There are several nursing programs such as Auxiliary Nurse Midwife (ANM), General Nursing Midwife (GNM), B.SC (Basic) Nursing, Post Basic (P.B. BSC) Nursing and M.SC Nursing. Syllabus included for nursing programs are Foundation (Fundamental of Nursing), Microbiology, Biochemistry, Medical Surgical Nursing, Communication and Educational Technology, Biochemistry and Biophysics, Nutrition and Dietics, Anatomy and Physiology, Biosciences (Anatomy and Physiology and Microbiology), Psychology, Sociology, Pathology, Genetics, Mental Health Nursing (Psychiatric), Maternal (OBG) (Obstetrics and Gynaecology), Midwifery, Management of Nursing Services and Education, Nursing Research and Statistics, Behavioural Sciences (Psychology and Sociology), Community Health Nursing and Pediatrics Nursing.
ABOUT NURSING
Nursing is a dynamic and essential profession within the healthcare system, focused on promoting and maintaining the health and well-being of individuals, families, and communities.
Questions and answers for preparing AIIMS, PGIMER, ESIC, RRB, DSSSB, State PSCs, Kerala PSC, NIMHANS, BHU, GMCH, SNB, Nursing Officer/Staff Nurse/HAAD/Prometric/NCLEX Exam
Which of the following is the primary function of white blood cells? a) Carrying oxygen to tissues b) Fighting infection and disease c) Transporting nutrients to cells d) Clotting blood
Which of the following is a symptom of hypoglycemia? a) Excessive thirst b) Increased appetite c) Abdominal pain d) Shakiness or dizziness
ANS: d. Shakiness or dizziness
Which of the following is a common side effect of opioids? a) Hypertension b) Hypoglycemia c) Constipation d) Insomnia
ANS: c. Constipation
A patient with a blood pressure of 160/95 mmHg is classified as having: a) Hypotension b) Prehypertension c) Hypertension stage 1 d) Hypertension stage 2
ANS: d. Hypertension stage 2
What is the normal range for adult respiratory rate per minute? a) 12-20 breaths per minute b) 20-30 breaths per minute c) 30-40 breaths per minute d) 40-50 breaths per minute
ANS: a. 12-20 breaths per minute
Which of the following is an appropriate nursing intervention for a patient with a fever? a) Apply cold packs to the forehead b) Administer antipyretic medication as ordered c) Encourage the patient to wear heavy clothing d) Restrict fluid intake to prevent dehydration
ANS: b. Administer antipyretic medication as ordered
Which of the following is a priority nursing action when caring for a patient experiencing anaphylaxis? a) Administering epinephrine b) Assessing vital signs c) Initiating intravenous (IV) access d) Notifying the healthcare provider
ANS: a. Administering epinephrine
Which of the following best describes the purpose of a Foley catheter? a) Administering medication directly into the bladder b) Monitoring urine output c) Providing a sterile environment during surgery d) Preventing urinary tract infections
ANS: b. Monitoring urine output
Which of the following is an early sign of respiratory distress in a pediatric patient? a) Cyanosis (blue coloration of the skin) b) Bradycardia (slow heart rate) c) Nasal flaring d) Hypotension
ANS: c. Nasal flaring
A patient with a history of heart failure presents with bilateral lower extremity edema. Which of the following nursing interventions should be prioritized? a) Assessing lung sounds b) Elevating the legs c) Administering diuretic medication d) Monitoring blood pressure
ANS: a. Assessing lung sounds
Which of the following is an example of a modifiable risk factor for cardiovascular disease? a) Age b) Gender c) Family history d) Smoking
Answer: d) Smoking
What is the purpose of the Glasgow Coma Scale (GCS) in nursing? a) Assessing pain level b) Evaluating cognitive function c) Monitoring vital signs d) Assessing level of consciousness
Answer: d) Assessing level of consciousness
Which of the following is a priority nursing intervention for a patient experiencing a seizure? a) Restrain the patient to prevent injury b) Administer antiepileptic medication immediately c) Place a padded tongue depressor in the patient’s mouth d) Ensure a safe environment and protect the patient from injury
Answer: d) Ensure a safe environment and protect the patient from injury
A patient with type 1 diabetes mellitus presents with symptoms of hyperglycemia. Which of the following interventions should be prioritized? a) Administering a rapid-acting insulin b) Providing a high-carbohydrate meal c) Administering a glucagon injection d) Encouraging increased fluid intake
Answer: a) Administering a rapid-acting insulin
Which of the following actions should a nurse take before administering medication to a patient? a) Verify the patient’s identity using two patient identifiers b) Administer the medication and then document it immediately c) Ask the patient if they have any allergies to the medication d) Consult the patient’s family for permission to administer the medication
Answer: a) Verify the patient’s identity using two patient identifiers
Which of the following is a characteristic of a clean-catch urine specimen? a) It is collected in a sterile container b) It requires the patient to empty their bladder completely c) It is collected midstream, after the initial urine flow d) It is used to test for glucose and ketones in the urine
Answer: c) It is collected midstream, after the initial urine flow
When performing a physical assessment, which of the following should a nurse assess first? a) Pulse rate b) Respiratory rate c) Blood pressure d) Body temperature
Answer: b) Respiratory rate
Which of the following is an appropriate nursing intervention for preventing pressure ulcers? a) Applying lotion to the skin regularly b) Keeping the skin dry and moisturized c) Repositioning the patient every 4 hours d) Using a donut-shaped cushion for support
Answer: c) Repositioning the patient every 4 hours
Which of the following is an example of an isotonic solution? a) 0.9% saline (normal saline) b) 3% saline c) 5% dextrose in water d) Lactated Ringer’s solution
Answer: a) 0.9% saline (normal saline)
What is the normal range for blood pH in the human body? a) 6.0-6.5 b) 6.5-7.0 c) 7.0-7.5 d) 7.35-7.45
Answer: d) 7.35-7.45
Which of the following is a priority nursing intervention for a patient with impaired gas exchange? a) Administering bronchodilators b) Encouraging deep breathing and coughing exercises c) Administering oxygen therapy as prescribed d) Monitoring blood pressure every hour
Answer: c) Administering oxygen therapy as prescribed
Which of the following is an appropriate nursing intervention to prevent complications in a patient with a central venous catheter? a) Cleaning the catheter site with alcohol swabs daily b) Changing the catheter dressing every 24 hours c) Flushing the catheter with normal saline after each use d) Using the catheter for blood draws when peripheral veins are inaccessible
Answer: c) Flushing the catheter with normal saline after each use
Which of the following is a sign of increased intracranial pressure (ICP) in a patient with a head injury? a) Hypotension b) Bradycardia c) Dilated pupils d) Decreased respiratory rate
Answer: c) Dilated pupils
Which of the following is a priority nursing intervention for a patient experiencing an acute asthma attack? a) Administering a bronchodilator medication b) Providing oxygen therapy c) Assisting with intubation and mechanical ventilation d) Administering corticosteroids
Answer: a) Administering a bronchodilator medication
Which of the following is an appropriate nursing intervention for a patient with impaired urinary elimination? a) Encouraging fluid intake in the evening b) Limiting bathroom trips to promote bladder stretching c) Assisting the patient to a sitting position for urination d) Providing privacy and a calm environment for voiding
Answer: d) Providing privacy and a calm environment for voiding
Which of the following is a common side effect of anticoagulant medications? a) Constipation b) Hypertension c) Bleeding d) Urinary retention
Answer: c) Bleeding
Which of the following is the priority nursing intervention for a patient experiencing an allergic reaction? a) Administering an antihistamine medication b) Assessing airway patency and providing oxygen c) Applying a cold compress to the affected area d) Documenting the reaction in the patient’s chart
Answer: b) Assessing airway patency and providing oxygen
Which of the following is a potential complication of immobility in older adults? a) Increased muscle strength b) Improved balance and coordination c) Pressure ulcers d) Enhanced joint flexibility
Answer: c) Pressure ulcers
Which of the following actions should a nurse take to promote effective communication with a patient who is visually impaired? a) Speak in a louder voice to ensure the patient can hear b) Use gestures and non-verbal cues to convey information c) Face the patient and speak clearly, providing verbal descriptions d) Provide written instructions for all information
Answer: c) Face the patient and speak clearly, providing verbal descriptions
Which of the following is an appropriate nursing intervention for a patient with impaired swallowing (dysphagia)? a) Offering large bites of food to stimulate swallowing reflexes b) Administering medications with a small amount of water c) Providing thin liquids, such as water or juice, with meals d) Elevating the head of the bed to 90 degrees during meals
Answer: d) Elevating the head of the bed to 90 degrees during meals
Which of the following is a common symptom of hypothyroidism? a) Weight loss b) Heat intolerance c) Hyperactivity d) Fatigue
Answer: d) Fatigue
Which of the following is an appropriate nursing intervention for a patient with a nasogastric tube? a) Irrigating the tube with saline every hour b) Taping the tube to the patient’s cheek to secure it in place c) Checking the tube placement by aspirating gastric contents d) Administering medication via the nasogastric tube
Answer: c) Checking the tube placement by aspirating gastric contents
Which of the following is a primary responsibility of the scrub nurse during a surgical procedure? a) Administering anesthesia to the patient b) Assisting the surgeon by passing instruments c) Documenting the surgical procedure in the patient’s chart d) Monitoring the patient’s vital signs during surgery
Answer: b) Assisting the surgeon by passing instruments
Which of the following is an appropriate nursing intervention for a patient with a urinary tract infection (UTI)? a) Restricting fluid intake to minimize urine output b) Encouraging the patient to consume cranberry juice c) Administering a diuretic medication to increase urine production d) Applying heat to the suprapubic area to relieve discomfort
Answer: b) Encouraging the patient to consume cranberry juice
Which of the following is a priority nursing intervention for a patient experiencing acute chest pain? a) Administering an antacid medication b) Providing emotional support and reassurance c) Initiating immediate cardiac monitoring and obtaining an electrocardiogram (ECG) d) Encouraging deep breathing exercises
Answer: c) Initiating immediate cardiac monitoring and obtaining an electrocardiogram (ECG)
Which of the following is an appropriate nursing intervention for a patient with impaired mobility? a) Encouraging prolonged bed rest to conserve energy b) Promoting regular exercise and physical activity within the patient’s capabilities c) Limiting fluid intake to minimize the need for frequent toileting d) Administering sedatives to promote sleep and relaxation
Answer: b) Promoting regular exercise and physical activity within the patient’s capabilities
Which of the following is an early sign of acute kidney injury? a) Increased urine output b) Hypotension c) Elevated creatinine levels d) Decreased urine specific gravity
Answer: c) Elevated creatinine levels
Which of the following is an appropriate nursing intervention for a patient with a suspected deep vein thrombosis (DVT)? a) Elevating the affected extremity b) Applying heat to the affected area c) Administering a diuretic medication d) Encouraging ambulation and leg exercises
Answer: d) Encouraging ambulation and leg exercises
Which of the following is an appropriate nursing intervention for a patient with a tracheostomy tube? a) Changing the tracheostomy dressing every 48 hours b) Providing frequent oral hygiene to prevent infection c) Removing the inner cannula for cleaning once a week d) Placing the patient in a supine position during tube changes
Answer: b) Providing frequent oral hygiene to prevent infection
Which of the following is a priority nursing intervention for a patient experiencing a hypertensive crisis? a) Administering a beta-blocker medication b) Monitoring blood pressure every 4 hours c) Restricting sodium intake in the diet d) Initiating antihypertensive therapy as ordered
Answer: d) Initiating antihypertensive therapy as ordered
Which of the following is an appropriate nursing intervention for a patient with a new colostomy? a) Applying petroleum jelly to the stoma site b) Emptying the colostomy bag when it is three-quarters full c) Using adhesive tape to secure the ostomy bag in place d) Assessing the stoma and surrounding skin for signs of irritation
Answer: d) Assessing the stoma and surrounding skin for signs of irritation
Which of the following is a common side effect of corticosteroid medication? a) Hypotension b) Hyperglycemia c) Weight gain d) Bradycardia
Answer: c) Weight gain
Which of the following is a priority nursing intervention for a patient experiencing anaphylaxis? a) Administering antihistamine medication b) Placing the patient in a supine position c) Administering epinephrine immediately d) Providing emotional support and reassurance
Answer: c) Administering epinephrine immediately
Which of the following is an appropriate nursing intervention for a patient with impaired wound healing? a) Applying a heating pad to the wound site b) Keeping the wound covered and moist c) Administering an antibiotic without consulting the healthcare provider d) Encouraging the patient to scratch or pick at the wound
Answer: b) Keeping the wound covered and moist
Which of the following is a common side effect of chemotherapy? a) Constipation b) Hypotension c) Hair loss d) Weight gain
Answer: c) Hair loss
Which of the following is an appropriate nursing intervention for a patient with a suspected myocardial infarction (heart attack)? a) Encouraging the patient to engage in vigorous physical activity b) Administering aspirin without consulting the healthcare provider c) Monitoring blood pressure every 4 hours d) Providing emotional support and reassurance
Answer: b) Administering aspirin without consulting the healthcare provider
Which of the following is a priority nursing intervention for a patient with a traumatic brain injury? a) Monitoring intracranial pressure b) Administering pain medication every 4 hours c) Assisting with range-of-motion exercises d) Providing a high-protein diet
Answer: a) Monitoring intracranial pressure
Which of the following is an appropriate nursing intervention for a patient with a urinary tract infection (UTI)? a) Encouraging the patient to limit fluid intake b) Administering a diuretic medication c) Promoting frequent urination d) Applying a heating pad to the lower abdomen
Answer: c) Promoting frequent urination
Which of the following is a priority nursing intervention for a patient experiencing a seizure? a) Restraining the patient to prevent injury b) Placing a padded tongue depressor in the patient’s mouth c) Administering antiepileptic medication immediately d) Ensuring a safe environment and protecting the patient from injury
Answer: d) Ensuring a safe environment and protecting the patient from injury
Which of the following is an appropriate nursing intervention for a patient with diabetes mellitus? a) Encouraging a high-carbohydrate diet b) Administering insulin only if the blood glucose level is very high c) Promoting regular physical activity d) Limiting blood glucose monitoring to once a day
Answer: c) Promoting regular physical activity
Which of the following is an appropriate nursing intervention for a patient with a nasogastric tube? a) Taping the tube to the patient’s cheek to secure it in place b) Administering medication through the nasogastric tube without flushing it c) Checking the tube placement by observing the patient’s respiratory rate d) Assessing the patient’s bowel sounds regularly
Answer: d) Assessing the patient’s bowel sounds regularly
Which of the following is a priority nursing intervention for a patient experiencing a hypertensive crisis? a) Administering a diuretic medication b) Monitoring blood pressure every hour c) Restricting sodium intake in the diet d) Initiating antihypertensive therapy as ordered
Answer: d) Initiating antihypertensive therapy as ordered
Which of the following is an appropriate nursing intervention for a patient with impaired skin integrity due to pressure ulcers? a) Massaging the area surrounding the pressure ulcer to increase circulation b) Applying a dry dressing to the pressure ulcer c) Repositioning the patient every 2 hours d) Using alcohol-based cleansers to clean the pressure ulcer
Answer: c) Repositioning the patient every 2 hours
Which of the following is a common side effect of opioid analgesics? a) Hypertension b) Diarrhea c) Sedation d) Increased appetite
Answer: c) Sedation
Which of the following is a priority nursing intervention for a patient experiencing acute respiratory distress? a) Administering supplemental oxygen as ordered b) Encouraging deep breathing and coughing exercises c) Administering bronchodilator medication immediately d) Providing emotional support and reassurance
Answer: a) Administering supplemental oxygen as ordered
Which of the following is an appropriate nursing intervention for a patient with impaired urinary elimination? a) Restricting fluid intake to minimize urine output b) Administering diuretic medication to increase urine production c) Providing a bedside commode or urinal within reach d) Encouraging the patient to hold urine for as long as possible
Answer: c) Providing a bedside commode or urinal within reach
Which of the following is a priority nursing intervention for a patient with a suspected spinal cord injury? a) Placing the patient in a flat supine position b) Administering pain medication immediately c) Immobilizing the patient’s head and neck d) Applying heat to the affected area
Answer: c) Immobilizing the patient’s head and neck
Which of the following is an appropriate nursing intervention for a patient with a history of falls? a) Keeping the patient’s room dimly lit to avoid glare b) Encouraging the use of scatter rugs for better traction c) Providing a walking aid, such as a cane or walker d) Administering sedative medication for improved sleep
Answer: c) Providing a walking aid, such as a cane or walker
Which of the following is an appropriate nursing intervention for a patient with impaired glucose tolerance? a) Encouraging a high-carbohydrate diet b) Monitoring blood glucose levels only once a day c) Administering insulin without consulting the healthcare provider d) Promoting regular physical activity and a balanced diet
Answer: d) Promoting regular physical activity and a balanced diet
Which of the following is a priority nursing intervention for a patient with a suspected myocardial infarction (heart attack)? a) Encouraging the patient to engage in vigorous physical activity b) Administering aspirin without consulting the healthcare provider c) Monitoring blood pressure every 4 hours d) Providing emotional support and reassurance
Answer: b) Administering aspirin without consulting the healthcare provider
Which of the following is a common side effect of anticoagulant medication? a) Hypotension b) Constipation c) Increased appetite d) Risk of bleeding
Answer: d) Risk of bleeding
Which of the following is an appropriate nursing intervention for a patient with a suspected pulmonary embolism? a) Administering oxygen therapy without consulting the healthcare provider b) Elevating the head of the bed to a high Fowler’s position c) Encouraging the patient to lie flat and avoid movement d) Administering a bronchodilator medication
Answer: a) Administering oxygen therapy without consulting the healthcare provider
Which of the following is a priority nursing intervention for a patient experiencing a seizure? a) Restraining the patient to prevent injury b) Placing a padded tongue depressor in the patient’s mouth c) Administering antiepileptic medication immediately d) Ensuring a safe environment and protecting the patient from injury
Answer: d) Ensuring a safe environment and protecting the patient from injury
Which of the following is an appropriate nursing intervention for a patient with impaired vision? a) Providing written instructions without verbal communication b) Using bright and intense lighting in the patient’s room c) Orienting the patient to the physical environment and providing clear verbal instructions d) Encouraging the patient to rely solely on assistive devices for mobility
Answer: c) Orienting the patient to the physical environment and providing clear verbal instructions
Which of the following is a priority nursing intervention for a patient with a suspected head injury? a) Administering pain medication immediately b) Encouraging the patient to sleep to aid in recovery c) Monitoring neurologic status and vital signs closely d) Allowing the patient to ambulate independently
Answer: c) Monitoring neurologic status and vital signs closely
Which of the following is an appropriate nursing intervention for a patient with a suspected stroke? a) Placing the patient in a flat supine position b) Administering anticoagulant medication without consulting the healthcare provider c) Encouraging the patient to perform active range-of-motion exercises d) Notifying the healthcare provider immediately
Answer: d) Notifying the healthcare provider immediately
IMPORTANT QUESTIONS AND ANSWERS FOR AIIMS, PGIMER, ESIC, RRB, DSSSB, State PSCs, Kerala PSC, NIMHANS, BHU, GMCH, SNB, Nursing Officer/Staff Nurse/HAAD/Prometric/NCLEX Exam
Patient
admission, hospital stays and discharges follow an established procedure, i.e.
planned nursing activities. For patients requiring long-term care and repeated
hospitalization, the activities must be coordinated so that the nursing care is
continuous. The specific medical treatment prescribed by the doctor, and the
nursing regime followed by the nurse, are administered by the nurse in order to
meet patient needs. The nurse monitors patient responses throughout the stay.
ADMISSION PROCEDURE
Admission to
the nursing unit prepares the patient for his stay in the health care facility.
Whether the admission is scheduled or follows emergency treatment.
Definition
Admission is defined as allowing a
patient to stay in hospital for observation, investigation, treatment and care
Admission is the entry of a patient
into a hospital/ward for therapeutic or diagnostic purposes
Purpose
To establish guidelines regarding
admission of patients
To make the patient feel welcome,
comfortable and at ease
To acquire vital information
regarding the patient
To assess the patient from which the
nursing care plan can be initiated and implemented
Principle Involved
Sudden change or strangeness on the
environment produces fear and anxiety
Entering the hospital is a threat to
one’s personal identity
People have diversity of habits and
modes of behavior
Illness can be novel experience for
the patient and bring stress on his physical and mental health
General Instructions
To receive the patient and help him
to adjust to the hospital environment
To welcome and establish a positive
initial relationship with the patient and relatives
To obtain the needed identifying data
concerning the patient
To provide immediate care, safety and
comfort
To collaborate with patient in
planning and providing comprehensive care
To observe, report signs and symptoms
and general condition of the patient
To secure safety of the patient and
his belongings
Effective admission
procedures should accomplish the following goals:
Verify the patient’s identity and
assess his clinical status
Make him as comfortable as possible
Introduce him to his roommates and
the staff
Orient him to the environment and
routine
Provide supplies and special
equipment needed for daily care
Admission
routines that are efficient and show appropriate concern for the patient can
ease his anxiety and promote cooperation and receptivity to treatment.
Conversely, admission routines that the patient perceives as careless or
excessively impersonal can lead to:
Heighten anxiety
Reduce cooperation
Impair his response to treatment
Perhaps aggravate symptoms
Types of Admission
Emergency admission: means the
patient are admitted in acute conditions requiring immediate treatment, e.g. patient
with accidents poisoning, burns and heart attacks
Routine admission: the patients are
admitted for investigation and medical or surgical treatment is given
accordingly, e.g. patients with hypertension, diabetes and bronchitis
Admission
Involves
Authorization from a physician that
the person requires specialized care and treatment
Collection of billing information by
the admitting department of the health care agency
Completion of the agency’s admission
data base by nursing personnel
Documentation of the client’s medical
history and findings from physical examination
Development of an initial nursing
care plan
Initial medical orders for treatment
Medical authorization
The admitting department (preliminary
data collected, addessography plate)
Initial nursing plan for care
Medical admission responsibilities
General Instructions
Nurses should make every effort to
the friendly and courteous with the patient
Make proper observations of the
patient’s condition, record and report
Orient the patient and his relatives
to hospital and ward policies
Observe policies in dealing with
medicolegal cases
Deal with the patients belonging very
carefully communicable diseases
Insolate the patient if suffering
from communicable diseases
The nurse should recognize the
various needs of the patient and meet them without delay
The needs to understand the fears and
anxieties of patient and help to overcome
The nurse should find out the likes
and dislikes of the patient and include the patient in his plan of care
The nurse should address the patients
by their name and proper title
Patient’s valuables and cloths should
hand over to the relatives with proper recording
Equipment
Gown,
personal property form, valuables envelope, admission form, nursing assessment
form, thermometer, emesis basin, bedpan or urinal, bath basin, water pitcher,
cup, and tray, urine specimen container, if needed. An admission pack usually
contains soap, comb, toothbrush, toothpaste, mouthwash, water pitcher, cup,
tray, lotion, facial tissues, and thermometer. An admission pack helps prevent
cross-contamination and increases nursing efficiency
Preparation of Equipment
Obtain a gown and an admission pack
Position the bed as the patient’s
condition requires. If the patient is ambulatory, place the bed in the low
position; if he is arriving on a stretcher, place the bed in the high position
Fold down the top linens
Prepare any emergency or special
equipment, such as oxygen or suction, as needed
Preparation of the Patient
Greet the patient and his relatives
and introduce yourself to them
Receive the patient cordially and
seat comfortable
Introduce him to other person in the
ward
Complete the admission record
Collect history and carry out simple
physical examination
Carry out the prescribed treatment
and keep a record
Help the patient to maintain personal
hygiene and change into hospital clothes
Orient the patient to the ward-toilet
bath room, drinking water supply, nurse’s station and treatment room
Hand over the patients valuable to
his relatives
Issue visitor pass
Encourage patient to take hospital
diet especially when therapeutic diet is ordered
Obtain local address or telephone
number, relatives lodge room and document in admission record
Procedure
Adjust the room lights, temperature
and ventilation
Make sure all equipment is in working
order prior to the patient’s admission
Admitting the adult patient
Speak slowly and clearly, greet the
patient by his proper name, and introduce yourself and any staff present
Compare the name and number on the
patient’s identification bracelet with that listed on the admission form. Verify
the name and its spelling with the patient. Notify the admission office of any
corrections
Quickly review the admission form and
the physician’s orders. Note the reason for admission, any restrictions on
activity or diet, and any orders for diagnostic tests requiring specimen
collection
Escort the patient to his room and, if
he is not in great distress, introduce him to his roommate. Then wash your
hands, and help him change into a gown or pajamas; if the patient is sharing a
room, provide privacy
Take and record the patient’s vital signs
and collect specimens if ordered. Measure his height and weight if possible. If
he cannot stand, use a chair or bed scale and ask him his height. Knowing the
patient’s height and weight is important for planning treatment and diet and
for calculating medication and anesthetic dosages
Show the patient how to use the
equipment in his room. Be sure to include the call system, bed controls, TV
controls, telephone and lights
Explain the routine at your health
care facility. Mention when to expect meals, vital sign checks and medications.
Review visiting hours and any restrictions
Take a complete patient history.
Include all previous hospitalizations illnesses, and surgeries; current drug
therapy; and food or drug allergies. Ask the patient to tell you why he came to
the facility. Record the answers (in the patient’s own words) as the chief
complaint. Follow up with a physical assessment, emphasizing complaints. Record
any wounds, marks, bruises or discoloration on the nursing assessment form
After assessing the patient, inform
him of any tests that have been ordered and when they are scheduled. Describe
what he should expect
Before leaving the patient’s room,
make sure he is comfortable and safe. Adjust his bed, and place the call button
and other equipment (such as water pitcher and cup, emesis basin, and facial
tissues) within easy reach. Raise the side rails
Using Patient Care reminders
When placed
at the head of the patient’s bed, care reminders call attention to the
patient’s special needs and help ensure consistent care by communicating these
needs to the hospital staff, the patient’s family and other visitors. You can a
specially designed card or a plain piece of paper to post important information
about the patient, such as:
Allergies
Dietary restrictions
Fluid restrictions
Specimen collection
Patient deaf or hearing-impaired in
right ear
Foreign-language speaker. You can
also use care reminders to post special instructions, such as:
Complete bed rest
No blood pressure on right arm
Turn every 1 hour
Nothing by mouth
Admitting the Pediatric Patient
Your initial goal will be to
establish a friendly, trusting relationship with the child and his parents to
help relieve fears and anxiety
Speak directly to the child, and
allow him to answer questions before obtaining more information from his
parents
While orienting the parents and child
to the unit, describes the layout of the room and bathroom, and tells them the
location of the playroom, television room, and snack room, if available
Teach the child how to call the nurse
Explain the facility’s rooming in and
visiting policies so the parents can take every opportunity to be with their
child
Inquire about the child’s usual routine
so that favorite foods, bedtime rituals, toileting, and adequate rest can be
incorporated into the routine
Encourage the parents to bring some
of their child’s favorite toys, blankets, or other items to make the child feel
more at home amid unfamiliar surroundings
Special Considerations
If the patient does not speak English
and is not accompanied by a bilingual family member, contact the appropriate
resource
Keep in mind that the patient
admitted to the emergency department requires special procedures
If the patient brings medications
from home, take an inventory and record this information on the nursing
assessment form. Instruct the patient not to take any medication unless
authorized by the physician
Find out the patient’s normal
routine, and ask him if he would like to make any adjustments to the facility
regimen
Documentation
After
leaving the patient’s room, complete the nursing assessment form or your notes,
as required. The completed from should include the patient’s vital signs,
height, weight, allergies, and drug and health history; a list of his
belongings and those sent home with family members; the results of your
physical assessment; and a record of specimens collected for laboratory tests
Legal Aspects of Patient Admission
Providing information about the
patient to family members and to the next of kin is governed by applicable
legislation
In the case of acutely ill patients
who cannot express consent with hospitalization (e.g. unconscious, following
strokes, etc) a detention procedure or the “procedure concerning patient
admission and detention by a healthcare facility” is put into place. The
healthcare provider reports the patient admission without their consent to the
court
Under emergency hospitalization, the
court will appoint a guardian to represent the patient during detention
NURSES ROLE IN ADMISSION
Admission to
an acute hospital may be planned (elective) or may be required as a matter of
urgency (emergency). Elective admissions are those which occur as a consequence
of referral to hospital by a general practitioner, medical consultant, a visit
to the hospital outpatient department or a planned transfer from another
hospital. Some patients may confound these definitions, e.g. patients requiring
chemotherapy who may be both urgent and planned. A number of principles should
underpin the development of an effective emergency and elective admissions and
discharge planning function. These include:
The provision of patient centered
services, which are accessible to the population without compromising safety,
quality and clinical standards, to the right people in the right location and
at the right time
Patients should be consulted and
included in all decisions about their care
Clinical practice and care should be
based on the most up to date evidence
Cooperation and clinical networking
between hospitals and between care groups are essential to optimize outcomes,
particularly where complex care issues are involved
A service based on good clinical
governance (i.e. founded on continuous quality improvement, staff development,
risk management and audit)
Acute hospital services should be
organized into three parallel streams of care interdependent of each other.
This involves a division of acute hospital services into emergency, elective
and out patients department/day care
The pivotal role of the Primary Care
Teams should be emphasized
Early induction training of
healthcare professionals in relation to the principles set out above
The
effective management of hospital beds and associated resources is vital if the
growing demand placed on hospital resources is to be met. Recognized
impediments to patient “flow” in hospitals include:
Difficulties in gaining access to
inpatient beds (i.e. insufficient bed capacity)
The resulting congestion within
Emergency Departments
Inappropriate retention of patients
in hospital beds
To ensure
that all patients admitted to hospital receive the high quality and safe
service to which they are entitled, resources must be efficiently and
effectively utilized. Services are organized so that patients, depending on
their needs, can move smoothly between emergency care and the best and most
appropriate inpatient care, primary care and continuing care. Effective quality
assurance and safe care are essential rights of all users of the health
services. Achieving the standards set by the Irish Health Services
Accreditation Board will ensure that all hospitals are providing such care
EMERGENCY ADMISSIONS
An emergency
hospital admission is defined as one that is not planned and which results from
trauma (injury) or acute illness which cannot be treated on an outpatient
basis. In order to manage the balance between elective and emergency
admissions, the factors below have been identified as effective in improving
the management of admissions and general patient flow in the Emergency
Department
Managing
emergency admissions: for the patient admitted through the emergency department
(ED), immediate treatment take priority over routine admission procedures.
After ED treatment, the patient arrives on the nursing unit with a temporary
identification bracelet, a physician’s order sheet, and a record of
treatment. Read this record and talk to
the nurse who cared for the patient in the ED to ensure continuity of care and
to gain insight into the patient’s condition and behavior. Next, record any
ongoing treatment, such as an IV infusion, in your notes. Take and record the
patient’s vital signs, and follow the physician’s orders for treatment. if
family members accompany the patient, ask them to wait in the lounge while you
assess the patient and begin treatment. Permit them to visit the patient after
he’s settled in his room. When the patient’s conditions allows, precede with
routine admission procedures.
ELECTIVE ADMISSIONS
Achieving
the correct balance the competing demands for hospital beds by elective and
emergency cases of varying complexity is likely to remain a considerable challenge
for the future. In order to improve the experience of patients waiting for
elective admission, the following priorities have been identified:
Local clinical consensus on the ratio
of emergency admissions to planned elective procedures
Measures to review and monitor
criteria for hospital admission and for lengths of stay
Greater emphasis on ensuring that in
admitting elective patients, consideration is given to the length of time they
have been waiting since the decision to admit was taken – taking account of
their clinical needs
Greater standardization of waiting
list administration with consistent monitoring of cancellations, suspensions
and removal from lists without treatment.
Emphasis on planning discharge from
day of admission
The adoption of a whole systems
approach to bed management
The appointment of a manager or
clinician with sufficient authority and support to balance and monitor the
competing demands of emergency and elective pressures ensuring all bed and
theatre resources are fully utilized
A patient’s
episode of care should be planned before his/her admission and should take
account of the entire “journey” up to and after discharge from hospital.
Patients and their care taker should be partners in the planning. Bed management
should be overseen by a Hospital Bed Manager who has the authority to implement
the bed management policy and to coordinate the bed management team. The bed
management service should operate on a permanent basis, i.e. for 24 hours on
everyday of the year. The bed manager reports to a senior member of management.
Part of their role would include continuous analysis and the provision of
reports and forecasts. The function of allocating beds to patients should be
centralized and the Hospital Bed Manager should have authority over the access
to all hospital beds. There should be an awareness of the bed designation ratio
as set out by the Department of Health and Children. The Hospital Bed Manager
should work within the notional allocation of beds to each specialty to ensure
that patients are accommodated in the most appropriate bed available at the
time of their admission, and to ensure that patients are cared for by staff
with the appropriate expertise
The
following key requirements have been identified to facilitate effective
elective admission practices:
Centralized waiting list management
and agreement on the parameters for scheduling theatre lists with clinicians
Pre-admission assessment should be
standard requirement for all elective admissions to ensure appropriate planning
of the entire patient journey
The anticipated length of stay (this
should be indicated as early as possible to facilitate scheduling) for elective
admissions should be indicated as early as possible to facilitate scheduling
Increased day surgery can also the
supported by before admission assessment to ensure appropriate scheduling and
to minimize transfer to in-patient beds
The hospital admission procedure involves several steps to ensure that patients receive appropriate care and that the necessary information is collected. Here is a general overview of the hospital admission process:
Pre-Admission Coordination:
In some cases, pre-admission coordination may take place. This involves scheduling the admission, verifying insurance information, and obtaining necessary pre-authorizations.
Arrival at the Hospital:
Upon arrival, the patient or accompanying family member should check in at the hospital’s admission or registration desk. This is typically located in the main lobby or near the emergency department.
Completion of Admission Forms:
The patient will be asked to fill out admission forms, which include personal information, medical history, insurance details, and consent forms. In emergency situations, a family member or healthcare proxy may assist in completing these forms.
Identification and Insurance Verification:
The hospital staff will verify the patient’s identification and insurance information. This step ensures that the hospital has accurate details for billing and other administrative purposes.
Medical Assessment:
A nurse or healthcare provider will conduct a medical assessment to gather information about the patient’s current health status, symptoms, and medical history. Vital signs such as blood pressure, heart rate, and temperature may be measured.
Initial Treatment and Stabilization:
If the patient requires immediate medical attention, they may receive initial treatment and stabilization in the emergency department before being admitted to a specific unit or ward.
Assignment of Room or Bed:
Once the admission process is complete, the patient is assigned a room or bed in the appropriate unit or department, depending on their medical condition and the type of care needed.
Introduction to Care Team:
The patient will be introduced to the healthcare team responsible for their care. This team may include doctors, nurses, technicians, and other healthcare professionals.
Patient Education:
The healthcare team provides information about the hospital routine, safety measures, and the patient’s plan of care. This includes details about medications, tests, and procedures.
Consent for Treatment:
Patients or their legal representatives will be asked to provide informed consent for specific treatments, procedures, and interventions. This ensures that the patient is fully aware of and agrees to the proposed medical interventions.
Financial Arrangements:
Hospital staff may discuss financial arrangements, including insurance coverage, copayments, and any potential out-of-pocket expenses. Financial counselors may be available to assist with financial-related queries.
Medication Reconciliation:
A thorough review of the patient’s current medications is conducted to ensure accurate and safe administration during the hospital stay.
Personal Belongings and Valuables:
Patients are advised on the hospital’s policy regarding personal belongings and valuables. It’s common for hospitals to provide a safe place for items like jewelry, wallets, and other valuables.
Communication Plan:
A communication plan is established, including how family members will be informed about the patient’s progress and any important updates. This may involve providing contact information and discussing visiting hours.
Discharge Planning (if applicable):
If the admission is for a planned procedure or treatment, initial discussions about discharge planning may take place, outlining post-discharge care, follow-up appointments, and medications.
BANDAGING (Definition, Purpose, General Principles, Types and Techniques)
Updated 2024
A bandage is
a strip of fabric used to dress and bind up wounds. In medicine, bandage
refines and elaborates upon this basic form, combining it with casts, slings,
and splints to heal all kinds of injuries. It is important to do the proper
bandaging technique when using and administering first aid on a wound or
injury. The main goal of placing a bandage on an injury is for immobilization,
protection, support or compression. If the bandaging technique is not done
properly, it could exacerbate the damage.
DEFINITION
A bandage is
any gauze or cloth material used for any of the purpose to support or to hold
or to immobilize the body part. Bandaging is a technique of application of
specific roller bandages to different parts of body
PURPOSE
To control bleeding by pressure
To immobilize sprained or fractured
limb
To hold a dressing or compress in
place
To secure splints in case of fracture
of deformity
To protect open wound from
contaminants
To provide support and aid in case of
varicose veins or impaired circulation
The patient should be placed in a
comfortable position and it should convenient for the nurse
The position of the part to be ban
aged should be well supported and elevated if necessary
The nurse should stand directly in front
of the patient or facing part to be damaged
A bandage should accomplish its
purpose. It may be used to hold dressing in place, to support a part or to
immobilize
Apply and fix bandage at least two
circular turns around part is its smallest diameter, so that it can stay in
place
Skin surfaces should be separated.
They may be separated. They may be separated by either gauze or cotton. In the
application of casts, special padding is used over bony prominences
Always bandage to the right
Exert even pressure as far as
possible. The bandage should be done in the direction of the venous circulation
Do not cover the ends of the finger
or toes, unless it is necessary in order to cover the injury. It is necessary
to observe circulatory changes
Never apply a wet bandage. When wet
bandage applied, terms to shrink and become tight as it dries
Do not apply a bandage too loosely
because it may slip and expose the wound
All turns of bandage should be made
clockwise unless there is some special reason for doing otherwise the roll
should be held in the palm of the hand, with the free end of the bandage coming
from the part of the roll
Applying bandage, secure terminal
extremity by pinning with safety pins or strapping adhesive
Remove bandages by gathering folds in
a loose mass. Passing mass from one hand to the other
Examine the bandage part frequently for pain, swelling, etc
ROLLER BANDAGE TYPES
A roller bandage is a strip of gauze or cotton material
prepared in a roll. Roller bandages can be used to immobilize injured body
parts (sprains and torn muscles), provide pressure to control internal or
external bleeding, absorb drainage, and secure dressings. Three types of
bandages are the Kerlex bandage, the gauze bandage, and the elastic bandage
Kerlex bandage: the bandage is absorbent, loosely woven, and
conforms easily to uneven surfaces, such as the hand, wrist, elbow, shoulder,
groin, knee, ankle, and foot. The Kling bandage is similar to the Kerlex’s
bandage. These bandages are used primarily for bleeding injuries
Gauze roller bandage: the gauze roller bandage is absorbent, loosely
woven, cotton fabric. It does not conform well to uneven surfaces and is not to
be used on areas prone to chafing such as shoulders, elbows, groin and other
jointed areas. It is used primarily on bleeding injuries on the upper arm,
forearm, thigh and lower leg
Elastic Roller Bandage: the elastic roller bandage is
composed of cloth and elastic that allows it to stretch and retract. It
conforms to uneven surfaces and applies even pressure to the area covered. It
is used to apply pressure and/or restrict movement. The elastic bandage is
normally used when a sprain needs to be immobilized. Make sure the bandage is
not right enough to restrict blood flow unless it is used as a pressure
dressing
TYPES
Circular bandage: the bandage is wrapped around the part with
complete overlapping of the previous bandage turn. This is used primarily for
anchoring a bandage where it is begun and where it is terminated
Spiral bandage: the bandage ascends in a spiral manner so
that each turn overlaps the preceding one by one half or two-thirds the width
of the bandage. The spiral turn is useful for the wrist, the finger and the
trunk
Figure-of-eight: the figure-of-eight turn consists of making
oblique overlapping turns that ascend and descend alternatively. It is
effective for use around joints, such as the knee, the elbow, and the ankle.
Recurrent-stumps bandage: after a few circular turns to
anchor the bandage the initial end of the bandage is placed in the center of
the body part being bandaged, well back from the tip to be covered. Recurrent
bandages are used for gingers for the hand and for the stump of an amputated
limb
T-bandage: it is used to secure rectal or perineal dressing.
The double “T” bandage is used for males and single “T” bandages is for the
females. The strips of the “T” bandage are brought between the patients leg and
is pinned to the waist band in front
MATERIALS
Gauze
Muslin
Rubber
Elastic
Flannel
Crinoline for plaster
Adhesive
ASSESSING
BEFORE APPLYING BANDAGE
Inspect and palpate the area for
swelling
Inspect for the presence of and
status of wounds
Note the presence of drainage
(amount, color, odor, and velocity)
Inspect and palpate for adequacy of
circulation (skin temperature, color and sensation)
Ask the patient about any pain
experienced (location, intensity, onset and quality)
Assess the ability of the patient to
reapply the bandage when needed
Assess the capabilities of the
patient regarding activities of daily living (to dress, comb hair, bath)
EQUIPMENT
Clean
bandage of the appropriate material and width, safety pin, adhesive tape, and
special metal clips
PROCEDURE
Explain to patient
Make sure that the area to be
bandaged is clean and dry
Stand opposite to the patient if
possible
Support the affected part adequately
ensuring correct body alignment to prevent deformity and impair circulation
Keep bandage roll uppermost with free
and above site to be bandaged
Bandage from below to upward
Cover two – thirds of previous turn,
avoid loose edges
Take requires number of turns so that
purpose is achieved.
Secure the end of the bandage with
tape. Metal clips or a safety pin over an uninjured area
Document the site and type of bandage
used
SPECIAL
BANDAGES
Eye bandage (monocular): bandage of
1.5-2 width is required. Place the free end of bandage at temporal region on
the same side of eye to be bandaged. A piece of tape is passed under bandage on
side of eye and tie so as to prevent
bandage from sliding over good eye
Binocular bandage: figure-of-eight
technique is used. Start from right temporal region take one turn. Around head,
down over the left eye, under right ear right eye to right to left temple.
Repeat around heal to right temple following previous pattern until both eyes
are covered
Ear-mastoid bandage: bandage with 2
feet width and 5 yards length is required make circular turns around head above
ears, beginning on affected side. Follow with circular turns. The first turn is
taken beneath occiput, and carried high over to opposite side of head below ear
Jaw Barton bandage: used in fracture
of lower jaw and to hold dressing on chin. Bandage of 2 inches width and 5-6
yards length is required. Begin at nape of neck below occiput, carry bandage
obliquely up, behind and close to ear, then under chin and up in front of left
ear to top of head
Cape line bandage (head bandage): a
double roller bandage of 2 feet width and 8 yards length is required. Place
center of bandage in middle of forehead and carry roller in opposite direction
to occipital. Cross rollers one over other. The roller in inferior position in
brought over head to middle of forehead
Shoulder spica: a bandage of 2 ½
inches width and 8 yards is required. The spica may be either descending or
ascending. The ascending type is most commonly used. While applying bandage,
stand at side which is to be bandage. A pad must be placed in axilla.
BANDAGING
TECHNIQUES
Guidelines
in Using Dressing and Bandages
There are
certain guidelines to follow to ensure proper bandaging technique.
Use a dressing that is large enough
to go beyond at least 1 inch of the wound edges
For exposed body tissues or organs,
make sure to cover the wound with non-stick dressing, e.g. moistened gauze or
plastic. Secure the dressing using adhesive tapes or bandages
For bandages over a point, keep the
joint immobilized by creating a bulky dressing
Ensure that the bandage is tight but
not too tight to cut off circulation. Signs that circulation is cut off include
color change (to bluish) especially of the extremities, tingling sensation,
feeling cold, or swelling. Once these begin to show, loosen the bandage.
Bandaging technique will depend on,
the first aider’s skills, the size and location of the wounds, and the
materials available
Triangular
Bandage
The first
bandaging technique to be discussed is the triangular bandage. The triangular
bandage is one of the most standard contents of a first aid kit. It has plenty
of uses, such as a sling to support an injury to the upper body, padding for
major wounds and a bandage for immobilization purposes. It is quite easy to
make and they are as follows:
Stretch the piece of fabric that will
be used. Opt to use a long stretch to create more triangular bandages, which
can be used in the fracture
Cut the fabric into a square,
approximately 3 ft multiply 3 ft. cut the square diagonally into two equal
halves, creating two triangle
There are two ways to sterilize the
bandages (sterilizing will reduce infection risk). First option is to pull the
bandage in boiling water. The second option is to soak the bandage in hydrogen
peroxide or any other disinfectant. Dry before use
If possible, iron the triangular bandage,
so it can be easily used during a time of need
Roller
Bandage
The second
bandaging technique to be discussed is the roller bandage. Similarly, the
roller bandage is a standard for many first aid kits and has many practical
uses. These include controlling bleeding, pressure bandage and keeping the
dressing in place. The following are the steps to make a roller bandage:
Allow the individual to stay in a
position where they are most comfortable. Give enough support to the affected
part before beginning to apply the bandage. Hold the “head” end of the bandage
while using the “tail” end to wrap the affected part. Wrap the affected area
only a few centimeters at a time to ensure that tightness is maintained
After each turn, begin with a locking
turn to hold the start of the bandage in place
One has two options, whichever is
more applicable. Begin from the middle part of the affected part or limb moving
toward an outward direction. The second option is to begin with the narrowest
part, below the dressing, and moving upward
Ensure that each turn of bandage will
cover two thirds of the prior turn of bandage
Cover the dressing or padding used
completely
Finish with a straight turn at the
end of the bandage. Use an adhesive tape to secure the roller bandage in place
CONCLUSION
Many
bandages are simple to use and are available in hospitals and the community.
Many of the
products can be bought over the counter and used without any supervision from a
healthcare professional. Because of the range of products available today, it
is no longer necessary to be able to carry out the many complicated bandaging
techniques that used to be taught in nurse training, such as the application of
the many-tailed bandage or the thumb spica. However, this does not detract from
the fact that bandaging is a skill and the application of proper bandages
requires thorough training and assessment of competence.
Selecting an appropriate method of fixation requires thought, identification of the main objectives, and common sense. The overriding objective must be to retain a dressing or support a limb but consideration must also be given to the practicalities of the patient’s daily life.
BANDAGING (Definition, Purpose, General Principles, Types and Techniques)
Bandaging is an essential nursing procedure that involves the application of dressings and bandages to wounds or injuries. Here are key points to consider when performing bandaging procedures:
Hand Hygiene:
Wash hands thoroughly before and after the procedure to prevent the risk of infection.
Assessment:
Assess the wound type, size, and condition before choosing an appropriate dressing and bandage.
Evaluate the patient’s skin condition and any allergies to materials or adhesives.
Gathering Supplies:
Ensure all necessary supplies are readily available, including dressings, bandages, tape, scissors, and any prescribed topical medications.
Explain the Procedure:
Communicate the procedure to the patient, explaining the purpose and expected outcome.
Obtain informed consent if required.
Positioning:
Position the patient comfortably, exposing the wound while maintaining their privacy and dignity.
Wound Cleaning:
Clean the wound gently with a prescribed solution or sterile saline.
Use aseptic technique to minimize the risk of infection.
Dressing Application:
Apply the appropriate dressing, ensuring it covers the wound adequately.
Choose dressings based on the wound’s characteristics, such as moisture level and depth.
Bandage Selection:
Select a suitable bandage material, considering the purpose (compression, support, or protection).
Ensure the bandage is of the correct size and length to secure the dressing adequately.
Technique:
Employ proper bandaging techniques to secure the dressing without impairing circulation or causing discomfort.
Be mindful of tension and avoid applying the bandage too tightly.
Securing the Bandage:
Use appropriate fastening methods, such as clips, adhesive strips, or self-adherent bandages.
Ensure the bandage is secure but not too tight to allow for adequate blood circulation.
Labeling and Documentation:
Clearly label the dressing with the date, time, and initials.
Document the procedure, including wound assessment, type of dressing used, and the condition of the surrounding skin.
Education:
Educate the patient and caregivers on proper care, signs of infection, and when to seek medical attention.
Provide written instructions for home care if applicable.
Follow-up:
Schedule follow-up appointments to monitor the wound’s progress and reassess the bandaging as needed.
Modify the bandaging technique based on the wound’s healing trajectory.
The duty of the nurse is to ensure that the patients unit is kept clean and tidy at all times. She should learn all the cleaning skills in order to teach others and should willingly clean where necessary. The patient and his relatives are also taught to keep the unit clean and tidy.
Care of patient unit is defined as
keeping the patients unit clean, neat and tidy. It also helps to provide
maximum comfort to the patient
Patients unit is the area furnished and
equipped according to the need to give adequate care to the patient
Sufficient air movement to evaporate
sweats and favors vascular changes within the skin
Atmospheric pressure within man’s
tolerance
Provision for disposed of
refuse/excreta
Removal of dust. Injurious chemicals
and pathogenic bacteria from the atmospheric air
Reasonable cleanliness of all surface
and furnishing that the individual is likely to handle
A dwelling place free from insects,
animal pests, fire hazards, mechanical injuries, electric shocks, radiation and
poisons
Freedom from disagreeable odors and noises, harmony of town and design in the immediate surroundings, provision of privacy etc
INFLUENCE OF EXTERNAL ENVIRONMENT
Atmospheric temperature: in an ideal temperature, the person does not feel chilly, but it should be sufficiently warm enough to cause perspiration. A room temperature ranging from 68 to 72 degree F (20-22 degree Celcius) is considered comfortable
Humidity: humidity is the amount of moisture in the air. It affects the evaporation of moisture from the skin. A humidity of 40-60% considered comfortable
Air Movement
Ventilation
means movement in the air. The chief purpose of ventilation is to supply fresh
air and to maintain a proper humidity. Air in motion increases the radiation of
heat from the skin and improves circulation and respiration. The velocity of
the air movement should be 15-45 feet/minute or 1-3 miles/hour
Air may keep
in motion by opening doors and windows, and by the use of fans and air conditioners.
The air movement should not be much to cause draughts.
Lighting
The amount
of light is an important factor in comfort. It is provided by natural or
artificial light. Avoid direct light on the face and eyes. Prevent glare.
Artificial light should not be too strong for reading. Remember, it is
difficult for a patient to rest when there is excessive light.
He will not
be able to read and write when there is dim light. The amount of light depends
upon the use of light, the kind of work being done, conditions of the patient,
age of the patient and the time of the day. The patient if conscious should
have within his reach a light, which he can control
Noise
produces irritability, restlessness, fatigue, and exhaustion. In an acutely ill
patient noise interfere with sleep. On the contrary, a melodious sound induces
pleasure. The degree of noise may be reduced by various measures. Noise caused
by friction may be reduced by various measures. Noise caused by friction may be
reduced by lubrication. Use of rubber tyres and castors for trolleys and wheel
chairs reduce the sound when moving furniture. Make echo proof rooms. Avoid
dropping object. Loud talking, laughing and heavy walking with shoes should be
avoided. Whispering is also not good, as it tends to cause apprehension and
uncertainty in the patient
Purity of the Air
Dust cause significant
hazards to patients. Dust in hospital may be laden with microorganisms, which
cause infection in addition to irritation of the respiratory tract of precipitating
allergic reaction
To control
the dust, it is important to avoid those activities that stirrup dust such as
dusting and dry duster and sweeping damp dusting and cleaning, folding bed
linen and gently shaking them rather than flapping them, restricting the
cigarette smoking and above all providing proper ventilation and ample spacing
of bed maintains the purity of air.
Elimination of Unpleasant Odors
Good
ventilation, cleanliness, proper disposal of excreta and rubbish are necessary
to eliminate unpleasant odors
Water Supply and Sewage Disposal
There should
be provision for safe water supply and disposal of excreta
Esthetic Factor
The
environment becomes attractive it appeals to the series whether we are
conscious or not, the design or arrangement of the room contributes to its
harmony. Through skillful use of color, the room can be made attractive. Color
preferences vary with age, sex and race. Flower vase, picture and curtains add
to the pleasant outlook of the room
Esthetic
considerations should include freedom
from unpleasant sights, bedpans, urinals, soiled dressings and used linen, etc,
should be removed from the sick room immediately.
Optimum Environment for the Patient
Influence of
external environment are atmospheric temperature, humidity, air movement,
lighting, noise, purity of air, elimination of unpleasant odors, water supply
and sewage disposal and esthetic factors.
Factors of
safety include freedom from mechanical injury, thermal injury, chemical injury,
radiation, bacteriologic ingests, allergens, free from vermin, insects and
animal pests.
Furnishing
for the patients unit are cot, spread over bed, table, bedside locker, bedside
table, chair and stool, bedside commode, bed pans, and urinals, sputum cup,
kidney trays, water flasks, and drinking glasses, plate, spoon, fork, knives
and toilet articles.
Carliolization
Carliolization
is a process of disinfecting the whole external environment of the patient and
rendering it free from pathogenic organisms.
Vermin and Insects
Clean the patients unit regularly.
Eliminate all the breeding places. Keep garbage well-covered and dispose of all
refuse properly
Store food properly. Use fly screens
on windows and doors.
FURNISHING PATIENT UNIT
Cot or bedstead: the hospital beds are made up of metal, simple in design, light and easily moveable, easy to clean, and strong durable with hard rubber castors. Some bed will have side rails to prevent the patient from falling.
Over bed table or cardiac table: generally, this is used for patients suffering from cardiac diseases to lean and rest forward when he has breathing difficulty. It can also use for eating, reading, and writing and for placing articles for self care.
Bedside locker: it is used to store the patient personal articles
Bedside table: it can be used for taking the meals and other purposes.
Chair and stool: the chair can be used for the patients when he is out of bed, i.e. while changing the bed linens or bathing the patients. The workers and visitors should sit on the chair and not on the patient’s bed.
Bedside commode: it is a chair or wheelchair that has opening in the center of a seat under which a bedpan can be inserted. It is used for defecation and urination.
Bedpan and urinals: for a bedridden patient, these are used for defecation and urination.
Sputum cup: it is used to collect the sputum and spitting
Kidney tray: it is used to collect vomits body fluids and soiled dressings
Water flask and drinking glasses: the water flask is filled with drinking water and is given to the patient within his reach.
Plate,
spoon, fork, knifes, etc: these are used to serve the meals for the patient and
is kept in-patients unit
Call signal: a bell is kept near the patient to call the nurse in his need
Toilet articles: soap with soap dish, toothbrush and toothpaste, mouthwash, comb, etc. are kept in patients unit. Bucket, mug, basin, etc. are kept in bathroom.
Waste basket: it is used to collect the rubbish
Bedding and bed linens: the mattresses and pillows should be firm, thick and smooth and all should have a washable cover. It gives support to the patients. Bed sheets are made up of strong cotton material, which are used to protect the mattress from soiling and to cover the patients; draw Mackintosh sheet, extents from the patient shoulder to below knee, made up of rubber or plastic material, which is used to protect the mattress and bottom sheet from soiling. Sometimes, Kelley’s pads are used in place of a Mackintosh.
PURPOSE OF THE UNIT CARE
To provide comfort to patient
To prevent cross infection
To keep the unit clean and neat
To keep the unit away from
microorganisms
To keep the articles ready for use
To prolong the life of the articles
PRINCIPLES OF GOOD HOUSEKEEPING
Wear gloves before cleaning the unit
Use a damp dusting
Dust with firm and even strokes
Use disinfectant for cleaning
Use a brush to clean grooved surface
Remove albuminous materials such as
sputum with cold water
Expose cleaned area to sunlight as it
helps destroy bacteria
Implement measures to ensure patient safety, including fall prevention, infection control, and the reduction of medical errors.
Staffing and Training:
Ensure an adequate number of qualified staff members with appropriate training and skills to meet the needs of patients.
Communication:
Foster effective communication among healthcare professionals, patients, and their families to enhance care coordination.
Patient-Centered Care:
Promote patient-centered care by respecting individual preferences, involving patients in decision-making, and addressing their unique needs.
Documentation:
Maintain accurate and timely documentation of patient information, care plans, and interventions, following established protocols and privacy regulations.
Infection Control:
Implement and monitor infection control measures to prevent the spread of infections within the patient care unit.
Quality Improvement:
Participate in ongoing quality improvement initiatives to enhance patient outcomes and the overall efficiency of the unit.
Resource Management:
Efficiently manage resources, including medical supplies, equipment, and staffing, to optimize patient care and minimize waste.
Collaboration:
Encourage collaboration among healthcare team members, fostering a multidisciplinary approach to patient care.
Patient and Family Education:
Provide education to patients and their families regarding their conditions, treatment plans, and self-care strategies.
Ethical Considerations:
Uphold ethical standards in patient care, respecting autonomy, confidentiality, and the rights of patients.
Emergency Preparedness:
Develop and regularly update emergency preparedness plans to handle unforeseen situations or disasters within the unit.
Continuous Monitoring:
Implement continuous monitoring of vital signs, patient progress, and response to interventions to ensure timely adjustments to care plans.
Cultural Competence:
Foster a culturally competent environment, recognizing and respecting the diverse backgrounds and beliefs of patients and staff.
Patient Flow:
Optimize patient flow within the unit to minimize wait times, enhance efficiency, and improve overall patient satisfaction.
Staff Well-being:
Prioritize the well-being of healthcare professionals by addressing workload, providing support, and promoting a positive work environment.
Regulatory Compliance:
Ensure compliance with all relevant healthcare regulations, standards, and accreditation requirements.
ICE CAP/ICE COLLAR (Cold Application) – Definition, Purpose, General Instructions, Preliminary Assessment Check, Effects, Physiologic Effects, Indications, Preparation of the Patient and Environment, Equipment, Procedure, After Care and Contraindications
Updated 2024
The ice bag
is another means of applying local cold to the skin. It should be filled with
finely chopped ice so that it is about 2 cm thick. The air is driven out by
water. Then the cap is screwed on; the bag should hold its shape by reason of
the predominance of ice. It is covered with a layer of face towel before it is
applied to skin. Commonly, the ice bag is not kept in place continuously but is
removed for 20 minutes after 20 minutes application. Specially shaped ice bags
are mad for the spine, the neck (cravat) and head (ice cap).
DEFINITION
Ice cap is
defined as small rubber bag filled with small pieces of ice and salt, that
serves as a device for cold application.
PURPOSE
To reduce temperature between 101-101.8
degree F.
To prevent bleeding especially after
thyroid surgery, tonsillectomy and dental surgery
To relieve urinary retentions
To relieve inflammation
To decrease metabolic rate of body
GENERAL INSTRUCTIONS
Fill the ice bag and ice collar with
small pieces of ice and sprinkle sodium chloride
The salt lowers the melting point and
prevents the ice from melting
Check the ice bag for leakage by
pouring cold water into it. Empty the water and fill the bag about 1/3rd
with the ice
The ice bag/ice collar is colder than
the skin, the ice takes up heat from the body and reduce the body temperature
Condensation of moisture collects on
the outside of the bag, and the flannel cover with absorb this moisture
The ice bag is applied for about ½
hour, and then it is discontinued for at least one hour to hollow for the
recovery period
PRELIMINARY ASSESSMENT
Check
The doctors for any specific
instructions
General condition and diagnosis of
the patient
Self care ability of the patient
Frequency and duration of application
For any contraindication of cold
application
Articles available in the unit
PREPARATION OF THE PATIENT AND ENVIRONMENT
Explain the procedure to the patient
Provide privacy, if needed
Assess the temperature of the patient
Position the patient comfortably in
the bed
Arrange the articles at the bedside
Assess the part of body needs to be
applied
EQUIPMENT
A clean tray
containing
Small Mackintosh with towel
Ice cap with ice cubes
Flannel cover
Salt
Thermometer tray
Duster
PROCEDURE
Wash hands
Fill 2/3rd ice cap with
ice cubes and expels air before closing cap
Add pinch of salt to ice cubes before
closing
Check for any leakage
Cover bag with flannel cover after
drying with duster
Placed on desired area
Apply for ½ hour and then remove
AFTER CARE
Observe for bluish skin discoloration
or mottling
Recheck patient’s temperature
Replace the articles after cleaning
Position the patient in a comfortable
position
Wash hands
Record the procedure in the nurse’s
record sheet and vital signs in TPR sheet
ICE CAP/ICE COLLAR (Cold Application) – Definition, Purpose, General Instructions, Preliminary Assessment Check, Effects, Physiologic Effects, Indications, Preparation of the Patient and Environment, Equipment, Procedure, After Care and Contraindications
Using an ice cap or cold collar is a common method for applying cold therapy, which is often used to reduce pain and inflammation. Here are key points to consider when applying an ice cap or cold collar:
Indications:
Cold therapy is typically indicated for acute injuries, such as sprains, strains, and swelling.
It can also be used post-surgery to minimize swelling and relieve pain.
Timing:
Apply cold therapy as soon as possible after an injury or surgery to maximize its effectiveness.
Duration of application is usually 15-20 minutes at a time. Longer application may cause tissue damage.
Frequency:
Apply cold therapy multiple times a day if necessary, with at least a 1-hour gap between sessions.
Protection:
Place a cloth or thin towel between the ice pack or cold collar and the skin to prevent frostbite or ice burns.
Avoid direct contact of the ice with the skin.
Adjustment:
If the cold sensation becomes too intense, remove the ice pack for a few minutes and then reapply.
Check the skin regularly for signs of irritation or numbness.
Compression:
Cold collars often come with straps or fasteners that allow for compression along with cold application, which can help control swelling.
Elevation:
Elevate the injured or swollen area whenever possible, especially when applying cold therapy. This helps reduce swelling.
Medical Advice:
Seek advice from a healthcare professional before using cold therapy, especially if there are pre-existing health conditions like circulatory problems.
Contraindications:
Cold therapy is not suitable for everyone. Individuals with conditions like Raynaud’s disease, cold hypersensitivity, or compromised circulation should avoid using cold applications without consulting a healthcare provider.
Ice Pack Rotation:
If using multiple ice packs, rotate them to ensure a continuous cooling effect.
Temperature:
Commercial ice packs or cold collars are designed to maintain a specific temperature range. Homemade ice packs should not be too cold and should conform to the recommended temperature guidelines.
Storage:
Follow manufacturer guidelines for storing and caring for reusable cold packs or collars.
Ensure the ice pack is fully frozen before each use.
COMMUNITY BAG – Importance of Community Bag, Principles of Bag Techniques, Articles Used in Community, Steps of Procedure with Community Bag, Home Health Nursing Procedure and Principles to be observed (Community Health Nursing)
Updated 2024
Community Bag Technique
The community health nurse requires some tools and instruments for doing procedures during home visits. The purpose of community bag is to carry out nursing procedures in home, which includes weighing the children, performing minor dressing and to conduct delivery in emergency situations
The “community bag technique” in nursing often refers to a method used to organize and carry essential supplies during community health nursing visits or home health visits. The purpose is to ensure that healthcare professionals have all the necessary tools and resources readily available when providing care in the community.
The
community health bag can be made of khaki material or any material with an
aluminum or iron frame to fit inside. Leather bags can also be used if the
agency can afford this. it is designed to carry equipment and material needed
during a visit to the home, school or factory
The nursing
bag is a vehicle for carrying the material and equipment needed during. The bag
should have outside packets for keeping a note book, waste paper bag, folder,
newspaper, stationeries, and tablet container
IMPORTANCE OF COMMUNITY BAG
It is essential during each home
visit, school and industrial visit to do some nursing procedures
The community bag and material
required are kept ready to use at any time
The community bag helps to demonstrate
some nursing procedures during home visit
The community bag acts as a vehicle
for carrying the tools during a home visit
PRINCIPLES OF BAG TECHNIQUES
The community bag must be kept
scrupulously clean ad ready for use at all times
The community bag should be kept in
clean areas without danger of being contaminated by the children or domestic
animals
Clean or boil the instruments after
use and replace it safely
Avoid unnecessary exposure while
doing procedure
Secure the bag by often cleaning and
cover it properly
The community bag placed on a clean
surface or on a piece of newspaper or a plastic sheet
Remove the soap, towel and nail brush
and wash the hands well
Open the bag and remove only the
needed articles and close the bag
Carry out the procedure placing
soiled swabs inside a newspaper bag for disposal by burning or any other
suitable method
Fold used paper or plastic sheet with
exposed side innermost and keep it in the outside pocket of the bag
Write brief note of the observation,
procedure done or instructions given
Check the bag daily, washing hands
before opening it and make necessary replacements
ARTICLES USED IN COMMUNITY BAG
Outside pocket: newspaper,
stationeries, family folders, flash cards and waste paper bag
Side flap: tablets containers should
have paracetamol, septran, multivitamin or B-complex, anti-inflammatory, etc.
solutions antiseptic, savlon, betadine, Benedict’s solution, acetic acid,
methylated spirit and eye drops or
ointment
Lower compartment: urine analysis
kit, specimen bottle, kidney tray, test tubes, test tubes holder, spirit lamp
and match box. The hand washing items-soap, towel, nail brush, small mackintosh
or plastic sheet and plastic aprons
Physical assessment instruments:
fetoscope, inch tape, shakir tape and spring balance to check weight
Sterile compartment:
instruments-artery forceps, thumb forceps, small towel and scissors. A pair of
disposable glove or paper gloves
Miscellaneous articles: mucous
suckers, tallquist paper for checking hemoglobin and small catheter
STEPS OF PROCEDURE WITH COMMUNITY BAG
Select a work area according to the
convenient of the family
Place the bag in a mat in a veranda
on newspaper
Unbutton the bag of lower compartment
Remove hand washing equipment and
wash hands properly
Remove apron from the bag and put it
on
Remove the need items from the
outside compartment
Give nursing care based on the plan
When procedure is over, wash hands
with soap and water
Place the articles to the bag after
cleaning
Fold used newspaper with used side
inside
Close the bag
Record your procedures and
observation and instructions given
HOME HEALTH NURSING PROCEDURES
The
community health nurse primary responsibility to meet health needs of the
family, it is necessary to provide nursing care on a selective basis and to
demonstrate the care to some responsible members of the family. It is
recognized that nurses working in the community health field have been trained
in many different hospitals and schools; they were taught procedures have
changed community
PRINCIPLES TO BE OBSERVED
Resources usage: standard procedures
should be followed as far as possible utilizing materials and equipment found
in the home
Demonstration: demonstration of
nursing care in the home is most effective method of teaching
Standing orders: medical instructions
in the form of standing instructions or individual instructions must be
available before administering medicine or treatment
Prevent spread of disease: the health
worker must know to check the disease at its sources. The practice of medical
asepsis and the habit of thorough cleanliness at all time is basic to all
procedures
Respect the families: practice as far
as possible custom and habits are scared to the family. Habit changes are slow
and come with knowledge and action which the nurse may initiate and/or
participate in through individual and group teaching
Comfort and relationships: consider
comfort and relationship when selecting the patients unit. The nurse must
select the place where the patient will get rest, privacy and clean air. The
sick person may be housed comfortably and at the same time, prevent the spread
of infectious material
Economical use: supplies and
equipment economically, always consider the high cost of fuel, the hardship in
getting water and the family economics
Teaching: the community health nurse
should teach the patient and responsible member of the family, teach with
proper demonstration and also encourage to do return demonstration
Record keeping: adequate records and
reports are an integral part of every good nursing service. Records should be
maintained up to date
Prevention of accidents: write name
of the drug and instructions for taking using the language of the people.
Inform the family to keep all drugs locked in their cupboards and out of reach
of children
Health promotion: safe water,
latrines, drainage, cooking arrangement, bathing, absence or presence of
animals within the compound or in the house is of major importance in the
promotion of health
Nutritional observation: observation
and action relative to the nutritional status of the family is a primary
responsibility of the nurse
COMMUNITY BAG – Importance of Community Bag, Principles of Bag Techniques, Articles Used in Community, Steps of Procedure with Community Bag, Home Health Nursing Procedure and Principles to be observed (Community Health Nursing)
Here is a general outline of the community bag technique:
1. Purpose and Preparation:
Identify the purpose of the visit, whether it’s a routine assessment, health education, or specific care needs.
Review the patient’s health record and care plan to determine the required supplies.
2. Selecting the Bag:
Choose a durable and easily portable bag with compartments or pockets to organize different types of supplies. Backpacks or tote bags with multiple sections are commonly used.
3. Essential Supplies:
Pack essential supplies based on the nature of the visit. Common items may include:
TEPID SPONGE/COLD SPONGE (Cold Application) – Definition, Purpose, General Instructions, Preliminary Assessment Check, Effects, Physiologic Effects, Indications, Preparation of the Patient and Environment, Equipment, Procedure, After Care and Contraindications
Updated 2024
Tepid
sponging or cold sponging is a general application of moist cold liquid to cool
skin, by evaporation and by the absorption of body heat in the cold water.
Tepid sponge is a process of sponging with tepid water to reduce body temperature by evaporation. The temperature of water used for tepid sponge is 80-90 degree F.
Tepid water is lukewarm, neither hot nor cold. It is often recommended for cleaning wounds or sensitive skin.
It can be more comfortable for general cleaning tasks, as extreme temperatures can be harsh on the skin.
Tepid water is suitable for washing the face or body, especially if you have sensitive skin.
Cold Sponge:
Cold water can be refreshing and invigorating, making it a good choice for hot weather or when you need a pick-me-up.
It can help reduce inflammation and soothe sore muscles or joints.
Cold water may be preferred for some beauty routines, as it can tighten pores and give a refreshing feeling to the skin.
PURPOSE
Tepid sponge helps to reduce the
temperature between 102 and 102.8 degree F.
Cold sponge helps reduce the
temperature of above 103 degree F.
To stimulate circulation
To decrease toxicity
Nervousness and delirium
To soothe the nerves and promote
sleep
GENERAL INSTRUCTIONS
Cold sponging is used to reduce
temperature in a patient with hyperpyrexia
Large areas of the body are sponged
at one time, permitting the heat of the body to transfer to the cooler solution
on the body surface.
Often wet towels are applied to the
neck, axillae, groin and ankles, where the blood circulation is close to the
skin surface
The vital signs are checked very
frequently to detect the early signs of complications
The physiological effect of the cold
applications are vaso-constriction, decreased blood circulation, decreased
capillary permeability, decreased metabolism, decreased blood viscosity, etc.
The application moist cold is more
effective than the application of dry cold as the moisture distributes the cold
to large and deep area
There must be a written order for
tepid sponge or cold sponge
Use long strokes for sponging and
avoid circular movements or friction while sponging
Keep the hot water bag ready at the
foot end of the bed
PRELIMINARY ASSESSMENT
Check
The doctors order for any specific
instructions
General condition and diagnosis
Self-care ability of the patient
Assess the duration of application
For contraindication to cold
application
Articles available in the unit
PREPARATION OF THE PATIENT AND ENVIRONMENT
Explain the sequence of the procedure
Provide privacy
Check the initial temperature and
should be checked every 15 minutes intervals
Position the patient comfortably in
the bed
Remove the patient gown and place
with bath blanket
Bring the patient to the edge of the
bed
Place the long Mackintosh and draw
sheet under the patient
Arrange the articles to the bedside
PROCEDURE
Wash hands
Mix the water with ice cubes
Soak the wash cloths in the ice cold
water for some time
Place cold sponge cloths in each
axial and groin
Put the face towel under the head
sponge the face and dry with face towel
Sponge the neck, right arm from the
shoulder to the finger tips for 3 minutes
Change sponge cloth when it becomes
warm
Sponge the left arm, chest and
abdomen for 3 minutes
Change the water if it becomes dirty
and check the temperature
Cover the upper half, of the body and
expose the lower half of the body
Sponge the right and left lower limb
for 3 minutes
Then carefully turn the patient for
his side and bring patient to edge of bed. Sponge the back with long strokes
for 3 minutes
Dry the part with bath towel and
apply spirit on the back
Check the temperature at 20 minutes
interval and record it in the TPR chart
TEPID SPONGE/COLD SPONGE – Definition, Purpose, General Instructions, Preliminary Assessment Check, Effects, Physiologic Effects, Indications, Preparation of the Patient and Environment, Equipment, Procedure, After Care and Contraindications
SURGICAL SOAK – Purpose, Preliminary Assessment, Preparation of the Patient, Equipment, Solutions Used and Procedure
Updated 2024
Surgical
soak is the submerging or directly immersing a body part or wound in a
therapeutic solution using sterile technique
Surgical
soak is the local bath of the part of the body such as arm or foot. When there
is an open wound moist heat is applied by soaking or immersing the part in
sterile warm solution
PURPOSE
To promote wound healing by increased
circulation
To relieve discomfort and pain
To relieve congestion and crust
formation
To reduce edema
To aid cleaning of slough from wounds
To apply medication to locally
infected area
To make manipulation of painful area
easier
As preparation for surgery, for
example, diabetic ulcer foot for skin grafting
However, here are some general key points that might apply to such procedures:
Aseptic Technique: Maintaining aseptic or sterile conditions is crucial during any surgical procedure. This includes the use of sterile solutions for soaking or irrigating to minimize the risk of infection.
Choice of Solution: The choice of solution for soaking or irrigating depends on the nature of the surgery and the body part involved. Common solutions include saline, antiseptic solutions, or specialized irrigation solutions.
Temperature Considerations: Ensure that the solution used for soaking or irrigating is at an appropriate temperature. Extreme temperatures can be harmful to tissues, so solutions are typically warmed to body temperature.
Proper Irrigation Technique: The technique used for irrigation is important. It should be gentle yet effective in removing debris or contaminants. The surgeon or medical professional performing the procedure needs to be skilled in proper irrigation techniques.
Monitoring Fluid Absorption: In some cases, especially in procedures involving body cavities, it’s important to monitor the volume of fluid used for irrigation to prevent complications such as fluid overload.
Postoperative Care: After the procedure, postoperative care includes monitoring for any signs of infection, proper wound care, and ensuring that the patient is recovering well.
