CHAPTER SEVEN

MAKING AND MAINTAINING BED

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 Learning objective
• At the end of this lesson the student will be
able to;
Define bed making
List types of bed
List different types equipment used for bed
making
Apply the standard of bed making

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 Bed making
• Bed making - is a technique, which provides enough
area to the patient on which s/he can be comfortable.
• Types
– Unoccupied bed
• Closed bed
• Open bed
– Occupied bed
– Cardiac bed
– Post operative/anesthetic bed
– Amputation bed
– Fracture bed

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 Cont..
• A standard hospital beds has 66cm (26in) height,
0.9m (3ft) width and 1.9m (6.5ft) length.
• Some beds can be extended in length.
• Most hospital beds have” high” and “low”
position that can be adjusted either mechanically
or electrically.
Purpose
– To give comfort
– Facilitate pt movement
– Prevent skin irritation
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General instruction
1. Put bed coverings in order of use
Order of Beddings
1. Mattress cover
2. Bottom sheet
3. Rubber sheet
4. Cotton (cloth) draw sheet
5. Top sheet
6. Blanket
7. Pillow case
8. Bed spread
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2. Wash hands thoroughly after handling a
patient's bed linen
3. Linens and equipment soiled with secretions
and excretions harbor micro-organisms that
can be transmitted directly or by hand’s
uniforms
4. Hold soiled linen away from uniform
5. Linen for one client is never (even
momentarily) placed on another client’s bed.

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6. Soiled linen is placed directly in a portable
linen hamper or a pillow case before it is
gathered for disposal.
7. Soiled linen is never shaken in the air because
shaking can disseminate secretions and
excretions and the microorganisms they
contain.
8. When stripping and making a bed, conserve
time and energy by stripping and making up
one side as completely as possible before
working on the other side. 7
9. To avoid unnecessary trips to the linen supply
area, gather all needed linen before starting to
strip bed.
10. Make a vertical or horizontal toe pleat in the
sheet to provide additional room for the
client’s feet.
11. While tucking bedding under the mattress
the palm of the hand should face down to
protect your nails.

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Note
• Pillow should not be used for babies
• The mattress should be turned as often
as necessary to prevent sagging, which
will cause discomfort to the patient.

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 Stripping of a Bed
• is removing the bed linen from a bed which
had been previously made-up.
Purpose:
• To prevent cross contamination
• To Ventilate the bed and bedding
• To Prepare the bed for remaking
• To prevent damage of bedding
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Precautions
1. No bedding, either clean or soiled, should
ever be put on the floor. It should be
discarded in hamper.
2. Do not let your uniform touch the bedding.
Woolen blankets are never discarded in soiled
clothes hamper. If soiled, they should be dry-
cleaned or washed carefully or treated with
direct sunlight.
3. Use glove if the bed soiled or used by patient
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 Making Unoccupied Bed
1. Closed bed
• Closed bed is a smooth, comfortable and
clean bed, which is prepared for a newly
admitted patient.
• In closed bed: the top sheet, blanket and
bed spread are drawn up to the top of the
bed and under the pillows.

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Purpose:
• To receive new patient
• To keep the bed neat and clean until a
new patient is admitted

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Equipment
• Mattress (1)
• Bed sheets(2): Bottom sheet (1), Top
sheet (1)
• Pillow (1)
• Pillow cover (1)
• Mackintosh/ Rubber sheet (1)
• Draw sheet (1)
• Blanket (1)
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• Savlon water or Dettol water in basin.
• Sponge cloth (4): to wipe with solution
(1) to dry (1)
• When bed make is done by two nurses,
• sponge cloth is needed two each.
• Laundry bag or hamper (1)
• Trolley(1)
• Clean glove

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Procedure
1. Wash hands and collect necessary
materials
2. Place the materials to be used on the
chair. Turn mattress and clean the
mattress.
3. Move the chair and bed side locker.
4. Clean Bed-side locker, chair: Wipe with
wet and dry.
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5. Clean the mattress:
Stand in right side.
A. Start wet wiping from top to center and
from center to bottom in right side of
mattress.
B. Gather the dust and debris to the bottom.
C. Give wiping as same as procedure 2
Move to left side.
• Wipe with wet and dry the left side.
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6. Move to right side. Start making the bed,
Place bottom sheet with correct side up,
center of sheet on center of bed and
then at the head of the bed.
7. Tuck sheet under mattress at the head
of bed and miter the corner.
• Mitering steps:
A. Face the side of bed and lift and lay the
top edge of the sheet onto the bed to
form a triangular fold.
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B. With your palms down, tuck lower edge of
sheet (hanging free at side of mattress) under
mattress.
C. Grasp the triangular fold, bring it down over
the side of the mattress and tuck the sheet
smoothly under the mattress Straighten the
free hanging sheet on mattress side.
8. Remain on one side of bed until you have
completed making the bed on that side.
9. Tuck sheet on the sides and foot of bed,
mitering the corners.
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10. Tuck sheets smoothly under the mattress,
there should be no wrinkle.
11. Place rubber and draw sheet at the center
of the bed and tuck smoothly and tightly.
12. Place cotton draw sheet on top of rubber
draw sheet and tuck. The rubber draw sheet
should be covered completely.
13. Place top sheet with wrong side up, center
fold of sheet on center of bed and wide it at
head of bed.
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14. Tuck sheet of foot of bed, mitering the
corner.
15. Place blankets with center of blanket on
center of bed, tuck at the foot of beds and
miter the corner.
16. Fold top sheet over blanket
17. Place bed spread with right side up and tuck
it.
18. Miter the corners at the foot of the bed.

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19. Go to other side of bed and tuck in bottom
sheet, draw sheet, mitering corners and
smoothening out all wrinkles, put pillow case
on pillow and place on bed.
20. See that bed is neat and smooth
21. Leave bed in place and furniture in order
22. Wash hands
23. Recording and documenting.

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 2. Open bed

• Open bed is one which is made for an

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Purposes of making open bed
• To provide clean and comfortable
bed for the patient
• To reduce the risk of infection by
maintaining a clean environment
• To prevent bed sores by ensuring
there are no wrinkles to cause
pressure points
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• Equipment
• Two large sheets
• Rubber draw sheet
• Draw sheet
• Rubber sheet (Mackintosh )
• Blankets
• Pillow cases
• Bed spread
• Clean glove
• Chart 25
Procedure
1. Wash hands and collect necessary materials.
2. Place the materials to be used on the chair.
Turn mattress and arrange evenly on the bed.
3. Place bottom sheet with correct side up,
center of sheet on center of bed and then at
the head of the bed.
4. Tuck sheet under mattress at the head of bed
and miter the corner.

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5. Remain on one side of bed until you have
completed making the bed on that side.
6. Tuck sheet on the sides and foot of bed,
mitering the corners.
7. Tuck sheets smoothly under the mattress,
there should be no wrinkles.
8. Place rubber and draw sheet at the center of
the bed and tuck smoothly and tightly.

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9. Place cotton draw sheet on top of rubber
draw sheet and tuck. The rubber draw sheet
should be covered completely.
10. Place top sheet with wrong side up, center
fold of sheet on center of bed and wide it at
head of bed.
11. Tuck sheet of foot of bed, mitering the
corner.
12. Place blankets with center of blanket on
center of bed, tuck at the foot of beds and
miter the corner. 28
13. Fold top sheet over blanket
14. Place bed spread with right side up and tuck
it.
15. Miter the corners at the foot of the bed.
16. Go to other side of bed and tuck in bottom
sheet, draw sheet, mitering corners and
smoothening out all wrinkles, put pillow case
on pillow and place on bed.

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17. See that bed is neat and smooth
18. Leave bed in place and furniture in
order
19. Wash hands
20. Recording and documenting

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 Making an occupied Bed
• An occupied bed is a bed prepared for a weak
patient (bed ridden) who is unable to get out
of bed.
Purposes
• To provide comfort and to facilitate
circulation of the patient
• To provide cleanliness and facilitate position
of the patients bed
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• To conserve patient’s energy and
maintain current health status
• To comfort the patient

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Equipment
• Two large sheets
• Draw sheet
• Rubber sheet (mackintosh).
• Pillow case
• Pajamas or gown, if necessary
• Spread sheet
• Chart
• Clean glove
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Procedure
1. Wash hands and collect equipment
2. Explain procedure to the patient
3. Carry all equipment to the bed and arrange in
the order it is to be used.
4. Make sure the windows and doors are closed.
5. Make the bed flat, if possible
6. Loosen all bedding from the mattress,
beginning at head of the bed, and place dirty
pillow cases on the chair for receiving dirty
linen. 34
7. Have patient flex knees, or help patient do so.
With one hand over the patient’s shoulder
and the other hand over the patient’s knees,
turn the patient towards you.
• Never turn a helpless patient away from you,
as this may cause him/her to fall out of bed.
8. When you have made the patient
comfortable and secure as near to the edge of
the bed as possible, go to the other side
carrying your equipment with you.

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9. Loosen the bedding on that side.
10. Fold, the bed spread half way down from
the head. Fold the bedding neatly up over
patient.
11. Roll dirty bottom sheet close to patient
12. Put on clean bottom sheet on used top
sheet center, fold at center of bed, rolling the
top half close to the patient, tucking top and
bottom ends tightly and mitering the corner

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13. Put on rubber sheet and draw sheet if
needed.
14. Turn patient towards you on to the clean
sheets and make comfortable on the edge of
bed.
15. Go to the opposite side of bed. Taking basin
and wash cloths with you, give patient back
care.
16. Remove dirty sheet gently and place in dirty
pillow case, but not on the floor.
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17. Remove dirty bottom sheet and unroll clean
linen.
18. Tuck in tightly at ends and miter corners.
19. Turn patient and make position comfortable.
20. Back rub should be given before the patient
is turned on his /her back
21. Place clean sheet over top sheet and ask the
patient to hold it if she/he is conscious. Go to
foot of bed and pull the dirty top sheet out
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22. Replace the blanket and bed spread
23.Miter the corners
24. Tuck in along sides for low beds
25. Leave sides hanging on high beds
26. Turn the top of the bed spread under the
blanket
27. Turn top sheet back over the blanket and
bed spread

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28. Change pillowcase, lift patient’s head to
replace pillow. Loosen top bedding over
patient’s toes and chest.
29. Be sure the patient is comfortable
30. Clean bedside table
31. Remove dirty linen, leaving room in order
32.Wash hands.
33. Recording and documentation

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 Making cardiac bed
• Cardiac bed is a bed prepared for a patient
with heart disease or dyspnea and to provide
easy breathing for patient with minimum
strain.
Purpose
• In order to ease difficulty in breathing
• To Provide comfort and safety
• To relieve dyspnea
• To prevent complication 41
EQUIPMENT
• Linens
• Bed spread
• Blanket
• Extra pillows (4 – 6 Pillows)
• Pillowcase
• Cylinder with oxygen
• Draw Sheet
• Footrest& back rest
• Rubber sheet
• Over bed table 42
Procedure
1. Wash your hands
2. Assemble the necessary equipment and carry
to bed side
3. Place chair at the foot of the bed
4. Arrange the linen on chair in the order that it
will be used
5. Turn mattress and arrange on the bed.
6. Put on mattress cover if available
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7. Place bottom sheet with right side up, center
of sheet on center of bed and wide hem at the
head of the bed.
8. Tuck sheet under mattress at head of bed and
miter the corner.
9. Remain on one side of bed until you have
completed making the bed on that side.
10. Tuck sheet on the sides and foot of bed
mitering the corners.
11. Tuck sheets smoothly under the mattress.
There should be no wrinkles. 44
12. Place rubber draw sheet in the center of the
bed and tuck tightly.
13. Place cotton draw sheet on top of rubber
draw sheet and tuck. Rubber draw sheet
should be covered completely.
14. Place top sheet with wrong side up, center
fold sheet at center of bed and wide hem at
foot of bed.
15. Tuck sheet at foot of bed mitering the
corner.
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16. Place blankets with center of blanket on
center of bed and tuck at the foot of bed and
miter corner. Fold top sheet over blanket.
17. Place bed spread with right side up. Tuck at
the foot of bed miter corners and cover top
bedding.
18. Go to other side of bed fanfold the top covers at
the center of bed and tuck in bottom sheet and
draw sheet mitering corners, smoothing out all
wrinkles, continue with blanket and spread the
same with the opposite side.
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19. See that bed is neat and smooth
20. Put bed in semi fowler’s position by raising
the head of bed; if bed is gatched raise at the
head of bed if bed is normal bed put extra
pillows.
21. Put footrest to prevent the patient from
sliding down.
22. Place over bed table over the bed and a
pillow over it to allow the patient’s hands to
rest on it.
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23. Wash the hand thoroughly
24. Record in the nurse’s order of any
observation made on the patient

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 Post operative/anesthetic bed making
• Anesthetic bed is a bed especially prepared to
receive a patient after surgery and major
recovery from general anesthesia.
Purposes
• To facilitate easy transfer of the patient from
stretcher to bed.
• To facilitate removal of secretion

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• To protect the mattress and bedding from
bleeding, vomiting, drainage or discharges.
• To protect the patient from becoming chilled
or give warmth.

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Equipment
A. For bed making
1. Two large sheets.
2. Draw sheet(two)
3. Bath blanket
4. Woolen blanket
5. Rubber sheet (Mackintosh)
6. Two tongue blades or a mouth gag
7. Small towel.
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8. Pillow case
9. Spread sheet
10. Additional Sheets and blanket
11. bed blocks as needed
12. An extra rubber sheet & draw sheet for
operated areas
B. For first aid activity
1. Emergency drug
2. Minor set
3. Vital sign equipment
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4. Suction machine
5. Oxygen cylinder
6. Sterile Suction catheter
7. Sterile glove
8. Examination lamp (at hand if needed).
9. Airway tube
10. Sterile drainage bottle with tubing,
11. IV Stand.
12. Emesis basin and paper bag.
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13. Iv fluid
14. Hot water bag
15. Safety pin
16. Bed cradle
17. Tissue paper
18. An emesis basin
19. Chart
20. Paper and pen for recording vital signs
and charting

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Procedure
1. Wash your hand & prepared equipment
2. Strip the bed
3. Make the foundation of the bed as usual with
large sheet, rubber draw sheet, bath blanket,
draw sheet, etc.
4. Place one rubber sheet where the site of
operation will rest

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5. Place other rubber sheet across head of the
bed where head will lie to protect bed from
vomitus}
6. Cover each rubber sheet with draw sheet
tucking it firmly under matters
7. Place top bedding as before but do not tuck
in the bottom. Fold down the top as you
would do in an occupied bed.

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57
8. Then fold the bottom of the linens up so that
the fold is even with the bottom of the
mattress.
• Do not tuck the linen in. Unfold the top linens
to the side so that they lay opposite from
where you will place the client’s stretcher.
• Alternatively, you may fanfold the linens to
the foot of the bed. Leave a tab on top for
easy grasping.

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9. In cold season, place hot water bottles in
middle of the bed, and cover with fanfold top
bedding temperature of hot water is never to
exceed 50°C (122°F).
10. Have two or more pillows available, but do
not put them on the bed.
• Rationale: A pillow may be contraindicated for
a client; usually the physician or charge nurse
will determine when it is safe for the client to
have one.
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11. Place pillow at the head of the bed between
bed & mattress and tie it back with a piece of
bandage to protect had of Patient.
12. Place all necessary materials at the side of
the bed opposite to the stretcher on which
the patient will come
13. Arrange emergency equipment{ B/P
apparatus ,suction machine, Drug}
14. Close the windows. Leave the room clean
and in order
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15. Receiving the patient from operation room
A. Remove folded to cover of the bed
B. Place the patient on bed and cover quickly
C. See that patient is properly placed in bed
with head to the left side and comfortable
D. Check patient s condition operated area,
urine, vital sign, colour of patient etc.
E. Do after care and Comfort the patient after
procedure
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16. Return used equipment to utility room
and wash your hand
17. Proper documentation

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 Making an amputation bed
Amputation: - is the surgical removal of a part
of the body or a limb, performed to treat
recurrent infections or gangrene in peripheral
vascular disease, to remove malignant tumors
& in severe trauma.
Amputation bed/ stump bed is a regular bed
with cradle, which is prepared for amputated
patient.
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Purpose
• To give extra warmth
• To leave the part open for observation.
• To ensure more safety and comfort by
preventing soiling and staining.
• To keep the stump in a good position
• To prevent jerky movements for the
amputated leg
• To prepare for emergency, to have easy access
and economy of time and energy
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Equipment
1. Linens (3)
2. Pillow
3. Blanket(2)
4. Pillow case
5. Bed cradle
6. Trolly
7. sponge
8. safety pin
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9. Draw sheet
10. face &bath towel
11. Tourniquet
12. Rubber sheet
13. Mackintosh
14. Small rubber sheet with cover
15. Dressing set
16. Sand bags with cover

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Procedure
1. Wash hands thoroughly
2. Collect equipments arrange fresh folded
linens in following order on trolly. ( blanket,
towel ,sponge, face and bath towel , draw
sheet , mackintosh , bottom sheet, mattress
cover)
3. Clean mattress, similar with open bed
4. Cover mattress with fresh cover and tuck
firmly
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5. Spread long mackintosh length and top to
bottom covering mattress
6. Spread bottom sheet and tuck neatly
7. Top sheet, draw mackintosh and draw sheet
will be received along the patient which
should be firmly tucked
8. To make the lower half, use one sheet and
blanket, for upper also ,one top sheet and
blanket

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9. Keep the lower half of the bed overlapped
with the upper half as, in this way ,we can
easily separate thetwo halves and observe the
stump
10. Elevate the stump over the soft pillow
covered with mackintosh
11. Place the sand bags on either side of the
stumps to prevent it from jerking ,sand bags
help prevent bleeding from jerking
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12. Bed cradles are used to take up the weight
of the bed linen
13. Cover the patient and make the unit tidy.
14. Wash the hand thoroughly
15. Document in the nurse’s order of any
observation made on the patient

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 Making Fracture bed
• Fracture bed is a hard firm bed designed for a
patient with fracture.
Purpose
• To give firm, even support to the broken
limbs and back.
• To maintain position.
• To make the patient comfortable.
• To provide a flat, unyielding surface to
support the fractured limb. 71
Equipment
• Articled as for a closed bed
• Small blanket or draw sheet
• fracture board
• Bed cradle
• Small rubber sheet
• Draw sheet
• Sand bags
• Pillow if required
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Procedure:
1. Place the fracture board directly over the
bed springs and the mattress on it.
• If the mattress is thin, an extra mattress
must be added to prevent pressure sore due
to pressures on the head surface.
2. Make the bottom bed as usual, and then
place the small rubber sheet covered with
draw sheet at the place where the injured
part will be resting.
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• The small rubber and draw sheet are easier to
change then the whole bed. This applies
specially to an arm or a leg, which is bleeding
or has discharge.
3. Fold back the bed cloths at foot of the bed for
leg fracture.
• Cover the uninjured limb with a small blanket.
• On draw sheet placed the cradle over the
linen to adjust the cover over it.
• Extra blanket and spreads may be necessary.
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• Be sure that the covers come high enough on
the shoulder
4. Do after care and Comfort the patient after
procedure
5. Return used equipment to utility room and
wash your hand
6. proper documentation
N.B:
Never cover a plaster cast until it is thoroughly
dry.

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The fracture board keeps the bed with no
danger of sagging. It is also used for
fracture of the spine.
 A bed cradles are a frame made of wire
wood or iron .it is used to keep the top
cover from touching the injured part.

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 Baby crib
• the bed that prepare for pediatric
case with bed side safety
Purpose
• To make comfort for baby with
safety

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Equipment
• The same with closed bed
Procedure
1. Place baby at the foot of bed
2. Loosen bottom sheet at head
3. Place clean bottom sheet and tuck in
4. Place small rubber sheet or water proof pad
on top
5. Place baby at the head of bed
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6. Remove soiled linen and tuck clean bottom
sheet mitring corners
7. Place clean top sheet and tuck at the bottom
8. Place blanket and tuck, and place baby bed
spread
9. Complete making bed on both sides
10. Raise side rails of bed and leave baby
comfortable in bed.

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