Chapter 12

Question 1

NAs can help residents feel at home and possibly even improve their health by maintaining a clean and comfortable environment.

Ways to promote comfort in the resident’s unit:

Answer 1

*Help keep the noise level low.

*Don’t bang equipment or meal trays.

*Keep voice low —- students in group

*Answer phones and call lights promptly.

*Close doors when asked to do so — visitor noise

*Turn off televisions when not in use.

Question 2

Control odors:

Answer 2

*Change incontinence briefs promptly and dispose of them properly – bag and remove from room

*Empty and clean bedpans, urinals, commodes, and emesis basins promptly, stoma bags = strong odors

*Change soiled linens and clothing as soon as possible.

*wound drainage can be odorous

*Give regular oral care and personal care.

Question 3

Promote comfort through body temperature:

Answer 3

*OBRA requires facilities maintain temperature range of 71-81°F.

*Layer clothing and bed covers – long underwear, sweaters

*Keep residents away from drafts.

*Offer blankets to residents in wheelchairs.

*Keep residents covered while giving personal care

*If residents control heat/air conditioning in their rooms, do not change the temperature.

Question 4

Promote comfort:

Answer 4

*Provide appropriate lighting and keep lighting controls within resident’s reach to promote safety.

*Report resident complaints about food to the nurse.

*Caffeine may need to be decreased to promote better rest.

*Listen to residents’ concerns and provide emotional support.

Question 5

This equipment is usually found in a resident’s unit:

Answer 5

Bed – normally kept in the lowest horizontal position whether occupied or unoccupied – safety

Bedside

Over bed table

Call light

Privacy curtain

Question 6

Bedside stand, often with water pitcher and cup and telephone on top. May contain the following:

Answer 6

*Wash basin

*Emesis basin

*Soap dish and soap

*Toilet paper

*Personal hygiene items

*Bedpan or urinal

Question 7

Over bed table –

Answer 7

considered the cleanest surface in the room

Soiled items, dirty linens, bedpans, and urinals should never be placed on the over bed table.

Question 8

Call Light –

Answer 8

OBRA/OSHA requires a call light must always be within reach – whether the person is conscious or not

Question 9

Privacy Curtain –

Answer 9

should be pulled every time care is given

*Remember that a privacy curtain does not prevent sound from traveling in a semi-private room!

Question 10

Infection prevention:

Answer 10

*PPE measures must be followed when cleaning a resident’s unit – wear gloves!

Question 11

Guidelines for care of this environment:

Answer 11

*Clean the over bed table after each use – place it within their reach

*Keep call light within reach.

*Keep equipment clean and in good condition. Report problems with equipment to nurse.

*Remove meal trays promptly, then remove crumbs and straighten linen.

*Change linen if it is wet, soiled, or wrinkled.

*Restock personal supplies as needed.

*Keep water pitchers filled.

*Remove trash when you leave if housekeeping staff is not available.

*Report signs of insects or pests immediately.

*Do not move residents’ belongings.

*Clean equipment and return it to proper storage.

*Tidy the area — remember the T in STOW (safety, tidy, observe, wash hands)

Question 12

Circadian rhythm:

Answer 12

the 24-hour day-night cycle.

Question 13

Insomnia:

Answer 13

inability to fall asleep or remain asleep.

Question 14

Lack of sleep can cause the following problems:

Answer 14

*Decreased mental function

*Reduced reaction time

*Irritability

*Decreased immune system function

Question 15

The following factors can affect sleeping patterns:

Answer 15

*Fear

*Stress

*Noise

*Diet

*Medications

*Illness

*Sharing a room with another person

Question 16

NAs should observe for the following when a resident is not sleeping well:

Answer 16

*Sleeping too much during the day

*Drinking too much caffeine

*Dressing in night clothes during the day

*Eating too late at night

*Refusing prescribed medications

*Taking new medications

*Having TV, radio, computer, or light on late at night

*Pain

Question 17

Occupied bed:

Answer 17

a bed made while a person is in the bed.

Question 18

Unoccupied bed:

Answer 18

a bed made while no person is in the bed.

Question 19

Closed bed:

Answer 19

a bed completely made with the bedspread and blankets in place.

Question 20

Open bed:

Answer 20

a bed made with linen folded down to the foot of the bed.

Question 21

Surgical bed:

Answer 21

a bed made to accept residents who are returning to bed on stretchers.

Question 22

Proper bedmaking is important for the following reasons:

Answer 22

*Damp and wrinkled sheets are uncomfortable and may keep the resident from sleeping well.

*Microorganisms thrive in moist, warm places, and damp, unclean bedding may cause infection or disease.

*Sheets that are not flat increase risk for pressure injuries.

Question 23

NAs should remember these guidelines for bedmaking:

Answer 23

*Keep linen wrinkle-free and tidy.

*Wash hands before handling clean linen.

*Place clean linen on clean surface, such as chair, overbed table, or bedside stand.

*Don gloves before removing bed linen.

*Look for personal items before removing linen.

*When removing linen, fold or roll linen so the dirtiest area is inside.

*Do not shake linen or clothes.

*Bag soiled linen at point of origin, and do not take it to other residents’ rooms.

*Sort soiled linen away from care areas.

*Place wet linen in leakproof bags.

*Wear gloves when handling soiled linen. Hold soiled linen away from your body. If dirty linen touches your uniform, your uniform becomes contaminated.

*Disposable bed protectors or pads are used for incontinent residents. Change them as soon as they are soiled or wet, and dispose of them properly.

Question 24

Making an occupied bed

Answer 24

Equipment: clean linen—mattress pad, fitted or flat bottom sheet, disposable absorbent pad (if needed), cotton draw sheet, flat top sheet, blanket(s), bedspread (if used), bath blanket, pillowcase(s), gloves

1. Identify yourself by name. Identify the resident by name.
2. Wash your hands.
3. Explain procedure to the resident. Speak clearly, slowly, and directly. Maintain face-to-face contact whenever possible.
4. Provide for the resident’s privacy with curtain, screen, or door.
5. Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair).
6. Adjust bed to a safe working level, usually waist high. Lower head of bed. Lock bed wheels.
7. Put on gloves.
8. Loosen top linen from the end of the bed on the working side.
9. Unfold bath blanket over the top sheet to cover the resident, then remove the top sheet. Keep the resident warm for comfort and covered for privacy throughout the procedure.
10. You will make the bed one side at a time. Raise side rail (if bed has them) on far side of bed. This protects the resident from falling out of the bed while you are making it. After raising side rail, go to the other side of the bed. Help resident to turn onto her side, moving away from you, toward the raised side rail.
11. Loosen bottom soiled linen, mattress pad, and protector, if present, on the working side.
12. Roll bottom soiled linen toward resident, soiled side inside. Tuck it snugly against the resident’s back.
13. Place the mattress pad (if used) on the bed, attaching elastic at corners on working side.
14. Place the clean bottom linen or fitted bottom sheet, finishing with bottom sheet free of wrinkles. If a flat sheet is used, leave enough overlap on each end to tuck under the mattress. If the sheet is only long enough to tuck in at one end, tuck it in securely at the top of the bed. Make hospital, or mitered, corners to keep bottom sheet wrinkle-free. If a fitted sheet is used, tightly pull the two fitted corners on the working side.
15. Smooth the bottom sheet out toward the resident. Be sure there are no wrinkles in the mattress pad. Roll the extra material toward the resident. Tuck it under the resident’s body.
16. If using a disposable absorbent pad, unfold it and center it on the bed. Tuck the side near you under the mattress. Smooth it out toward the resident. Tuck as you did with the sheet.

*If using a draw sheet, place it on the bed. Tuck in on your side, smooth, and tuck as you did with the other bedding.

1.) Raise side rail on the working side. Help resident turn onto clean bottom sheet, toward you. Explain that she will be rolling over a pile of linen. Protect the resident from any soiled matter on the old linens.

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

17. Pull the clean linen through as quickly as possible. Start with the mattress pad and wrap around corners. Pull and tuck in clean bottom linen just like the other side. Pull and tuck in the disposable absorbent pad and draw sheet if used. Finish with bottom sheet free of wrinkles.
18. Ask resident to turn onto her back. Help as needed. Keep resident covered and comfortable, with a pillow under her head. Raise the side rail nearest you.
19. Unfold the top sheet. Place it over the resident and center it. Ask the resident to hold the top sheet. Slip the bath blanket or old sheet out from underneath. Put it in the hamper or bag.
20. Place a blanket over the top sheet, matching the top edges. Place the bedspread over the blanket (if used). Tuck the bottom edges of top sheet and blanket under the bottom of the mattress. Make hospital corners on each side. Loosen the top linens over the resident’s feet. This prevents pressure on the feet. At the top of the bed, fold the top sheet over the blanket about six inches.
21. Remove the pillow. Do not hold it near your face. Remove the soiled pillowcase by turning it inside out. Place it in the hamper or bag.
22. Remove and discard gloves. Wash your hands.
23. With one hand, grasp the clean pillowcase at the closed end. Turn it inside out over your arm. Next, using the same hand that has the pillowcase over it, grasp one narrow edge of the pillow. Pull the pillowcase over it with your free hand. Do the same for any other pillows. Place them under resident’s head with open end away from door.
24. Make resident comfortable.
25. Return bed to lowest position. Leave side rails in the ordered position. Remove privacy measures.
26. Place call light within resident’s reach.
27. Take laundry bag or hamper to proper area.
28. Wash your hands.
29. Report any changes in resident to the nurse.
30. Document procedure using facility guidelines.

Question 25

Making an unoccupied bed:

Answer 25

Equipment: clean linen—mattress pad, fitted or flat bottom sheet, waterproof bed protector if needed, blanket(s), cotton draw sheet, flat top sheet, pillowcase(s), gloves

1. Wash your hands.
2. Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair).
3. Adjust bed to a safe working level, usually waist high. Put bed in flattest position. Lock bed wheels.
4. Put on gloves.
5. Loosen soiled linen. Roll soiled linen (soiled side inside) from head to foot of bed. Avoid contact with your skin or clothes. Place it in a hamper or bag. Remove pillows and pillowcases, and place pillowcases in the hamper. Do not put linen on the floor or furniture.
6. Remove and discard gloves. Wash your hands.
7. Remake the bed. Place the mattress pad (if used) on the bed, attaching elastic at corners on working side. Place a clean bottom sheet or fitted bottom sheet, finishing with the bottom sheet free of wrinkles. If a flat sheet is used, leave enough overlap on each end to tuck under the mattress. If the sheet is only long enough to tuck in at one end, tuck it in securely at the top of the bed. Make hospital corners to keep the bottom sheet wrinkle-free. If a fitted sheet is used, tightly fit corners over all four corners of the bed.
8. Put on a disposable absorbent pad and then draw sheet if used. Place them in the center of the bed on the bottom sheet. Smooth and tightly tuck the bottom sheet and draw sheet together under the sides of the bed.
9. Place the top sheet over the bed and center it. Place the blanket over the bed and center it. Place the bedspread (if used) over the bed and center it. Tuck the bottom edges of the top sheet, blanket, and bedspread under the foot of the bed, making hospital corners on each side.
10. Fold down the top sheet over the blanket about six inches. Fold both the top sheet and blanket down so resident can easily get into bed. If the resident will not be returning to bed immediately, leave bedding up.
11. Put on clean pillowcases (as described in previous procedure). Replace pillows.
12. Return bed to lowest position.
13. Take laundry bag or hamper to proper area.
14. Wash your hands.
15. Document procedures using facility guidelines.

Question 26

Making a surgical bed:

Answer 26

Equipment: clean linen (see procedure: Making an unoccupied bed), gloves

1. Wash your hands.
2. Place clean linen on clean surface within reach (e.g., bedside stand, overbed table, or chair).
3. Adjust bed to a safe working level, usually waist high. Lock bed wheels.
4. Put on gloves.
5. Remove all soiled linen, rolling it (soiled side inside) from head to foot of bed. Avoid contact with your skin or clothes. Place it in a hamper or bag.
6. Remove and discard gloves. Wash your hands.
7. Make an unoccupied, closed bed. See procedure: Making an unoccupied bed.
8. Loosen linens on the side of bed that is away from the door (where the stretcher will be).
9. Fanfold linens lengthwise to the side away from door. Fan folded means folded several times into pleats.
10. Put on clean pillowcases. Replace pillows.
11. Leave bed in its locked position with both side rails down.
12. Make sure the pathway to the bed is clear.
13. Take the laundry bag or hamper to proper area.
14. Wash your hands.
15. Document procedure using facility guidelines.