2/22/14

Making a post operative bed

◘ The entire bed need clean linen.

◘ Make the bottom of bed as you normally would. The post operative the bottom of bed as you normally would. The post operative bed usually requires a draw sheet under the client’s hips. Usually another draw sheet is placed under the client’s heard.

◘ In some cases, top liners are simply tan-folded to the foot of the bed. In others, a full post operative bed is made. To do this, put the top linens over the foundation, but do not tuck them in. Fold down the top as you would do in an occupied bed. 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. Fanfold 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.

◘ Have two or more pillows available, but do not put them on the bed. Rational: 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.

◘ Be sure all furniture is out of the way.

◘ Be sure the call light is available, but keep it on the bed side stand until the client is in bed. The call light cord is kept out of the way, to facilitate the transfer of the client to bed.

◘ Know what surgical procedure your client has had before you determine what special equipment is needed. For the client’s convenience and safety, make the following items available: tissue, an emesis basin, a blood pressure cuff and stethoscope, a “frequent vital signs” flow sheet an in take and output record, and an intravenous (IV) stand. Other items can be added according to the client specific requirements.

◘ Report to your charge nurse when you have completed the postoperative bed and assembled the necessary equipment.

N.B. Procedures for other beds like cardiac bed are similar except the following points.
• For cardiac patient the bed need extra materials such as over bed table and additional pillows
• Hard board is needed under the mattress for fracture bed.

Study questions
1. How many types of bed making do you know?
2. What is the function of bed the cradle?
3. Which types of bed are usually prepared for newly admitted patients?
4. What is the difference between open and closed bed?
5. Define occupied bed.
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Occupied bed making procedure

Purpose: to provide comfort, cleanliness and facilitate position of the patients

Essential equipment:
• Two large sheets
• Draw sheet
• Pillow case
• Pajamas or gown, if necessary

Procedure:
• If a full bath is not given at this time, the patient’s back should be washed and cared for
• Wash hands and collect equipment
• Explain procedure to the patient
• Carry all equipment to the bed and arrange in the order it is to be used
• Make sure the windows and doors are closed
• Make the bed flat, if possible
• Loosen all bedding from the mattress, beginning at head of the bed, and place dirty pillow cases on the chair for receiving dirty linen
• Have patient flex knees, or help patient do so. With one hand over the patient’s shoulder and the shoulder 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 bed
• When you have made the patient comfortable and secure as near to the edge of the bed as possible, to go the other side carrying your equipment with you
• Loosen the bedding on that side
• Fold, the bed spread half way down from the head
• Fold the bedding neatly up over patient
• Roll dirty bottom sheet close to patient
• 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
• Put on rubber sheet and draw sheet if needed
• Turn patient towards you on to the clean sheets and make comfortable on the edge of bed
• Go to the opposite side of bed. Taking basin and wash cloths with you, give patient back care
• Remove dirty sheet gently and place in dirty pillow case, but not on the floor
• Remove dirty bottom sheet and unroll clean linen
• Tuck in tightly at ends and miter corners
• Turn patient and make position comfortable
• Back rub should be given before the patient is turned on his/her back
• 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
• Replace the blanket and bed spread
• Miter the corners
• Tuck in along sides for low beds
• Leave sides hanging on high beds
• Turn the top of the bed spread under the blanket
• Turn top sheet back over the blanket and bed spread
• Change pillowcase, lift patient’s head to replace pillow.
Loosen top bedding over patient’s toes and chest
• Be sure the patient is comfortable
• Clean bedside table
• Remove dirty linen, leaving room in order Wash hands
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Closed Bed Making Procedure

• It is a smooth, comfortable, and clean bed that is prepared for a new patient

Essential Equipment:
• Two large sheets
• Rubber draw sheet
• Draw sheet
• Blankets
• Pillow cases
• Bed spread

Procedure:
• Wash hands and collect necessary materials
• Place the materials to be used on the chair. Turn mattress and arrange evenly on the bed
• Place bottom sheet with correct side up, center of sheet on center of bed and then at the head of the bed
• Tuck sheet under mattress at the head of bed and miter the corner
• Remain on one side of bed until you have completed making the bed on that side
• Tuck sheet on the sides and foot of bed, mitering the corners
• Tuck sheets smoothly under the mattress, there should be no wrinkles
• Place rubber draw at the center of the bed and tuck smoothly and tightly
• Place cotton draw sheet on top of rubber draw sheet and tuck. The rubber draw sheet should be covered completely
• Place top sheet with wrong side up, center fold of sheet on center of bed and wide hem at head of bed
• Tuck sheet of foot of bed, mitering the corner
• Place blankets with center of blanket on center of bed, tuck at the foot of beds and miter the corner
• Fold top sheet over blanket
• Place bed spread with right side up and tuck it
• Miter the corners at the foot of the bed
• 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
• See that bed is neat and smooth
• Leave bed in place and furniture in order
• Wash hands
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Bed Making

Learning Objectives

At the end of this unit, the learner able to:
• Describe different types of bed making. State the purposes of bed making in health care facilities.
• Develop understanding about general instruction of bed making
• Develop a skill to make different types of bed.
• Explain the purposes of side rails.
• List necessary equipment for bed making.
• Arrange bed-making equipment in order of their use.

Key terminology
Bed cradle - occupied bed - traction
Closed bed - open bed - unoccupied bed
Mitered corner - postoperative bed

In most instances beds are made after the client receives certain care and when beds are unoccupied. Unoccupied bed can be both open and closed.

Closed bed: is a smooth, comfortable and clean bed, which is prepared for a new patient
• In closed bed: the top sheet, blanket and bed spread are drawn up to the top of the bed and under the pillows.

Open bed: is one which is made for an ambulatory patient are made in the same way but the top covers of an open bed are folded back to make it easier of a client to get in.

Occupied bed: is a bed prepared for a weak patient who is unable to get out of bed.

Purpose:
1. To provide comfort and to facilitate movement of the patient
2. To conserve patient’s energy and maintain current health status

Anesthetic bed: is a bed prepared for a patient recovering from anesthesia

◘ Purpose: to facilitate easy transfer of the patient from stretcher to bed

Amputation bed: a regular bed with a bed cradle and sand bags
◘ Purpose: to leave the amputated part easy for observation

Fracture bed: a bed board under normal bed and cradle
◘ Purpose: to provide a flat, unyielding surface to support a fracture part

Cardiac bed: is one prepared for a patient with heart problem
◘ Purpose: to ease difficulty in breathing

General Instructions
1. Put bed coverings in order of use
2. Wash hands thoroughly after handling a patient's bed linen Linens and equipment soiled which secretions and excretions harbor micro-organisms that can be transmitted directly or by hand’s uniforms
3. Hold soiled linen away from uniform
4. Linen for one client is never (even momentarily) placed on another client’s bed
5. Soiled linen is placed directly in a portable linen hamper or a pillow case before it is gathered for disposal
6. Soiled linen is never shaken in the air because shaking can disseminate secretions and excretions and the microorganisms they contain
7. 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
8. To avoid unnecessary trips to the linen supply area, gather all needed linen before starting to strip bed
9. Make a vertical or horizontal toe pleat in the sheet to provide additional room for the clients feet.
Vertical - make a fold in the sheet 5-10 cm 1 to the foot
Horizontal – make a fold in the sheet 5-10 cm across the bed
near the foot
10. While tucking bedding under the mattress the palm of the hand should face down to protect your nails.

Order of Bed Covers
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

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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12/20/13

Caring for a Patient Receiving Continuous Wound Perfusion Pain Management

Goal: The patient reports increased comfort and/or decreased pain, without adverse effects.

1. Check the medication order against the original medical order, according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close the door to the room or pull the bedside curtain.

6. Assess the patient’s pain. Administer postoperative analgesic, as ordered.

7. Check the medication label attached to the balloon. Compare with the medical order and MAR, per facility policy. Assess the patient for perioral numbness or tingling, numbness or tingling of fingers or toes, blurred vision, ringing in the ears, metallic taste in the mouth, confusion, seizures, drowsiness, nausea and/or vomiting. Assess the patient’s vital signs.

8. Put on gloves. Assess the wound perfusion system. Inspect tubing for kinks; check that the white tubing clamps are open. If tubing appears crimped, massage area on tubing to facilitate flow. Check filter in tubing, which should be unrestricted and free from tape.

9. Check the flow restrictor to ensure it is in contact with the patient’s skin. Tape in place, as necessary.

10. Check the insertion site dressing. Ensure that it is intact. Assess for leakage and dislodgement. Assess for redness, warmth, swelling, pain at site, and drainage.

11. Review the device with the patient. Review the function of the device and reason for use. Reinforce the purpose and action of the medication to the patient.

To Remove the Catheter
12. Check to ensure that infusion is complete. Infusion is complete when the delivery time has passed and the balloon is no longer inflated.

13. Perform hand hygiene. Identify the patient. Put on gloves. Remove the catheter site dressing. Loosen adhesive skin closure strips at catheter site.

14. Grasp the catheter close to the patient’s skin at the insertion site. Gently pull catheter to remove. Catheter should be easy to remove and not painful. Do not tug or quickly pull on the catheter during removal. Check the distal end of the catheter for the black marking.

15. Cover puncture site with a dry dressing, according to facility policy.

16. Dispose of the balloon, tubing, and catheter according to facility policy.

17. Remove gloves and additional PPE, if used. Perform hand hygiene.
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Caring for a Patient Receiving Epidural Analgesia

Goal: The patient reports increased comfort and decreased pain; and shows no signs of adverse effects, oversedation, or respiratory depression.

1. Check the medication order against the original medical order according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Prepare the medication syringe or other container, based on facility policy, for administration. (See Chapter 5, Medications, for additional information.)

4. Perform hand hygiene and put on PPE, if indicated.

5. Identify the patient.

6. Show the patient the device, and explain the function of the device and reason for use. Explain the purpose and action of the medication to the patient.

7. Close the door to the room or pull the bedside curtain.

8. Complete necessary assessments before administering medication. Check allergy bracelet or ask patient about allergies. Assess the patient’s pain, using an appropriate assessment tool and measurement scale. (See Fundamentals Review 10-1 through 10-6.) Put on gloves.

9. Have an ampule of 0.4 mg naloxone (Narcan) and a syringe at the bedside.

10. After the catheter has been inserted and the infusion initiated by the anesthesiologist or radiologist, check the label on the medication container and rate of infusion with the medication record and patient identification. Obtain verification of information from a second nurse, according to facility policy. If using a barcode administration system, scan the barcode on the medication label, if required.

11. Tape all connection sites. Label the bag, tubing, and pump apparatus “For Epidural Infusion Only.” Do not administer any other narcotics or adjuvant drugs without the approval of the clinician responsible for the epidural injection.

12. Assess the catheter exit site and apply a transparent dressing over the catheter insertion site, if not already in place. Remove gloves and additional PPE, if used. Perform hand hygiene.

13. Monitor the infusion rate according to facility policy. Assess and record sedation level and respiratory status every hour for the first 24 hours, then at 4-hour intervals (or according to agency policy). Notify the physician if the sedation rating is 3 or 4, the respiratory depth decreases, or the respiratory rate falls below 10 breaths per minute.

14. Keep the head of bed elevated 30 degrees unless contraindicated.

15. Assess the patient’s level of pain and the effectiveness of pain relief.

16. Monitor urinary output and assess for bladder distention.

17. Assess motor strength and sensation every 4 hours.

18. Monitor for adverse effects (pruritus, nausea, and vomiting).

19. Assess for signs of infection at the insertion site.

20. Change the dressing over the catheter exit site every 24 to 48 hours or as needed per agency policy using aseptic technique. Change the infusion tubing every 48 hours or as specified by agency policy.
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Caring for a Patient Receiving Patient Controlled Analgesia

Goal: The patient reports increased comfort and decreased pain; and shows no signs of adverse effects, oversedation, or respiratory depression.

1. Gather equipment. Check the medication order against the original physician’s order according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.

3. Prepare the medication syringe or other container, based on facility policy, for administration. (See Chapter 5, Medications, for additional information.)

4. Perform hand hygiene and put on PPE, if indicated.

5. Identify the patient.

6. Show the patient the device, and explain its function and the reason for use. Explain the purpose and action of the medication to the patient.

7. Plug the PCA device into the electrical outlet, if necessary. Check status of battery power, if appropriate.

8. Close the door to the room or pull the bedside curtain.

9. Complete necessary assessments before administering medication. Check allergy bracelet or ask patient about allergies. Assess the patient’s pain, using an appropriate assessment tool and measurement scale. (See Fundamentals Review 10-1 through 10-6.)

10. Check the label on the prefilled drug syringe with the medication record and patient identification. Obtain verification of information from a second nurse, according to facility policy. If using a barcode administration system, scan the barcode on the medication label, if required.

11. If using a barcode administration system, scan the patient’s barcode on the identification band, if required.

12. Connect tubing to prefilled syringe and place the syringe into the PCA device. Prime the tubing.

13. Set the PCA device to administer the loading dose, if ordered, and then program the device based on the medical order for medication dosage, dose interval, and lockout interval. Obtain verification of information from a second nurse, according to facility policy.

14. Put on gloves. Using antimicrobial swab, clean connection port on IV infusion line or other site access, based on route of administration. Connect the PCA tubing to the patient’s IV infusion line or appropriate access site, based on the specific site used. Secure the site per facility policy and procedure. Remove gloves. Initiate the therapy by activating the appropriate button on the pump. Lock the PCA device, per facility policy.

15. Remind the patient to press the button each time he or she needs relief from pain.

16. Assess the patient’s pain at least every 4 hours or more often, as needed. Monitor vital signs, especially respiratory status, including oxygen saturation at least every 4 hours or more often as needed.

17. Assess the patient’s sedation score and end-tidal carbon dioxide level (capnography) at least every 4 hours or more often as needed.

18. Assess the infusion site periodically, according to facility policy and nursing judgment. Assess the patient’s use of the medication, noting number of attempts and number of doses delivered. Replace the drug syringe when it is empty.

19. Make sure the patient control (dosing button) is within the patient’s reach.

20. Remove gloves and additional PPE, if used. Perform hand hygiene.
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Applying and Caring for a Patient Using a TENS Unit

Goal: The patient reports increased comfort and decreased pain; and is free from injury, skin irritation or breakdown.

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.

3. Show the patient the device, and explain its function and the reason for its use.

4. Assess the patient’s pain, using an appropriate assessment tool and measurement scale. (See Fundamentals Review 10-1 through 10-6.)

5. Inspect the area where the electrodes are to be placed. Clean the patient’s skin, using skin cleanser and water. Dry the area thoroughly.

6. Remove the adhesive backing from the electrodes and apply them to the specified location. If the electrodes are not pregelled, apply a small amount of electrode gel to the bottom of each electrode. If the electrodes are not selfadhering, tape them in place.

7. Check the placement of the electrodes; leave at least a 2 (5 cm) space (about the width of one electrode) between them.

8. Check the controls on the TENS unit to make sure that they are off. Connect the wires to the electrodes (if not already attached) and plug them into the unit.

9. Turn on the unit and adjust the intensity setting to the lowest intensity and determine if the patient can feel a tingling, burning, or buzzing sensation. Then adjust the intensity to the prescribed amount or the setting most comfortable for the patient. Secure the unit to the patient.

10. Set the pulse width (duration of the each pulsation) as indicated or recommended.

11. Assess the patient’s pain level during therapy.
a. If intermittent use is ordered, turn the unit off after the specified duration of treatment and remove the electrodes. Provide skin care to the area.
b. If continuous therapy is ordered, periodically remove the electrodes from the skin (after turning the unit off) to inspect the area and clean the skin, according to
facility policy. Reapply the electrodes and continue therapy. Change the electrodes according to manufacturer’s directions.

12. When therapy is discontinued, turn the unit off and remove the electrodes. Clean the patient’s skin. Clean the unit and replace the batteries.

13. Remove PPE, if used. Perform hand hygiene.
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Giving a Back Massage

Goal: The patient reports increased comfort and decreased pain and exhibits a relaxed state.

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.

3. Offer a back massage to the patient and explain the procedure.

4. Put on gloves, if indicated.

5. Close room door and/or curtain.

6. Assess the patient’s pain, using an appropriate assessment tool and measurement scale. (See Fundamentals Review 10-1 through 10-6.)

7. Raise the bed to a comfortable working position, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009), and lower the side rail.

8. Assist the patient to a comfortable position, preferably the prone or side-lying position. Remove the covers and move the patient’s gown just enough to expose the patient’s back from the shoulders to sacral area. Drape the patient, as needed, with the bath blanket.

9. Warm the lubricant or lotion in the palm of your hand, or place the container in small basin of warm water. During massage, observe the patient’s skin for reddened or open areas. Pay particular attention to the skin over bony prominences. (See Chapter 8, Skin Integrity and Wound Care, for detailed information regarding skin assessment.)

10. Using light, gliding strokes (effleurage), apply lotion to patient’s shoulders, back, and sacral area.

11. Place your hands beside each other at the base of the patient’s spine and stroke upward to the shoulders and back downward to the buttocks in slow, continuous strokes. Continue for several minutes.

12. Massage the patient’s shoulder, entire back, areas over iliac crests, and sacrum with circular stroking motions. Keep your hands in contact with the patient’s skin. Continue for several minutes, applying additional lotion, as necessary.

13. Knead the patient’s skin by gently alternating grasping and compression motions (pétrissage).

14. Complete the massage with additional long, stroking movements that eventually become lighter in pressure.

15. Use the towel to pat the patient dry and to remove excess lotion.

16. Remove gloves, if worn. Reposition patient’s gown and covers. Raise side rail and lower bed. Assist patient to a position of comfort.

17. Remove additional PPE, if used. Perform hand hygiene.

18. Evaluate the patient’s response to interventions. Reassess level of discomfort or pain using original assessment tools. Reassess and alter plan of care, as appropriate.
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Promoting Patient Comfort

Goal: The patient experiences relief from discomfort and/or pain without adverse effect.

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.

3. Discuss pain with the patient, acknowledging that the patient’s pain exists. Explain how pain medications and other pain management therapies work together to provide pain relief. Allow the patient to help choose interventions for pain relief.

4. Assess the patient’s pain, using an appropriate assessment tool and measurement scale (see Fundamentals Review 10-1 through 10-5).

5. Provide pharmacologic interventions, if indicated and ordered.

6. Adjust the patient’s environment to promote comfort.
a. Adjust and maintain the room temperature per the patient’s preference.
b. Reduce harsh lighting, but provide adequate lighting per the patient’s preference.
c. Reduce harsh and unnecessary noise. Avoid having conversations immediately outside the patient’s room.
d. Close room door and/or curtain whenever possible.
e. Provide good ventilation in the patient’s room. Reduce unpleasant odors by promptly emptying bedpans, urinals, and emesis basins after use. Remove trash and laundry promptly.

7. Prevent unnecessary interruptions and coordinate patient activities to group activities together. Allow for and plan rest periods without disturbance.

8. Assist the patient to change position frequently. Assist the patient to a comfortable position, maintaining good alignment and supporting extremities as needed. Raise the head of the bed as appropriate. (See Chapter 9, Activity, for more information on positioning.)

9. Provide oral hygiene as often as necessary to keep the mouth and mucous membranes clean and moist, as often as every 1 or 2 hours if necessary. This is especially important for patients who cannot drink or are not permitted fluids by mouth. (See Chapter 7, Hygiene, for additional information about mouth care.)

10. Ensure the availability of appropriate fluids for drinking, unless contraindicated. Make sure the patient’s water pitcher is filled and within reach. Make other fluids of the patient’s choice available.

11. Remove physical situations that might cause discomfort.
a. Change soiled and/or wet dressings; replace soiled and/or wet bed linens.
b. Smooth wrinkles in bed linens.
c. Ensure patient is not lying or sitting on tubes, tubing, wires, or other equipment.

12. Assist the patient as necessary with ambulation, and active or passive range-of-motion exercises, as appropriate. (See Chapter 9, Activity, for more information about activity.)

13. Assess the patient’s spirituality needs related to the pain experience. Ask the patient if he/she would like a spiritual counselor to visit.

14. Consider the use of distraction. Distraction requires the patient to focus on something other than the pain.
a. Have the patient recall a pleasant experience or focus attention on an enjoyable experience.
b. Offer age or developmentally appropriate games, toys, books, audiobooks, access to television, and/or videos, or other items of interest to the patient.
c. Encourage the patient to hold or stroke a loved person, pet, or toy.
d. Offer access to music the patient prefers. Turn on the music when pain begins, or before anticipated painful stimuli. The patient can close his or her eyes and
concentrate on listening. Raising or lowering the volume as pain increases or decreases can be helpful.

15. Consider the use of guided imagery.
a. Help the patient to identify a scene or experience that the patient describes as happy, pleasant, or peaceful.
b. Encourage the patient to begin with several minutes of focused breathing, relaxation, or meditation. (Refer to specific information in steps 15 and 16.)
c. Help the patient concentrate on the peaceful, pleasant image.
d. If indicated, read a description of the identified scene or experience, using a soothing, soft voice.
e. Encourage the patient to concentrate on the details of the image, such as its sight, sounds, smells, tastes, and touch.

16. Consider the use of relaxation activities, such as deep breathing.
a. Have the patient sit or recline comfortably and place hands on stomach. Close the eyes.
b. Ask the patient to mentally count to maintain a comfortable rate and rhythm. Have the patient inhale slowly and deeply while letting the abdomen expand as much as possible. Have the patient hold his or her breath for a few seconds.
c. Tell the patient to exhale slowly through mouth, blowing through puckered lips. Have the patient continue to count to maintain comfortable rate and rhythm, concentrating on the rise and fall of abdomen.
d. When the patient’s abdomen feels empty, have the patient begin again with a deep inhalation.
e. Encourage patient to practice at least twice a day, for 10 minutes, and then use as needed to assist with pain management (Schaffer & Yucha, 2004).

17. Consider the use of relaxation activities, such as progressive muscle relaxation.
a. Assist the patient to a comfortable position.
b. Direct the patient to focus on a particular muscle group. Start with the muscles of the jaw, then repeat with the muscles of the neck, shoulder, upper and lower arm, hand, abdomin, buttocks, thigh, lower leg, and foot.
c. Ask the patient to tighten the muscle group and note the sensation that the tightened muscles produce. After 5 to 7 seconds, tell the patient to relax the muscles all at once and concentrate on the sensation of the relaxed state, noting the difference in feeling in the muscles when contracted and relaxed.
d. Have the patient continue to tighten-hold-relax each muscle group until the entire body has been covered.
e. Encourage patient to practice at least twice a day, for 10 minutes, and then use as needed to assist with pain management (Schaffer & Yucha, 2004).

18. Consider the use of cutaneous stimulation, such as the intermittent application of heat or cold, or both. (See Chapter 8, Skin Integrity and Wound Care, for additional information on heat and cold therapy.)

19. Consider the use of cutaneous stimulation, such as massage (see Skill 10-2).

20. Discuss the potential for use of cutaneous stimulation, such as TENS, with the patient and primary care provider. (See Skill 10-3.)

21. Remove equipment and return patient to a position of comfort. Remove gloves, if used. Raise side rail and lower bed.

22. Remove additional PPE, if used. Perform hand hygiene.

23. Evaluate the patient’s response to interventions. Reassess level of discomfort or pain using original assessment tools. Reassess and alter plan of care as appropriate.
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