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CARE OF THE BED BOUND PATIENT

THE BED

Remember that the bed should be made at least once a day, stretching the sheets adequately to avoid creasing, which may be very disturbing or even cause wounds in people who remain lying down for long periods of time.

The sheets should be changed regularly. It would be desirable on a daily basis and, at least, every time they get stained. If the patient is incontinent (is unable to hold faeces or urine), place a water proof sheet over the mattress, or a piece of plastic completely covered by a towel under the sheet.

In severely ill patients, with a low consciousness level, place side rails to prevent falls. You should change the position every four to six hours to prevent ulcers.

Provide the patient with a call device (ring, bell, intercommunication device…) if no one remains at their side. Logically, in the case of severe disease or accident, the patient should be accompanied at all times in case there is any change in his or her state. This precaution should also be taken in the case of psychiatric patients.

If the patient is unable to move, the bed linen should be changed rolling him over to one side of the bed and, pulling the dirty linen away by rolling it Siguiente to the patient. The clean sheet is placed on the clear side of the bed, rolling the other edge Siguiente to the patient, who will be rolled over to the clean side, and then the bed is made. To perform these manoeuvres the help of two people is required.

If the patient has wounds, fractures, etc., the weight of the bed linen may bother him or her. Use Kramer's splint (DRAWER 15, first aid kits A and B) to build a protective arch to prevent direct contact with bed linen. You may improvise it with a box by removing the top and bottom sides.

Avoid contact of any hard surface with the skin, as it may cause ulcers. Pad such areas with cotton.

WASHING OF THE BED BOUND PATIENT

At least once daily, the bed bound patient who is unable to manage on his own must be fully washed. We should use a washbasin with lukewarm water and soap, and it is convenient to follow an order: face, hands, armpits, back, thorax, genitalia and feet. Each area should be washed and dried completely before moving on to the Siguiente one. Change the water as many times as required.

At the end it is important that all skin remains dry, especially folds. After, moisturizing cream or vegetable oil should be applied in pressure areas and skin folds, to prevent the appearance of ulcers.

Care of mouth and eyes

Give the patient everything required for mouthwash after every meal.

In severely ill or unconscious patients, dentures should be removed cleaning gums and teeth with a soft toothbrush. If lips are dry, apply Vaseline or moisturizing cream. If eyelids do not cover the eyes properly, wash with a gauze damped in normal saline solution or boiled water every six hours, applying afterwards an ophthalmic ointment on the exposed eye area.

Incontinent patients

Some patients may lose voluntary control of urinating or defecating. In such cases, hygienic measures should be upgraded, changing bed linen and washing the patient as required, and regularly checking the patient's status. If conscious, the situation will be embarrassing for the patient, so reassurance is required, insisting that we can understand the problem.

In case of urinary incontinence, a device may be improvised to collect the urine (see picture).

FLUID BALANCE

In some diseases it is very important to know the amount of fluid given and lost. To help us with this issue, and if suggested by the radio medical centre, we should make use of a «Fluid balance chart». Example:

ISOLATION PROCEDURE

In specific transmissible diseases, and to avoid spreading to the rest of the crew, isolation of the patient will be necessary.

Isolation may be strict or regular. The doctor will determine this.

Strict isolation: The patient will not be able to leave the infirmary or cabin arranged for this purpose, which will be used exclusively by the patient.

The patient should be cared for by a single person, who will strictly follow hygiene rules (see Chapter 13, CREW HYGIENE), washing his hands before and after each time he handles the patient, even when wearing gloves (there are disposable plastic gloves in DRAWER 14, first aid kit A).

If disposable crockery is available for eating and drinking, they should be destroyed after use. If regular plates and cutlery of the ship are used, they should be of exclusive use of the patient, and be washed separately from the ones used by the rest of the crew (best within the cabin) and later disinfected by boiling (20 minutes) or immersion in water with bleach, and should be stored in the cabin.

All sheets, towels and clothes of the patient should be washed separately from the ones used by the rest of the crew and disinfected or boiled afterwards (ver Chapter 14.5, DISINFECTION).

Defecation, vomit or urine of the patient should be collected in bedpans or chamber pots to be disinfected with bleach before disposal. The person in charge should wear disposable gloves (DRAWER 14, first aid kit A) to avoid contact with them.

In the same fashion, syringes or needles or any other sharp or cutting object used with the patient should be disposed of inside a hard container (for example, soft drink can) and, when possible, incinerated later on.

Regular isolation: The patient will enjoy exclusive use of a cabin, and strict regulations are not needed, but visits should be restricted until full recovery.

MEASURES AGAINST INFECTION

Besides isolation measures, which have just been explained, we should avoid the spread of infection with a series of measures, which should always be considered when taking care of an injured or accident victim.

• Hand washing before and after each contact with the patient and with objects or equipment used in his or her care.
• Use disposable plastic gloves (DRAWER 14, first aid kit A) for any assistance requiring patient contact.
• Use sterile gloves (DRAWER 14, first aid kits A, B and C) for cleaning wounds.
• Use sterile sheet for burns as required (DRAWER 14, first aid kits A and B).
• Use disposable towels.
• The patient should also wash his or her hands after using the urine bottle or bedpan (DRAWER 14, first aid kit A).
• All disposable objects should be disposed of in a closed bag. The reusable objects should be washed and disinfected before being used again (see Chapter 14.5, DISINFECTION).