Bed of the patient and change of linen
If a patient by the nature and severity of his illness and with the permission of a doctor can get out of bed, sit, walk, then his position in bed is usually called active. The requirements for a bed for this group of patients are not so strict as for another, when patients can not move, turn, raise their heads or hands, but retain the position they were given( passive position in bed).In the latter case, the mesh or mattress of the bed, the surface of the sofa, other furniture used for the patient, should be well stretched, be a flat surface without deformations and damages, hillocks and hollows. If this condition is not met, then during a prolonged stay of patients in uncomfortable poses, because of the inability to change the position of the body, severe disorders and bedsores can develop( violations of the local blood circulation of the skin, subcutaneous fat, muscles as a result of prolonged squeezing of a limited area of the body).An inconvenient bed can be an opposing factor in the treatment of patients who are in a compulsory position in bed to alleviate their suffering. So, patients with dyspnea occupy a forced sitting position with their legs lowered, leaning their hands on the edge of the bed;with pleurisy patients for a long time trying to lie on the sore side, thus reducing the pain. There are many more examples of the difficult conditions of patients with which caring relatives can meet. It is not difficult to imagine the patient's health, forced to lie for a long time in an uncomfortable position, which does not alleviate, but aggravates suffering.
In each case, you should get advice from a doctor about the features of the bed necessary for the patient. For example, patients with exacerbation of lumbosacral radiculitis, as well as after spinal injuries, require a bed with a firm and level surface;Patients with circulatory failure should be given a semi-sitting position in bed. In the latter case, in addition to the headrest, it is necessary to make an emphasis for the legs, so that the patient does not slip. All this shows that in any case, an important condition for the well-being of the patient and for his recovery is bed comfort, the nature and characteristics of which depend on the severity and clinical form of the disease, as well as the protective and medical regimen prescribed by the doctor.
The patient's bed should be in the room so that the patient can be approached from all sides. This is due to the need for convenient care for the patient when changing clothes, performing medical and hygienic measures, when carers have to turn the seriously ill patient alternately on the left or right side, perform massage, rubbing, washing or other procedures. It is not recommended to put a bed near the heating appliances, stove or near the window. Experience shows that it is best to set the bed so that the headboard is at the wall, and the light is falling on the side.
In those cases when the patient is unconscious or because of the severity of his illness occupies a passive position, the risk of falling sick from the bed is high. This is especially true if the disease is accompanied by periodic excitation of the patient, an unconscious increase in motor activity. To prevent the fall and the patient does not receive a mechanical injury as a result of this, it is necessary to provide for the equipment of the bed with special barriers. To do this, on both sides of the bed is attached to the board in a width of 15 cm and a length equal to the length of the bed. Board-barriers are wrapped with soft material( blanket, blanket, etc.), so that the patient can not get hurt on the barrier. When changing clothes, performing the prescribed procedures, barriers should be removed for a while.
A thick, cotton or foam rubber mattress is placed on top of the bed or spring mattress, the surface of which should be flat. For care of patients the mattress consisting of separate parts is very convenient: in case of its contamination only the soiled part changes. On top of the mattress are put a mattress from thick linen cloth. It should be often cleaned, washed and ventilated to remove an unpleasant odor, and, if necessary, disinfected. For patients suffering from incontinence of urine and feces, an oilcloth is attached over the entire width of the mattress, and its edges are bent, which prevents the contamination of the bed. On the mattress, put the sheet, the edges of which are folded under the mattress so that it does not roll down and does not gather in the folds.
Pillows should be of sufficient size and soft( down, feather).Blankets, respectively, seasonal, flannel, wool, down should also be soft, but not cause overheating of the patient's body. At least once a week, blankets should be ventilated, cleaned.
Bedding - sheets, duvet covers, pillowcases - must be clean, white. You need to change it at least once a week. If the laundry is soiled with something( blood, purulent stains, urine, dirt, feces) or if the patient is sweating strongly, you must immediately change your underwear. Sheets on the beds of seriously ill patients should not have scars and stitches, and pillowcases - knots and fasteners on the side facing the patient.
Bedding of patients regularly - in the morning and at night, as well as before the afternoon afternoon rest should be transplanted. The caretaker shakes and spreads the sheets and blankets, whacks up the pillows. The patient can be put on a chair for this time. If the patient can not move, then he needs to shift it to the edge of the bed, then spread the mattress, mattress and the sheet on the loose half, removing the crumbs from them, then shift the patient to the cleaned half of the bed and do the same with the other side.
When changing underclothes, the seriously ill patients need to be very careful not to cause the patient unnecessary pain or anxiety. Changing bedsheets in these cases requires a caring certain skill. If the patient is allowed to turn on his side, you must first gently lift his head and remove the pillows from under it, and then help the patient turn on their side, facing the edge of the bed. The loose side begins to roll a dirty sheet along the bed with a roller, and after it roll out a clean, pre-folded roller along the length. Reaching the middle of the mattress, turn the patient gently to the other side, so that he finds himself lying on the clean half of the sheet. After that, they remove the dirty sheet, and the blank rolls out to the end and carefully spread out so that there are no wrinkles on it. Folds, in addition to causing an unpleasant sensation, contribute to the formation of bedsores.
In cases where patients are not allowed to move, the sheet should be changed in another way. This requires the help of two carers. Rolls of sheets are made not along the bed, but across, beginning with the foot end. Simultaneously with the collection of the old sheet, a new one is gradually rolled out. One of the carers alternately lifts the shin, thighs and buttocks of the patient, the other rolls a dirty sheet to the waist of the patient with a roller. The clean sheet rolled in the transverse direction is placed on the foot of the bed and is straightened towards the head end. A roller of a clean sheet will be next to a dirty roller under the waist. Then one of the carers slightly lifts the head and chest of the patient, while the other at this time removes the dirty sheet and spreads the clean one in its place, so that there are no wrinkles on it. In order to avoid the formation of wrinkles in the future after changing sheets, it is recommended to carefully fill it under the mattress, especially in the corners.
The dirty laundry( sheets, pillowcases, duvet covers, etc.) removed from bed must be immediately taken out of the patient's room. You should also follow the purity of the mattress and mattress. If they are stained, wash the soiled areas with hot soapy water and dry. The patient will have to shift to another mattress at this time.
For cleanliness of underwear also it is necessary to watch the most careful way and to make its change at least 2 times a week. If the laundry becomes contaminated with sweat, blood, a purulent department or feces, then it must be replaced immediately. Sometimes you have to change your laundry several times a day. You should know that underwear should not consist of a single shirt, preferably with a long hem below the knees. As the state of patients improves and the regime of motor activity is extended, men wear a regular undergarment and pants.
Changing the shirt, despite all the precautions and dexterity of the caregiver, inevitably causes much concern to the seriously ill. Therefore, this important and very necessary procedure should be carried out quickly, but without fuss. First of all, slightly lifting the upper part of the trunk and pelvis of the patient, they gather the shirt from the back to the neck, then lift the hands of the patient, take off the shirt through the back of the head and head, after which it remains to release the arms from the sleeves in turn. In the reverse order, they put on a clean shirt, first they put on sleeves, then pull it over the head and finally spread it along the back.
In cases where the patient is dirty with vomit or feces or is very sweaty, after removing the dirty shirt, the body should be rubbed with a damp towel, dryed, and only after that you can wear a clean shirt. Treating the skin of fevering and strongly sweating patients with a weak solution of vinegar in half with alcohol when changing shirts brings at least temporary relief. Dry sweat on the skin often causes unbearable itching, causes anxiety to the patient, increases unpleasant sensations of heat.
Near the bed of the patient there should be a bedside table, on which the medicines necessary for treatment( in accordance with the doctor's prescriptions), including those related to emergency medicine, drinks recommended by the doctor for alleviation of thirst, should be placed in strict order. On the second from the top shelf should be concentrated diagnostic tools( thermometer, apparatus for measuring blood pressure, etc.), as well as care items( drinker, spittoon, etc.), daily and regularly used for observation and care. In the bottom drawer of the bedside table or bedside table, clean linen should be folded for a change, the need for which can appear at any time.
During the night sleep of a patient on a bedside table a night light should be switched on. Do not forget that at any time the patient may need help from the caretaker, who, if necessary, went to another room. Therefore, on the bedside table, it is required to hold a bell to alert and call the caregiver. In this connection, it is also worthwhile to recall once again that in a very important and responsible case for the care of patients there can be no trifles, therefore, with utmost attention, all, even seemingly unimportant details in medical, protective and hygienic measures should be envisaged. The caregiver on all these issues should receive detailed advice from the attending physician,
to have an idea of all possible adverse situations during the course of the disease in order to be as ready as possible to them.