Describe environmental health risks/hazards
Oxygen: risk of fire or explosion
b. Nutrition : Not practicing basic techniques for food handling (handwashing and checking for spoilage. As well as not practicing basic techniques for food preparation (keeping food refrigerated before serving)
c. Temperature and humidity:
d. Lighting: adequate lighting and security around the home. Includes use of night lights, exterior lights, and locks on windows and doors to reduce risk of injury from crime.
e. Obstacles: risk of falling, injuries
f. Fire: breathing concerns, death, burns
g. Poisoning: risk of being toxic if inhaled/consumed, burns, death
h. Security: locks and privacy to increase security and minimize injury
i. Pollution:
j. Terrorism: risk of injuries
Describe the principles to be considered in making a bed.
- when patients are diaphoretic, have draining wounds, or are incontinent, nurses should check frequently for soiled linen.
- to avoid air currents (can spread microorganisms), bed linens should never be shaken or placed on the floor (could transmit infection).
- for the patients comfort and safety, use side rails to aid positioning and turning, keep a call light within the patient’s reach, and maintain the proper bed position.
- after making a bed, always return it to the lowest horizontal position to prevent accidental falls.
What are the three components of WHIMIS?
- Worker education programs
- Cautionary labelling of products
- The provision of material safety data sheets (MSDSs).
How is the physical environment interrelated with other determinants of health?
Physical environment can cause injury, which can affect an individual’s work and home life.
Physical environment is related to income because if you are unable to afford to live in a good community, you may have to live in a place with higher crime rates, with lower air and water quality (more prone to getting sick), etc.
Describe data to be gathered about the DOH: physical environment (health history)
- Gather data about the clients level of wellness to determine if any underlying conditions exist that would pose a threat to their safety
- Review the clients developmental status
- Review whether the client has been exposed to any environmental hazards or is taking medications or undergoing procedures that would pose risks
- Give special attention to the client’s gait, muscle strength, coordination, balance, and vision.
How do you make an unoccupied bed
- Perform hand hygiene.
- Assess the environment for safety, such as checking the room for spills, making sure
equipment is working properly, and ensuring that the bed is in the locked, low
position. Check the position of the chair for transfer. Pull the room divider curtain or
close the room door to provide privacy. - Assess activity orders and mobility restrictions in deciding whether the patient can get
out of bed for the procedure. Help the patient into a bedside recliner or other chair. - Clean linen should be stacked in the order that it will be used. Apply gloves to
remove the soiled linen. - Lower the side rails on both sides of the bed, and raise the bed to a comfortable
working height. Loosen the top linen at the foot of the bed. Remove the bedspread
and blankets separately. If they are soiled, place them in a linen bag or linen hamper,
holding them away from your uniform. If the blanket or bedspread is to be reused,
fold into a square and place on the chair. Remove the pillowcase and leave it on the
bed. Place the pillow on the chair. - Move to the other side of the bed and lower the side rail. Remove the soiled linen,
holding it away from your uniform and placing it in a linen bag or linen hamper.
Avoid shaking or fanning the linen. - Reposition the mattress, and wipe off any moisture using a washcloth moistened with
antiseptic solution (consult agency housekeeping policy). Dry thoroughly. - Apply all bottom linen on one side of the bed before moving to the opposite side.
A. For a fitted sheet: Make sure the fitted sheet is placed smoothly over the mattress and
over the top and bottom mattress edges. Fit the corners on one end and then on the
other.
B. For a flat sheet: Place the sheet over the mattress. Allow about 25 cm (10 inches) to
hang over the side edge of the mattress. The lower hem of the sheet should lie seam
down and even with the bottom edge of the mattress. Pull the remaining top portion
of the sheet over the top edge of the mattress. While standing at the head of the bed,
miter the top corner of the bottom sheet.
To miter a corner, pick up the top of the sheet about 45 cm (18 inches) from the top of
the mattress. Lift the sheet and lay it on top of the mattress to form a triangular fold,
with the lower base of the triangle even with the side edges of the mattress. Tuck in
the lower edge of the sheet, which is hanging free under the mattress. Hold the
portion of the sheet covering the side of the mattress in place with one hand. With the
other hand, pick up the triangular linen fold and bring it down over the side of the
mattress. Tuck with your palms down, without pulling the triangular fold. Tuck this
portion under the mattress. Tuck the remaining portion of the sheet under the
mattress, moving toward the foot of the bed. Keep the linen smooth.
- Optional: Apply a drawsheet and/or a waterproof pad, laying the center fold
lengthwise along the middle of the bed. Smooth the drawsheet and/or waterproof pad
over the mattress, and tuck the excess edge under the mattress, keeping your palms
down. - Move to the opposite side of the bed, and spread the bottom sheet smoothly over the
edge of the mattress, from the head to the foot of the bed.
A. For a fitted sheet: Make sure the fitted sheet is placed smoothly over the mattress,
from the head to the foot of the bed and over the mattress edges.
B. For a flat sheet: Miter the top corner of the bottom sheet, making sure the corner is
taut. Grasp the remaining edge of the flat bottom sheet, and tuck it tightly under the
mattress while moving from the head to the foot of the bed.
11. Smooth the waterproof pad or folded drawsheet over the bottom sheet, and tuck it
under the mattress, first in the middle, then at the top, and then at the bottom.
- Place the top sheet over the bed with the vertical centerfold positioned lengthwise
down the middle of the bed. Open the sheet out from head to foot, being sure the top
edge of the sheet is even with the top edge of the mattress. - Tuck in the remaining portion of the sheet under the foot of the mattress. Then place
the blanket over the bed, with the top edge parallel to the top edge of the sheet and 15
to 20 cm (6 to 8 inches) down from the edge of the sheet. (Optional: Apply an
additional bedspread over the bed.) - Make a cuff by turning the edge of the top sheet down over the top edge of the
blanket and bedspread. - Standing on one side at the foot of the bed, lift the mattress corner slightly with one
hand, and with other hand tuck the top sheet, blanket, and bedspread under the
mattress. Make a modified mitered corner with the top sheet, blanket, and bedspread.
After making a triangular fold, do not tuck the tip of the triangle. - Go to the other side of the bed. Make a horizontal toe pleat: stand at the foot of the
bed and fanfold the sheet 5 to 10 cm (2 to 4 inches) across the bed. Pull the sheet up
from the bottom to a make the fold approximately 15 cm (6 inches) from the bottom
edge of the mattress. - Fanfold the sheet, blanket, and bedspread at the foot of the bed, with the top layer
ready to be pulled up (this leaves an open bed). - Apply a clean pillowcase. Pick up the center of the closed end of the pillowcase. Hold
the pillowcase with a firm grip in one hand. With the other hand, open the pillowcase
from the open end and fold the back over the closed end (inside-out). Pick up the
pillow with the hand holding the pillowcase. Invert the pillow for the pillowcase to
drape over the pillow. Pull the pillowcase over the pillow with the other hand. Do not
place the pillow or pillowcase under the chin, in the teeth, or under the arms. Adjust
the corners of the pillowcase with the hands between the pillowcase and the pillow.
Do not shake the pillow to position the pillowcase. - Place the call light within the patient’s reach on the bed rail or pillow, and return the
bed to its lowest position, to allow for patient transfer. Help the patient into bed. - Place the linen bag into an appropriate receptacle. Remove and dispose of your
gloves. - Arrange and organize the patient’s room, and perform hand hygiene.
How do you make an occupied bed ?
Perform hand hygiene.
- Verify the health care provider’s orders. Assess any activity or mobility restrictions
that might affect patient position as the patient safety and comfort are of the utmost
priority. - Assemble the necessary equipment and supplies on the bedside table.
- Provide for the patient’s privacy.
- Introduce yourself to the patient and family if present.
- Identify the patient using two identifiers, such as name and date of birth or name and
account number, according to agency policy. Compare these identifiers with the
information on the patient’s identification bracelet. - Explain the procedure to the patient. Check the floor for spills. Make sure the bed is
in locked position. Assemble the linen on a clean, dry bedside table and in order of
use. - Raise the bed to a comfortable working height, and lower the head of the bed as much
as the patient can comfortably tolerate. If the patient is on aspiration precautions,
keep the head of the bed no lower than a 30-degree angle. - Apply a clean pair of gloves.
- Loosen the top linen at the foot of the bed.
- Remove the bedspread and blanket separately. If they are soiled, place them in the
linen bag. If either is to be reused, fold the item into a square and place it over the
back of a chair. - Cover the patient with a bath blanket, placing it over the topsheet. Have the patient
hold the top edge of the bath blanket, or tuck the blanket under the patient’s
shoulders. Reach beneath the blanket and remove the topsheet. Discard the topsheet
in the linen bag. - Lower the side rail on your side of the bed. Help the patient into a side-lying position,
facing away from you. Encourage the patient to use the side rail to turn. Then adjust
the pillow under the patient’s head. - Make sure no tension has been placed on any external medical devices, such as
indwelling urinary catheters, wound drains, or intravenous tubing. - Stand on one side of the bed. Loosen the bottom linens, moving from the head to the
foot of the bed. Fanfold or roll the bottom sheet and drawsheet or waterproof pad
toward and under the patient. Tuck the edges of old bottom linen alongside the
patient’s buttocks, back, and shoulders. Clean, disinfect, and dry the mattress surface,
if necessary. - Remove gloves and perform hand hygiene.
- Apply clean linens to the exposed half of the bed in separate layers. Place the fitted
bottom sheet on the bed lengthwise. Secure the top and bottom corners on the near
side with the center crease in the middle of the bed. Fanfold this layer of bedding to
the center of the bed alongside the patient’s torso. Repeat this process with the
bottom sheet and the drawsheet or waterproof pad. - If you are using a fitted sheet, pull the sheet smoothly over the mattress corners at the
top and the bottom of the bed. If you are using a flat sheet, allow the edge of the sheet
to hang about 25 cm (10 inches) over the edge of the mattress. Be sure that the lower
hem of the bottom sheet lies seam down and even with the bottom edge of the
mattress. - If the bottom sheet is flat, miter the top corner at the head of the bed. To do so, face
the head of the bed in a diagonal position. With your hand that is farther away from
the head of the bed, lift the top corner of the mattress. With your other hand, tuck the
top edge of the bottom sheet smoothly under the mattress, so that the side edge of the
sheet above and below the mattress meets when brought together. - Next, pick up the top of the sheet about 45 cm (18 inches) from the top of the
mattress. Lift the sheet, and lay it on top of the mattress to form a triangular fold.
Tuck in the lower, free-hanging edge of the sheet under the mattress. With palms
down, tuck this portion of the sheet under the mattress. The lower base of the triangle
should be even with the side edges of the mattress. - With one hand, hold in place the portion of the sheet that covers the side of the
mattress. With the other hand, pick up the triangular linen fold and bring it down over
the side of the mattress. - Tuck the remaining portion of the sheet under the mattress, moving toward the foot of
the bed and keeping the linen smooth as you go. - Place the open drawsheet or waterproof pad lengthwise along the middle of the bed,
and tuck the remainder under the patient’s buttocks and torso. The drawsheet or
waterproof pad should be fanfolded or rolled on top of the bottom sheet. Keep the
linen under the patient as flat as possible, because the patient will need to roll over the
new layers of linen when you are ready to make the other side of the bed. You may
also place a waterproof pad under the drawsheet. - Raise the side rail, and ask the patient to turn toward you. Tell the patient that he or
she will be rolling over layers of linen. Help him or her do so if necessary. Make sure
the patient turns slowly, keeping the body in correct alignment. - Move to the opposite side of the bed and lower the side rail. Help position the patient
over the fanfolded linen on the other side of the bed. - Loosen the edges of the soiled linen from beneath the mattress, and remove it by
folding it into a bundle or square. - Hold the linen away from your body, and place the soiled linen in the linen bag.
- Clean, disinfect, and dry the other half of the mattress as needed.
- Remove and dispose of gloves.
- Raise the side rails and perform hand hygiene.
- Lower the side rails and pull the clean, fanfolded or rolled linen, as well as the
mattress pad and drawsheet or waterproof pad, over the edge of the mattress from the
head to the foot of the bed. If the bottom sheet is fitted, pull the corners over the
edges of the mattress. If you are using a flat sheet, unfold and pull the sheet toward
you. Miter the top corner of the bottom flat sheet (see steps 14 to 16). - Facing the side of the bed, grasp the remaining edge of the bottom flat sheet. Lean
back, keeping your back straight, and pull the sheet, tucking the excess linen under
the mattress from the head to the foot of the bed. - Make sure the sheets and the pad are smooth and wrinkle free.
- Help the patient roll back into a supine position.
- Cover the patient with a topsheet, placing the vertical center fold lengthwise down the
middle of the bed. Open the sheet out from head to foot as you unfold it over the
patient. Be sure the top edge of the sheet is even with the top edge of the mattress. - Have the patient hold on to the sheet and blanket as you remove the bath blanket.
- Place a clean or reused bed blanket over the patient. Make sure the top edge of the
blanket is parallel with the top edge of the sheet and 15 to 20 cm (6 to 8 inches) from
the edge of the topsheet. - Go to the other side of the bed, and spread out the sheet and the blanket evenly.
- Make a cuff by turning the edge of the topsheet down over the top edge of the
blanket. - Standing at the side of the bed, tuck the remaining portion of the sheet and blanket
under the foot of the mattress. Tuck the topsheet and blanket together, being careful
not to pull out the toe pleat. - Make a modified mitered corner with the topsheet and blanket simply by leaving the
tip of the triangle hanging, rather than tucking it in, after you make the triangular fold. - Go to the other side of the bed, and repeat Steps 37 and 38.
- Make a horizontal toe pleat by standing at the foot of the bed and fanfolding the sheet
and blanket 5 to 10 cm (2 to 4 inches) across the bed. Pull the sheet and blanket up
from the bottom to make a fold about 15 cm (6 inches) from the bottom edge of the
mattress. - Apply a clean pillowcase. Pick up the center of the closed end of the pillowcase. Hold
the pillowcase with a firm grip in one hand. With the other hand, open the pillowcase
from the open end and fold the back over the closed end (inside-out). Pick up the
pillow with the hand holding the pillowcase. Invert the pillow for the pillowcase to
drape over the pillow. Pull the pillowcase over the pillow with the other hand. Do not
place pillow or pillowcase under the chin, in the teeth, or under the arms. Adjust the
corners of the pillowcase with your hands between the pillowcase and the pillow. Do
not shake the pillow to position the pillowcase. - Help the patient into a comfortable position. To ensure the patient’s safety, raise the
appropriate number of side rails and lower the bed to the lowest position. - Place the call light within easy reach, and make sure the patient knows how to use it
to summon assistance. - Place the linen bag in an appropriate receptacle. Dispose of used supplies and
equipment. Remove and dispose of gloves, if used.
48. Arrange and organize the patient’s personal items so they are within reach.
- Perform hand hygiene.
Document and report the patient’s response and expected or unexpected outcomes.
What is the reasoning/rationale behind call bells and use of side rails?
Call bell should always be in patient’s reach, for their safety.
Side rails can maintain patients body alignment and safety when turning. Can reduce risk of falling out of bed.
why are side rails used?
side rails may help to increase a patient’s mobility and stability when in bed or when moving from bed to a chair. Side rails also help prevent the unconscious patient from falling out of bed or off a stretcher. However, raise side rails that cannot be opened by the patient are considered a restraint. The use of side rails for a disoriented patient may cause more confusion and further injury. A confused patient who is determined to get out of bed may attempt to climb over the side rail or climb out at the foot of the beed, often resulting in a fall or injury. Nursing interventions to reduce a patient’s confusion should focus first on the cause of the confusion. Frequently, a patient’s attempt to explore his or her environment or to self-toilet is mistaken as confusion. A thorough assessment is essential. Whenever side rails are used, make sure the bed is in the lowest position.
