Cleaning
individuals center of gravity should
- Removal of visible dirt
- Reducing levels of harmful
microorganisms
Risk-Based Environmental Cleaning
Frequency Principles
- Probability of Contamination
- Vulnerability of Patients to Infection
- Potential for Exposure to pathogens
Cleaner to Dirtier Cleaning Strategy –
prevent the further spreading of dirt and
microorganisms
1. Shared equipment and common
surfaces
2. Items touched during patient care
3. Patients and direct contact items
 Techniques
o Terminal cleaning (low touch
vs b4 high touch)
o Patient zone b4 toilets
o Top to bottom (prevent dirt
and microorganisms from
contaminating already
cleaned areas)
o Methodical/Systematic
Manner (avoids missing
areas)
Damp Dusting – is the removal of dirt and
bacteria from hard, flat surfaces, with a
damp cloth or sponge
 Low dusting – easily reached by
standing; done everyday
 High dusting – areas over windows,
pipes, wall and ceiling
 Varnished – do not use soap
 Unvarnished – do not use mineral
oil
Body Mechanics – coordinated efforts of
the musculoskeletal system and NS to
maintain balance, posture and body
alignment during lifting, bending, moving
and performing ADL’s; application of
mechanical laws
Alignment and Balance
 Positioning of the joints, tendons,
ligaments, and muscles while
standing, sitting, and lying
 To keep the body aligned, the
always be stable
 Reduces incidence of muscle strain
Gravity and Friction – The greater the
surface area the greater the friction
 Gravity – invisible force that
pulls objects toward each other
 Friction – is a force that occurs
in a direction to oppose
movement
Skeletal System
 Provides attachments for muscles
and ligaments
 Supporting framework as it allows
movement of the body
o Ligaments – white, shiny,
flexible bands of tissue that
bind joints together, connect
bones and cartilages, and aid
joint flexibility and support
o Tendons – are white,
glistening, fibrous bands of
tissue that connect muscle to
bone and are strong, flexible
and inelastic
o Cartilage – non-vascular,
supportive connective tissue
located chiefly in the joints
and thorax, trachea, larynx,
nose and ear
Nervous System – regulates movement and
posture
Postural Abnormalities – congenital or
acquired postural abnormalities affect the
efficiency of the musculoskeletal system and
body alignment, balance, and appearance.
1. Torticollis – inclining head to
affected side
2. Lordosis – exaggeration of anterior
convex curvature of lumbar spine
3. Kyphosis - increases convexity in
curvature of thoracic spine
4. Scoliosis – lateral- S or C – shaped
spinal column with vertebral rotation
5. Congenital Hip Dysplasia – hip
instability with limited adduction
contractures
6. Knock-knee (genu valgum) – legs
curved inward so knees come
together
7. Bowlegs (genu varum) – one or
both legs bent outward at knew;
normal until 2-3 years of age
 8. Clubfoot – 95% medial deviation
and plantar flexion; 5% lateral
deviation
9. Foot drop – inability to dorsiflex
and invert foot
10. Pigeon toes – internal rotation of
forefoot/entire foot; common in
infants
Muscle Abnormalities – injury and disease
lead to numerous alterations in
musculoskeletal function
 Direct trauma to the musculoskeletal
– results in bruises, contusions,
sprains and fractures
 Damage to the CNS – results in
impaired body alignment, balance
and mobility
Hand Washing
5 Moments for Hand Hygiene
1. Before touching the patient
2. Before an aseptic task/procedure
3. After body fluid exposure
4. After touching the patient
5. After touching patient surrounding
Bed Making - Attempt to make patients
room as comfortable as home. It needs to be
safe and large enough to allow the patient
and visitors to move about freely. Removal
of barriers along walkways reduces risk of
falls. Control room temperature, ventilation,
noise and doors. Keeping the room nest and
orderly also contributes to the patient’s
sense of well-being
 To provide patients comfort
 To provide a clean environment for
the clients
 To provide a smooth, wrinkle free
bed foundation, thus minimizing
sources of skin irritation
 To conserve a client’s energy and
maintain current healthy status
 To prevent and avoid microorganism
to come intact with the patients
Maintaining Comfort
 What makes a comfortable
environment depends on a patient’s
age, severity of illness and level of
normal daily activity. Depending on
age and physical condition,
maintaining room temp between 20
and 23 degrees Celsius (68 to 73.4
degrees Fahrenheit). Infants, older
adults and the acutely ill often need a
warmer room
Points to Remember:
 An effective ventilation system
keeps stale air and odor from
lingering in a room
 Protect the acutely ill, infants, and
older adults from drafted by ensuring
that they are dressed adequately and
covered with a lightweight blanket
 Always empty and rinse commodes,
bedpans and urinals promptly
 Room deodorizers help remove any
unpleasant odors but before using
deodorizers, determine first if the
patient is not allergic or sensitive to
the deodorizer
 Ill patients seem to be more sensitive
to noises and lighting commonly
found in health care settings
 Try to lower the noise level;
especially when a patient is trying to
sleep
 Explain the source of unfamiliar
noises such as an IV pump or pulse
oximeter alarms
 Proper lighting provides safety and
comfort
Room Equipment’s
1. Over-bed table
2. Bedside stand
3. Chairs
4. Patient’s Bed - seriously ill patients
often remain in bed for a long time.
Because a bed is the piece of
equipment used most by a
hospitalized patient. It is designed
for comfort, safety and adaptability
for changing positions. A typical
hospital bed has a firm mattress on a
metal frame that you can raise and
lower horizontally
Types of Linens
1. Bottom Sheet – used to cover the
bed after mattress cover
2. Rubber Sheet – used to protect the
bottom sheet from soothing due to
patient secretions. It is usually placed
over the center of the bottom sheet
3. Cotton Draw Sheet – a piece of
cloth spread over the rubber sheet
and is used to absorb moisture
4. Top sheet – used to cover the patient
to provide warmth, made of thick
cotton, thermal material
 5. Blanket – a large piece of cloth soft,
wooden and is used for warmth as a
bed cover
Instructions for Folding Linens
 Bed Spread and Blanket – fold
linen lengthwise; wrong side out
 Top Sheet – fold linen lengthwise;
right side out and the wider hem
should always be on the head part
 Draw and Rubber Sheet - fold
crosswise at the center; wrong side
out
 Bottom Sheet – fold lengthwise;
wrong side out
 Pillow Case – fold linen crosswise;
wrong side out
2 Types of Bed
1. Occupied Bed – made when the
patient is unable to or not permitted
to get out of bed.
2. Unoccupied Bed – when there is no
patient confined in bed, while the
patient is I the bathroom or waiting
for a newly admitted patient arriving
from the ER
a. Open Bed – the top covers
are folded back so the patient
can easily get back into bed
b. Closed Bed – the top sheet
blankets and bed spreads are
drawn up to the head of the
mattress and under the
pillow; this is prepared before
a new patient is admitted to
the room
c. Post-operative/ Surgical
Bed – Aka recovery
bed/anesthetic bed
Definition of Terms
 Bed Making – the technique of
preparing different types of bed,
making patients/clients comfortable
 Fan Folding – folding the edge of
the sheet 6-8 inches outwards
 Mitered Corner – anchoring the
sheet on mattress
 Top Pleat – a fold made in the
sheets that allows a patient in bed
move his feet
 Foot Drop – plantar flexion of the
foot with permanent contracture of
the calf muscle
 Foot Board – used to support the
immobilized client’s foot in a normal
right angle to the legs to prevent
plantar flexion contractures
 Intravenous Rods – usually made of
metal, support intravenous (IV)
containers while fluid is being
administered
Patient Transferring and Positioning
Ankle-foot Orthotic (AFO) – device that
helps maintain dorsiflexion
Patient Transferring:
1. Trochanter Roll – prevents external
rotation of the hips when patient is in
a supine position. Under buttocks
counterclockwise
2. Trapeze Bar – is a triangular device
that hangs down from a securely
fastened overhead bar that is
attached to the bed frame. Allows
patient to pull with the upper
extremities.
Patient Positioning
1. Fowler’s Position – head of the bead
is elevated
a. Low Fowler – 15-30 degrees
b. Semi Fowler – 30-45 degrees
c. Standard Fowler – 45-60
degrees
d. High Fowler – 80-90
degrees; best for eating
2. Supine Position – for sleeping; after
operation (2 hours); on the back
3. Prone Position – face or chest down
4. Sim’s Position – patient places
weight on the anterior ileum,
humerus, and clavicle; used for rectal
exam
5. Side-lying Position – patient rest on
the side with the major portion of
bodyweight on the dependent hip
and shoulder. For pressure ulcers,
30-degree lateral is recommended.
6. Logrolling – for transferring the
patient from bed to stretcher and vice
versa; for patient’s who have spinal
injury or recovering from neck, back,
or spinal surgery. Repositioning is
done every 2 hours, without it patient
will develop ulcers
7. Orthopneic Position – client sits in
bed on a high fowler position; best
for patients who have difficulty
breathing since it allows for
maximum lung expansion.
 8. Lithotomy Position – in supine, chemical
both knees are flexed and placed irritation
close to the hips, widely separated; 2.Sensation
used for vaginal exanimation or  Skin contains  Minimize
labor sensory organs friction to
9. Knee Chest (Genupectoral) for touch, pain, avoid loss of
Position – patients kneel on the bed heat, cold and stratum
pressure corneum,
then leans forward with the hips in
which results
the air; used for procedure in the in
spine or rectal development
10. Trendelenburg Position – pt is in of pressure
supine, head of the bed is down (in ulcers
reverse the foot is down) and entire  Smooth linen
body frame is tilted downwards. out to remove
11. Jackknife of Bozeman Position – sources of
prone position, hip directly over the mechanical
break in the table irritation
12. yung pang check ng hernia  Remove rings
and bracelets
to not injure
the patient’s
Skin skin
 Functions as protection, secretion,  Water is not
excretion, body temp regulation, and excessively
cutaneous sensation hot/cold
3.Temp Regulation
 Primary layers: epidermis and
 Radiation  Wala
dermis. Just beneath the skin is the
(electromagneti
subcutaneous tissue (Hypodermis) c radiation),
Function/Description Implications for Care evaporation
1.Protection (water vapor),
 Relatively  Weakening conduction
impermeable occurs by (transfer), and
layer that scraping or convection (air)
prevents stripping its 4-5. Excretion and
entrance of surface Secretion
microorganisms  Excessive  Sweat promotes  Perspiration
. Relative dryness heat loss by and oil harbor
dryness of causes cracks evaporation. microorganis
surface of skin and breaks Sebum m
inhibits where bacteria lubricates skin  Bathing
bacterial can enter and hair removes
growth. Sebum  Constant excess body
removes exposure of secretions; of
bacteria from skin to excessive it
hair follicles moisture causes dry
causes skin
softening,
interrupting Epidermis
dermal
integrity,  Outermost layer of the skin
promoting  Comprises of several thin layers of
ulcer and epithelial cells (protects the skin
bacterial against water loss and injury and
growth prevent entry of disease providing
 Keep bed microorganisms)
linen and
clothing dry
 Misuse of
chemicals Bathing and Skin Care
causes
Hygiene – science that deals with the 1. Fracture Bedpan
preservation of health/science of health and 2. Bedpan
its maintenance 3. Female Urinal
4. Male Urinal
Hygienic Care – promotes cleanliness,
provides for comfort and relaxation, Bed bath – is given to provide cleanliness
improves self-image and promotes healthy and comfort who is unable to get out of bed
skin because of physical or mental limitations
Purpose:
 To remove transient microorganisms,
body secretions and excretions and
Early Morning Care (AM Care)
dead skin cells
 Nursing personnel on the night shift  To stimulate circulation to the skin
provide basic hygiene to patients  To promote a sense of well-being
getting ready for breakfast,  To produce relaxation and comfort
scheduled tests, or early morning  To prevent and eliminate unpleasant
surgery body odors
 Offering a bedpan or urinal if the
2 General Baths
patient is not ambulatory (able to
walk around), washing the hands and 1. Cleaning bath – provided as routine
face, helping with oral care client care; main purpose is patient’s
hygiene
Routine Morning Care (Complete AM
o Complete Bed Bath
Care)

 After breakfast, offer bedpan/urinal; o Partial Bed Bath
provide a full or partial bath or a o Sponge Bath
shower, including perineal care and o Tub Bath
oral, foot, nail, and hair care; give a o Shower
back rub; change gowns/pajamas; o Bag Bath (Travel Bath)
bed making is performed; and o Chlorohexidine Gluconate
straighten the patient’s bedside unit
Bath (CHG Bath)
and room
2. Therapeutic Bath
Afternoon Care
 Hospitalized patients often undergo
exhausting diagnostic tests or
procedures in the morning. In
rehabilitation centers, patients
participate in physical therapy in the
morning. Afternoon hygiene care
includes washing the hands and face,
helping with oral care, offering a
bedpan or urinal, and straightening
the linen
Evening Care (PM Care)
 Before bedtime after personal
hygiene care that helps patients relax
and promotes sleep
 Changing solid linens, gowns, or
pajamas; helping patients wash the
face and hands; providing oral
hygiene; giving a back massage and
offering the bed bedpan or urinal

4 Types of Urinals and Bedpan