By D. Curtis. Stanford University. 2019.
Dressing of a Clean Wound 305 Purpose • To keep wound clean • To prevent the wound from injury and contamination • To keep in position drugs applied locally • To keep edges of the wound together by immobilization • To apply pressure Equipment • Pick up forceps in a container • Sterile bowl or kidney dish • Sterile cotton balls • Sterile galipot • Sterile gauze • Three sterile forceps • Rubber sheet with its cover • Antiseptic solution as ordered • Adhesive tape or bandages • Scissors • Ointment or other types of drugs as needed • Receiver • Spatula if needed • Benzene or ether caverta 100mg otc erectile dysfunction treatment by injection. Technique Aseptic technique to prevent infection 306 Procedure Explain procedure to the patient • Clean trolley or tray order discount caverta online smoking erectile dysfunction statistics; assemble sterile equipment on one side and clean items on the other side 50 mg caverta amex erectile dysfunction circumcision. Method of Application • Ointment and paste must be smeared with spatula on gauze and then applied on the wound. The above-mentioned equipment can be prepared in a separate pack if central sterilization department is available. Dressing of Septic Wound The purpose is to • Absorb materials being discharge from the wound • Apply pressure to the area • Apply local medication • Prevent pain, swelling and injury Equipment • Sterile galipot • Sterile kidney dish • Sterile gauze • Sterile forceps 3 • Sterile test tube or slide • Sterile cotton- tipped application • Sterile pair of gloves, if needed, in case of gas gangrene rabies etc. Dressing with Drainage Tube Purpose • Aids to prevent haematoma or collection of fluid in the affected area. Procedure Explain procedure to the patient • Cleanse tray or trolley and organize the needed equipment and make sure it is covered. Pull it up a short distance while using gentle rotation and cut off the tip of the drain with sterile scissors (the length to be cut depends on the instruction or order). Equipment • Sterile galipot or kidney dish • Sterile cotton balls • Sterile gauze • 3 Sterile forceps • Sterile catheter • Sterile syringe 20 cc • 2 receiver • Rubber sheet and its cover • Rubber sheet and its cover • Solutions (H2O2 or normal saline are commonly used) • Adhesive tape or bandage • Bandage scissors 313 • Receiver for soiled dressings Procedure Explain the procedure to the patient and organize the needed items. Purpose • To approximate wound edges until healing occurs • To speed up healing of wound • To minimize the chance of infection • For esthetic purpose Equipment • Tray or trolley covered with a sterile towel • Sterile needle holder • Sterile round needle (2) • Sterile cutting needle (2) • Sterile silk • Sterile cat- gut • Sterile tissue forceps • Sterile suture scissors • Sterile cotton swabs in a galipots • Sterile solution for cleaning • Sterile dressing forceps • Sterile receiver • Sterile gauze 315 • Sterile plaster • Dressing scissors • Local anesthesia • Sterile needle & syringes • Sterile gloves • Sterile hole- towel (Fenestrated towel) Procedure • Explain procedure to patient • Adjust light • Wash your hands • Clean the wound thoroughly • Wash your hands again • Put on sterile gloves • Drape the Wound with the hold- sheet • Infiltrate the edges of the wound to be sutured with local anesthesia. How ever, such wounds have to be seen by a doctor since excision of all dead & devitalized tissue and eventual suturing may be required. Removal of the Stitch Technique: Use aseptic technique 317 Principles • Sutures may be removed all at a time or may be removed alternatively. Procedure The first part of procedure is the same as for suturing with stitch Except that instead of suturing the skin with thread and needle you would apply clips with the applier. Removal of Clips Technique Use aseptic technique Equipment • Sterile gauze • Sterile cotton balls • Sterile kidney dish • Sterile forceps 3 319 • Sterile clip removal forceps • Antiseptic solution (Savalon 1% and iodine) • Receiver • Benzene or ether • Adhesive tape or bandage Procedure Explain procedure to the patient and organize the needed equipment • Drape and position patient • Protect bedding with rubber sheet and its cover • Remove old dressing and discard. Key terminology anaesthesia hypothermia postoperatve atlectasis hypoxia preoperative elective intraoperative suture embolus perioperative evisceration pneumonia 322 Preoperative Care – Nursing Process Assessment Assessment Priorities - Nursing history - Client’s understanding of the proposed surgical procedure - Past experiences with surgery - Fear (fear of unknown, fear of pain or death, fear of change of body image or self concept) - Factors that increase surgical risk or the potential for post operative complications. Evaluation Determine the adequacy of the plan of care by evaluating the client’s achievement of the preceding goals. Equipment As necessary • It is important that the patient be in a good state of physical health before he has surgery. Try to relieve his fears about the operation and any fear of death: explain to him what will be done and that every measure will be taken for his safety. Procedure The day before surgery: Physical preparation • Give the patient a complete bed bath to keep the body clean before surgery. If the surgery is on the face, neck, shoulders or upper chest, the hair should be the thoroughly washed, combed and tied up to keep it from touching the operative area. Any thing abnormal such as pain, fever cough rapid pulse or elevated blood pressure must be reported immediately. Equipment Basin of warm water Washcloth Towel Soap Blade and razor holder, if available Scissors Rubber sheet and towel Procedure • Prepare the equipment and bring it to the bedside. Specific Area to be shaved: Head Operations • Explain the reason for having the head to the patient • If the hair is long, it must be cut short • Wash the head and hair well • Shave the area of the operation as directed. Anterior Neck Operations: • Wash the patient’s head and neck • If the patient is a woman, tie her hair, and keep it away from her neck, or cut it short. Breast Operations • Shave the anterior and posterior chest from neck to the waist line on the side where the surgery will be 331 • Shave the axilla on that side and the arm as far down as the elbow. Doing so will not only give the student a better idea of surgical procedures, but it will also help in understanding the client’s feelings and apprehensions. Duties include handling instruments to the surgeon, threading needles, cutting sutures, assisting with retraction and suction, and handling specimen. Duties include opening sterile packs, delivering supplies and instruments to the sterile team, delivering medications to sterile nurse, labeling specimens, and keeping records during the surgical procedure. This person acts as a client advocate by monitoring the situation and maintaining safety in the operating room. Post- operative Care Purpose • To prevent any complication from anesthesia • To detect any sign of post- operative complications 333 • To rehabilitate the patient. Equipment • Anesthetic bed • Oxygen • Sphygmomanometer • Stetoscope • Suction machine (as needed) • Extra rubber sheet (as needed) • I. V stand • Emergency drugs (to be ready in wards) • Bed blocks (as needed) for shock Procedure • Prepare anesthetic bed (see section on bed making) • Assist operating room nurse in placing patient in bed. Charting • Time of return • General condition and appearance ⇐ State of consciousness ⇐ Color of skin ⇐ Temperature of skin to touch ⇐ Skin- moist or dry ⇐ Blood pressure, plus and respiration ⇐ Any unusual condition such as bleeding drainage, Vomiting etc. Generals Instructions • If patient shows any signs of shock immediate action should be taken and then be reported to the doctor. The head of the bed should be lowered (If no gatches on bed, bed blocks may be used) • Do not leave unconscious patient alone. Breast Surgery • Encourage deep breathing often, because of danger of pneumonia • Special arm exercises should be given Abdominal Surgery • Encourage deep breathing • Turn from side to side often st • Sit patient on edge of bed 1 day postoperatively and • Start walking second day post operatively (unless contra- indicated) • Intake and output should be recorded 336 • If gastric suction is present make sure it is working properly • Frequent mouth care for patients who are not allowed to drink. Eye Surgery • Must lie very still because the incision and sutures can be damaged by pulling on the eye muscles. This will make it easier to breathe since the pressure of dressing and swelling may give choking feeling. Key terminology Autopsy Cheyne-Stkes respiration postmortum examination Brain death Kussmal’s breathing A. Spirituality and Death Death often forces people to consider profaned questions: the meaning of life, the existence of the soul, and the possibility of an after life. Individuals faced with death, their close friends, and family often relies on a spiritual foundation to help them meet these challenging concepts. For those whose spirituality does not include beliefs rooted in organized religion, support may take the form of compassionate care and the acceptance of personal beliefs. Meeting basic human needs is an expression of caring that dying individuals will appreciate even if they can no longer communicate with you verbally. As a person learns of his or her own impending death, he or she experiences grief in relation to his or her own loss. The denial may be partial or complete and may occur not only during the first stages of illness or confrontation but later on from time to time. This initial denial is usually a temporary defense and is used as a buffer until such time as the person is able to collect him or herself, mobilize his or her defenses, and face the inevitability of death. This emotion may be directed toward persons in the environment or even projected into the environment at random. Ross discusses this reaction and the difficulty in handling it for those close to the person by explaining that we should put ourselves in the client’s position and consider how we might feel intense anger at having our life interrupted abruptly.
Hold the electronic thermometer in place until the reading registers directly • Remove and read the thermometer buy generic caverta on-line erectile dysfunction in teens. Many pediatric and intensive care units use this type of thermometer because it records a temperature so rapidly discount 50mg caverta visa erectile dysfunction anxiety. Procedure • Wash the hands • Explain the procedure to the client to ensure cooperation and understanding • Hold the probe in the dominant hand buy 100 mg caverta free shipping zopiclone impotence. For a 76 Basic Clinical Nursing Skills child of 6 years or younger, use your nondominant hand to pull the ear down and back. Position changes: when a patient assumes a sitting or standing position blood usually pools in dependent vessels of the venous system. Carotid: at the side of the neck below tube of the ear (where the carotid artery runs between the trachea and the sternoclidiomastoid muscle) 2. Apical: at the apex of the heart: routinely used for infant and children < 3 yrs th th th In adults – Left midclavicular line under the 4 , 5 , 6 intercostals space Children < 4 yrs of the Lt. Brachial: at the inner aspect of the biceps muscle of the arm or medially in the antecubital space (elbow crease) 5. Pedal (Dorslais Pedis): palpated by feeling the dorsum (upper surface) of the foot on an imaginary line drawn from nd the middle of the ankle to the surface between the big and 2 toes 79 Basic Clinical Nursing Skills Method Pulse: is commonly assessed by palpation (feeling) or auscultation (hearing) The middle 3 fingertips are used with moderate pressure for palpation of all pulses except apical; the most distal parts are more sensitive, Assess the pulse for • Rate • Rhythm • Volume • Elasticity of the arterial wall Assess the Pulse for Fig. Hyperventilation: very deep, rapid respiration Hypoventilation: very shallow respiration Two Types of Breathing 1. Costal (thoracic) • Involves the external muscles and other accessory muscles (sternoclodio mastoid) • Observed by the movement of the chest up ward and down ward. Diaphragmatic (abdominal) • Involves the contraction and relaxation of the diaphragm, observed by the movement of abdomen. Assessment • The client should be at rest • Assessed by watching the movement of the chest or abdomen. Systolic pressure: is the pressure of the blood as a result of contraction of the ventricle (is the pressure of the blood at the height of the blood wave); 2. Pulse pressure: is the difference between the systolic and diastolic pressure Blood pressure is measured in mm Hg and recorded as fraction. Conditions Affecting Blood Pressure Fever Increase 84 Basic Clinical Nursing Skills Stress " Arteriosclerosis " Obesity " Hemorrhage Decrease Low hematocrit " External heat " Exposure to cold Increase Sites for Measuring Blood Pressure 1. Leg using posterior tibial or dorsal pedis Methods of Measuring Blood Pressure Blood pressure can be assessed directly or indirectly 1. Direct (invasive monitoring) measurement involves the insertion of catheter in to the brachial, radial, or femoral artery. Phase 1: The pressure level at which the 1st joint clear tapping sound is heard, these sounds gradually become more intense. To ensure that they are not extraneous sounds, the nurse should identify at least two consecutive tapping sounds. Phase 2: The period during deflation when the sound has a swishing quality Phase 3: The period during which the sounds are crisper and more intense Phase 4: The time when the sounds become muffled and have a soft blowing quality Phase 5: The pressure level when the sounds disappear Procedure Assessing Blood pressure Purpose o To obtain base line measure of arterial blood pressure for subsequent evaluation o To determine the clients homodynamic status o To identify and monitor changes in blood pressure resulting from a disease process and medical therapy. Prepare and position the patient appropriately • Make sure that the client has not smoked or ingested caffeine, with in 30 minutes prior to measurement. The arm should be slightly flexed with the palm of the hand facing up and the fore arm supported at heart level • Expose the upper arm 2. The bladder inside the cuff must be directly over the artery to be compressed if the reading to be accurate. For initial examination, perform preliminary palipatory determination of systolic pressure 87 Basic Clinical Nursing Skills • Palpate the brachial artery with the finger tips • Close the valve on the pump by turning the knob clockwise. Position the stethoscope appropriately • Insert the ear attachments of the stethoscope in your ears so that they tilt slightly fore ward. Key Terminology: 90 Basic Clinical Nursing Skills Hemoglobine Hematocrite Leukocyte Occult Stroke Urinalysis Specimen Collection Specimen collection refers to collecting various specimens (samples), such as, stool, urine, blood and other body fluids or tissues, from the patient for diagnostic or therapeutic purposes. General Considerations for Specimen Collection When collecting specimen, wear gloves to protect self from contact with body fluids. Get request for specimen collection and identify the types of specimen being collected and the patient from which the specimen collected. Give adequate explanation to the patient about the purpose, type of specimen being collected and the method used. Get the appropriate specimen container and it should be clearly labeled have tight cover to seal the content and placed in the plastic bag or racks, so that it protects the laboratory technician from contamination while handling it. Put the collected specimen into its container without contaminating outer parts of the container and its cover. All the specimens should be sent promptly to the laboratory, so that the temperature and time changes do not alter the content. Collecting Stool Specimen Purpose • For laboratory diagnosis, such as microscopic examination, culture and sensitivity tests. Equipments required o Clean bedpan or commode o Wooden spatula or applicator o Specimen container o Tissue paper 92 Basic Clinical Nursing Skills o Laboratory requests o Disposable glove, for patients confined in bed o Bed protecting materials o Screen Procedure i) For ambulatory patient Give adequate instruction to the patient to • Defecate in clean bedpan or commode (toilet) • Avoid contaminating the specimen by urine, menstrual period or used tissue papers, because these may affect the laboratory analysis. Obtain stool sample • Take the used bedpan to utility room/toilet container using spatula or applicator without contaminating the outside of the container. Timed urine specimen • It is two types Short period → 1-2 hours Long period → 24 hours Purpose • For diagnostic purposes - Routine laboratory analysis and culture and sensitivity tests Equipments Required • Disposable gloves • Specimen container • Laboratory requisition form (Completely filled) 95 Basic Clinical Nursing Skills • Water and soap or cotton balls and antiseptic solutions (swabs). Obtain urine specimen • Ask patient to void • Let the initial part of the voiding passed into the receptacle (bed pan or urinal) then pass the next part (the midstream) into the specimen container. Care of the specimen and the equipment • Handle and label the container correctly • Send the urine specimen to the laboratory immediately together with the completed laboratory requested forms • Empty the receptacles content properly • Give appropriate care for the used equipments 6. Collecting the urine • Usually it begin in the morning • Before you begin the timing, the patient should void and do not use this urine (It is the urine that has been in the bladder some time) • Then all urine voided during the specified time (e. Collecting sputum specimen Sputum is the mucus secretion from the lungs, bronchi and trachea, but it is different from saliva. The best time for sputum specimen collection is in the mornings up on the patient’s awaking (that have been accumulated during the night). If the patient fails to cough out, the nurse can obtain sputum specimen by aspirating pharyngeal secretion using suction. Purpose 99 Basic Clinical Nursing Skills Sputum specimen usually collected for: • Culture and sensitivity test (i. Patient preparation • Before collecting sputum specimen, teach pt about the difference between sputum and saliva, how to cough deeply to raise sputum. Obtain sputum specimen 100 Basic Clinical Nursing Skills • Put on gloves, to avoid contact with sputum particularly it hemoptysis (blood in sputum) present. Recomfort the patient • Give oral care following sputum collection (To remove any unpleasant taste) 4. Care of the specimen and the equipments used • Label the specimen container • Arrange or send the specimen promptly and immediately to laboratory. Document the amount, color, consistency of sputum, (thick, watery, tenacious) and presence of blood in the sputum. Collecting Blood Specimen 101 Basic Clinical Nursing Skills The hospital laboratory technicians obtain most routine blood specimens. Patient preparation 102 Basic Clinical Nursing Skills • Instruct the pt what to expect and for fasting (if required) • Position the pt comfortably 2.
Dyspnea in healthy individuals (a) Exercise: In healthy individuals dyspnea occurs during exercise purchase caverta 100mg online erectile dysfunction age onset, particularly in untrained individuals buy cheap caverta 100mg on-line impotence jokes. This feeling is greatly enhanced in people who have a psychologicalfear of not being able to receive a sufficient quantity of air caverta 100mg with amex erectile dysfunction pump australia, such as in entirely small or crowded rooms. Periodic breathing An abnormality of breathing called periodic breathing occurs in a number of disease conditions. The person breathes deeply for a short interval of time and then breathes slightly or not all for an additional interval. Cheyne -Stokes breathing The most common type of periodic breathing is Cheyne-Stokes breathing, is characterized by slowly waxing and waning respiration, occurring over and over again every 45 seconds to 3 minutes. Occurrence in disease: (a) Congestive heart failure and uremia: Cheyne-Stokes breathing is commonly found in congestive heart failure and uremia. Occurrence in healthy individuals: (a) Sleep (b) High altitude (c) Infancy 271 Causes Cheyne-Stokes breathing is due to sluggishness of chemical regulation of respiration. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. The clinical nursing skills for the nurses are of paramount important not only to provide comprehensive care but also enhance clinical competence. The purpose of preparing this lecture note is to equip nurses with basic clinical nursing skills, which will enable them to dispatch their responsibility as well as to develop uniformity among Ethiopian Professional Nurse Training Higher Institutions. The lecture note series is designed to have two parts: part-I is composed of most basic clinical skills, where as part two will be covering most advances clinical skills as well as fundamental concepts related to the skills. For nurse to provide health service at different settings; hospital, health center, health post and at the community level including home based care for chronically sick patients, the course is very essential. It is also hoped that other primary and middle level health professional training institution will utilize the lecture notes to rational exercise the professional skills. The lecture note is therefore organized in logical manner that students can learn from simpler to the complex. Important abbreviations and key terminologies i have been included in order to facilitate teaching learning processes. Glossary is prepared at the end to give explanation for terminologies indicated as learning stimulants at beginning of each chapter following the learning objectives. Trial is made to give some scientific explanation for procedure and some relevant study questions are prepared to each chapter to aid students understand of the subject. To enhance systematic approach in conducting nursing care the nursing process is also indicated for most procedures. Lecture note preparation is one of the activities that got due attention to strengthen the teaching learning process in Ethiopia by Ethiopian staff. There fore, I congratulate Professor Denis Carlson for the success you achieved with dedicated Ethiopian partners. I also extend many thanks to colleagues and staff of our School of Nursing particularly Ato Andargachew Kassa and Ato Aweke Yilma for their valuable comments and criticism, other wise the lecture note would have not been shaped this way. I would like to extend my thanks to Ato Asrat Demissie Academic Vice President of Defence University College and Ato Daniel Mengistu Head of School of Nursing in University of Gondar for their critical review and valuable comments. Next, I thank all our College authorities for permission to work on this lecture note besides the routine activities of the college. Last but not least, my deepest gratitude is to W/rt Lemlem Adebabay who has managed to write the document with in very urgency giving up her rest time and comfort. It is assisting the individual, sick or well in the performance of those activities contributing to health or its recovery (to peaceful death) that he will perform unaided, if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible (Virginia Henderson 1960). It is a dynamic, therapeutic and educational process that serves to meet the health needs of the society, including its most vulnerable members. Human beings have always faced the challenge of fostering health and caring for the ill and dependent. Those who were especially skilled in this area stood out and, in some instances, passed their skills along to others. Uprichard (1973) described the early history of nursing using three images: the folk image, the religious image, and the renaissance image. The Folk Image of Nursing: The Nurse as Mother The early development of nursing was rarely documented, so we must speculate about its character from what we know of early civilizations. The nurse was generally a member of the family or, if not, then a member of the community who demonstrated a special skill in caring for others. Indeed, the word nursing itself may have been derived from the same root as the words nourish and nurture. This view of nursing was prevalent in the earliest historical records and is still present in primitive cultures. In the middle Ages, the traditional role of the religious groups in caring for the ill was continued by various orders of monks and nuns. When the crusade attempted to regain Jerusalem from Muslim control, the Knights Hospitalers, and order of religious workers who cared for the injured and fought to protect them, marched with the armies. During this time, unfortunately, the knowledge of hygiene and sanitation gained by Greek, Roman, Egyptian, and other ancient civilizations was forgotten. With the advent of the Reformation and the presence of Protestant religious groups, the nature of these orders changed. For example, a church order of deaconesses was organized by Pastor Theodor Fleidner in Kaiserswerth, Germany called the Sisters of Mercy of the Church of England. The Protestant Nursing groups were comprised totally of women, and only one nursing order made up of men, the Brothers Hospitalers of St. Rofiada al Islamiah, one of the wives of Mohammand who cared for the sick and injured, is considered the mother of nursing in the Mideastern Muslim countries (Meleis, 1985). The Renaissance Image of Nursing: The Nurse as Servant The Renaissance saw the decline of monastic orders and the rise in individualism and materialism. There was a radical change from the image of the selfless nurse that had developed in the early Christian period and the Middle Ages. The hospitals of this time were plagued by pestilence and filled with 4 Basic Clinical Nursing Skills death; those who worked in them were seen as corrupt and unsavory. The Emergence of Modern Nursing To some extent, the three early images of the nurse were held th simultaneously for hundreds of years. Although born to wealth and a family well placed in Victorian English Society, Florence Nightingale had a firm belief in Christian ideals that made h1er disdainful of a life of luxury. As an intelligent and well- educated woman, she recognized that optimum care of the sick required education. She persevered against family and social opposition and initiated personal study and research into sanitation and health.