Promoting Comfort

7/29/2019 Promoting Comfort

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Describe comfort theory and its application to pain managementnursing practice.

Discuss the application of comfort theory in clinical practice

Individual

Select Populations and Practice Settings

Health Care Systems

Discuss the importance of bed making and its procedures

Demonstrate the proper procedures when doing bed bath, ROMand positioning

Assess the participants acquired knowledge after the presentation


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Promoting Patient's Comfort


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Definition:

-Latin word



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1. PHYSICAL

COMFORT

- bodily

sensations,

homeostatic

mechanisms,immune function

> Pain relief

> Regular bowelfunction

> Fluid/electrolytebalance

> Adequate oxygensaturation

> Turning andpositioning



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2. PSYCHOSPIRITUAL

COMFORT

- internal awarenessof self:

* esteem

* identity

* sexuality* meaning in

one's life

- relationship to a higher

order or being.

> Deep breathing> Imagery

> Change of dressing

> Coaching



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3. ENVIRONMENTAL

COMFORT

- external background* temperature

* light

* sound

* odor

* color

> Music> Quiet/Silence

> Routine for sleep



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4. SOCIOCULTURAL

COMFORT

- interpersonalrelationship

- family traditions,

rituals, and religious

practices.

> Family memberspend the night

> Connect withfriends/school

> Financial support-meals

> Chaplin referral



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Transcendence

Ease

Relief

Discomfort Promoting Patient's Comfort


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Kozier, B. (2004). Fundamentals of Nursing.

NewJersey: Pearson Education.

Kolcaba, K. (2010). Comfort Theory

. January 9, 2012,

http://www.thecomfortline.com/theory.html

http://www.thecomfortline.com/theory.htmlhttp://www.thecomfortline.com/theory.htmlhttp://www.thecomfortline.com/theory.htmlhttp://www.thecomfortline.com/theory.html


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P R O M O T I N G P A T I E N T ' S C O M F O R T


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It helps maintain a clean, orderly and comfortable

room which contributes to the patients sense ofwell-being.

Helps the patient secure proper rest and comfort

which are essential for health and refresh him/her

by providing cleanliness.



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It helps prevent or avoid microorganisms to come in

contact with the patient which could causetribulations.

Physical and psychological comfort



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To promote the clients comfort To provide a clean neat

environment

To provide a smooth, wrinkle-free bed foundation, thus

minimizing sources of skin

irritation.


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Hold soiled linen away from uniform.

Do not shake soiled linen in the air. Linen for one client is never placed on another

clients bed.

Gather all linen before starting to strip a bed.


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1. Wash hands thoroughly before and after handling

clients bed linen.

2. Soiled linen is placed directly in a portable linen

hamper or tucked into a pillow case at the end of the

bed. Pillowcase is then tied and labeled with: name,

room number, communicable/non-communicable


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3. When stripping and making a bed, conserve time andenergy by stripping and making up one side beforeworking on the other side.

4. Gather all materials before starting to strip thelinens.

5.Keep the patients environment as clean and as neatas possible.


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Bottom sheet

Rubber sheetDraw sheet

Top sheet

Pillow case

Bed cover


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UNOCCUPIED BEDIt is a type of hospital

bed that does not

have a patient in it.


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Two Types of Unoccupied Bed:A. Open Bed the top covers are folded back to

make it easier for a client to get in.

B. Closed Bed - the top sheet, bed cover/spread

are drawn up to the top of the bed and under

the pillows.


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Assess the clients readiness to be out of bed. Assist to a comfortable position.

Explain the procedure to the client.

Wash hands.

Assemble and arrange linen in order of use. Adjust the bed to an appropriate

working height.

Strip the bed.a) Remove attached equipment. Remove cases from pillows and place pillow

in a chair or bedside table.

b.) Standing at the side of the bed nearest you, loosen top and bottom of sheet

from the mattress. Move from head to foot of bed and on opposite side.


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c.) Remove items to be reused, fold into quarters and place at the back of

chair.

d.)Remove remaining linens, roll inside the bottom sheet, hold it away fromyour uniform, and put into hamper.

Place bottom sheet at the foot of bed. Fanfold the upper half toward the head of

bed, then roll the other half towards the center of the bed. Smooth over the

mattress and tuck all the head part.

Miter the corner at the head part of the bed.

a) Pick up the side edge of the sheet approximately 12 inches from the

corner of the mattress to form a 45-degree angle. Hold it straight and

parallel to the side of the mattress to keep linens in place, bring it down and

tuck the mattress.

b) Tuck the part of the sheet that is hanging under the mattress.

c) Lift the folded part of the linen previously placed on top of the mattress (with

one hand on the side of the mattress to keep linens in place, bring it down,

bring it down and tuck under the mattress.


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Lay rubber sheet halfway along center line of mattress and top and bottom

edge extend from the middle of the clients back to the area of the mid thigh or

knee. Place draw sheet over the rubber sheet in the same manner.

Tuck remainder of the bottom sheet, rubber and draw sheet under the mattress

all the way to the foot part.

*Repeat procedure on the side of bed (follow agency policy) or:

Place the centerfold of the top sheet folded lengthwise, seam side up, alongcenter of the bed and even with the head part of the bed.

Unfold half and then roll the other half towards center of the bed.

Tuck the top sheet under the foot part of the mattress.

Move to the other side of the bed and unroll all the bottom, rubber, and draw

sheet. Gently pulling to stretch and smoothen surface.


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Straighten the top sheet, tuck the foot part or make a toe pleat (optional) andmiter the corner, leaving the side hanging free.

To open the bed, grasp the upper edge of the top sheet with both hands,

bringing it all the way toward the middle of the bed. This is termed as

fanfolding.

Cover the pillow.a) Fold the open end of the pillowcase toward the middle, then grasp the

center of the closed end, gather the pillowcase up over the hand and grasp

the pillow.

b) Pulled the case down over the pillow with the other hand.

c) Straighten and smoothen the case over the pillow and place it on the head

part of the bed with open end and away from the door.


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If available, a bed cover is placed on top to cover the entire bed. It may be

placed at the foot part of the bed or left hanging free on both sides.

Assist client to bed.

Wash hands.


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Where there is a patient

physically on the bed or

the bed is being

retained for a patient



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The client is unable

or is contraindicatedto move from thebed

Presence ofequipment that limitpatients movement.



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Assess clients health status.

Be mindful of the different equipment/s or materials thatcan be dislodged.

Note specific orders or precautions for moving and

positioning the client.



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Assess skin condition

Remind patients to move from one position to another toprevent orthostatic hypotension.

Ask for assistance for patients with problems with

immobility.



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Explain the procedure to client and how he or she can cooperate.

Wash hands.

Assemble equipment and arrange in order of use.

Assemble equipment and arrange in order of use.

Adjust bed to comfortable working position. Loosen top linen at foot of bed.Remove bedspread, if soiled place them in linen bag, if to be reused, fold inquarters and place over back of chair.


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Cover client with bath blanket.

a) Unfold bath blanket over top sheet.

b) Ask client to hold top edge of blanket. If unable to help, tuck top of bath

blanket under shoulder.

c) Grasp top sheet under bath blanket and bring sheet down to foot of bed.

d) Remove sheet and discard in linen bag.

Position client on the far side of bed, facing away from you. Be sure side rail is

up. Adjust pillow under clients head.

Loosen bottom linens, moving from head to foot.

With seam side down, fanfold draw sheet , rubber sheet and bottom sheet

toward client. Tuck edges of linen just under buttocks, back and shoulder.



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Unfold bottom sheet lengthwise along center of the bed. Fanfold top layer

toward center of bed alongside the client. Smooth bottom layer of sheet and

bring edge over closest side of mattress.

Miter bottom sheet at head of bed.

Tuck remaining portion of sheet under mattress, moving toward foot of bed.

Keep linen smooth. Folds of linen are source of irritation.

Place rubber sheet, with the centerfold against clients side. Fanfold top layer

toward client.

Place draw sheet over rubber sheet in the same manner.

Tuck rubber sheet and draw sheet under the mattress.



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Roll client slowly toward you, over the layers of linen. Raise side rail and go to

other side.

Position client for removal and placement of linens.

Loosen edges of soiled linen from under the mattress.

Remove soiled linen by folding it into a bundle with soiled side turned in.Discard linen in bag.

Pull clean, fanfold linen smoothly over edge of mattress from head to foot of

bed.Miter top corner of bottom sheet. Be sure sheet is smooth and free ofwrinkles.

Smooth fanfolded draw sheet out over bottom sheet. Grasp edge of sheet with

palms down, tuck sheet under mattress. Tuck from middle to top and then to

bottom.



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Assist client in rolling back into supine position. Reposition pillow.

Place top sheet over client with centerfold lengthwise down middle of bed.

Open sheet from head to foot and unfold over client.

Ask client to hold clean top sheet. Remove bath blanket and discard.

Place spread/blanket over (optional)

Make cuff by turning edge of top sheet down over top edge of blanket and

spread.

Standing on one side at foot of bed, lift mattress corner slightly with one hand

and tuck top linens under mattress. Be sure that linens are loose enough to

allow movement of clients feet.



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Change pillowcase. Place pillow under clients head.

Place call light within clients reach and return bed to comfortable position.

Discard dirty linen in hamper and wash hands.



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The science of health and its

maintenance

Types:

a. Early morning care

b. Hour of sleep care

c. As-needed care



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Removes accumulated oil,

perspiration, dead skin cells

and some bacteria

Stimulates circulation

Produces a sense of well

being

Offers an excellent

opportunity for the nurse to

assess clientPromoting Patient's Comfort


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1. An intact, healthy skin is the bodys first line of

defense.

2. The degree to which the skin protects theunderlying tissues from injury depends on thegeneral health of the cells, the amount ofsubcutaneous tissue, and the dryness of the

skin.3. Moisture in contact with the skin for more than

a short time can result in increased bacterialgrowth and irritation.



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4. Body odors are caused by resident skin bacteria

acting on body secretions.5. Skin sensitivity to irritation and injury varies

among individuals and in accordance with their

health.6. Agents used for skin care have selective actions

and purposes.



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A. Cleaning baths given chiefly for hygiene

purposes

-Temperature should be 43C to 46C B. Therapeutic baths given for physical

effects

-Temperature may be 37.7C to46C for adults and 40.5C for

infants



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A. Complete bed bath

B. Self-help bed bath

C. Partial bathD. Bag bath

E. Tub bath

F. Shower



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Gender (male or female)

Age group

(child/adolescent/adult) Condition (health and physical

status)

Religion and culture

Environment


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Consent (approval)

The purpose and type of bath the client

needs

Self care ability of client

Any movement or positioning precautions

specific to the client

Other care the client may be receiving

Clients comfort level while being bathed by

someone else


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Basin

Soap and soap dish

Linens (bath blanket, two bath towels, washcloth, clean gown)

Gloves

Personal hygiene articles Table for bathing equipments

Laundry hamper



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Condition of skin

Fatigue

Presence of pain and need for adjunctivemeasures before the bath

ROM of the joints

Any other aspects of health that may affectclients bathing process



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1. Explain the procedure.

2. Perform infection control procedure.

3. Provide privacy.

4. Prepare the client and environment.

5. Prepare bed and position clientproperly.

6. Make a bath mit with a wash cloth.Promoting Patient's Comfort


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7. Wash the face.

8. Wash arms and hands.

9. Wash chest and abdomen.

10. Wash legs and feet.

11. Wash back and perineum.12. Assist client with grooming aids.



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refers to activity aimed at improving movement of a

specific joint.

reduce stiffness, prevent deformities and help keepyour joint flexible.

range-of-motion is the normal amount of yourchoice can be moved in certain directions.



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Essential for establishing normal ROM of jointsand soft tissue

Important decreasing risk of injury to the

musculotendinous unitPrevent contractures and adaptive shortening

Combats the effects of prolonged

immobilizationOptimal flexibility will reduce stresses to

surrounding joints and tissues



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Do not stretcho Around acutely inflamed or infected joints

o Patients who are already hypermobile

o Patients when shortened muscles are providing stability if normal jointstability is decreased or assists with functional abilities such as in

persons with paraparesis

o Across a joint when a bony block prevents motion



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A. Passive Range of Motion (PROM)

B. Active-Assistive Range of Motion

(AAROM)

C. Active Range of Motion (AROM)

D. Resistive Range of Motion (RROM)

E. Isometric Range of Motion (IROM)Promoting Patient's Comfort


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are performed by the patient, without assistance, to

increase muscle strength.

The patient performs the exercises alone or uses a

device such as a pulley or bicycle.



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These are active exercises performed by the patient

by pulling or pushing against an opposing force.



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These exercises are performed by the patient by contracting

and relaxing muscles while keeping the part in a fixed position.

These are done to maintain muscle strength when a joint is

immobilized. Full patient cooperation is required.



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Flexion - the state of being in a straight line. The cervical

spine is extended when the head is held straight.

Hyperextension - the state of exaggerated extension. The

cervical spine is hyperextended when the person looks

overhead, toward the ceiling.

Abduction - Lateral movement of a body part away from the

midline of the body. The arm is abducted when it is held away

from the body.

Adduction - Lateral movement of a body part toward themidline of the body. The arm is adducted when it is moved

from an outstretched position toward the body.



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Rotation - turning of a body part around an axis. The

head is rotated when moved from side to side to

indicate "no."

Circumduction - rotating an extremity in a completecircle. Circumduction is a combination of abduction,

adduction, extension, and flexion.

Supination - the palm or sole is rotated in an upward

position

Pronation - the palm or sole is rotated in a downward

position.



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Wash your hands

Explain what you are going to do

Provide privacy. Make sure client is wearingadequate clothing

Raise bed to a comfortable working height if

possible

Lock the wheels of the bed or wheelchair

Assist client into supine position



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CPM for the Knee

Continuous Passive

Motion Machine

Knee CPM Machine

R i f R t t C ff
http://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=QWfyspe92n0&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=QWfyspe92n0&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=QWfyspe92n0&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=uSgJV986Knc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_player


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Continuous Passive Motion

(Movement) Machine (Bilateral

Total Knee Replacement) - CPM

Repair of Rotator Cuff

Tears: Continuous

passive motion machine
http://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=7ADcxXLaj-E&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=CSEOKJqp5Kg&feature=youtube_gdata_player


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Finger Contracture

Disorders and the Use of

Continuous Passive

Motion (CPM)

continuous passive motionUpper extremity CPM is used for returning

of full ROM to shoulder, elbow, wrist that

will not include hand movements. Useable

for orthopedic conditions.
http://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=MYHITOe0XHc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=MYHITOe0XHc&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_playerhttp://www.youtube.com/watch?v=pmIRF44tB-w&feature=youtube_gdata_player


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1. Check the plan of care for instructions or limitations beforestarting ROM exercises.

2. Always handle the client gently with open palms.

3. Be aware of the normal ROM for each joint.

4. Support each joint above and below the joint beingexercised. This prevents joint pain and possible injury.

5. Exercise as many times as ordered, usually three to fivetimes.

6. Never exercise or stretch a joint to the point of pain.

7. Exercise joints only within the range of easy movement.Always stop the exercise if discomfort, pain, or spasmsdevelop.

8. Allow client to assist in procedure as much as possible.Remember: hyperextension of the neck is not possible with

the client in a supine position.Promoting Patient's Comfort


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http://www.brooksidepress.org/Products/Nursing_Fundamen

tals_1/lesson_5_Section_1A.htm

http://www.ehow.com/about_5070066_definition-passive-

range-motion.html

http://nursingcrib.com/nursing-notes-

reviewer/fundamentals-of-nursing/passive-range-of-motion-

exercises/

http://www.missouricareereducation.org/doc/ciha/CIHA_ch2

8.pdf

http://www.digplanet.com/wiki/Continuous_passive_motion#

tabs-2

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Why is it

important to do

active ROM

exercises?



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Active ROMexercises will help

keep good blood flow

going to the joint areathat is being

exercised. They may

help prevent bloodclots.



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Exercising is natural and needed for

the body to stay well. Your heart

pumps stronger and easier when you

exercise regularly.

You also breathe quicker and moreoften while exercising.

Walking and other exercises help makeyour BMs and urine more regular.



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Do all ROMexercises

smoothly and

entlPromoting Patient's Comfort


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Lock your bed or

wheelchairwheels before you

start doing your

exercises.


Ask for help if you


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Ask for help if you

think you cannot

do an exercise by

yourself.



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How are activeROM exercises

done?



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Starting position: You may sit or stand. Face forward. Your

shoulders should be straight and relaxed.


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shoulders should be straight and relaxed.



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Starting position: Stand or sit. Hold your arm straight down at your side.

Face palms in toward your body. It is best to use a chair without arms if you

i itti iti


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are in a sitting position.

Shoulder movement, up

and down. Raise your right

arm forward and upward

over your head. Try to raiseit so that your inner arm

touches your ear. Bring

your arm back down to

your side. Bring it back asfar as possible behind your

body. Return your arm to

the starting position.Promoting Patient's Comfort


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Starting position: Your forearm is the part of your arm between your elbow and

wrist. Sit down to do this exercise. Bend your elbow and keep it tucked against your

side Rest your right forearm on your right thigh (your lap) or on a flat surface like a


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side. Rest your right forearm on your right thigh (your lap) or on a flat surface like a

table.


Palm up, palm down. Faceyour palm down. Rotate (turn)

your palm so that it faces up

toward the ceiling. Rotate

your palm again so it facesdown.


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Starting position: Sit down. Bend your right elbow and restyour forearm on a flat surface, like a table. Make sure your

wrist hangs loosely over the side of the table


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wrist hangs loosely over the side of the table.

Wrist bends. Bend

your hand back toward

your wrist so that yourfingers point toward the

ceiling. Bend your hand

down so that your

fingers point toward the

floor.



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Starting position: Sit or stand. Place

your hand out in front of you


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your hand out in front of you.

Finger bends.

Make a tight fist.Then open and

relax your hand.



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Starting position: Lie flat on the bed with your legs flat and

straight. Only do hip exercises with instructions from your

caregiver if you have had a hip injury or surgery


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caregiver if you have had a hip injury or surgery.

Hip and knee

bends. Point your

toes. Slowly bendyour right knee up as

close to your chest

as possible.Straighten your leg

and return it to a flat

position on the bedPromoting Patient's Comfort


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Leg rotation, in and out. With your right leg

flat on the bed, roll your leg toward the middle

so the big toe touches the bed. Roll your leg

outward. Try to make your smallest toe touch

the bed.



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Starting position: Sit in a chair with both feet flat on

the floor.


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Ankle bends. Keep

your toes on the floor

and raise your heel as

high as you can. Loweryour heel and relax.

Keep your heel on the

floor and try to raiseyour toes as high as

you can.Promoting Patient's Comfort


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A providers order may be needed for complete

ROM exercises. The provider also may order

ROM exercises for specific joints.

Practice personal body mechanics, to preventinjury.

Do not force joint movements.

Perform limited ROM movements during

treatments.

If the client becomes tired, allow reasonable

rest periods between exercises.Promoting Patient's Comfort


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DESCRIPTION: Client lies face down

INDICATION: Alternate position for immobilized patient.

Promotes drainage from the mouth and is especially

useful for unconscious clients or those clients recovering

from surgery of the mouth or throat.

CONTRAINDICATION FOR USE: Post abdominal surgery,

and among those with respiratory or spinal problems.



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DESCRIPTION: Client lies flat on the back

INDICATION: Clients on bedrest, post spinal surgery and

post anesthesia

CONTRAINDICATION FOR USE: Clients with dyspnea

or those at risk for aspiration.



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DESCRIPTION: Clients lies on the side with weight on

the hip and shoulder, with pillows supporting legs, arm,

head, and back.

INDICATION:A choice position for clients with pressure

sore on bony prominences of back and sacrum.

CONTRAINDICATION FOR USE: Clients post hip

replacement and other orthopedic surgery.



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DESCRIPTION: In this semiprone position, the client lies

on the side with weight distributed towards the anterior

ileum, humerus, and clavicle with pillows supporting

flexed arms and legs.

INDICATION: for unconscious clients because

itbfacilitates drainage from the mouth and prevents

aspiration of fluids.

CONTRAINDICATION FOR USE: Clients with spine or

orthopedic conditions.



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DESCRIPTION: Sitting position raises clients head 80-90

degrees (high)with pillows support for head, arms and

legs.

INDICATION: Clients with difficulty of breathing. Also for

eating, improvement of cardiac output, and watching TV.

CONTRAINDICATION FOR USE: Post spine or brain

surgery.



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DESCRIPTION: Semi-sitting position with head elevation

of 30-45 degrees.

INDICATION: Clients with difficulty of breathing. Also for

eating, improvement of cardiac output, and watching TV.

CONTRAINDICATION FOR USE: Post spine or brain

surgery.



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DESCRIPTION: Lies prone with buttocks elevated and

knees drawn to the chest.

INDICATION: For rectal procedures and examination.

CONTRAINDICATION FOR USE: Arthritis, and other

joint deformity.



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DESCRIPTION: Lies supine with head 30-40 degrees

lower than the feet.

INDICATION: For postural drainage and promotion of

venous blood return

CONTRAINDICATION FOR USE: Increased intra-cranial

pressure. hypotension may result from this position.



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DESCRIPTION: Clients lies supine with legs flexed and

rotated outward.

INDICATION: For vginal examination.



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DESCRIPTION: Lies supine with hips flexed, and calves

and heels parallel to the floor using stirrups

INDICATION: For vaginal and rectal examinations and

procedures (DRAPE!!!for comfort and privacy).



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Help the patient assume the desired or required

bed position. the nurse assists the patient to

achieve proper body positioning and alignment.

Support patient's body in correct alignment usingpillows or splints.

Assure the proper use of supportive devices.

Frequently monitor and evaluate the position

selected.

Provide skin care.



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Materials: Pillow to support the client comfortably in the

required positions

Tissues for expectorated secretions

Sputum container for expectorated secretions Mouthwash to clean and freshen the mouth following

the treatment

Bed that can be placed in trendelenburgs position

Gown or pajama to prevent undue exposure and toprotect the skin during percussion and vibration

A towel to place over the area to be percussed toprevent discomfort



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To drain the apical segments of the upper lobes

-Lie back at a 30-90 degrees angle.

-Percuss and vibrate between the clavicles (collar bones) and the

above the scapulae (shoulder blades


To drain the posterior segments of the upper lobes

-Have client sit upright in a chair or bed with the head bent slightly

forward.


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-Percuss and vibrate the areas between the clavicles and the scapulae.


To drain the anterior segments of the upper lobes

-Have client on a flat bed with pillows under the knees to flex them.

-Percuss and vibrate the upper chest below the clavicles down to the

i l li t f


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nipple line, except for women.



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To drain the right lateral and medial segments

-Elevate the foot of the bed about 15 degrees or 40cm (15 in) and have

the client lie on the left side. Help the client to lean back slightly(about a quarter turn) against the pillow extending at the back from

the shoulder to the hip. A pillow may be placed between the knee for

comfort.

-For male: percuss and vibrate over the right side of the chest at the

level of the nipple between the 4th and 6th rib.-For female: position the heel of your hand toward the axilla and your

cupped finger extending forward beneath the breast to percuss and

vibrate beneath the breast.



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To drain the left lingular segments.

-Elevate the foot of the bed about 15 degrees and have the client lie on

the right side.


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-Percuss the left side of the chest beneath the breast


To drain the s perior segments


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To drain the superior segments

-Have client lie on the abdomen on a flat bed and place two pillowsunder the hips

-Percuss and vibrate the middle area of the back (below the scapulae)

on the both sides of the spine.


To drain the anterior basal segments

-Have client lie on the unaffected side, with the upper arm over the

head. Elevate the foot of the bed about 30 degree or 45cm (18 in), or


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g ( )

to the height tolerated by the client. Place one pillow between the

knee. Another under the head is optional.

-Percuss and vibrate the affected side of the chest over the lower ribs,

inferior to the axilla.


To drain the lateral basal segments

-Have the client lie partly on the unaffected side and partly on the

abdomen. Elevate the foot of the bed about 30 degrees or 45 cm (18

in) or to the height tolerated by the client. An alternative is to elevate


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in) or to the height tolerated by the client. An alternative is to elevate

the hips with pillows.

-Percuss and vibrate the uppermost side of the lower ribs.


To drain the posterior basal segments

-Have client lie prone. Elevate the foot of the bed abput 30 degrees or

45cm (18 in) or to the height tolerated by the client. Elevate the hip

on two or three pillows to produce a jack knife position from the


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on two or three pillows to produce a jack knife position from the

knees to the shoulders.-Percuss and vibrate over the lower ribs on both sides close to teh

spine, but not directly over the spine or the kidneys.



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KOZIER BOOK ( 8TH

EDITION)

INTERNET ( GOOGLE)


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Documents

Promoting Comfort