watchers and others.

14. Lounging in undignified positions and talking in

loud boisterous voices are damaging to the nurse’s
poise and composure.
 NURSING ROLES
NURSING CHARACTERISTICS OF NURSING

 An understanding of contemporary nursing a. Nursing is caring

practice includes a look at definitions of b. Involves close, personal contact with the
nursing, recipients of nursing and even diff recipient of care.
roles nurses assume. c. Concerned with services that considers man
 The act of utilizing the ENVIRONMENT of the as a multi-facet being.
patient to assist him in his recovery (Definition d. Committed to promoting individual, family,
of nursing given by Florence Nightingale 150 community, and national health goals in the
year ago). best manner possible.
 Virginia Henderson was one of the first e. Committed to involvement in ethical, legal,
modern nurses to define nursing. and political issues in the delivery of
 She wrote, the unique function of the nurse is to health care.
assist the individual, SICK or WELL, in the f. Utilizes research to improve quality of
performance of those activities contributing to human life.
health that he would perform unaided if he had  WHOM RECIEVES CARE:
the necessary strength, will, or knowledge. - PATIENT Latin: to bear or to suffer:
 Like Nightingale, she described nursing in - “Passive acceptance” of Health care
relation to the CLIENT and his ENVIRONMENT. services.
 Unlike Nightingale Henderson emphasize that - Usually people become patient when
NURSES are concerned with both HEALTHY and they seek assistance because of illness or for
ILL INDIVIDUALS. surgery.

COMMON THEMES TO MANY DEFINITIONS - CLIENT – is a person who engages the

advice / services of another who qualifies.
 In the latter half of 20th century, a number of - “receivers of health care who
nursing theorists developed their own collaborates in the care of health”
theoretical definitions of nursing. - Has felt responsibility over their
 Certain themes are common to many of these health.
definitions:
 HELPING, CARING, CLIENT-CENTERED, KINDS OF ROLES
HOLISITIC, ADAPTIVE, ART, SCIENCE
 THERAPEUTIC ROLE
NURSING AS AN ART - a.k.a. “healing” or “curative”
- A nurse may use appropriate techniques
 Concerned with skills that require: which help the natural process of healing
- PROFICIENCY – competence, know-how… - Whether it is of physical, psychological, and
knowledge and experience. interpersonal process
- DEXTERITY – handiness, not being clumsy. PHYSICAL – Abuse, trauma, TSB (total serum
bilirubin)
NURSING AS A SCIENCE Psychological – FEAR, reassurance
Interpersonal – Isolating, may offer oneself
 Requires the systematic application of scientific
knowledge.  CARING ROLE
 Unified body of knowledge concerned with a - a.k.a. “comforting” or “Mothering role”
specific subject matter and as the processes and - CARING – includes those activities which
methodologies necessary to produce such provides SUPPORT while preserving client’s dignity,
knowledge i.e. assistance in the performance of ADL.
 Processes involved:
- OBSERVATION, IDENTIFICATION,  COMMUNICATING ROLE
DESCRIPTION, EXPERIMENTAL INVESTIGATION, - Utilize to identify client’s needs and then
THEORETICAL EXPLENATION communicate these to other members of the
healthcare team.
- Quality of nurse’s communication is
important in nursing care.
 - Communication is integral to all NURSING  LEADERSHIP ROLE
ROLES, a nurse must communicate clearly - A nurse influences other to work together to
and accurately. accomplish a specific goal
- Ex. LEADERS IN HEALTH MAINTENANCE
 TEACHING ROLE AND MANAGEMENT
- imparting information and reinforcing - LEVELS
change in behavior of client a. Clientele
Includes: b. Colleagues
a. Assessing learning needs & readiness c. Community
b. Set learning goals
c. Enacts learning strategies  ADMINISTRATIVE ROLE
d. Measures learning - A nurse must see to it that nursing services
are organized, coordinated, & dispensed
 PLANNING ROLE appropriately.
- Use during the entire phases of nursing
care. - This requires knowledge about
- A nurse plan with patients, their families, and organizational structure and dynamics, authority,
members of the accountability, delegation, supervision
healthcare team
- Includes the patients:
- Diet, activities, treatment
regimen, rehabilitative therapy, hygiene

 COORDINATION ROLE
- needed to achieve high-quality care
- Prevents unnecessary duplications and
gaps in services.

 PROTECTING ROLE
- The key is the “safety of patients”
- Protect patient form:
- i.e. falls, transmission-based
precautions, adverse reactions, et cetera

 REHABILATING ROLE
- Any activities which MAXIMIZES patient’s
remaining potentials or capabilities…
- Includes:
- i.e. teaching the use of assistive
devices,

 SOCIALIZING ROLE
- Pertains to engagement of enjoyable,
carefree conversation.
- Offers distraction and respite from the focus
on illness.
- Not necessarily therapeutic
conversations but topics of interest or the news.

 COUNSELOR ROLE
- A process which helps client to recognize
and cope with problems.
- Therapeutic communication techniques are
indispensable in this role.
- Let client RECOGNIZE their feelings SO
THAT THEY CAN identify options.
 APPROACHES TO PATIENT CARE
THINK OF THE PATIENT AS AN
INDIVIDUAL WHO

 Needs help
 Have fears and worries about illness or
injury.
 Has to be allowed to maintain identity.
 Should be given privacy, dignity, and
maintain self-esteem.
 Can continue to practice his own religious
faith, customs and patterns of his nationality.
 Should be allowed to continue in his ways,
habits, rituals, and idiosyncrasies.
 Should know what you are going to do.

TO GIVE CARE TO THE PATIENT MEANS

TO:

 Help patient maintain or improve physical

fitness.
 Provide a comfortable atmosphere
 Help in prevention of injuries and accidents
 Help prevent patient from contacting a new
illness.
DISCHARGING A CLIENT FROM HEALTH CARE
AGENCY
 ADMITTING IN A HEALTH CARE AGENCY
• Initiate medical record.
ADMISSION - all information of the patient.
- A patient is entering a health care agency for - the patient is the owner of the chart.
nursing care and medical/surgical treatment. • Prepare ID bracelet. This is the single most
- In admitting section, one of the effective way of identifying the patient.
responsibilities is to take hold the reservation of - ID band contains surname, name, room no.
rooms. and doctor of the patient
INVOLVES: - most effective way of identifying the patient.
a. Authorization from a physician. - two ways in identifying the patient:
b. Collection of billing info from the admitting 1. Let the patient state their name.
department. 2. Compare the medication ticket to the
c. Completion of the admission process by nursing. ID bracelet of the patient.
- Medical order must be carried out by the • May bypass in emergency situation
admitting nurse. • An addressograph card is made
d. Documenting patients medical history and - Usually used in the information desk.
Physical Exam. • Consent forms and signed
Nursing assessment has two parts: - Eg. Living will, Directives, Waivers
1. Health History - subjective part • Initial orders obtained
2. Physical Examination - objective part. • Verbal report given to floor rn
e. Initial medical orders for treatment are carried • Patient is escorted
out.
TYPES OF ROOMS NURSING RESPONSIBILITIES
- professional fee of the doctor, laboratory 1. PREPARE ROOM
workups will depend on what type of • Provides personal care items.
accommodation a patient will get. • Suction
1. WARD ROOM • Oxygen
- comprises up to 6-8 patients. • IV Pole
2. SEMI-PRIVATE ROOM • Bed in high position if arriving by guerney
- comprises 3 patients. • Bed in low position if arriving by wheel chair
3. PRIVATE ROOM • Blue pads if NE
INCLUSIONS: - These are placed to prevent the frequent
- Coffee table with 2 chairs, change of the linen.
- TV and refrigerator.
- Watchers bed. 2. IDENTIFY SELF
4. SUITE ROOM • Makes patient feel secure.
INCLUSIONS: - the nurse will introduce themselves so that
- Receiving area (sofa) the patient will feel secure.
- Watcher’s bed is bigger than private room. • Makes pt feel welcome.
- Telephone • Alleviates anxiety/fear.
5. PRESEDENTIAL SUITE
INCLUSIONS: 3. ORIENT PATIENT
- Kitchen • Location of nurses station
- watchers bed is bigger than private & suite • Clothes storage
room. • Call light
- Cabinets • Bed controls
6. INTENSIVE CARE UNIT (ICU) • Light switches
- 1 patient in each cubicle • Telephone policy
- Gadgets that are attached to the patient is • TV controls
inside the cubicle. • Watchers pass
- Supplies are provided. - small piece of paper that contains the name
of the watcher and the patient.
RESPONSIBILITIES OF THE ADMITTING - usually used if the watcher is going out of
the hospital beyond 9PM.
DEPARTMENT
- if lost, there is 50-100 pesos charge.
• Gather info for billing.
• Mealtimes
- this will identify if the patient has insurance,
- serves breakfast around 6:00-6:30, 12:00-
Phil health, etc.
12:30 for lunch, and 5:00-5:30 for dinner.
• Safety measures such as bed rails • Collect info for database
• Visiting hours • Perform initial admission assessment if
- 10:00-12:00 and 2:00-8:00 appropriate. (Some facilities require an RN to do
• What tests are scheduled initial assessments)
• Diet
• Room boundaries COMPONENTS OF A MEDICAL HISTORY
• Scheduled surgery time
• Times for DR visits • Identifying data
• Chief complaint
4. GATHER INFORMATION • Personal hx
THE NURSE WILL GATHER INFO ABOUT: • Past health hx
• Medical orders • Hx of present illness
- CBR (Complete Bed Rest) • Family hx
• TXs • Review of body systems
• Labs • Conclusion
• Tests
• Diet WHAT TO WATCH FOR IN NEWLY
• Activity
• Physical assessment within 24hrs
ADMITTED PATIENTS

1. ANXIETY
TYPES OF ADMISSION
APPEARANCE
1. INPATIENT STAY • Exhibits separation anxiety
- Longer than 24hrs • Sad
 PLANNED • Worried
• No immediate threat • Restless
• Planned elective surgery, test • Reduced appetite
• Patient is prepared • Insomnia
 EMERGENCY
• Unplanned HOW TO HELP
• Stabilize in emergency room (chest pain, trauma) • Acknowledge feelings
 DIRECT ADMISSION • Provide explanations and instructions before
• Unplanned performing procedures
• Bypass emergency (vomiting, diarrhea) • Inquire about stress due to children/pets/spouse
at home
2. OUTPATIENT STAY • Reassure, Separation anxiety can cause the elderly
OBSERVATIONAL: to be confused and disoriented
• Head injury
• Premature labor 2. LONELINESS
• Unstable vital signs
• Make frequent contact with your patient
VALUABLES • Orient your client
• Allow liberal visitation
WHEN DOCUMENTING VALUABLES, MAKE SURE
TO USE WORDS LIKE: 3. DECREASED PRIVACY
• White/yellow metal not gold
• Clear stone not diamonds, rubies, etc • Pull curtain and close door
• Have a witness • Knock
• Have nurse & pt sign valuables list • Identify room boundaries, esp. if sharing room
• Dont forget dentures, glasses, etc • Be careful of exposing patient
• When transferring pt, sign-off with nurse • Patient feels uncomfortable because of unkempt
• Know your facility’s valuables policy appearance, so announce visitors

PATIENT COMFORT 4. LOSS OF IDENTITY

• Provide privacy. ( shut door & pull curtain) • Call patient by name they prefer
• Assist if needed to remove clothing and put gown • Allow patient to wear own gown
on • Display pictures
• Provide extra blankets if requested • Give them some choices. (Bathing, eating, etc)
 DISCHARGE PROCEDURE
1. Check to see that the patient has a written
• TERMINATION OF CARE FROM A HEALTH CARE discharge order.
AGENCY - must be the physician’s order.
• METHOD (ACRONYM) 2. Make sure that the patient or support person
M- Meds has had discharge instructions
E-Environment - I.e regarding diet, medication, etc.
T-Treatment 3. Return unused medicines and inform the
H-Health teaching watcher that after payment, returning of
O-Outpatient referral medicine after 72 hours will not be entertained.
D-Diet - as the policy of the hospital, medicines
• AMA (AGAINST MEDICAL ADVICE) should be bought from the hospital pharmacy. If you
- Patient leaves prior to obtaining a written have to buy medicines outside, you have to sign a
order. Nurse request pt to sign form. If refuses, nurse waiver.
must let pt leave and note refusal to leave and note 4. Scan computer for un-rendered services before
refusal to sign AMA in chart. tagging “May go home”
5. Send summary of discharge to accounting
PURPOSE office(green form). Instruct the watcher to go to the
- To return the person to a state of accounting section for financial assessment and
independent living . payment.
- To provide continued care by home-health - green form contains name of the patient,
nurses or with family assistance. room number, and doctor’s name with professional
fees. This will be brought to the accounting office
ASSESSMENT para ma-start na ng bill.
6. Review the chart for completeness.
 Review the discharge planning forms. - need to be complete because once the
 Discuss the possible option after discharge. patient will be discharge, the chart will be endorsed
- Discuss the preparation that the watcher or to the medical record.
private nurse needs to do to continue the medication 7. After settlement of the bill, the watcher
or care at home. presents the discharge slip to the head nurse or
 Determine if the patient or his family have the nurse on duty for signature and to retrieve the
knowledge and skills necessary to maintain or watcher’s pass. At the same time returning all extra
improve the current level of health. medications in the box bought by the patient outside
 Explore dietary changes, medication of the hospital. Write the exact time of discharge.
administration, use and care of technical equipment. 8. Transport through wheelchair and assist the
 Identify if assistive devices such as walker or patient into the car as necessary and give the
commode have been obtained. discharge slip to the security guard.
 Check to see if the home environment has been 9. Strip the linen and clean the patient’s unit.
modified to avoid structural barriers such as stairs. Wash your hands.
 Assess if a patient can obtain transportation for 10. Make necessary recording on the patient’s
subsequent health care. chart or record and complete discharge summary.
 Check if the patient has had contact with a social
worker for assistance with finances, insurance or NOTE: Log time of dischargein the 24 hourse floor
Medicare. cencus and discharge notebook.
- if the patient has financial problems, you
can refer it to the social worker. DISCHARGE PATIENT (AMA)
- social worker: can recommend referral to
DSWD, PCSO, and etc. - Sending home patients per patient/relative
 Determine if the patient has been referred to on their will.
appropriate community services. OBJECTIVE:
 Interview the patient to determine his -To ensure proper communication to patients
perceptions concerning discharge and recovery. going home, not returning to a normal state of health.
- Refer the patient to social worker to help
them with their financial if the family decided to REFERENCE:
discharge the patient. - Patient’s chart
 Explore the patient’s and family’s attitudes and PROCEDURE:
beliefs that affect health and illness. 1. PATIENT
- Request discharge against medical advice
- Signs form on discharge against advice.
 - Presents duly accomplished clearance to the PROCEDURE:
ward nurse. 1. The nurse on duty must take note of the exact
2. STAFF NURSE time the patient left the unit.
- Refers request to attending physician. 2. Check also with the accounting department if the
- Fills up AMA (Against Medication Advice) patient was able to settle his hospital bill.
form. 3. The patient can officially be discharged after 24
- Request patient/watcher to sign form hours.
- Prepares and sends clearance slip to the
billing section. NURSES RESPONSIBILITY FOR
- Discharge patient after duly paid and signs DISCHARGING A PATIENT
clearance slip indicating exact date and time.
- Discharges patients per wheelchair or • Gather belongings/check inventory
stretcher. • Arrange transportation
3. ATTENDING PHYSICIAN • Inform pt of checkout time to avoid being billed for
- Advises patient or watcher on implication an extra day
and consequences of discharge against advice. • Escort until pt safely inside vehicle
- Indicates AMA on patient’s chart. • Write discharge summary
• Terminal cleaning. Bedside cabinet
ABSCONDED restocked/cleaned.
- Has no medical order of MGH. Went home
and was not able to settle the hospital bill. TRANSFER
PROCEDURE:
1. The nurse on duty must see to it that she does her • Discharging a patient from once unit or agency and
rounds as frequently as possible. admitting them to another unit
2. When the nurse discovers that the patient is not in • Informs patient or family
bed or has left the unit without permission. Must • Complete transfer summary
take note of the exact date and time. • Speaks with nurse on transfer unit
3. Inform the attending physician. • Transports patients/belongings/supplies & chart
4. Document the findings. • Checks orders/makes new addressograph card
5. After 24 hours, the patient has not returned and with new room number.
the nurse may discharge the patient.
WHO/WHAT IS INVOLVED IN A PLANNED
OUT ON PASS (OOP) DISCHARGE
- Ex. The patient has to attend hearing, the
Doctor will allow the patient to go out or discharge PHYSICIAN’S UNIT SECRETARY CALLS FOR
PROCEDURE: ORDER TRANSPORT, COPIES
1. The patient must inform the nurse on duty that CHART/ORDERS
she/ he wishes to go out on pass.
2. The nurse on duty will inform the attending CARE RN OR SOCIAL WORKER
physician regarding the request of the patient. PROVIDER
3. The attending physician will explain the
SAFEKEEPING EXTENDED CARE FACILITY
consequences to the patient and let the patient sign
on the medical order sheet stating that she or he will PATIENT NURSE-EXPLAINS DISCHARGE
go out on pass and promise to come back at what INSTRUCTIONS TO
time. FAMILY/CARE GIVER
4. The nurse on duty will take note of the exact time
the patient left the unit.
5. Upon return of the patient, the nurse on duty must SETTINGS STANDARDS
also take note of the exact time and document.
REMEMBER
OUT OF BED (OOB) • The american nurses association sets the standards
- Has a medical order of MGH. for pt care & documentation for RN’s
- The patient left the unit without the • LPN’s are governed by jcah
discharge slip. • Do not use “seems” or “appears” in documentation.
Disadvantage: the patient cannot receive the Implies doubt and lack of knowledge.
discharge instructions and medicines.
- If the patient did not settle the bill, the next
time the patient will be admitted, the patient will be
blacklisted because of the unsettled bill.
 COMMUNICATION
 Exchanging information or feelings between PATIENT’S CALL
people.
 Basic component of human relationship. 1. Keep alert for patient’s call or bell
 PURPOSE: to influence others and obtain the - Go IMMEDIATELY to patient’s bedside
information needed. 2. Do the thing the patient asks if your SURE it is
RIGHT & SAFE for the patient.
ESSENTIAL COMPONENTS OF 3. Place signal cord within reach
COMMUNICATION HOW TO ANSWER THE PHONE

1. SOURCE/SENDER When receiving, state the following

- A person or group who wishes to convey a a. HOSPITAL - Name of the Hospital
message to another; source-encoder. b. WARD - Location of Ward
- ENCODING - use of signs/symbols such as c. NAME - Your name
language, words to use, how to arrange the words, d. POSITION - “Nurse on Duty”
tone of voice, gestures to use. e. “May I help you” or “How may I help you”
- Nurses must cope with 2 language levels: 1. When someone is looking for somebody
a. Layman’s - “Who’s calling please?.... Just a minute”
b. Health professionals 2. When the person concerned is out
2. MESSAGE - “Sorry he’s not in, would you like to leave a
- Actually said or written. message?
- Ever use medical terms on patient. 3. When terminating, say thank you & goodbye
- You can use medical terms on health
professionals. POINTS TO REMEMBER WHEN USING THE
2. CHANNEL HOSPITAL PHONE
- Medium through which a message is
transmitted 1. LENGTH OF CALL
EXAMPLE: - Limit your phone call
a. Visual (sight, observation, perception) 2. DO NOT USE TELEPHONE FOR PERSONAL USE
- “I can see how sad you are” 3. ANSWER WARD PHONE PROMPTLY
- “You look busy today” - Answer at once
b. Auditory (hearing, listening) 4. ANSWER WITH A WELL MODULATED VOICE &
- “tell me where it hurts now baby..” IN A COURTEOUS MANNER
- “sounds like it really is terrible”
c. Kinesthetic (procedural touch, caring touch)
- Touch is therapeutic or caring
POINTS TO REMEMBER WHEN BRINGING
(depends) CELL PHONES
4. RECEIVER or DECODER
- Person who listens, observe, and attend 1. Turn off your mobile phone in order not to disturb
and interprets the sender’s message the patients or interfere with the functioning of
- DECODE equipment.
- Sort out the meaning of the message. 2. Do not send or create any text messages while on
- Depends largely on their similarity duty or in the classroom
of knowledge, experience, and sociocultural 3. Answer only emergency calls and never on bedside.
background Limit the duration for 3 minutes
- Decoded message = sender’s intent
(effective)
- Decoded message = sender’s intent
A
(ineffective)
5. RESPONSE
- Message that the receiver returns to the
sender.
- also called as feedback
- Can be verbal or nonverbal.
- Communication is not complete when there
is no feedback.
 ASEPSIS
TERMINOLOGIES RESIDENT FLORA

 ASEPSIS - The resident flora (resident microbiota)

- A “absence”. consists of microorganisms residing under the
- Sepsis “state of infection” superficial cells of the stratum corneum and can also
- Absence of microorganism or disease be found on the surface of the skin.
producing pathogen.
- Any activity that prevents infection Examples:
- It can break the chain of infection.  Staphylococcus epidermidis
 ASEPTIC TECHNIQUE  Proprionibacterium acnes
- clean technique with medical and clinical  Staphylococcus aureus
hand-washing.  Streptococcus pneumoniae
- Infection control practice used to prevent  Lactobacillus
transmission of pathogens.  Fusobacterium
 MICROORGANISM  Clostridium
- Infectious agent  Candida albicans
- any microscopic entity naturally presents in
the environment INFECTION
- cannot be seen by the naked eye.
 Pathogenic - capable of producing - Pathogens or microorganism that gain
disease (Pathogens, bacteria, parasites & entrance into the body causing disease.
viruses) - Multiplication of microorganism normally
VARIED CHARACTERISTICS: found in the body.
- Virulence  Disease - detectable alteration.
- Severity of disease they produce. INFECTION CAN BE:
- Degree of communicability. A. Clinical - with symptoms.
Ex. headache, pain, fever, cough
TYPES OF MICROORGANISMS B. Sub-clinical - asymptomatic/ carrier shows no
illness but have the pathogen in the body that can be
1. BACTERIA transferred.
- Tubercle bacilli cause of tuberculosis - Ex. Covid positive that does not show any sign of
- Bacterial pneumonia infection
- Gastrointestinal disorder - Patient with hepatitis B they don’t manifest
2. VIRUS jaundice, not all the time will have a change in their
- Corona Virus skin color, they have normal physical appearance
3. FUNGI/FONGUS that can be asymptomatic carrier. Can be transmitted
- Candidiasis - foul smelling discharge coming thru blood born or STD.
from the reproductive system caused by C. Community Acquired
candid albicans, fungus that has strive in the - Aerosolized - can be transferred thru air.
reproductive system of a woman. D. Hospital Acquired (nosocomial Infection)
- Microcytosis or pneumonia that are occurring - failure of the hospital to disinfect equipment.
to a patient with aids and that is an
opportunistic microorganism that is causing
infection to a very susceptible individual. PATHOGENICITY
4. PARASITES - ability to produce disease
- Ascaris lumbricoides the cause of ascariasis - Pathogen - responsible microorganism
(bitok) can cause problem to patient if ova - true pathogen - healthy individual
are ingested to the mouth through the hands - opportunistic pathogen - only in susceptible
from the soil. individual.
 Non-pathogenic - not capable to cause a
disease. NOSOCOMIAL INFECTION
Ex. Bacteria in our intestine, it helps in
digestion, degrading the undigested stuff in - Infections that are associated with the
large intestine and it helps in manufacturing delivery of health care services.
of vitamin A, bacteria in body produce - It can either develop during a client’s stay in
vitamin A in the form of lactobacilli a facility or manifest after discharge
COMMON SITES: d) Susceptibility of the host.
- urinary tract - you have to boost your immune system so that you
- respiratory tract are not susceptible to any infection, increase vitamin
- bloodstream c, eat healthy foods.
- wounds
HOW TO CONTAIN/ BREAK PATHOGEN?
ASEPSIS AND ITS TYPES:
- prompt diagnosis and treatment.
1. MEDICAL ASEPSIS - consult doctor, when there is a prompt
- To confine microorganism diagnosis treatment can be given to a person.
- To limiting the number, growth, and
transmission
- Clean: absence of almost all
microorganisms
- Dirty: soiled, contaminated. Likely to have
microorganisms that may be capable of causing
infection.
2. SURGICAL ASEPSIS
- To free of all microorganisms
- To destroy microorgansisms including
spores
- Observed on procedures involving sterile
areas of the body
- STERILE versus UNSTERILE

CHAIN OF INFECTION

- spread of disease in the community.

INFECTIOUS AGENT/ PATHOGEN DISINFECTING & STERILIZING

- may come from the environment. can get out
- Disinfectant – chemical preparation, either
from the host or somewhere, it can be in the
phenol or iodine compounds, used on inanimate
reservoir.
objects.
- can get out in the portal of exit.
- Antiseptic can be used in the skin
POTENTIAL FACTORS TO CAUSE A DISEASE:
sterilization.
a) Sufficient number of organisms
FOUR COMMONLY USED METHODS
- Even the non-pathogenic microorganism
1.Moist heat
when they multiple it is enough to cause a disease to
2. Gas
a particular susceptible host.
3. Boiling water
b) Virulence/ Potency
4. Radiation
- Ability to produce a disease.
- Just like the covid virus one variant is so RESERVOIR
virulent than the other, it was known that delta is - the source of pathogen growth.
more potent than omicron. - normal location of pathogens.
c) Ability to enter and survive in the host. - Where infectious agent normally lives and
- if the host has a very acidic environment this multiply
microorganism may not survive.
 ANIMATE (LIVING THINGS) SUSCEPTIBILITY OF THE HOST
- human (most common), animals (monkey&
dogs), insects (cockroaches, mosquito) plants - Individuals’ degree of resistance to a
- microorganism can stay dormant in the body. pathogen.
 INANIMATE (NON-LIVING THINGS) - Must keep the immune system strong for us
- soil, water, food, feces, IVF, equipment. not to be susceptible host to any infection.

HOW TO RBEAK THE CHAIN IN RESERVOIR? Breaks the chain by: Immunization, Treatment of
- cleaning, disinfection, sterilization. underlying disease, patient education

PORTAL OF EXIT BREAKING THE CHAIN

- Exit from reservoir to enter to a host after - Uses medical and surgical aseptic technique.
multiplying. 1. MEDICAL ASEPSIS - clean technique.
- Can be the same portal for entry to another a. Cleaning - reduce or inhibit the growth of
host. microorganism thru the removal of all foreign
- Can get out thru skin, mucous materials such as soul and organic materials
membranes(eyes), respiratory tract, urinary from object with the use of soap and water.
tract (when you cough or sneeze), GIT, repro  the amount that can be eradicated by the
tract, blood. alcohol is the same amount that can be
eradicated with soap and water.
Breaks the chain by: Proper hygiene, PPE, Eg. Hand-washing - a universal method to
Respiratory etiquette prevent the spread of infection. It is the most
important and most basic technique.
MODE OF TRANSMISSION 2. DISINFECTION - a process that eliminates all or
many microorganism except bacterial spores( single
1. DIRECT TRANSMISSION - contact bet. Reservoir celled microbes in resting/ inactive phase)
and host- x touching, droplets, sexual contact, use of
injection PRINCIPLE OF MEDICAL ASEPSIS
2. INDIRECT TRANSMISSION - intermediate means 1. Soap & water are the best cleanser
to infect host. 2. Cleaning is conducted from the cleanest to
a) vehicle borne- improperly handled food, dirtiest part.
contaminated needles. 3. Dispose soiled items that are contaminated
b) vector borne- flies, mosquito- dengue, filaria directly into appropriate containers
or elephantiasis 4. Sterilize items that are suspected of containing
mosquito that live in banana , malaria) louse, pathogens (autoclave or boiling water)
cockroach
3. AIR BORNE TRANSMISSION (AEROSOLIZED 5. Practice personal grooming that helps prevent
DROPLET) the spread of microorganisms

Breaks the chain by: Hand hygiene, PPE, food HANDWASHING

safety, cleaning, sterilization, isolation - Most effective way to help prevent the
spread of microorganisms.
PORTAL OF ENRTY - Effective hand-washing requires at least 10
to 30 seconds vigorous washing with plain soap or
- Organisms enter the body thru the same disinfectant and water.
routes they use for exiting the reservoir. EQUIPMENTS:
- open wound can be a portal of entry for 1. Liquid or bar soap
another infection 2. Hand towel or paper towel.
- 3. Sink with running water
Breaks the chain by: hand hygiene, PPE, personal 4. Trash can
hygiene, first aid 5. Tissue paper
-
HOST BASIC TYPES OF FAUCET
1. Knee-lever faucet.
- Any person especially those receiving care. 2. Foot-pedal faucet
3. Hand-operated faucet
4. Long-lever fauce
 BODY MECHANICS
WHAT IS BODY MECHANICS? ANATOMICAL POSITION

- Nurses are 6x more likely to develop back injury &  The balanced upright position.
have the possibility to have back pain.  Standard anatomical position: feet flat with toes
 Coordinated use of the body parts to produce pointing forward, torso and back straight, arms
motion & maintain their equilibrium in hang loosely at the sides, palms facing forward.
relation to the skeletal, muscular & visceral
systems & their neurological association. PRINCIPLES OF BODY MECHANICS
 ABCs (alignment, balance, coordination)
 Cerebellum: controls our movement, balance 1. 1. The wider the base of support, the greater the
& coordination. stability of the nurse.
 Term used to describe the efficient, coordinated  Keep the feet apart by 2-3 inches apart.
and safe use of the body to move objects and  When pushing, front food should be forward
carry out the activities and one foot at the back when pulling.
2. The lower the center of gravity, the greater the
PURPOSE OF BODY MECHANISMS stability of the nurse.
3. The equilibrium of an object in maintained as long
as the line of gravity passes through its base of
1. To maintain good body posture. support.
 body alignment 2. 4. facing the direction of movement prevents
2. To promote good physiological functions of the abnormal twisting of the spine.
body. 3. 5. dividing balanced activity between arms and legs
 ease in breathing. reduces the risk of back injury.
3. To use the body correctly and to match and to 4. 6. Leverage, rolling, turning or pivoting requires less
maintain its effectiveness. work than lifting.
 Proper shipment of the weight. 5. 7. When friction is reduced between the object to be
4. To prevent injury or limitation of movement of the moved and the surface on which it is moved, less
musculoskeletal system. force is required to move it.
6. 8. Reducing the force of work reduces the risk of
EQUILIBRIUM injury.
7. 9. Maintaining good body mechanics reduces fatigue
 A state of balance. of the muscle groups.
 An equal distribution of weight to be able to stay 8. 10. Alternating periods of rest and activity helps to
upright and steady. reduce fatigue.
9. 11. Pulling action requires less effort than pushing or
PRINCIPLE OF BALANCE lifting.
10. 12. Get help whenever possible.
- Balance is maintained if the line of gravity passes
through the center of gravity and the base of support.
TIPS
1. LINE OF GRAVITY
 Imaginary vertical line drawn through the
 Work as close to your center of gravity as
body’s center of gravity.
possible.
2. CENTER OF GRAVITY
 Flex hips and knees slightly in preparation for
 The points at which all body mass is centered.
lifting.
3. BASE OF SUPPORT
 Bend from your hips & knees, never your back.
 The part that makes contact with the
 Hold objects to be lifted as close as possible to
supporting surface.
your body’s center of gravity.
 Golfer Tee Lift
 Hold onto something sturdy.
 Bend forward.
 Lift one leg for counter balance.
 Pivot! Don’t twist.
 Keep weight centralized.
 Move your feet, not your hips.
 Push! Don’t pull.
 Elbows and knees at 90-100 degrees.
 Lower back and support
 Stretch it out!  Chin tucks
 Squeeze shoulder blades then relax.  Lower back.
 Roll shoulders forward and backwards.

APPLICATION OF BODY MECHANICS

 STANDING  BODY MOVEMENT

Stand erect with head upright, face forward,  Start any body movement with proper
shoulders squared, back straight, abdominal alignment and balance.
muscles tucked in, arms straight at side with  Adjust the working area to waist level and
pants forward. keep your body close to the area.
 Keep 3-4 inches apart for a wide base of  Face in the direction of the task.
support. Place equal weight on both legs to  When moving a heavy object, keep your
minimize strain on weight-being joints. center of gravity as low as possible and
 SITTING centered over your base of support.
 Position the buttocks against the back of the  Avoid working against gravity whenever
chair. Hips and knees are flexed at right possible.
angle to the trunk.  Tighten the gluteal and abdominal muscles
 Keep trunk and heads as in standing position. before lifting any object. Often referred to as
 Place feet flat of the floor at a 90-degree angle “putting on the internal girdle”
to the lower legs.  Carry object close to the body and to the base
 If the chair has arms, flex the elbows and of support.
place the forearms on the armset to avoid  Use the palmar grip when grasping and lifting
shoulder strain. object.
 When lifting heavy objects, squat rather than
stop.
 Use the body’s weight to pull or push objects.
 Make your body movements smooth and
rhythmic.

PROCEDURES ON TRANSFERRING CLIENTS

 TRANSFERRING FROM BED TO
 MOVING UP IN BED CHAIR/WHEELCHAIR
 Changing the position or moving a semi-  Enables the patient to have a change in
helpless or immobilized patient up in bed. surroundings and increase opportunities for
 NURSE ALERT! Avoid dragging the patient up socialization.
in bed. This can cause bedsores/pressure  NURSE ALERT! This requires the assistance
sores. of the patient and should not be attempted if
the patient is unable to help or understand
 TURNING TO LATERAL OR PRONE POSITION IN the nurse’s instructions
BED
 Movement to lateral position may be
necessary when:
- placing a bedpan
- underneath the buttocks
- changing the bed linen
- repositioning the client.

 LOGROLLING
 Turning a patient whose body must be kept
in straight alignment at all times, like a log.
 Equipment needed:
- pillows
- draw sheet or full sheet folded in half.
- wedge
- extra linen, as needed.
 APPLICATION OF BODY MECHANICS
STANDING

- Stand erect with head upright, face forward, shoulders squared, back straight, abdominal muscles
tucked in, arms straight at sides with palms forward.
- Keep feet 3-4 inches apart for a wide base support. Place equal weight in both legs to minimize strain on
weight-bearing joints.

SITTING

- Position the buttocks against the back of the chair. Hips and knees are flexed at right angle top the trunk.
- Keep trunk and head as in standing position.
- Place feet flat on the floor at a 90-degree angle to the lower legs.
- If the chair has arms, flex the elbows and place the forearms on the armrest to avoid shoulder strain.

BODY MOVEMENT

KEY POINT RATIONALE

1. Start any body movement with proper Stretching creates unnecessary muscle fatigue and
alignment and balance. strain and places the lines of gravity outside the base
of support, resulting in instability.

2. Adjust the working area to waist level and This is to bring object being carries close to the
keep your body close to the area center of gravity

3. Face in the direction of the task This avoids torsion of the spine as well as increases
your stability and balance.

4. When moving heavy object, keep your center The closer the line of gravity to the center of the
of gravity as low as possible and centered base support the greater the persons stability.
over your base of support.

5. Avoid working against gravity whenever It takes less effort to slide, push or pull objects than
possible. it does to lift or carry them.
6. Tighten the gluteal and abdominal muscles Helps to support the abdomen and stabilizes the
before lifting any object often referred to as pelvis to prepare them for action and prevent injury.
“putting on the internal girdle”.

7. Carry object close to the body and to the base Holding objects close to the body prevents strain on
of support. the arms muscles. Body stability is enhanced if the
object is close to the base support
8. Use the palmar grip when grasping and lifting The hand muscles are larger and stronger than the
objects. finger muscles.
9. When lifting heavy objects, squat rather than Bending from the waist to lift a heavy load is a major
stoop. cause of back strain. The squatting position uses the
larger and stringer ventral and femoral muscles of
the buttocks and thighs
10. Use the body’s weight to pull or push the Body weight adds power to muscle action
objects.
11. Make your body movements smooth and Sudden, jerky movements expend more energy and
rhythmic put more strain in the muscles than controlled
smooth motions.
 MOVING UP THE CLIENT IN BED
The nurse will frequently encounter a semi-helpless or immobilized patient whose position must be
changed or who must be moved up in bed. Proper use of body mechanics can enable her (and the helper) to
move, lift, or transfer such a patient safely and at the same time avoid musculoskeletal injury.

ACTION RATIONALE

1. Check client’s record To assess client’s physical abilities (muscle strength,

presence of paralysis) and ability to understand.
2. Identify the client, introduce self and explain An explanation reduces apprehension and facilities
the procedure to the patient. cooperation. It also promotes the patient’s
autonomy.
3. Perform hand hygiene and don gloves. Reduces transient and microorganism of pathogens
to others and self.
4. Provided for client’s privacy The closer the line of gravity to the center of the
base support the greater the persons stability.
5. Elevate bed to working height. Lessens the strain on nurse’s back muscles by
bringing the height to center of gravity.
6. Lock the wheels of the bed and raise the rail on Helps to support the abdomen and stabilizes the
the side of the bed opposite you. pelvis to prepare them for action and prevent injury.

7. Adjust the head of the bed to flat position as Moving client upward against gravity requires more
low as the client can tolerate force and cause back pain.

8. Remove all pillows and place one against the To protect the client’s head from injury during
head of the bed. upward movement.
9. Elicits clients help by asking him to:

a. Flex the hips knees and position the feet. Lessen the workload of a nurse flexing the hips and
the knees keep the entire lower legs off the bed
surface thus preventing friction. The Large muscles
of client’s legs when pushing, increase force of
movement.

b. Grasp the head of the bed and pull during the Clients assistance provides additional power to
move or; raise the upper part of the body on overcome inertia and friction during the move.
the elbows and push with the hands and
forearms during the move. Or; grasp the
overhead trapeze with both hands and pull
during the move
10. Position yourself appropriately
a. Face the direction of the movement Prevents twisting the body when moving the client.

b. Place your feet apart This increase your balance and wider base of
support.

c. Place your arm under the client’s thigh. This supports the heaviest part of the client’s body
(buttocks).

d. Push down the mattress with the far arm. Far arm acts as lever during the move.
11. Instruct the client to move up in bed in the Prepares the client for actual move thus reinforcing
count of three assistance.
12. Move in coordination to transfer the client up Enables the nurse to improve balance as he
toward the head of the bed. overcomes inertia.
13. Ensures client’s comfort and reassess patients Proper body alignment increases client’s comfort,
body alignment promotes rest and reduces hazards of immobility.
14. Elevate side rails. Ensures clients safety
 15. Remove gloves and wash hands. Decrease transient microorganisms and the
transmission of pathogens to others and self.
16. Document the procedure that was done Record in nurse’s notes patients’ new position.
Variation A: For a client who has limited strength of
the upper extremities follow steps 1-8 (moving up
client in bed)
1. Assists the client to flex the hips and knees and This keeps them off the bed surface and minimize
position the feet. Place the client’s arm across friction during movement
the chest.
10. Ask the client to flex the neck and keep the
head off the bed surface during the move.
11. Position yourself as in step 10 (a&b) and This placement of the arms distributes the client’s
place once arm under the clients back and weight and support the heaviest part of the body.
shoulders and the other arm under the
client’s arm.
12. Ensure clients comfort and reassess
patients body alignment.
13. Elevate side rails
14. Remove gloves and wash hands
15. Document the procedure that was done

Variation B: Two nurses using a hand forearm

interlock.
Two people are required to move clients who are
unable to assist because of their condition or weight.

Using the technique described in variation A, with the

second staff member on the opposite side of the bed,
both will interlock their forearms under the client’s
thighs and shoulders and lift the client up in bed.

Variation C. Two Nurses Using a Turn sheet.

Follow 1-10 in Variation A
12. Place a draw sheet or full sheet folded in half A turn sheet distributes the client’s weight more
under the client, extending from the shoulder evenly, decreases friction, and exerts a more even
to the thighs. force on the client during the move.

13. Each person rolls up or fanfold the turn sheet This draws the weight closer to the nurse’s center of
close to the client’s body on either side and gravity and increases their balance and stability,
grasp the sheet close to the shoulders and permitting a smoother movement.
buttocks of the client.

14. Assist the client to flex the hips and knees and The keeps them off the bed surface and minimize
position the feet. Place the client’s arm across friction during movement.
the chest.

15. Ask the client to flex the neck and keep the Enables the nurse to improve balance as he
head off the bed surface during the move. overcomes inertia.

16. Ensures clients comfort and reassess patients Proper body alignment increases client’s comfort,
body alignment. promotes rest and reduces hazards of immobility

Ensures clients safety.

17. Elevate side rails.

Record in nurses’ notes patients’ new position.

18. Remove gloves and wash hands
19. Document the procedure that was done.
NURSE ALERT:
The nurse must avoid dragging the patient up in bed. Dragging against the bed linen causes shearing
force. With a shearing force the skin adheres to the surface of bed while the layers of subcutaneous tissue and
even the bones slide in the direction of body movement. The underlying tissues and capillaries are compressed
and may be severed by the pressure This can cause bedsores or pressure sores.

TURNING A CLIENT LATERAL OR PRONE POSITION IN BED

PURPOSE:
Movement to the lateral (side-lying) position may be necessary when placing the bedpan beneath the
client, when changing the client's bed linen., or when repositioning the client.
ACTION RATIONALE

1. Review client's record Determine the reason for logrolling the patient and
the patient's diagnosis.
2. Identify the client, introduce self and An explanation reduces apprehension and facilitates
explain the procedure to the patient. cooperation. It also promotes the patient's
autonomy.
3. Perform hand hygiene and don gloves Reduces transient and microorganism of pathogens
to others and self.
4. Provide for client's privacy To maintain client's dignity
5. Raise the bed to a comfortable working level. Lessens strain on nurse's back muscles by bringing
the height to center of gravity.
6. Lock the wheels of the bed and raise the rail on Prevent bed from dragging and client from injury.
the side of the bed opposite you.
7. Move the client closer to the side of the bed This will ensure that the client will be
opposite the side the client will face when positioned safely in the center of the bed after
turned with the use of a pull sheet. turning
8. Place the client's near arm across the chest, Pulling the one arm forward facilitates the turning
abduct the far shoulder slightly and externally motion, pulling the other arm away from the body
rotate it Place the client's near ankle and foot and externally rotating the shoulder prevents that
across the far ankle and foot. arm from being caught beneath the client's body
during the roll.
9. Raise the side rails next to the client before This ensures that client, who is dose to the edge of
going to the other side of the bed. the mattress will not fall.

10. Position yourself on the side of the bed toward This facilitates the turning motion_ making these
which the client will turn, directly in line with preparations on the side of the bed closest to the
client's waistline and as close to the bed as client helps prevent unnecessary reaching.
possible. Lean your trunk forward from the
hips. Flex hips, knees and ankles. Assume a
broad stance with one foot forward and place
weight on this foot moved forward.
11. Pull or roll the client to lateral position by This position of the hands supports the client at the
placing one hand on the client's hip and the two heaviest parts of the body, providing greater
other hand on the client's far shoulder control of movement during the roll.
12. Position the client on his side with arms and Proper positioning of the arms and legs will prevent
legs positioned and supported. injury.
Variation: Turning the Client to a Prone Position

Follow the pre-proceeding steps with two exceptions:

•Instead of abducting the far aim, keep the
client's arm alongside the body for the client to Keeping the arm alongside the body prevents it
roll over. from being pinned under the client when the client
•Roll the client completely onto the abdomen is rolled

13. Assess the patient's comfort and body Maximizes the patient's comfort and provides good
alignment. body alignment.
 14. Wash your hands and remove gloves Decreases transient microorganisms and the
transmission of pathogens to other and self.

15. Record the procedure, time patient’s response Communicates to other members of the health care
and other observations. team and contributes to the legal record by
documenting the care given to the patient.

LOGROLLING THE PATIENT

PURPOSE:
Logrolling is a technique used to turn a patient whose body must at all times be kept in straight
alignment (like a log). An example is the client who has a spinal cord injury or a spinal disorder, or who has had
a spinal cord operation or a hip operation with a prosthesis or pin). Another nurse should assist you with this
procedure.
ACTION RATIONALE

1. Review client's record Determine the reason for logrolling the patient and
the patient's diagnosis
2. Identify the client, introduce self and The reason for the procedure should be explained to
explain the procedure to the patient. the patient.
3. Perform hand hygiene and don gloves Reduces transient microorganism or pathogens to
transfer others and self
4. Provide for client's privacy To maintain client's dignity
5. Raise the bed to a comfortable working level. Lessens strain on nurse's back muscles by bringing
the height to center of gravity.
6. Lock the wheels of the bed and raise the rail on Prevent bed from dragging and client from injury.
the side of the bed opposite you, gently remove
supportive device around the patient (1F
APPLICABLE).
7. The two nurses should position themselves on To have a balanced force when moving the patient.
opposite sides of the bed.
8. Place the client's arm across the chest. To ensure that the hands will not be injured or
become trapped under the body during the turn.
9. Place a pillow lengthwise between the patient's Helps to maintain the correct alignment of the
legs. client's lower extremities during the turn.
10. One nurse should grasp the patient at the Each staff member then has a major weight area of
patient's shoulders and waist, supporting the the client centered between the arms
neck. The other nurse should grasp the patient
at the patient's buttocks and knees, supporting
the legs. Roll the patient all in one motion to a
side-lying position.
11. One nurse count: one, two, three, go then at the Moving client in unison maintain the client’s body
same time all staff members pull the client to alignment.
the side of the bed.
12. Elevate the side rail on this side of the bed. This prevents the client from falling while lying so
close to the edge of the bed.
13. Place the patient in correct body alignment and The patient is aligned correctly to prevent any
put the wedge against his or her back. contractures and damage to the spinal cord
14. Flex the patient's top leg at the knee and place a
pillow under the knee and lower leg. A small Max i m i zes th e pat i en t ' s com for t and
pillow or folded linen may be placed under the provides good body alignment.
head and shoulders.
Variation Using a draw sheet/bedsheet folded in half

a. The two nurses should position themselves on The nurses will grip the rolled draw sheet to roll the
opposite sides of the bed and roll the edges patient.
of the draw sheet toward the patient.
 b. With the draw sheet, slide the patient to the Allows ample room for positioning the patient once
edge of the bed opposite the direction to he or she is rolled to the opposite side.
which the patient is to be turned.

c. Place a pillow lengthwise between the patient's Helps maintain the correct alignment of the
legs patient's lower extremities as he or she is turned.

d. Position the patient's arms. To turn the patient Proper positioning of the arms will prevent injury.
to the right, place his or her left arm to the
side and the right arm either flexed above
the head or at the side. Raise the bedrolls to
the opposite side where you will turn the
patient. Both nurses should move to the
side of the bed to where patient will be
turned.

e. The first nurse goes to the farthest side of the To ensure good alignment in the lateral position.
bed. Reaching over the client grasp the far
edge of the turn sheet, and roll the client
toward you. The second nurse (behind the
client) helps turn the client and provide
pillow supports.

f. Remove gloves and wash your hands. Decreases transient microorganisms and the
transmission of pathogens to other and self.

g. Record the procedure, time, patient's response Communicates to the other members of the health
and other observations. care team and contributes to the legal record by
documenting the care given to the patient.

TRANSFERRING A PATIENT FROM BED TO CHAIR WHEELCHAIR

Transferring a patient from bed to chair enables the nurse to change his surroundings as well as his
position. If the patient is able to tolerate transfer to a wheelchair, the nurse can move him out of his room into
other surroundings and increase his opportunities for socialization. For patients who have been on bed rest,
this is one of the first activities to be resumed.

ACTION RATIONALE

1. Review client's record Assess patient for ability to assist the transfer and
for presence of cognitive or sensory deficits.
2. Verify Client's identity, introduce yourself Reduces patient anxiety and increases cooperation.
and inform patient of the purpose and
destination,
3. Perform hand hygiene and don gloves Reduces transient and microorganism of pathogens
to others and self.
4. Provide for client's privacy To maintain client's dignity.
5. Lower the height of the bed. Reduces distance patients has to step down, thus
decreasing risk of injury.
6. Allow patient to dangle feet for a few Allows time for assessing patient's response to
minutes. sitting; reduces possibility of orthostatic
hypotension.
7. Move the client closer to the side of the bed This will ensure that the client will be
opposite the side the client will face when positioned safely in the center of the bed after
turned with the use of a pull sheet. turning
8. Assist patient to side of bed until feet touch Guides and helps patient maintain balance.
 the floor.
9. Assist patient to a standing position and Helps patient stand safely and gives time to assess
provide support. status.

10. Pivot patient so patient’s back is toward the Moves patients into proper position to be seated.
wheel chair.
11. Place patient's hands on the arm supports of Allows patient to gain balance and judge distance to
the wheel chair. sit.
12. Bend at the knees, easing the patient into a Increases stability and minimizes strain on back.
sitting position.

13. Assist to maintain proper posture resting on Broadest and therefore safest base of support is with
the chair's back. patient seated as far back on the seat as possible.

14. Secure safety belts (if present), place Ensures safety and prepares patient for movement.
patient's feet on foot pedals and release
brakes.

15. Remove gloves and wash your hands. Decreases transient microorganisms and the
transmission of pathogens to others and self.
16. Record in nurse's note patient's safe transfer Documents the action taken.
to chair.

NURSE ALERT:
Transfer of a patient from bed to chair by one nurse requires assistance from the patient and should not
be attempted if the patient is unable to help or to understand the nurse's instructions.

TRANSFERRING A PATIENT FROM BED TO STRETCHER

ACTION RATIONALE

1. Review client's record Assess patient for ability to assist the transfer and
for presence of cognitive or sensory deficits.
2. Verify Client's identity, introduce yourself Reduces patient anxiety and increases cooperation.
and inform patient of the purpose and
destination,
3. Perform hand hygiene and don gloves Reduces transient and microorganism of pathogens
to others and self.
4. Provide for client's privacy To maintain client's dignity
5. Raise the height of the bed and lock brakes It is easier for the client to move down a slant. Nurse
of bed. must bend, thus preventing back strain and prevents
bed from moving.
6. Instruct/assist patient to move to side of Decreases risk of patient falling.
bed near the stretcher. Lower side rails of
bed and stretcher.
7. Stand at outer side of stretcher and push it Diminishes gap between bed and stretcher; secures
towards bed. the stretcher position.
 8. Instruct patient to move unto stretcher with Promotes patient independence.
assistance as needed (for able patient).

Variation A (for disabled client)

a. Roll a pull sheet tightly against the client. This achieves better control over client movement.

To prevent injury to these body part.

b. Place the arms across the chest.

Prevent stretcher from moving.

c. In unison with other staff members, press
the body tightly against the stretcher.

d. Transfer the client to the stretcher.

Variation B: Using a transfer board

Transfer board is lacquered or smooth polyethylene

board which may measure 45 to 55 by 182cm. with
handholds along its edges. (it is imperative to have
enough people assisting).

a. Turn the client to a lateral position away

from you
b. Position the board to the patients back, and
roll the client onto the board
c. Pull the client and the board across the bed
to the stretcher safety belts maybe place
over the chest, abdomen and legs.

9. Cover patient with sheet. Promotes comfort and protects privacy.

10. Elevate side rails on stretcher and secure Prevents falls.

safety belt (if available). Release brakes of
stretcher
11. Stand at head of stretcher to guide it when Pushing, not pulling ensures proper body mechanics.
pushing.
12. Document relevant information Record in nurse’s notes the patient’s safe transfer to
stretcher.
 HOUSEKEEPING
WHAT IS HOUSEKEEPING CLEANING OPERATIONS
 Provision of the patient with a safe pleasant and  PURPOSE: to maintain a safe, clean and healthful
suitable environment. surrounding for the patients, visitors and staff.

NURSES’ RESPONSIBILITIES 1. SWEEPING

 Removes dirt from floor area & preceded all
 Daily care of the patient’s room or suit. other daily cleaning operations.
 Care of facilities - Equipment:
 Cleaning of the room after discharge of a patient 1. Dust pan
to make it ready for another patient. 2. Floor broom or brush
 Control of insects and pests 3. Trash can/garbage can
 Bring the equipment th the area to be swept.
IMPORTANT FACTORS TO CONSIDER IN  Trash can: out of traffic but near place of
work.
HOSPITAL HOUSEKEEPING
 Start: entrance with proper srokes towards
the center.
 Immediate disposal of wastes for good sanitary
Accumulate dirt -> dust pan & deposit into
practice
garage can.
 Promote cleanliness & provide an attractive
 If dust is heavy: tap brush or broom on the
surrounding by cleaning the floor.
floor at the end of each stroke to free dirt
 Furniture should be clean and in good working
 After sweeping: examine floor and dust
condition.
streaks are not present.
 Torn linen should be mend. Supply of linen
 Straighten furniture and do other necessary
should be enough.
cleaning operations.
 Equipment used for personal care should be
 Clean equipment used and return to proper
cleaned and ready for use at all time.
place.
 Solid wastes should not be thrown into the toilet
2. MOPPING
bowls.
 To rub or wipe the floor with a mop using
 Food droppings on the floor must immediately
soap and water.
be removed.
- Equipment:
1. Floor mop
CARE OF HOSPITAL FURNITURE 2. Pail with soap solution
3. Pail w/ rinsing water
 For matching set of furniture, do not, move it to 4. Mop wringer
another room.  Bring the equipment to the area
 Do not force drawers or doors which are difficult  Dip the mop into the soap solution
to open or close.  Place the mop on the wringer and wring
 Report damaged furniture to the carpentry shop.  Starting from the corner, mop floor using
 Place suitable dish or container under each firm & heavy strokes to loosen dirt.
flower vase or pot.  Rinse and dry as necessary until the whole
 When spilled something on the furniture, area had been mopped.
cleanse immediately.  Inspect work. Clean floor: does not have
 Use mild soap solution to wash the furniture and streaks of dirt
dry it carefully.  Clean all equipment used and return to the
 Raise overbed table high enough to prevent proper place.
damaged when moved. 3. SCRUBBING
 Bed cranks: pull completely out, to elevate or  To remove dirt by rubbing hard with the use
lower the head or foot of the bed. of a brush with or without soap and water.
 Metal furniture: wash with warm water & soap - Equipment:
and dry thoroughly. Handle carefully to prevent 1. Coconut husk/ electric polisher
denting. 2. Brush
 Daily cleaning of the rooms: be careful in moving 3. Pail w/ soap solution
the furniture so that it does not become marred 4. Pail w/ rinsing water
or scattered. 5. Mop
6. Dust cloth
 8. Inspect work: appear bright and free of dust
 Bring all equipment to the bedside streaks.
 Dip brush in soap solution, rub it against the 9. Return all equipment to proper places, clean
surface to be cleansed. and dry.
 Rinse using long strokes and following the 2. HIGH DUSTING - all places easily reached
grain of wood. by standing on a chair and is done periodically.
 Wipe to dry using the same strokes, Purpose: to do general cleaning of a room
 Inspect that all dirt has been removed. from the ceiling to the floor including all furniture
 After care of equipment. and cabinets.
Equipment:
4. WAXING  Similar in preparation for daily dusting.
 Application of a protective coating to an area  Additional:
which may be later polished by friction.  Broom or brush
 Pieces of newspaper to cover tops of
- Equipment: cabinets.
1. Appropriate wax PROCEDURE:
2. Several dust clothes 1. Bring the equipment and place tray on
chair/stool
5. WASHING lined with paper.
 Removing dirt by the use of soap and water. 2. Move all furniture to one side or cover
- Procedure: depending on the kind of article furniture with
to be washed. newspaper.
3. Dust/remove all cobwebs and other dirt from
6. DUSTING top to
 Remove dirt which may be washed. bottom.
 Classification of dusting: 4. Window screens/dust window bars: use dry
- According to the materials used: dust cloth or with soap & water.
1. DRY DUSTING - use of dry cloth to remove 5. Sweep the floor.
dust, as in varnished furniture. 6. Dust all furniture as well as inside the cabinet.
2. DAMP DUSTING - use o damp cloth to 7. When everything is already cleaned, return all
remove dust on furniture not destroyed by moisture. furniture on their position. Inspect the room.
- According to height:
1. LOW DUSTING - all places easily reached 7. CARE OF LINEN
by standing on the floor and is done daily.  Inspect whether it it needs mending.
Purpose: for daily dusting  Sorted accordingly.
Equipment: A tray containing:  Folded uniformly
 A basin or pail half filled with water.
 Laundry soap or any detergent CARE OF MEDICINE CONTAINERS &
 Whisk broom or chicken feathers, or a stick CABINETS
with cloth wound at one end.
 Metal polish, if necessary. 1. MEDICINES
 Pieces of dusting cloth  Removed from shelf at a time.
 Newspaper for lining.  Bottles: wiped from damped cloth, do not
PROCEDURE: remove the cork/cap.
1. Bring all equipment.  Make sure that the label will not be
2. Chair/stool: line with newspaper & place the discolored/destroyed.
tray on it ( never on the floor).  If with discoloration or precipitation.
3. Start: from highest point to be cleansed
towards the floor. 2. CABINETS (glass, shelves, doors)
4. Between bars & crevices: use a small brush,  Cleaned it with damp newspaper wiped with
chicken feather or a stick w/ cloth. dry or smooth dust cloth if necessary, lock
5. Dusting bars: palm the cloth & grasp the bar as cabinets or drawers.
you wipe along the surface.
6. If soap and water is used: Rub the cloth with UNIT = AREA, FURNISHINGS, EQUIPMENT +
soap to area with friction until dit has been NECESSARY FOR PATIENT CARE
loosened. Rinse & dry.
7. Clean & oil wheels of furniture and polish door
knobs w/ metal polish
 A UNIT VARIES IN DIFFERENT SIZES Meals, recreations, occupation and exercise may be
done while in bed.
1. A suit including living room, bedroom & bath.
2. Single room with furnishings, equipment and BED CLEANING
supplies used for comfort and care of just one patient.
3. Ward where several patients are placed. EQUIPMENT: A tray containing the following
PROCEDURE: 1. Mattress brush
1. Maintain proper lighting and ventilation. 2. A basin of pail half-filled with water.
2. Dust all furniture, windows, wals, drawers clean 3. Laundry soap or detergent.
and articles inside are clean and arranged in good 4. Several pieces of dusting cloth.
condition. 5. Chicken feathers or a stick with cloth wound at one
3. Keep mirrors clean and free from stains. end.
4. Provide clean drinking water 6. Lubricant or oil for wheels, if needed.
5. Check:
 Garbage can has been emptied. PROCEDURE:
 Toilet and bathroom are clean. 1. Inspect for stains and tears.
6. Take flowers to utility room (clean, arrange & 2. Brush the bed from head part using long firm
return at bedside) strokes towards the foot part.
7. Calling device (buzzer): functioning properly and 3. Turn the mattress upside down. Repeat same
within easy reach of the patient. procedure as #2.
8. See if patient is comfortable and room is clean, 4. Roll call the mattress to the foot part.
neat and in order. 5. Start cleaning the bed with soap and water, begin
at head part, wash bed frame, springs then raise head
ELIMINATION OF UNPLEASANT ODORS rest if provided. Rinse and dry.
6. If completed, transfer the mattress to the clean
 Precautions needed to prevent unpleasant odors side and do the same at the foot part.
in the patient’s unit: 7. Oil wheels if necessary.
1. Patient: cleaned daily 8. Return all equipment used to proper place, clean
2. Bed linen: changed daily/accordingly to hospital and dry.
policy. 9. Mop the floor if necessary.
3. Soiled linen & garbage: disposed of properly 10. Clean and arrange the furniture in the room or in
4. Water in the flower vase must be changed daily the immediate vicinity o the patient in the ward.
5. Receptacles of patients excrete: cleaned properly
6. Bathrooms: cleaned daily SOLID WASTE MANAGEMENT
7. Clean mop free from odor.
 Refers to all activities pertaining to the control of
CLEANING OF TOILET AND BATHROOM solid wastes
 It includes all materials from humans, animals,
PROCEDURE: and economic activities that are normally solid
1. Scrub tiled walls and are useless or unwanted.
2. Flush toilet, clean with soap & brush then proceed
on the outside portion. SOLID WASTE MANAGEMENT ACT OF
3. Scrub floor. 2000
4. Wipe the walls & outside of toilet bowl.
5. Replenish the suppl of toilet paper and soap, if  Emphasizes the proper collection of safe
provided by hospital. disposal of household garbage, industrial, and
hospital wastes.
LAVATORY AND SINK  Republic act 9003 of solid waste management
ensures proper segregation, collection, transport,
1. Wash thoroughly with soap and water (use storage, treatment, and disposal of solid wastes.
mop/brush)  Presidential decree 825: states the penalty for
2. If stains are hard to remove, use cleanser. improper disposal of garbage and other forms of
3. Rinse and dry with damp cloth. uncleanliness.
-> 5 Days to one year imprisonment & or a
CARE OF BED fine ranging from P100-P2000

COMFORT + REST AND SLEEP = HEALTH AND

RECOVERY FROM DIDEASE
 WASTE SEGREGATION

 BLACK: dry waste, drained IVF bag, non

biodegradable.
 GREEN: wet, left-over food, biodegradable.
 YELLOW: infectious, syringe, tubings
 RED: sharps
 ORANGE: radio-active
 HOSPITAL BEDMAKING
 The process of applying or changing bed linens.  SIDERAILS/SAFETY SIDES
 A process: - Supposedly standard to all beds
 is a series of actions - Used in both hospital beds and stretchers
 sequence
 step by step

SUPPORTING A HYGIENIC ENVIRONMENT

 ENVIRONMENT
 assess age, severity of illness, level of activity.
 Room temperature – a temperature of 20-
23 deg Celsius is comfortable.
 NOTE: very young, very old & acutely ill
need a room temp higher than normal
 Ventilation  HAND CRANKS
 Good ventilation is important to remove - Can be manually operated.
unpleasant odors. - Hospital beds are especially designed to:
 Odors: urine, draining wounds, vomitus 1. Raise the head, knee, and feet
2. Assist in positioning patients safely &
PREREQUISITES: comfortably
3. The height is adjustable for the convenience
1. Principle of Medical Handwashing of the staff
- Basic in all nursing procedures
2. Principles and Rules of Body Mechanics
- Must be observed all throughout
3. Turning a client on his side
- Occupied bed
4. Moving a client toward the head of the bed
5. Knowing the type of hospital bed

HOSPITAL BEDS

 66 cm (26 in) high

 0.9 meters (3 feet) wide
 1.9 m (6.6 feet) length
 Reasons:
 ELECTRONIC CONTROL
1. so the nurse can reach the client from the
- Requires electricity.
other side
2. Prevent muscle fatigue to the nurse

STANDARD EQUIPMENT OF A HOSPITAL

BED

 MATTRESS
- Most have inner springs – provide even
support to the body.
- Usually covered with a water repellent
material that resists soiling and can be easily cleaned
- Note: Nurses should note any awareness Of
the mattress surface (broken spring)
 WHEEL LOCKS 4. Gravity pulls downward, allowing greater lung
- Engaged by foot expansion
- Purpose: - Prevent the bed from moving  TRENDELENBURG POSITION
during the patient care, repositioning and bedmaking. - The head of the bed is lowered and the foot
 CLIENT SIGNAL part of the bed is elevated .
- Must be within the easy reach of the client - Used in postural drainage.
- Instruct the client how to use the signal and - Postural drainage is a technique for
when to use it loosening mucus in the airway so that it may be
coughed out.

BED POSITIONS:
 REVERSE TRENDELENBURG POSITION
 FLAT POSITION - Straight tilt on the opposite direction.
- Commonly used - The head part is elevated and the foot part
- Mattress is completely horizontal is lowered.
- Supine position - Use: Patients with problems arterial
circulation to the leg

 HYPEREXTENSION POSITION
- Both the head and the foot part are lowered
15 degree.
- Used for clients with fracture.
 FOWLER’S POITION - Use only with specific orders and
- Sitting position continuous nursing assessment of the client
2 kinds of Fowler’s position:
1. SEMI-FOWLER’S POSITION
- Head part is raised @ 15 – 45 deg

2. FOWLER’S POSITION
- Head and trunk elevated at 90 deg. OTHER TYPES OF BEDS

Purpose :
1. Gives the client the relief from lying position
2. Convenient for eating and reading
3. Position of choice for patients with difficulty of
breathing & with cardiac problems.
 4. WHEN STRIPPING AND MAKING A BED, MAKE
UP ONE SIDE AS COMPLETELY AS POSSIBLE
BEFORE MAKING UP THE OTHER SIDE.
- To conserve time and energy.

5. GATHER ALL NEEDED LINEN BEFORE

STARTING TO STRIP A BED
- To avoid unnecessary trips to the linen
supply area.
- To conserve time and energy

6. DO MEDICAL HANDWASHING IN MAKING A BED.

- To prevent transfer of microorganisms by
 STRYKER WEDGE FRAME the nurse ’s hands
- Indicated for patients with spinal injuries or
surgery requiring immobility. 7. OBSERVE PROPER BODY MECHANICS.
- Not for the sake of art, but to AVOID
MUSCLE STRAIN.

8. IN MAKING THE BED, THE LINEN MUST BE

SMOOTH AND WRINKLE-FREE TO AVOID
DECUBITUS ULCER OR BEDSORES.
 CIRCOLECTRIC BED
- This bed permits frequent turning of the
severely injured or immobilized patient with
minimal trauma and extraneous movement to
prevent or treat decubitus ulcer as well as
respiratory and circulatory complications.

- The safety factor of bedmaking relates

directly to the prevention of pressure ulcer.

CONCEPTS IN BEDMAKING PRESSURE ULCER/BEDSORE/ DECUBITUS

ULCER
1. LINENS THAT HAVE BEEN SOILED WITH
SECRETIONS AND EXCRETIONS HARBOR  It is a localized injury to the skin and other
MICROORGANISM THAT CAN BE TRANSMITTED underlying tissue, usually over a bony
TO OTHERS DIRECTLY. prominence as a result of prolonged unrelieved
Note: pressure.
1. Nurses should wash hands thoroughly  They can happen to anyone, but usually affect
after handling the client’s soiled linen. people confined to bed or who sit in a chair or
2. Hold soiled linen away from the uniform. wheelchair for long periods of time.
2. SOILED LINEN IS NEVER SHAKEN IN THE AIR
- Shaking can disseminate microorganisms.

3. SOILED LINEN IS PLACED DIRECTLY IN A

PORTABLE LINEN HAMPER
- If there is no available hamper, make use of
the soiled pillow case for dispersal.
  STAGE 3
- Full thickness skin loss with subcutaneous
damage, ulcer extends down to fascia, presents as
shallow center.

 STAGE 4
- Full thickness skin loss with extensive
AREAS SUSCEPTIBLE TO ULCERATION destruction, tissue necrosis, damage to muscle, bone,
tendon or joint capsule.
1. Areas over the bony prominences (spine & scapula)
2. Buttocks

STAGES OF SACRAL PRESSURE ULCER

 STAGE 1
- Nonblanchable erythema of intact skin.

 STAGE 2
- Partial thickness skin loss, Ulcer involves
epidermis or dermis.
BED SORES: HOW THEY DEVELOP

1. A bit of redness that

doesn’t lighten when
presses. Site might be
painful, especially when
touched.

2. Part of the skin might have

peeled off. The area looks like a
blister, or a blister that has
burst.
3. By now, a deep wound
often with some fat
exposed. It looks like a
crater, possibly with
yellowish dead tissue at
the bottom. If there is
tunneling, the wound
would be deeper that
what can be seen.
4. The wound is so deep
that muscle, bone and
tendon are exposed, with a
significant amount of dead
tissue at the base, either
yellowish, or even dark
and crusty.

PREVENTION AND TREATMENT

1. Turn patient every two hours.

2. Get patient out of bed-to walk or sit. Ensure
sufficient nutrition and water intake.
3. Change diapers at least every four hours.
4. Apply moisturizer and cream that protects against
moisture.
5. Use cushions to reduce pressure.
 BEDMAKING PROCEDURE
BEDMAKING TYPES OF BEDMAKING

It is the proper adjustment of bed linens. 1. UNOCCUPIED BED

a. open –bed
TYPES OF BED b. closed –bed
2. OBSTETRICAL BED
1. STANDARD HOSPITAL BED 3. POST-OPERATIVE BED
- Has a firm mattress on a metal frame that 4. OCCUPIED BED
canberaised or lowered horizontally. It is a bed that
can be adjusted to a varietyof positions. This type of GENERAL GUIDELINES IN FOLDING LINEN
bed can be controlled manually or electrically.
 BOTTOM SHEET
2. SPECIAL HOSPITAL BED
- A bed that is required for patients to maintain - Fold lengthwise with the right side inside(RIBS)
strict body alignment. It rotates on an axis to turn the with the wider hemat thefoot part of the bed.
patient fromsupine toprone or vice –versa. Two such - Fold again with the edge towards the
beds are Stryker wedge frame andtheCircOlectric centerfold of the linen.
bed. - Fold crosswise two times towards the foot part.

a. STRYKER WEDGE FRAME  TOP SHEET

- Is manually operated by the nurse, turns - Fold lengthwise with the right side
thepatient laterally through side-lying position. This outside( ROTS ) and the wider hemat thehead part of
bed is indicatedfor those with spinal injuries or the bed.
surgery requiring immobility.
 RUBBER SHEET
b. CIRCOLECTRIC BED - Roll both sides towards the center.
- Operated electrically by the nurse usingapush
button rotates the patient vertically through the  COTTON DRAW SHEET
standingposition. This bed permits frequent turning - Fold crosswise with the right side inside and
of the severely injuredor immobilized patient with fold again with the edge towards the centerfold. Fold
minimal trauma and extraneous movement to crosswise once.
prevent or treat decubitus ulcer, as well as
respiratoryand circulatory complications.  WATERPROOF UNDER PAD
- (to be used instead of rubber and draw
PARTS OF THE BED sheet i.e. blue chucks) Same folding with the draw
sheet.
The hospital bed is narrower than the usual bed
so that the nurse can reachtheclient from either side  BATH BLANKET
without undue stretching. It is 3 feet wide and 26 - With two students facing one another
inches in height and the length is usually 6 feet and 6 holding both ends of the blanket withthe right side
inches long. outside. Fold crosswise three times with the
centerfold inside. Maintaining the hold of the blanket,
1. SIDERAILS = protects the patients from place the loose end with the wider hem, fliptherest of
accidental falls the folded sheets and insert it back towards the hand
2. WHEEL LOCKS = prevents accidental movement that holds the blanket. Flip back the rest of the folds.
of the bed. Bring the edges towards the center once.
3. PATIENT’ SIGNAL = device to call for assistance
from the health personnel  TOP SHEET (OCCUPIED BED)
4. ELECTRONIC OR MANUAL CONTROL (CRANKS) - Fold the sheet crosswise. Follow the same
= to change the position of the bed sequence of folding with bath blanket.
INFECTION CONTROL IN BEDMAKING

Apply these principles of basic infection control to all

bed-making procedures:
1. Microorganisms move through space on air
current; therefore, handlelinen carefully. Avoid
shaking it or tossing it into the laundry hamper (it
should be placed in the hamper).

2. Microorganisms are transferred from one surface

to another whenever one object touches another.
Therefore, hold both soiled and clean linenaway from
your uniform to prevent contamination of the clean
linenbythe uniform and contamination of the
uniform by soiled linen. Inaddition, avoid placing it
on the floor to prevent the spread of anybacteria
present either on the linen or on the floor.

3. Proper handwashing removes many

microorganisms that wouldbetransferred by the
hands from one item to another. Therefore,
washyour hands before you begin and after you
finish bedmak
 A. UNOCCUPIED BED
Definition:
 Unoccupied bed – It is a bed that does not call for any special cases. For newly admitted patients.
Two Types:
1. Open-Bed
 The top covers are folded back to make it easier for a patient to get in.
2. Closed-Bed
 The top covers are drawn up to the headpart over the pillows.
Purposes:
1. To provide comfort of the patient.
2. To reduce transmission of microorganism.
3. To stimulate and refresh the patient.
4. To maintain hygienic environment.
Equipment:
 1 bottom sheet /Flat or fitted sheet  1 additional pillow
 1or 2 pillow cases  1 empty bed
 1 top sheet  1 bath blanket (optional)

Procedure (Flat Regular Sheet)

ACTION RATIONALE
1. Wash your hands. It deters the spread of microorganisms.

2. Assemble equipment and place on bedside at the Organization promotes efficient time management.
foot of the bed in their order of use.

If the pillow is new, include in on the tray. If not, To avoid contaminating the linens because an old
place the pillow on a chair or under the tray. pillow is considered contaminated.

2.5 Once you enter the room, adjust the bed to your To maintain good body mechanics.
working height using mechanical cranks.

3. Grasp the mattress securely and shift it up to the Allows more foot room for the client and moves the
head of the bed. mattress against the head of the bed.

4. Place the bottom sheet with its center fold on the Proper positioning of linen ensures that adequate linen
center of the mattress with the bigger hem in line will be available to the cover opposite side of the bed.
with the edge of the mattress at the footpart.
Open the sheet’s top layer towards the center of
the bed as you bring the extra to the headpart.

Roll the other layers inside toward the center of

the bed. (From vid of CI)

5. Grasp the corner of the mattress near you with

one hand and lift to tuck the excess.

6. Miter the sheet at the top corner by: Mitering will secure the bed linen while the bed is
 Picking up the edge of the sheet and holding occupied.
straight up forming a double triangle. (Fitted sheets do not require mitering).
 Lay the upper part on the top of the mattress.
 Make sure the linen underneath the mattress
is free of any creases and is straight.

 Tuck the hanging part of the sheet.

Making sure your linens are not going to be

stuck on the springs of the bed.

7. Supporting your mitered corner, tuck the sides of Proper positioning of linen ensures that adequate linen
the bottom sheet under the mattress on the side will be available to cover opposite side of the bed.
moving towards the footpart.

8. Place the top sheet on the bed with the

centerfold on the center and the wider hem even
at the head of the mattress. Open the sheet’s top
layer towards the center of the bed as you bring
the extra to the footpart. Follow the same
procedure with the top blanket or spread it
placing the upper edge approximately 6” below
the top of the sheet.

Roll the other layers outside toward the center of

the bed. (From vid of CI)

8.5 Miter the footpart of the bed for the topsheet.

9. Lifting the mattress, tuck the top sheet under it. Untucking the side of the sheet will make it easier for
Miter the corner but do not tuck at the side. the patient to slip in.

10. Fold the upper 18” of the top sheet down to Completing one entire side of the bed first conserves
make a cuff. Move to the other side of the bed time and energy.
and make that side of the bed following the same
procedure for securing the bed linen.

10.5 Put a pillowcase on the pillow. If the pillow is To avoid contaminating the linens because an old
new, you may place it on top of the bed. If not, pillow is considered contaminated.
do it on another surface.

10.6 Spread out the pillowcase to the edge of your

pillow, ensuring the closed part is where the
tag of the pillow is.

11. Grasp the center of the closed end of the pillow

case. Gather the pillow case and turn it inside out
over one hand. With the same hand, grasp the
middle of one end of the pillow and pull the case
over the length of the pillow. Keep a firm hold on
the pillow.

While making sure the edge of the pillow is going

to go into the edge of the pillow case before you
spread it out.

If there is excess, fold it in neat and tidy. Provides for a neater appearance.
12. Place the pillow at the headpart of the bed with
the open end facing away from the entrance.

13. For an open–bed, fanfold top sheet to the Having linen opened makes it more convenient for the
footpart. client to get into bed.

For closed bed, draw the topsheet over the

pillow. This is done if the patient is delayed.

14. Secure the signal device (buzzer) on the bed, Having the signal device within client’s reach makes it
according to hospital policy. possible for him to call for assistance as necessary.

15. Arrange the furniture.

16. Remove gloves and dispose properly. in to the The yellow bin is for infectious waste.
yellow bin.

17. Wash your hands.

B. OBSTETRICAL BED
Definition:
 Obstetrical bed – It is a bed prepared for a patient who has given birth.
Purposes:
 To have a bed ready for patients who have just delivered.
Equipment:
 1 bottom sheet any clean cotton sheet
 1 waterproof underpad (SPH dry sheet) adult diaper (patient’s supply)
 1 top sheet
 2 pillows
 2 pillow cases
 1 bed

Procedure

ACTION RATIONALE
1. Perform 1-10 of the open–bed.
2. Fanfold top sheet to the footpart. Fix the fanfold
to look neat and tidy and go to the other side to
do the same.

3. Place the waterproof underpad where the To avoid frequent changing of linen.
buttocks lie and tuck if long. If the pad is not
available, fold any clean cotton sheet and put it
where the buttocks will rest.

4. Slip the 2 pillows inside their cases (follow step The pillow at the headboard protects the head from
#11 of open bed). Put 1 pillow against the the injury, and the other to provide comfort to relax
headboard (if with epidural anesthesia) and the the abdominal muscle, thus provide comfort.
other, where the back of the knees will rest (with
the open end facing away from the entrance).
 If ever the patient underwent epidural This prevents cerebrospinal fluids from leaking,
anesthesia, then they should be flat on the bed causing gravitational traction on cranial structures and
and after 8 hours, you may place a pillow under resulting to post epidural anesthesia headache.
their knees.

5. Secure the signal device (buzzer) on the bed Having the signal device within client’s reach makes it
according to hospital policy. possible for him to call for assistance as necessary.

6. Arrange the furniture.

7. Remove gloves and dispose properly. in to the The yellow bin is for infectious waste.
yellow bin.

8. Wash your hands.

C. POST-OPERATIVE BED
Definition:
 Post-operative bed – It is a bed prepared for those who had undergone surgery.
Purposes:
1. To prepare warm, safe and comfortable bed in which the patient can be quickly placed after surgery.
2. To protect the mattress from being wet and soiled and possibly stained.
General Consideration:
 Ensure that all the needed equipment are assembled and ready for use before the patient arrives from the
Operating Room.
Equipment:
 Same as the unoccupied bed with the addition of the following:
a. bed protector
b. bath towel
c. gown
d. blanket
e. I.V. stand
f. Suction apparatus
g. Suction catheter (Fr. 12-14 for adults ; Fr. 8-10 for children)
h. Oxygen tank prepared with necessary connections
i. Goose neck lamp (optional)
j. Waterproof underpad (optional)
k. Hot Water Bag

On the bedside table are:

l. kidney basin lined with tissue paper
m. padded tongue depressor
n. tissue wipes/washcloth
Procedure

ACTION RATIONALE
1. Proceed in the same manner as in making an
unoccupied bed (Steps 1-7).

2. Place the bed protector across the headpart of Protects the linen from getting soiled. Patient may
the bed, line it with the bath towel and tuck (if vomit as an effect of anesthesia.
long).

3. Place the top sheet. And roll other layers. To provide easy accessibility.
 Without tucking at the footpart. Instead, fold
back the topsheet at the footpart in line with the
edge of the mattress. Fold back the upper 18
inches of the topsheet as well.

4. Move to the other side of the bed and do step 4.

5. Bring up the hanging side of the top sheet in line For easy access when transferring client from
with the edge of the mattress. Fanfold to the side stretcher to bed.
away from the entrance.

Do not overreach. Go to the other side of the bed to maintain good body
mechanics.

6. Place one pillow against the headboard with Protect the head of the client from the headboard.
open end away from the entrance.

7. If waterproof underpad is not available use the To protect the linen from being soiled
cotton draw sheet.

8. Hang the gown at the headboard. To provide easy access for the client to change
immediately if they vomit.

9. Prepare the necessary equipment at the bedside Facilitates access.

before the patient arrives.

The bedside equipment are as follows:

Kidney basin lined with tissue paper To catch vomitus of the patient. It is lined with tissue
paper so vomit does not stick at the bottom of the
kidney basin.

Padded tongue depressor To wet the lips of the patient. If have just finished an
operation, then they are on NPO, so we may only wet
their lips.

Tissue wipes/washcloth To wipe any secretions like saliva from the patient.

10. Once the patient is in from the Post Anesthesia The patient may feel cold.
Care Unit (PACU), place him comfortably in bed
and cover with top sheet.

11. Loosely tuck the footpart of the top sheet. To allow free movement of the feet.

12. Attach the necessary gadgets such as oxygen,

IVF, urine bag. suction apparatus, suction
catheter, and all the other equipment the patient
needs.

If patient has IV, then place IV pole on the side of To prevent the IV from overlapping the patient.
their arm where the IV is inserted.
13. Arrange the furniture.
14. Remove gloves and dispose properly. in to the The yellow bin is for infectious waste.
yellow bin.
15. Wash your hands.
 D. BEDSTRIPPING
Purposes:
 To remove the bed linen preparatory to cleaning. Done after the patient is discharged.
Equipment:
 A pair of working gloves
Procedure

ACTION RATIONALE
1. Place two chairs back to back at the footpart of This prevents contamination via soiled linen.
the bed or near it.

Do not place the chairs too close to the bed. There must be some distance so you can easily walk
between the bed and chair to conserve time and
energy.

2. Don working gloves. This prevents the nurse from contamination.

3. Remove the soiled pillow case from a pillow and

use it as a laundry bag. Make a cuff at the open
end of the slip and insert it at the back of one
chair. Remove the slip from the other pillows if
there are and place these in the laundry bag.

4. Place the pillows on the seat of the other chair.

5. Starting at the side near you, loosen all the Lifting the mattress makes sure the linen is not caught
bedlinens, by raising the mattress with one hand by the bed springs.
and drawing out the linen with the other. Bring
the linen to the top of the mattress. After this,
move to the other side of the bed and do the
same.

6. Roll the dirty linen one by one and place it inside

the bag.

Starting from the topsheet, roll the contaminated Anything that comes in contact with the patient is
side inside. The right side should be rolled considered contaminated. For the topsheet, the wrong
outside. side comes in contact with the patient’s skin.

For the bottom sheet, the right side comes in contact

Now on to the bottom sheet, roll the right side with the patient.
inside.
Airing the mattress keeps it dry since it could have
moisture.
7. After all linen have been placed inside the
laundry bag, turn the mattress upside down and
air. Airing of the mattress will depend on its type.

8. Unfasten the bag from the chair. Bring bag to the

Utility Room and place it inside the hamper
intended for the purpose.

Make sure the when you carry the bag, it should This prevents the transmission of microorganisms to
not come in contact with your uniform. the nurse and others.
9. Arrange the furniture.

10. Remove gloves and dispose properly. in to the The yellow bin is for infectious waste.
yellow bin.

11. Wash hands. Do medical hand washing. Linens and equipment that have been soiled with
secretions and excretions harbor microorganisms that
can be transmitted to others.