Home Care of the Sick - Making the patient comfortable

A good deal of the patient's time at home will be devoted to sleep or rest, most or all of it in bed. The bed should give firm support to the body; if the mattress does not offer such support, place a thick sheet of plywood between the springs and mattress. Pillows can be placed under the head and shoulders of the patient to raise those parts of the body from time to time. When the patient is lying on his back, a small pillow can be slipped under the knees to provide support and comfort. A small pillow can also be placed under the small of the back if necessary. Additional pillows may be placed as needed between the ankles or under one foot or both feet.

If the pressure of bed clothing on the feet causes discomfort, a bridge made from a grocery carton or similar box can be placed over the feet but beneath the blankets. To help maintain muscle tone and circulation in the feet and legs, a firm barrier can be placed as needed at the foot of the bed so the patient can stretch his legs and push against the barrier while lying on his back.

Changing Position

Helping the patient change position in bed is an important home-nursing technique. Unless a definite effort is made to help the patient change positions at regular intervals, the sick person may tend to curl up into a sort of fetal position, with the hips and knees flexed and the spine curved. While this position may be preferred by the patient in order to increase body warmth or to relieve pain, the practice of staying in one position for longer periods of time can lead to loss of muscle tone and even deformities.

Moving or positioning the patient in bed should, of course, be done according to directions outlined by the doctor for the specific medical problem involved. Body movements should not aggravate any injury or other disorder by placing undue strain or stress on a body part or organ system that is in the healing stage. At the same time, the patient should be stimulated and encouraged to change positions frequently and to use as much of his own strength as possible.

If the patient is likely to need a very long period of bed rest, and the family can afford the modest expense, it may be wise to purchase or rent a hospital-type bed. The basic hospital bed is higher from the floor than ordinary beds, making the tasks of changing bed linens, taking temperatures, etc., easier for the home nurse. More sophisticated hospital beds have manual or electrical controls to raise the head and foot of the bed.

Helping the Patient Sit Up

The patient can be helped to a sitting position in bed by placing one arm, palm upward, under the patient's shoulder while the patient extends an arm around the nurse's back or shoulders. The nurse also may slip both hands, palms facing upward, under the patient's pillow, raising it along with the patient's head and shoulders. The same procedures can be used to help move a patient from one side of the bed to the other if the patient is unable to move himself.

When the patient has been raised to a sitting position, he should try to brace his arms behind him on the bed surface with elbows straightened. If the patient feels dizzy or faint as a result of the effort, he can be lowered to the back rest position again by simply reversing the procedure.

When the patient is able to support himself in a sitting position, he should be encouraged to dangle his legs over the side of the bed, and—when his strength permits—to move to a chair beside the bed and rest for a while in a seated position.

Bathing the Patient

A patient who is unable to leave the bed will require special help in bathing. When bath time comes, the nurse will need a large basin of warm water, soap, a washcloth, and several towels, large and small. A cotton blanket also should be used to replace the regular blanket during bathing, and pillows should be removed from the bed unless they are necessary at the time.

One large towel should be placed under the patient's head and another should be placed on top of the bath blanket, with part of the towel folded under the bath blanket. This preliminary procedure should help protect the bed area from moisture that may be spilled during the bathing procedure.

The bath should begin at the area of the eyes, using only clear water and brushing outward from the eyes. Soapy water can be applied to the rest of the face, as needed, with rinsing afterward. After the face, bathing and rinsing are continued over the chest and abdomen, the arms and hands, the legs and feet, and the back of the body from the neck downward to the buttocks. The external genitalia are washed last.

During the washing procedure, the nurse uses firm strokes to aid circulation and checks for signs of pressure areas or bed sores. Skin lotions or body powders may be applied, and a back rub given, after washing. The teeth may be brushed and the patient may want to use a mouthwash. After the personal hygiene routine is completed, a fresh pair of pajamas can be put on. If bed linen needs to be changed, the bathing period provides a good opportunity for that chore.

Changing the Bed Linen

Changing the bed linen while the patient is in bed can be a challenge for any home nurse. However, there are a few shortcuts that make the task much easier. First, remove all pillows, or all but one, as well as the top spread if one is used. Loosen the rest of the bedding materials on all sides and begin removing the sheets from the head of the bed, top sheet first. By letting the patient hold the top edge of the blanket, or by tucking the top edges under his shoulder, the blanket can remain in place while the top sheet is pulled down, under the blanket, to the foot of the bed. If the top sheet is to be used as the next bottom sheet, it can be folded and placed on the side with the top spread.

Changing Patients' Bed

Next, the patient must be moved to one side of the bed and the bottom sheet gathered in a flat roll close to the patient. Then the clean bottom sheet is unfolded on the mattress cover and the edges, top, and bottom, tucked under the mattress. The rest of the clean sheet is spread over the empty side of the bed and pushed in a flat roll under the soiled sheet next to the patient's back.

The next step is to roll the patient from one side of the bed onto the clean sheet that has been spread on the other side. The soiled bottom sheets can be pulled out easily and the new bottom sheet spread and tucked in on the other side.

The new top sheet can be pulled up under the blanket, which has been used to cover the patient throughout the change of bed linens. Finally, the top spread and pillows can be replaced, after the pillow cases have been changed. A special effort should be made, meanwhile, to keep the mattress cover and bottom sheet of the patient's bed as flat and smooth as possible and to allow room for the feet to move while the sheets are firmly tucked in at the foot of the bed.

The home nurse should handle the soiled linens carefully if the patient is being treated for an infectious disease; they should never be held close to the face.

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