Nurseinfo.in provides free Nursing Notes, Nursing Procedures, Medical MCQs, Nursing Calculators, Care Plans and exam preparation resources for BSc Nursing, GNM, P.B. BSc and MSc Nursing students. Browse subject-wise notes, previous year questions and study materials based on the latest nursing syllabus.
Nurseinfo.in provides free Nursing Notes, Nursing Procedures, Medical MCQs, Nursing Calculators, Care Plans and exam preparation resources for BSc Nursing, GNM, P.B. BSc and MSc Nursing students. Browse subject-wise notes, previous year questions and study materials based on the latest nursing syllabus.
CHOLECYSTOGRAPHY – Purpose, Preparation of the Patient, Procedure, After Care and Complications
UPDATED 2024
Cholecystography
is a test for gallbladder disease, done by visualizing the gallbladder.
Visualization of the gallbladder depends upon absorption of the dye from the
intestinal tract, isolation and excretion by the liver cells and a free passage
way from the liver to the gallbladder.
PURPOSE
To detect gallstones
To test the contractibility of the
gallbladder
To find out filling ability of the
gallbladder
To find out its ability to
concentrate, its contents, and its condition when it is empty in normal states
PREPARATION OF THE PATIENT
Explain the procedure to the patient
to relieve tension and worries
Stop medications which contain iodine
compounds and bismuth three days prior to the test
Check whether the patient is allergic
to iodine or sea food before giving the dye
Record the patient’s weight to
calculate the dose of the dye
The patient is given a low-fat
evening meal to avoid gallbladder contraction. Thereafter, no food and water
should be given to the patient until the X-ray examinations are complete
The bowel is cleansed with saline
enema
The emergency drugs and resuscitation
equipment should be kept ready to resuscitate the patient
PROCEDURE
The patient is given a light diet at
7 pm without fat
A laxative like dulcolax is given to
clear the bowels
At 10 pm the patient is given 6
telepaque tablets to swallow
This dye is opaque to X-rays and is
absorbed from the intestines, and is excreted by the liver
When the gallbladder is normal, this
dye gets concentrated in the gallbladder, which becomes visible by X-ray
X-ray pictures are taken on the
following day approximately 14, 18 and 19 hours after the drug has been
administered, i.e. at 12 noon. 4 pm and 5 pm
No food is given during this period
Then, to test the contractibility of
the gallbladder, the patient is fed with a fatty meal, one hour before the last
X-rays taken at 12 noon and 4 pm, but it empties itself after the fatty meal
taken at 4 pm and is, therefore, not visible in the X-ray taken at 5 pm
An abnormal gallbladder may not get
filled properly or may fail to empty itself
AFTER CARE
Observe the patient for allergic
reactions. Check the vital signs of the patient
Accompany the patient throughout the
procedure
Make the patient comfortable
COMPLICATIONS
Severe
reactions to dye may lead to:
Respiratory difficulty
Urticaria
Shock
Collapse
CHOLECYSTOGRAPHY – Purpose, Preparation of the Patient, Procedure, After Care and Complications
THERAPEUTIC COMMUNICATION – Principles or Characteristics, Techniques and Non-therapeutic Communication
UPDATED 2024
Therapeutic
communication is an interpersonal interaction between the nurse and the patient
during which the nurse focuses on the patient’s specific needs to promote an
effective exchange of information. All nurses need skills in therapeutic
communication to effectively apply the nursing process and to meet standards of
care for their patients.
Therapeutic
communication can help nurses to accomplish many goals:
Establish a therapeutic nurse-patient
relationship
Identify the most important patient’s
needs
Assess the patient’s perception of
the problem
Facilitate the patient’s expression
of emotions
Implement interventions designed to
address the patient’s needs
To have an effective therapeutic communication, the nurse
must consider privacy and respect of boundaries, use of touch and active
listening and observation.
Principles or Characteristics of Therapeutic Communication
The patient should be the primary
focus of interaction
A professional attitude sets the tone
of the therapeutic relationship
Use self-disclosure cautiously and
only when it has a therapeutic purpose
Avoid social relationship with
patients
Maintain patient confidentiality
Assess the patient’s intellectual
competence to determine the level of understanding
Implement interventions from a
theoretic base
Maintain a nonjudgmental attitude.
Avoid making judgments about patient’s behavior
Avoid giving advice
Guide the patient to reinterpret his
or her experiences rationally.
Therapeutic Communication Techniques
Listening: It is an active process of
receiving information. Responses on the part of the nurse, such as maintaining
eye-to-eye contact, nodding, gesturing and other forms of receptive nonverbal
communication convey to the patient that he is being listened to and understood.
Therapeutic Value: Nonverbally communicates to the patient the nurse’s
interest and acceptance.
Broad Openings: Encouraging the
patient to select topics for discussion. For example, “What are you thinking
about?”
Therapeutic Value: Indicates acceptance by the nurse and the value of
patient’s initiative.
Restating: Repeating the main thought
expressed by the patient. For example, “You say that your mother left you when
you were 5-year-old”
Therapeutic Value: Indicated that the nurse is listening and validates,
reinforces or calls attention to something important that has been said.
Clarification: Attempting to put
vague ideas or unclear thoughts of the patient into words to enhance the
nurse’s understanding or asking the patient to explain what he means. For
example, “I am not sure what you mean. Could you tell me about the again?”
Therapeutic Value: It helps to clarify feelings, ideas and perceptions of
the patient and provides an explicit correlation between them and the patient’s
actions.
Reflection: Directing back the
patient’s ideas, feelings, questions and content. For example, “You are feeling
tense and anxious and it is related to a conversation you had with your husband
last night”.
Therapeutic Value: Validates the nurse’s understanding of what the
patient is saying and signifies empathy, interest and respect for the patient.
Humor: The discharge of energy
through comic enjoyment of the imperfect. For example, “That gives a whole new
meaning to the word ‘nervous’”, said with shared kidding between the nurse and
the patient.
Therapeutic Value: Can promote insight by making repressed material
conscious, resolving paradoxes, tempering aggression and revealing new options,
and is a socially acceptable for of sublimation.
Informing: The skill of information
giving. For example,” I think you need to know more about your medications.”
Therapeutic Value: Helpful in health teaching or patient education about
relevant aspects of patient’s well-being and self-care.
Focusing: Questions or statements that
help the patient expand on a topic of importance. For example, “I think that we
should talk more about your relationship with your father”.
Therapeutic Value: Allows the patient to discuss central issues and keeps
the communication process goal-directed.
Sharing Perceptions: Asking the
patient to verify the nurses understanding of what the patient is thinking or
feeling. For example, ”You are smiling, but I sense that you are really very
angry with me”.
Therapeutic Value: Conveys the nurse understands to the patient and has
the potential for clearing up confusing communication.
Theme
Identification: This involves identification of underlying issues or problems
experienced by the patient that emerge repeatedly during the course of the
nurse-patient relationship. For example, “I noticed that you said, you have
been hurt or rejected by the man. Do you think this is an underlying issue?”
Therapeutic
Value: It allows the nurse to promote the patient’s exploration and
understanding of important problems.
Silence:
Lack of verbal communication for a therapeutic reason. For example, sitting
with a patient and nonverbally communicating interest and involvement.
Therapeutic
Value: Allows the patient time to think and gain insight, slows the pace of the
interaction and encourages the patient to initiate conversation while enjoying
the nurse’s support, understanding and acceptance.
Suggesting:
Presentation of alternative ideas for the patient’s consideration relative to
problem solving. For example, “Have you thought about responding to your boss
in a different way when he raises that issue with you? You could ask him if a
specific problem has occurred.”
Therapeutic
Value: Increases the patient’s perceived notions or choices.
Ineffective/Non-therapeutic Communication
These include failure to listen, conflicting verbal or non-verbal messages, a judgmental attitude, false reassurance, giving of advice, the inability to receive information because of a preoccupation of impaired thought process and changing of the subject if one becomes uncomfortable with the topic being discussed.
THERAPEUTIC COMMUNICATION – Principles or Characteristics, Techniques and Non-therapeutic Communication
ORAL HYGIENE Care of Independent , Dependent & Unconscious Patients , Care of Dentures
UPDATED 2024
Oral hygiene
means maintaining the cleanliness of the mouth. Oral hygiene includes measures
to prevent the spread of disease from the mouth and increase the comfort of the
patient
It is
important because mouth is the portal entry of food and digestion starts from
mouth. So, the entry of any pathogen in mouth directly affects health.
Oral hygiene
means the cleanliness of the mouth oral hygiene includes measure to prevent the
spread of disease from the mouth and increase the comfort
Objectives
To keep the mouth and teeth in good
condition
To prevent the mucous membrane from
becoming dry and cracked
To prevent sores which resulting in
ulceration
To prevent bacterial in the mouth
from causing local and general infections
Emollients help to soften the dry
mucus membrane to prevent cracking
Purpose
To prevent and treat mouth infections
To keep the mouth fresh and clean
To prevent the mucus membrane from
becoming dry and cracked
To prevent dental caries and tooth
decay
To prevent sores which resulting in
ulceration
To stimulate salivation and increase
appetite
To prevent infection of parotid
glands
To prevent complications such as
stomatitis, glossitis, pyorrhea and parotitis, etc
To stimulate circulation in gums thus
maintaining health firmness
To maintain oral hygiene among
bedridden patients
The Patient who may require Frequent Mouth Care
Unconscious patients
Helpless patient
Patient with higher pyrexia
Malnourished and dehydrated patients
Patients who are not taking oral
feeds
Patients have local diseases of mouth
Paraplegic patients
Patients having a local disease of
mouth
Postoperative patients
Scientific Principles
Any new treatment or exposure to
unfamiliar situation produces fear and anxiety
Food particles left in the mouth
promote the growth of microorganism
Soap which is constituent of most
dentrifrice has a low surface tension and spreads readily and penetrate in
between teeth
Cold water reduces friction and hot
water destroys dentures
Cough reflex is depressed in
unconscious patients
Giving mouth care provides
opportunity to observe the condition of mouth and teeth
Knowledge about the technique of
keeping the mouth healthy helps in practicing it and maintains
A clean mouth and teeth aids to the
patient a feeling of self-approval
Emollient help to soften the dry
mucous membrane to prevent cracking
Patients comfort and safety may be
enhanced by practice of good techniques, which provide economy of time,
material and energy
Solutions Commonly Used for Mouth Wash
Potassium permanganate (KMnO4)
1:5000 (crystal to a glass of water)
Sodium chloride – one teaspoon to a
pint of water
Potassium chloride – 4-6%
Hydrogen peroxide (H2O2)
1:8 solution
Dentifrices Used
Glycerin with lime juice equal parts
Sodium bicarbonate paste
Reliable tooth paste or powder
Emollient Used Commonly
Clean or butter
White Vaseline
Liquid paraffin
Glycerin borax
Olive oil
Preliminary Assessment of the Patient and Environment
Identify the patient and observe the
general condition of the patient
Check the condition of the mouth
Assess the ability of the patient to
cooperate
Prepare the patient for acceptance
and realization
Assess the status of health habits
Decide the type of dentifrice and
emollient to be used
Assess the frequency of mouth care
needed
Note the precautions to be observed
while moving the patient
Articles available in the unit
Make sure about any or drink to be
given after mouth care if advisable
Equipment
A tray containing of:
Mackintosh
and towel
Small
jug with warm water
Feeding
cup
Small
cups – 2
Artery
forceps – 1
Dissecting
forceps – 1
A small container containing of:
Paper bag
Kidney tray
Choose one of the solutions for
mouthwash
Choose one of the emollients
Gauze piece
Face towel – 1
Procedure
Bring patient to edge of bed
Position pillow according to comfort
of patient
Place small mackintosh with face
towel on patient’s chest
Place K-basin close to chin of
patient
Raise head end of the bed to 45
degree
Pour antiseptic solution into cup
Soak gauze piece in solution and
squeeze out excess solution by using artery clump
Use same clamp to clean patient’s
mouth (avoid mixing of clamps)
Clean using up and down movements
from gums to crown, clean oral cavity from proximal to distal, outer to inner
aspect
Discard used cotton balls into
K-basin
Provide tumbler of water and instruct
the patient to gargle mouth. Position K-basin so that spillage is avoided
Clean tongue from inner to outer
aspect
Provide water to rinse mouth and dry
face with towel
Lubricate lips using swab stick
Rinse the used articles and replace
equipment
Document time, solution used,
condition of oral cavity, abnormalities noticed and patient’s response
Complication of Neglected Mouth Care
Local Complications
Parotitis: inflammation of the
parotid glands
Stomatisis: inflammation of the mucus
membrane of the mouth
Gingivitis: inflammation of the gums
Glossitis: inflammation of the tongue
Dental caries: forms cavity in the
teeth
Root abscesses: pus formation in the
root of the teeth
Periodontal diseases: it is also
known as pyorrhea or pus formation in the sockets of teeth
Bleeding gums: deficiency of vitamin
C and use a hard brushing of the teeth
Complication Neighboring Structure
Parotitis: inflammation of the
parotid gland
Rhinitis: inflammation of sinus
cavity
Otitis media: inflammation of middle
ear
Tonsillitis: inflammation of the
tonsils
Adenitis: inflammation of the
adenoids
Systemic Complication
Anorexia: loss of appetite
Bacterial endocarditis: inflammation
of the endocardium
Gastritis: inflammation of the
stomach
Nephritis: inflammation of the
kidneys
Rheumatic arthritis: inflammation of
the joints
Recording and Reporting
Record the procedure with date, time
and condition of the mouth, teeth, etc, on nurse’s record
Report and record any abnormal
condition to the ward sister and physician
Give health education to the patient
and relatives on oral hygiene
ORAL HYGIENE FOR INDEPENDENT PATIENTS
Patients who are able to sit in a Fowler’s or semi-Fowler’s
position can usually perform their own oral hygiene as long as the necessary
supplies are within easy reach. For independent patients, sitting on the edge
of the bed or standing at the sink is also an option when performing oral
hygiene.
While a patient is performing oral hygiene, it is important
for you to observe the process and provide any necessary teaching about
brushing and flossing. This is also a good time to discuss the importance of
oral hygiene and good oral health with the patient
When patients become ill, have surgery, or have a medical
condition that inhibits the use of their hands, you must perform oral hygiene
for them. Before assuming dependent patients are incapable of performing any of
their oral hygiene, be sure to assess their level of dependence and invite them
to participate in any way they can.
Be sure to add the level of assistance that is required to
the patient’s plan of care. The healthcare team can then be aware of how and to
what extent they have to assist the patient with oral care
ORAL HYGIENE FOR DEPENDENT PATIENTS
Patients become ill, have surgery, or have a medical
condition that inhibits the use of their hands; you must perform oral hygiene
for them. Before assuming dependent patients are incapable of performing any of
their oral hygiene, be sure to assess their level of dependence and invite them
to participate in any way they can be sure to add the level of assistance that
is required to the patient’s plan of care. The healthcare team can then to
aware of how and to what extent they have to assist the patient with oral care
ORAL HYGIENE FOR UNCONSCIOUS PATIENTS
Proper positioning can help reduce the risk of aspiration. For
an unconscious patient, the best position is side-lying with the patient’s head
turned toward you in either a semi-Fowler’s position or with the head of the
bed flat. Placing the patient is one of these positions allows fluid and any
oral secretions to collect in the dependent side of the mouth and drain out
Use a soft-bristled toothbrush and toothpaste to brush your
patient’s teeth gently to remove any debris, and then brush the patient’s
tongue. Use a syringe and water to rinse the teeth and tongue. Then use foam swabs
moistened with diluted hydrogen peroxide or other facility-approved solution to
remove crusts and secretions from the mucous membranes of the mouth. Be sure to
suction any oral secretions that pool in the patient’s mouth during the
procedure
Since, an unconscious patient cannot report any mouth pain or
discomfort, perform a thorough assessment of the oral cavity each time you
provide oral hygiene. If you note any inflammation, infection, sores, or
bleeding, initiate treatment immediately since oral health can affect the
patient’s overall health status
CARE OF DENTURES
Care of dentures of artificial teeth is the responsibility of
the nurse to guard against offending patient, by helping them to take care of
their mouth
Equipment Needed
Soft bristled tooth brush
Denture tooth brush
Dentifrice
Warm and cold water in glasses
Gauze pieces
Wash cloth
Plastic denture cup
Gloves
Basin
Care of Dentures
Procedure
Explain and secure the cooperation of
the patient
Remove the denture and inspect the
oral cavity for abnormalities if any
Wash hands and keep the articles near
the bed side sink
Take a basin and fill half of it with
water
Put on gloves to reduce transmission
of infection
Ask the patient to remove dentures
and place them in the basin
Brush the dentures. Use back and
front motion. Clean inside and outside by brushing
Rinse dentures thoroughly in running
water
Return them to the patient to keep
them in a denture cup in cold water
With a soft bristled tooth brush the
gum with tooth paste as well as the palate of tongue also
Rinse the mouth thoroughly with cold
water
Wipe the face and make the patient
comfortable
Procedure
Precautions
In cleaning dentures, they should be
held firmly as water reduces friction between the teeth and finger. They are
liable to slip and fall down
Denture should be dipped in cold
water to prevent friction
Hot water may destroy dentures,
dentures are expensive and may be difficult to replace if broken or lost
Privacy should be maintained
Discourage the use of brushed with
hard bristles because they cause grooves in dentures
If the patient is capable of
self-care, arrange the articles within the easy reach of the patient
Encourage the patients to wear the
denture during the day. This will improve the eating technique, speck
appearance and contour of the mouth
Seriously ill patient or a patient
who is under anesthesia or an unconscious patient, the denture is removed for
fear of dislodging the denture and blocking the respiratory passage
When dentures are removed from the
patient mouth, they should be stored in a labeled container to prevent lost and
breakage
ORAL HYGIENE – Care of Independent , Dependent & Unconscious Patients , Care of Dentures
Preparation of Sputum Smear: Procedure, Purpose, Requirements and Nursing Responsibilities
UPDATED 2026
Preparation of Sputum Smear: Complete Nursing Procedure, Purpose, Steps and Precautions
Preparation of a sputum smear is an important diagnostic procedure used to detect microorganisms present in respiratory secretions, particularly Acid-Fast Bacilli (AFB) that cause tuberculosis (TB). The procedure involves collecting sputum from a patient, preparing a thin smear on a clean glass slide, staining the specimen, and examining it under a microscope.
Sputum smear examination remains one of the most widely used methods for diagnosing pulmonary tuberculosis, especially in resource-limited healthcare settings.
What is a Sputum Smear?
A sputum smear is a laboratory preparation made by spreading a small amount of sputum on a glass slide for microscopic examination after staining.
The test helps identify:
Tuberculosis bacteria
Bacterial respiratory infections
Fungal infections
Other microorganisms affecting the respiratory tract
Definition
Preparation of sputum smear is the process of collecting sputum, spreading it evenly on a clean glass slide, fixing it, staining it, and examining it microscopically for the detection of disease-causing organisms.
Purpose of Sputum Smear Preparation
The main purposes include:
Diagnosis of pulmonary tuberculosis
Detection of Acid-Fast Bacilli (AFB)
Identification of respiratory infections
Monitoring tuberculosis treatment
Assessing infectiousness of patients
Supporting laboratory diagnosis
Assisting healthcare providers in treatment planning
Principles of Sputum Smear Preparation
The procedure is based on the principle that microorganisms present in sputum can be visualized after proper staining and microscopic examination.
A properly prepared smear:
Contains adequate sputum material
Is evenly spread
Is properly fixed
Is correctly stained
Allows accurate microscopic interpretation
Indications
Sputum smear examination may be performed for patients with:
Persistent cough
Chronic respiratory symptoms
Blood-stained sputum
Chest pain
Weight loss
Night sweats
Fever of unknown origin
Suspected tuberculosis
Suspected lung infections
Characteristics of a Good Sputum Sample
An ideal sputum specimen should:
Come from deep within the lungs
Be thick and mucoid
Contain purulent material
Not consist primarily of saliva
Be freshly collected
Be collected in a clean container
Articles Required
The following items are needed:
Clean glass slides
Sputum specimen container
Applicator stick
Forceps
Gloves
Face mask
Laboratory marker
Spirit lamp or slide warmer
Staining reagents
Microscope
Waste disposal container
Preparation of the Patient
Before collecting sputum:
Explain the Procedure
Inform the patient about the purpose and method of sputum collection.
Mouth Rinsing
Ask the patient to rinse the mouth with plain water to remove food particles.
Deep Breathing
Encourage deep breathing to loosen respiratory secretions.
Effective Coughing
Instruct the patient to cough deeply from the chest rather than clearing the throat.
Collection of Sputum Specimen
Step 1
Provide a clean sputum collection container.
Step 2
Ask the patient to take several deep breaths.
Step 3
Encourage forceful coughing.
Step 4
Collect the sputum directly into the container.
Step 5
Close the container immediately.
Step 6
Label the specimen correctly.
Procedure for Preparation of Sputum Smear
Step 1: Label the Slide
Write the patient identification details on the slide.
Step 2: Select Suitable Material
Choose thick, purulent, yellowish, greenish, or blood-stained portions of sputum.
Avoid using saliva.
Step 3: Spread the Specimen
Using an applicator stick:
Place a small amount of sputum on the slide.
Spread evenly to form a thin oval smear.
Step 4: Air Dry the Smear
Allow the smear to dry naturally at room temperature.
Step 5: Heat Fixation
Pass the slide gently through a flame several times.
This helps:
Attach material to the slide
Kill microorganisms
Prevent washing away during staining
Step 6: Staining
Apply the required stain according to laboratory protocol.
Step 7: Microscopic Examination
Examine the stained smear under a microscope.
Ziehl-Neelsen Staining Method
The Ziehl-Neelsen stain is commonly used for tuberculosis diagnosis.
Procedure
Cover smear with carbol fuchsin.
Heat gently until steaming.
Allow stain penetration.
Wash with water.
Decolorize using acid alcohol.
Wash again.
Apply methylene blue.
Wash and air dry.
Examine under oil immersion microscopy.
Appearance of Results
Positive Smear
Acid-Fast Bacilli appear as:
Bright red rods
Against a blue background
Negative Smear
No acid-fast organisms are visible.
Qualities of a Good Sputum Smear
A good smear should be:
Thin and uniform
Properly dried
Correctly fixed
Adequately stained
Free from contamination
Properly labeled
Nursing Responsibilities
Before Collection
Explain the procedure.
Provide instructions.
Ensure privacy.
Gather equipment.
During Collection
Encourage proper coughing.
Use infection control measures.
Ensure adequate specimen collection.
After Collection
Label specimens accurately.
Send samples promptly.
Document collection details.
Educate patients regarding follow-up testing.
Infection Control Measures
Important precautions include:
Wear gloves.
Use a face mask.
Avoid aerosol generation.
Handle sputum carefully.
Dispose of contaminated materials properly.
Perform hand hygiene before and after the procedure.
Advantages of Sputum Smear Examination
Simple procedure
Cost-effective
Rapid diagnosis
Widely available
Useful for tuberculosis screening
Suitable for large populations
Limitations
Despite its usefulness, sputum smear microscopy has limitations:
Lower sensitivity in some cases
May miss early disease
Cannot identify drug resistance
Requires proper specimen collection
Accuracy depends on smear quality
Common Errors in Sputum Smear Preparation
Errors that may affect results include:
Using saliva instead of sputum
Thick smear preparation
Poor staining technique
Improper labeling
Contaminated specimens
Inadequate fixation
Delayed laboratory processing
Documentation
Record the following:
Patient name
Hospital number
Date and time of collection
Specimen type
Laboratory request information
Test results
Follow-up instructions
Interpretation of Findings
Positive Findings
May indicate:
Pulmonary tuberculosis
Active respiratory infection
Negative Findings
May suggest:
Absence of detectable organisms
Need for repeat testing
Requirement for additional investigations
Frequently Asked Questions
Why is sputum smear examination performed?
It is mainly performed to diagnose pulmonary tuberculosis and evaluate respiratory infections.
What is the best time to collect sputum?
Early morning sputum is generally preferred because respiratory secretions accumulate overnight.
What stain is commonly used for tuberculosis diagnosis?
Ziehl-Neelsen stain is commonly used to detect Acid-Fast Bacilli.
Why should saliva be avoided?
Saliva contains fewer respiratory secretions and may lead to inaccurate results.
Conclusion
Preparation of sputum smear is a vital diagnostic procedure used for the detection of tuberculosis and other respiratory infections. Proper specimen collection, smear preparation, staining, and microscopic examination are essential for obtaining accurate results. Nurses play a key role in patient education, specimen collection, infection control, and documentation, contributing significantly to early diagnosis and effective treatment.
Preparation of Sputum Smear: Complete Nursing Procedure, Purpose, Steps and Precautions
SUTURE REMOVAL – Purpose, Principle, Usual Timing, Factors Affecting, Types, General Instructions, Preliminary Assessment, Preparation of Patient and Environment, Procedure, Equipment and Post-Procedure Care
UPDATED 2024
Suture
removal is a process removing materials used to secure wound edges or body
parts together from healed wound without damaging newly formed tissue
The timing
of suture removal depends on the shape, size and location of the sutured
incision
The sutures
may be removed by the surgeons or by the surges regarding to the tropical
customs. In all cages, the surgeon gives the written order for the removal of
the sutures
PURPOSE
Sutures are
foreign bodies and if they are not removed they are capable of causing local
inflammation
PRINCIPLE
Never pull the visible portion of the
suture through underlying tissue
Suture line is cleansed before and
after suture removal
No part of the stitch which is above
the skin level enter and contaminate the tissue under the skin
USUAL TIMING
Scalp and free: 2-5 days
Abdominal wounds: 7-10 days
Lower limbs: 10-14 days
FACTORS AFFECTING THE SUTURE REMOVAL
Type of suture
Wound bedding
TYPES
Removing staples: to remove staples,
the nurse simply inserts the tips of the staple remover under each wire
staples. Squeezes are center of the staple with the tips, freeing the staples
from the skin
Intermittent suture: the surgeon tied
each individual suture made in the skin
Continuous suture: it is the series
of sutures with only two knots
Retentions suture: they are placed
deeply than skin sutures
GENERAL INSTRUCTIONS
Confirm the doctor’s order for the
removal of the sutures
The suture removal is done in
conjunction with the dressing change
When removal interrupted in sutures,
alternate one are removed first
Suture material left beneath the skin
acts as a foreign body and clients the inflammatory response
If wound dehiscence occurs during the
removal of sutures, inform the surgeon immediately
After removing the sutures, even if
the wound is dry, the small dressing is applied for the day or two to prevent
infection
If wound discharge occurs, the
patient should be instructed to contact the surgeon
Abdominal belts or many tailed
bandages may be applied as the abdomen after removal of abdominal sutures in
obese patients to prevent wound dehiscence and evisceration
PRELIMINARY ASSESSMENT
Check the physician’s order
Assess the general candidates of the
patient
Check the specific precautions of any
Check the consciousness of the
patient and his ability to follow instructions
PREPARATION OF PATIENT AND ENVIRONMENT
Explain the procedure to the patient
Provide privacy, if needed
Clean the area before and after the
procedure
EQUIPMENT
Water proof thrash bag
Adjustable light
Clean gloves, if the wound is dressed
Sterile gloves
Sterile forceps
Normal saline solution
Sterile gauze pads
Antiseptic cleaning agent
Sterile curve tipped suture scissors
Povidone-iodine sponges
Optional adhesive butterfly strips
and compound benzoin tincture or other skin protectant
PROCEDURE
To remove the interpreted sutures,
grasp the suture at the knot with a toothed forceps and pull it gently to
expose the portion of the stitch under the skin
Cut the suture with a sharp scissors
between the knot and the skin on one side either below the knot or opposite the
knot. The pull the thread out of one piece
The suture which is already above the
skin should not be drawn under the skin. After removal of sutures, every suture
should be examined for completeness. The number of suture’s shower be countered
before and after removal
Mattress intercepted sutures have no
threads underlying the skin. The visible part of the suture opposite the knot
should be cut and the suture is removed by putting in the direction of the knot
If a continuous suture is applied, it
is cut through, close at each skin orifice on one side and the cut sections are
removed through the opposite side by gentle traction
POST-PROCEDURE CARE
After the removal of any suture we
showed clear the area
We can give dressing also the area to
prevent infection
Tell the patient to keep the area
clean
Document the status of the wound,
after suture removal
SUTURE REMOVAL – Purpose, Principle, Usual Timing, Factors Affecting, Types, General Instructions, Preliminary Assessment, Preparation of Patient and Environment, Procedure, Equipment and Post-Procedure Care
Patient lies
on left side with legs flexed at thighs. The upper leg is flexed more than the
other. A pillow is kept in front of the abdomen and at the back and one under
the upper leg.
Indications
Lateral position is used for giving
back care enemas and colonic irrigation
Used for examination of perineum or
rectum inserting suppositories
For taking rectal temperature
For change of position
Later position is a relaxing position
Giving back care
Procedure
Explain the procedure to the patient
Provide privacy
For left lateral position, place the
patient on left side with buttocks to the edge of bed, both thighs flexed and
left arm underneath
For right lateral position, place the
patient on right side with buttocks to the edge of bed, both thighs flexed and
right arm underneath
Place air ring under the hips to
reduce pressure on trochanters and at the hip joints, the cotton rings or foam
pads under the ankles of lower legs to reduce the pressure on ankles
Align the patient in good position and
make sure the patient is not lying on his arm
Support the body parts in good
alignment for comfort
Left lateral
position: with one pillow under the head, patient is placed to lie on the left
side
Use of left
lateral positions:
For giving edema
For inserting suppositories
To take rectal examination
To take rectal temperature
Contraindications of this position are
After hip surgery
After orthopedic surgery
SIM’S POSITION
Sim’s
position is similar to the lateral position except that the patient’s weight is
on the anterior aspects of shoulder girdle and hip. The patient’s lower arm is
behind him and the upper arm is flexed at the shoulder and elbow.
Indications
This position is used for unconscious
patient
It is used for rectal examinations
Used for vaginal examinations
Used for relaxation in antenatal
exercises
Procedure
Explain the procedure to the patient
Collect articles need at the bed side
Provide privacy
Place the patient on the side
One pillow is placed under the head
with the left check resting on it
The left arm is drawn behind the body
and the right arm may be in any position comfortable for the patient
The right thigh is flexed against the
abdomen
The left leg is extended well
Cover the patient with top sheet
neatly
Contraindications
Patients with deformities of the hip or knee may be unable to assume this position
Disinfectants
defined as the agent or solutions used to kill or destroy the growth of
microorganisms
Disinfectants
are the agent that free from infection. The term is usually applied to a
chemical or physical agents kills vegetative forms of microorganisms
Common Disinfectants Used
Dettol (chloroxylenol): 1:2 to 1:1000
strength
Hibitane (chlorhexidine): 1:100
strength
Eusol (sodium hypochlorite): 1: 80
strength
Lysol (cresol and soap solution): 1:40
strength
Savlon (0.3% chlorhexidine and 3%
cetrimide) – 1:20
Phenol (carbolic acid) – 1:10 to 1:20
strength
Formalin (formaldehyde) 50 g/l liter
of water
Betadine (iodine) – 1: 40 strength
H2O2 (liberates
O2) – 1:80 strength
Dilution
formula: the volume of stock solution to be used.
Formula: strength of lotion required/strength of stock solution (multiply) volume of solution required
Responsibilities of Nursing Personnel
To delegate the responsibilities to
other
To supervise the ward cleanliness
To provide adequate supplies for
cleaning
To make the patients environment safe
To replace or repair the damages
article
To keep the environment pleasant to
promote comfort of the patient
To maintain the unit attractive and
free from physical, chemical and biological hazards
Environment Setting
Atmospheric: temperature of 20-22 degree celcius is considered comfortable
Humidity of 40 – 60 % is more suitable
The room should be well ventilated
Adequate and artificial light should be provided
Noise should be minimum as it interferes with the rest and sleep of the patient. Damp dusting is done to maintain the purity of air
Eliminate unpleasant odors by maintaining proper cleanliness
ORAL REHYDRATION THERAPY – Purpose, the Formula for ORS, Equipment Needed, Procedure, Action of ORT and General Instructions
UPDATED 2024
Oral
rehydration therapy (ORT) is the giving of fluid by mouth to prevent and/or
correct the dehydration that is a result of diarrhea
PURPOSE
To prevent dehydration
To prevent morbidity and mortality
due to acute diarrheal diseases
THE FORMULA FOR ORS
The formula
for ORS (Oral Rehydration Solution) recommended by WHO and UNICEF contains
3.5 g sodium chloride
2.9 g trisodium citrate dehydrate (or
2.5 g solution bicarbonate)
1.5 g potassium chloride
20 g glucose (anhydrous)
The above
ingredients are dissolved in one liter of clean water
EQUIPMENT NEEDED
Take one liter of boiled and cooled
drinking water
Clean glass of 200 ml capacity
A clean vessel to mix the solution
A clean spoon to mix the solution and
feed the child
PROCEDURE
Pour one liter of clean water into a
clean vessel
Open a packet of ORS and pour all the
contents into the vessel
Stir with a clean spoon till it
completely dissolves
Take some solution in a clean glass
Feed the child frequently with small
doses of the solution
ACTION OF ORT
Oral rehydration therapy does not
stop the diarrhea, but it replaces the lost fluids and essential salts thus
preventing or treating dehydration and reducing the danger
The glucose contained in ORS solution
enables the intestine to absorb the fluid and the salts more effectively. ORT
alone is an effective treatment for 90-95% of patients suffering from acute
watery diarrhea regardless of cause
GENERAL INSTRUCTIONS
Oral rehydration therapy is the
cheap, simple and effective way to treat dehydration caused by diarrhea
ORT is a safe and can be used to
treat anyone suffering from diarrhea, without having to make a detailed
diagnosis before the solution is given
Children must always treat
immediately because they become dehydrated more quickly
The must learn to recognize the signs
of dehydration which need ORS or special care
If ORT is given at home early,
dehydration can often be prevented and many children will not become so ill
ORAL REHYDRATION THERAPY – Purpose, the Formula for ORS, Equipment Needed, Procedure, Action of ORT and General Instructions
A drug or
medicine is a substance used for diagnosis, treatment, cure, relief or
prevention of disease
Medicine is
defined as a substance used to promote health, to prevent and cure disease
Purpose of Medicine
It is used for diagnosis
It treats the disease condition
To prevent health alterations
To promote health condition
To treat infections, allergic and
inflammation
To relieve pain
Forms of Medications
Capsule: solid dosage form for oral care. Medicine is powder, liquid or oil of and encased by gelatin shell
Lotion: medicine in liquid suspension applied externally to protect skin
Solution: liquid preparation that may used orally, parentally or externally, can also be instilled into body organ or cavity (e.g. bladder irrigation) contains water with one or more dissolved compounds, most be sterile for parentaral use
Suppository: solid dosage form mixed with gelatin and shaped inform of pellet for insertion into body cavity (rectum or vagina)
Suspension: finely divided drug particles dispersed in liquid medium
Syrup: medication dissolved in concentrated sugar solution, may contain flavoring to make medication more palatable
Tablet: powdered dosage form compressed into hard disks or cylinders in addition to primary medication contains binders integrators, lubricates and filler
Types of Medication Action
Therapeutic effect: it is the expected or predictable physiological response a medication causes
Site: effect is the unintended secondary effects a medication predictably will cause. Side effects may be harmless or injurious
Adverse effect: there are generally considered serve responses to medication. For example, a client maybe becomes comatose when a drug is ingested
Toxic effect: may develop after prolonged intake of a medication or when a medication accumulation in the blood because of impaired. Metabolism or excretion
Idiosyncratic reaction: medicine may cause an idiosyncratic effect. This occurs when a patient over react or under reacts to a drug or has a reaction different form the normal
Allergic reaction: it is an unpredictable reaction to a drug. In this, the drug acts as an antigen and antibodies are produced. Allergy causes antigen-antibody reaction
Factors Influence the Medication Dosage
Age: infants, children and the old requires smaller dosage of a drug than that of an adult
Weight: a person of overweight requires a large dose the usual one
Male requires: large dose then females
Cumulative action of the drug: the frequency and dose of a drug administered depends upon the rate of excretion from the body
Tolerance: it is capacity of taking excessive does without producing toxic effect
Habituation: when a particular drug used continuously for a long period. The drug is withdrawn they may stop physical craving for it and show definite organic symptoms
Addition: prolonged use of alcohol and narcotics may produce an extreme form of habituation and result in a condition known addiction
Route of administration: drugs given by IV route have a very quick and immediate action
Route of Administration
The route of
a drug depends on its properties, desired effect, and patient’s physical and
mental condition
Oral administration: it is the most common route and the most convenient route for most patients
Sublingual: the drug is placed under the tongue and letting it slowly dissolve, e.g. nitroglycerine
Inhalations: the patient inhales the fumes in the lung to have a local and systemic effect, e.g. nitrous oxide (anesthetic effect)
Inunctions (topical application): it is the application of the drug to the skin, usually by a friction, e.g. ointment
Instillation: it is putting a drug in liquid form into the body cavity, such as urinary bladder or into body orifices such as ears, eyes and nose
Insertions: means introducing solid forms of drugs into the body orifices, e.g. suppositories are introduced into the rectum or vagina
Implantation: means planting or putting in of solid drugs into the body tissues
Parenteral administration: parenteral means giving of therapeutic agents outside the alimentary tract. It is the type if administration accomplished by a needle
Intramuscular: into the muscle
Subcutaneous: into the subcutaneous tissue
Intradermal: into the dermis
Intravenous: into the vein
Intraarterial: into the artery
Intracardiac: into the cardiac muscles
Intrathecal: into the spinal cavity
Intraosseous: into the bone marrow
Intraperitoneal: into the peritoneal cavity
Eight Rights of Giving Medication
Right Patient
Check the name on the order and the
patient
Use 2 identifiers
Ask patient to identify
himself/herself
When available, use technology (for
example, bar-code system)
Right Medication
Check the medication label
Check the order
Right Dose
Check the order
Confirm appropriateness of the dose
using a current drug reference
If necessary, calculate the dose and
have another nurse to calculate the dose as well
Right Route
Again, check the order and
appropriateness of the route ordered
Confirm that the patient can take or
receive the medication by the ordered route
Right Time
Check the frequency of the ordered
medication
Double-check that you are giving an
ordered dose at the correct time
Confirm when the last dose was given
Right Documentation
Document administration after giving
the ordered medication
Chart the time, route, and any other
specific information as necessary. For example, the site of an injection or any
laboratory value or vital sign that needed to be checked before giving the drug
Right Reason
Confirm the rationale for the ordered
medication. What is the patient’s history? Why is he/she taking this
medication?
Revisit the reasons the long-term
medication use
Right Response
Make sure that the drug led to the
desired effect. If an antihypertensive was given, has his/her blood pressure
improved? Does the patient verbalize improvement in depression while on an
antidepressant?
Be sure to document your monitoring
of the patient and any other nursing interventions that are applicable
Care of Medicine and Medicine
All the medicines and drugs must be
checked as they are received from the dispensary
Dangerous drugs are given by special
order and every dose should be accurate
Medicine cupboard should be kept in
room, near to the ward
All poisonous drugs must be kept
separately in a separate cupboard and it must be kept locked and the keys
should be with ward sister
Medicine for external use should be
kept in a separate part of the cupboard
The cupboard should be kept in well
lighted and poison bottles should be clearly labeled
There should be separate compartment
for mixture, tablets, powders, etc
The container should be arranged
alphabetically so that it is easy to find them
A register should be maintained to
keep the account of the dangerous drugs
Check the expiry date of every drug
and make sure of it before its expiry date
Emergency drugs should be kept in a
place where they are readily obtained for emergency use
Rule of Administration of Medicines
Rule Regarding Labels
Administer medications only form the
properly labeler container
Poisonous drugs should be labeled in
red ink
Read labels of medicine 3 times and
check with doctor’s order
Pour the medicine form the bottle
only after shaking the bottle
Do not use the medicine that is
different in color, test, odor and consistency
Rules Regarding Measuring Medicine
Always use a calibrated ounce glasses
or medicine glass to measure the medicine
Always give exactly what is ordered
Make sure that the medicine glasses
are clean and dry before pouring medicine
Hold the ounce glass at eye level and
place thumbnail of the hand at the required level and then pour the medicine
Pour the medicine just before the
time of administration into the medicine glasses
Rules Regarding Administration
Observe the five rights in giving
each medication; right patient, right time, right medicine, right dosage and
right method of administration
Give medicines only after checking a
signed medication order by the doctor
Accept verbal orders, only in
emergency to save the life of a patient
Always identify the patient before
giving medication
Stay with the patient until he has
taken medicine completely
An error in medication should be
immediately reported to the ward sister
Use proper light while giving
medicines because aim light can cause errors
Never give water after giving cough
syrups. It leaves a soothing effect to prevent cough
Drugs which stimulate appetite should
be given before food
Rules Regarding Recording of Drugs
Record each does if medicine soon
after it is administered
Follow standard observations in
recording medicine
Record time, dose and route of the
medicine given
Record only those medicines, which
have been administered
Record unusual effects such as
allergic reactions
Precautions to be taken
Check the doctor’s order, no medicine
should be given without doctor’s written order
Give the medications only form a
clearly labeled container
Be sure that the medicine glasses are
clean and dry before use
Shake the liquid medicine before
pouring into the ounce glass
Wipe the mouth of the bottle, close
it tightly and replace the bottle in the proper place after use
Pour the medicine from the bottle on
the side opposite to the label
Once poured out, the medicine should
not be returned to the bottle to prevent contamination of the whole medicine
Give medicine at the correct time and
see that patient takes it
Always give the medicine that you
have prepared yourself
Do not leave the medicine with the
patient
Record after drug is given
Nurses Responsibility in Drug Administration
The nurse
should know the following
The nature of the drug: that is the
name classification, types of preparation, effects, dosage absorption and
excretion, routes and time of administration
Essential parts of a medication order
Abbreviations and symbols used in
writing a medication order
Weights and measures used
Preparation of solutions and
calculation of fractional dose
Storing of medicines in proper
containers
Factors of safety in the
administration of medicines
Ethical and legal aspects
Legal Aspects of Drug Administration
Under the law the nurses are
responsible for their work, though there is a written order
The nurses must know the minimum and
maximum dose of every medicine which she gives to the patient and its effect
The nurse must know the law about the
use of narcotics. These drugs must be kept in a separate cupboard the cupboard
is kept locked and key is kept with the ward sister or senior nurse on duty
The special register should be
maintained for narcotics drugs, which includes clear detail about the patient
nurse and the doctor who ordered the narcotic drug
The nurse must observe five rights of
giving medications to avoid errors
The narcotic drugs should be stocked
only persons. Institutions who have licensed to do so
Scientific Principles
Almost all drugs are harm producer and are foreign materials that the body producing reactions
Additional force of water towards the glass produces a downward curve called meniscus
The human tongue presents an irregular surface and so tablets, powders and capsules produce friction and prevent easy swallowing
The sense of taste is acute and unpleasant taste may produce nausea and vomiting, the taste buds of the tongue can be partially desensitized by cold drinks
Well diluted drugs and empty stomach favor absorption of drugs. But certain drugs are irritating to mucous membrane of the stomach
Medical record is a legal one and reference for future study and research
Using common medicine glasses promote cross infection
Volatile liquids when kept open or not tightly corked diffuse through air and get decomposed
An element of error is a possibility of all human activity and commit or omit a dose of medicine means the existence of the end of life of the person
Understanding of how the drug benefits how it is to be given and side effects of the drug will help the patient to take drug regularly and a report to the physician concerned
Administration of the medicine is a therapeutic measure it will be therapeutic only, if the patient ge the desired effect of the drug
DRUG ADMINISTRATION – Definition, Purpose, Types and Forms, Route of drug administration, Eight rights, Rules, Care, Precautions, Nurse Responsibility, Legal Aspects, Principles
