UPDATED 2024

Terminal disinfection typically refers to the thorough disinfection of surfaces and equipment in a healthcare setting, particularly in areas such as patient rooms, operating rooms, and other high-risk areas where the spread of infections can occur. The goal is to eliminate or reduce the presence of pathogens, including bacteria and viruses, to prevent the transmission of infections.

Here are some general steps and considerations for terminal disinfection in healthcare settings:

1. Personal Protective Equipment (PPE): Ensure that individuals performing the disinfection process wear appropriate PPE, including gloves and, if necessary, masks and gowns.
2. Cleaning: Before disinfection, surfaces should be cleaned to remove any visible dirt or organic material. Use a detergent or cleaning solution appropriate for the surfaces being cleaned.
3. Disinfection Agents: Choose an appropriate disinfectant based on the type of pathogens you are targeting. Common disinfectants include quaternary ammonium compounds, hydrogen peroxide, and bleach. Follow the manufacturer’s instructions for dilution and contact time.
4. Application Method: Apply the disinfectant according to the recommended method. This could involve using wipes, sprays, or other application devices. Ensure thorough coverage of all surfaces, especially high-touch areas.
5. Contact Time: Allow the disinfectant to remain on surfaces for the recommended contact time. This is the time the disinfectant needs to be in contact with the surface to effectively eliminate pathogens.
6. Ventilation: Ensure proper ventilation in the area being disinfected. This helps to reduce the concentration of disinfectant fumes and aids in the drying of surfaces.
7. Equipment and Furniture: Disinfect all movable equipment and furniture in the room, including bedrails, tables, and medical devices. Pay extra attention to high-touch surfaces.
8. Waste Disposal: Dispose of disposable items, cleaning materials, and any waste generated during the disinfection process according to established protocols.
9. Post-Disinfection Inspection: After the disinfection process, perform an inspection to ensure that all surfaces are adequately disinfected. Re-clean and re-disinfect any areas that may have been missed.
10. Documentation: Maintain records of the disinfection process, including the disinfectant used, concentration, contact time, and any issues encountered during the process.

DISINFECTION OF ARTICLES

Disinfection means destroying of all the pathogenic organisms. It is done either by physical or chemical method.

Types of Disinfectants

• Alcohols
• Ethanol
• Isopropanol

Advantages: wide microbicidal activity, noncorrosive

Disadvantages: not universally sporicidal, limited residual activity, fire hazard

Recommended for: hand disinfection in outpatient clinics

• Aldehyde
• Glutaraldehyde
• Orthophthaldehyde

Advantages: wide microbicidal activity and are sporicidal and fungicidal

Disadvantages: glutaraldehyde is potentially a toxic health hazard

Recommended for: 2% glutaraldehyde with alkaline pH used for disinfecting laminated non-autoclavable equipments

Orthphthaldehyde replacing glutaraldehyde as a nontoxic disinfectant

• Oxidizing agents
• Sodium hypochlorite

Advantages: wide microbicidal activity and are sporicidal and fungicidal

Disadvantages: corrosive

Recommended for: useful for disinfecting surfaces, water contamined equipments

• Hydrogen peroxide

Advantages: wide microbicidal activity and are sporicidal and fungicidal

Disadvantage: unstable compound; to be used in correct concentration

Recommended for: used for logging – high level disinfection of Operation Theater when used in concentration of over 6%

• Phenolics

Advantage: easily available, cheap

Disadvantage: corrosive to the skin and sometimes toxic to sensitive people. Household disinfectants

Recommended for: resistant organisms are common

Suitable for surface disinfection of residential premises

• Quaternary ammonium compounds

Advantages: active against enveloped viruses

Disadvantages: low sporicidal activity

Recommended for: low level disinfectants

Disinfectant

• Should be efficient
• Should be used in the correct strength
• Should be applied for a sufficient length of time
• Should not be injurious to the articles
• The article should be fully immersed in it

CONCURRENT DISINFECTION

Concurrent disinfection is the immediate disinfection of all contaminated articles and bodily discharges during the course of the disease

Concurrent disinfection of the contaminated articles immediately, then and there during the course of illness. It includes cleaning the isolation unit daily with effective disinfectant

• Urinals and bedpans: after emptying clean with brush soak in carbolic solution 1:40 for disinfection of articles: 10 minutes
• Sputum mugs: collect the sputum in a sputum mug with disinfectant lotion. When container is full, it should be boiled or buried
• Linen: keep the linen in a carbolic solution or any other effective disinfectant for 4 hours rinse, dry and send to laundry
• Blankets: autoclaving is the best
• Mattresses and pillow: place in direct sunlight for 6 hours for two consecutive days
• Mackintosh: soap in Lysol or phenol 1:40 or 4 hours. Wash and dry in shade
• Paper, cotton swabs, books: burn in disposal of all wastes by incineration
• Disposal of excreta: especially for enteric isolation the urine and stool should be mixed with equal quantity of ( 1 part of lime to 4 parts of water) and allowed to stand for two to four hours. Then disposed by burial

Disinfectant should not be added in stool and discarded in septic tank as the disinfectant hinders the natural biological action

TERMINAL DISINFECTION

Terminal disinfection means disinfection of the patients unit and all the articles used after the discharge, transfer or death of the patient who was suffering from the contagious disease

It means after the patient has recovered from a communicable disease, the disinfection of the room and articles used by him is done after his discharge from the unit or transfer or death

Fumigation with sulfur: fumigation is disinfection by exposure to the fumes of a vaporized disinfectant or use of fumes or gases to destroy organisms. Fumigation with sulfur- the room should be filled with steam form a kettle. Sulfur in an earthen ware which is kept in a large container with water. Pour methylated spirit over the sulphur, put the sulphur afire and close the room

Fumigation with formalin: it is done with potassium permanganate crystals and formalin is used for this purpose. Mix and place them in a metal bowl. For 100 cu feet, 140 gm of KMO₄ and 250 ml of formalin are to be used then room should be closed completely and seated for 24 hours for effective disinfection

Isolation technique, a medical aseptic practice, inhibits the spread and transfer of pathogenic organisms by limiting the contacts of the patient and creating some kind of physical barrier between the patient and others. In isolation techniques, disinfection procedures are employed to control contaminated items and areas.

Disinfection is described as the killing of certain infectious (pathogenic) agents outside the body by a physical or chemical means. Isolation techniques employ two kinds of disinfection practices, concurrent and terminal

The post CONCURRENT & TERMINAL DISINFECTION first appeared on Nurse Info.

UPDATED 2024

Cardiopulmonary resuscitation is a lifesaving technique useful in many emergencies, including heart attack or near drowning, in which someone’s breathing or heartbeat has stopped. The American Heart Association recommends that everyone – untrained bystanders and medical personnel alike – begin CPR with chest compressions.

Resuscitation includes all measures that are applied to revive patients who have stopped breathing suddenly and unexpectedly due to either respiratory or cardiac failure.

Cardiac arrest is one of the common causes for cardio-respiratory failure. When a person stops breathing spontaneously, his heart also stops beating. Clinical death occurs within 4-6 minutes, the cells of the brain which is sensitivity to the paucity of oxygen begin to deteriorate. If the oxygen supply is not restored, the patient suffers irreversible brain damage and biological death occurs.

DEFINTION

Artificial ventilation accompanied by cardiac massage to facilitate normal breathing and heart action in the event of cardiac arrest.

PURPOSE

To re-establish effective ventilation and circulation

 EQUIPMENT

• Cardiac board
• Suction apparatus
• Oxygen supply
• Box containing Ambu bag
• Sterile endotracheal tube (2.5 – 5.5 mm)
• Extra-batteries
• Laryngoscope with 0, 1, 2 size tongue blades and stillet, Magill forceps, adhesive scissors, airway syringes 1, 2, 5, 10 cc
• Intracardiac needle 20 G, 22 G, 6-8 cm length
• Needles 23 G and 20 G
• Elastoplasts bandage
• Ventilation given with ambu-bag

GENERAL INSTRUCTIONS

• Identify “RED FLAG” signs of critically ill child-changes in level of consciousness, flaccid posturing, cyanosis severe chest retractions, grunting respiration, increased respiratory rate, shallow respiration, see saw respiration, i.e. abdominal protrusion with inhalation, irregular respirations with periodic deep sighs, apneas, absent pulse, absent heart rate, absent carotid pulse, dilated pupils, unrecordable blood pressure, cold clammy skin
• ACT quickly! As child can go into cerebral hypoxia within 3 to 4 minutes which will lead to permanent brain damage
• Assess child (look, listen, feel) and if not breathing call for help
• Immediately start cardiopulmonary resuscitation (CPR)
• Equipment for CPR to be always accessible and is functioning condition
• All CPR equipment to be checked at beginning of each shift
• All staff to be skillful at CPR

PROCEDURE

• Airway: establish patient airway by suctioning oropharynx with catheter, and deflate stomach by aspirating stomach contents

Ventilation by mouth to mouth:

• Breathing: establish breathing by artificial ventilation

Place

Ambu bag on mouth and nose, and connect to 100% oxygen. Select ET tube using the formula:

Age in years + 4 /4

Calculate size of ET tube approximately as diameter of child’s little finger. The ET tube is inserted

• Circulation: initiate cardiac compression to a distance calculated using the formula (ET size multiply 3 cm)

METHOD

Serial rhythmic compressions of chest that help circulate oxygen containing blood to vital organs

Infant

• Site: sternum compression – below level of infant’s nipples
• Width one finger breadth
• Depth 0.5 – 1 inch
• Rate 100 times per minute

Child

• Site: lower margin of child’s rib cage to notch where ribs and sternum meet
• Avoid compression over notch
• Place heel of nurse’s hand over lower half of sternum (between nipple line and notch)
• Depth: 1-1.5 inches
• Rate: 100 times per minute

Ratio of Cardiac Compression to Ventilation (CPR)

• 2 persons – 5:1
• 1 person – 15:2

One Rescuer CPR

Shake shoulders and ask “are you okay”, shout for help. Open the airway: the most important action for successful resuscitation is immediate opening of the airway. Tilt the head by applying firm backward pressure on the victim’s forehead with palm of one hand. Place two or three fingers of the other hand under the bony part of the lower jaw near the chin and lift the chin

Check for breathing: please check close to victim’s mouth and nose. Look at chest to see if it rises and falls. Listen and feel for exhaled air (for at least 5 seconds)

External Cardiac Massage

Breathe: maintain an open airway. Pinch nose. Seal lips around victims mouth and deliver two full breathes watching chest to rise and fall with each breath

Check for circulation: feel for a carotid pulse. Again shout for help/activate EMS system. If pulse is present, continue to give artificial ventilation at the rate of 1 breath or 12 mm

Circulate: if pulse is absent, run fingers along the lower rib to notch in centre of the heart where ribs meet sternum. With middle finger in notch, place index finger on lower end of sternum. Place heel of other hand on lower ½ of sternum next to index finger. Put the heel of 1^st hand on top. With shoulders directly over sternum and elbows locked, compress straight up and down 15 minutes, at the rate of 80 – 100 times a minute, using the count “one and two and three and”, etc. return quickly to victims head to deliver two breaths. Compression depth should be 1.5 – 2 inches

Two-rescuer CPR: two medical professional arriving at same time – no

CPR in Progress

• First rescuer

Determine unresponsiveness

Opens the airway

Checks for breathing

Ventilates twice, watching chest movement

Checks for carotid pulse: give command to begin compressions if pulse is absent

• Second rescuer

Locates landmark and proper hand position on sternum

Begins chest compressions on command – at rate of 80-100 per minute, counting “one and two and three and four and five and”

Pauses after each fifth compression to allow for ventilation

Calls for a switch when fatigued. Give clear signal “change and two and three and four and five”

• Both rescuers change simultaneously

Compression moves to victim’s head. After checking for pulse, give breath and command to continue compressions

Ventilator moves to chest: finds landmark and properly positions hands, begins compressions on command pausing after each 5^th compression for breath

If CPR is in progress by lay person, rescue team enters after completion of cycle of 15 compressions and 2 ventilations and start with a reassessment

If CPR is in progress by a professional rescuer, the 2^nd professional rescuer takes over compressions at the end of a cycle and after 1^st rescuer reassesses pulse and gives another breath

DO’S AND DONOT’S IN CPR

DO’S

• Reassure victim that help is on the way
• For major injuries call 9-1-1 immediately
• Check victim’s status regularly
• Use direct pressure to stop bleeding
• Check to see if victim’s airways are clear
• If no pulse or respiration, start CPR
• To prevent transmission of disease, use latex gloves
• Keep victims in shock warm (use blanket, etc)
• Assume spinal injury when blunt force trauma is present
• Raise head if bleeding in upper torso area
• Raise feet if bleeding in lower torso areas
• Flush all burns and chemical injuries with clean water
• Have MSDS sheets on the jobsite for 9-1-1 responders
• Call the Poison Control Center for chemical ingestion

DON’TS

• Do not move the victim unless absolutely necessary
• Always suspect “spinal injury” (and don’t move the victim)
• Do not set fractures and breaks (simply immobilize the victim)
• Do not apply a tourniquet (use “direct” pressure to stop bleeding)
• Do not remove items imbedded in the eye (cover with a Dixie cup)
• Do not use burn ointments
• Do not hesitate to call 9-1-1

COMPLICATIONS

Cardiopulmonary resuscitation, or CPR, is a technique used to support the circulation of blood and oxygen in the body of a victim who is not breathing and does not have a pulse. CPR is physically invasive for the victim and techniques used during CPR carry risks and the chance of complications. Ultimately, the risk of complications is small and should not deter the use of CPR for a victim in need

Broken bones

Rib fractures are the most common complication of CPR. Chest compressions administered during CPR are given quickly and with enough force to compress the chest about 1 inch in depth. This provides pressure to the ribs, which can be strong enough to cause ribs to fracture. Victims who are elderly, small in stature or children have the highest risk of developing rib fracture during chest compressions. Additionally, the chest bone, or sternum, also endures pressure and stress during chest compressions and can fracture as well

Internal Injuries

Internal organs lie within the area pressured by chest compressions. As the chest is compressed during CPR, ribs and chest bones can break, puncturing the lungs and liver. Additionally, internal bruising of the heart and liver can occur

Vomiting and Aspiration

As chest compressions are administered, pressure builds inside the body, which can force stomach contents up the esophagus and result in vomiting. This causes the risk of aspiration, or absorbing the vomit into the respiratory system. Aspiration is a serious complication which makes it difficult to provide the victim with adequate air and can ultimately damage lung tissue or result in infection, like pneumonia.

Body Fluid Exposure

CPR presents the risk of exposure to body fluids. It provides mouth-to-mouth rescue breathing to a victim without use of a mask results in saliva exposure between victim and rescuer. Blood and vomit may also be present during CPR, which carries the risk of communicable disease such as hepatitis and AIDS. The American Heart Association encourages the use of a barrier mask when administering rescue breathing during CPR for protection against contamination

Gastric Distention

Rescue breathing during CPR provides air directly into the lungs of the victim. If air is delivered too forcefully or for too long a time, the victim can accumulate air build-up in the stomach, called gastric distension. Gastric distension causes the stomach to swell and places pressure on the lungs. CPR efforts can become complicated if gastric distension occurs due to reduced ability to deliver adequate oxygen to the lungs, and can also result in vomiting and aspiration. Gastric distension can often be avoided by proper, careful administration of rescue breathing during CPR

ADMISSION PROCEDURE

CARE OF PATIENT UNIT

NURSING PROCEDURES LIST CLICK HERE

The post CARDIOPULMONARY RESUSCITATION (CPR) first appeared on Nurse Info.

UPDATED 2024

Back care means cleaning and massaging back, paying special attention to pressure points

Back massage provides comfort pleases and relaxes the patient; thereby it facilitates the physical stimulation to the skin and the emotional relaxation

Back rub means attending the back and pressure points of body with special care it is often called as back care or back massage

Purpose

• To give comfort to the patient
• To stimulate blood circulation
• To promote rest and sleep
• To prevent pressure sores
• To assess the skin condition
• To relax and relieve tension in tissues and muscles
• To refresh patient and relieve fatigue

General Instructions

• Back care given as a part of morning care and evening care
• Pressure points are attended more frequently and the position is changed
• When the skin is greasy, moist, thin about to break or patient is in continent or edematous used spirit or powder to reduce friction
• When the skin is dry, use oil for back rub. Spirit toughens the skins and powder reduces friction oil lubricates the skin and, hence friction
• When giving back rub, use more pressure on upward strokes towards the head and less pressure on the downward strokes
• Back rub may be contraindicated in patients susceptible to clotting disorders

Equipment

A tray containing of:

• A basin of warm water
• Sponge cloths – 2
• Soap and towel
• Surgical spirit or back-rub lotion and powder
• Mackintosh and towel
• Kidney tray and paper bag

Procedure

• Wash hands and explain the procedure
• Screen the patient and explain the procedure
• Turn the patient on his side
• Turn back top bedding and expose only required part
• Spread towel close to the patients back to protect bed linen
• Wash back thoroughly from cervical spine to the coccyx
• Apply soap in the same manner. Run hands firmly and slowly up the back on either side of the vertebral column up the neck and down across the shoulders
• Pour some spirit in to hand applies firmly in a circular motion repeat until back is thoroughly rubbed with it
• Wash off soap and dry thoroughly with towel
• The back must be rubbed three to five minutes especially over pressure points
• Apply back powder after through drying of the spirit
• Remove the towel
• Cover the patient with top bedding

After Care

• Make the patient comfortable
• Remove the screen and equipment
• Clean the articles with soap and water and keep ready for next use
• Wash hands
• Record the date, time treatment and observation made on nurse’s record

NURSING PROCEDURES LIST CLICK HERE

The post BACK CARE / BACK MASSAGE / BACK RUB first appeared on Nurse Info.

UPDATED 2024

Urine testing, also known as urinalysis, is a diagnostic test that involves analyzing a person’s urine for various markers, compounds, and characteristics. This type of testing can provide valuable information about a person’s overall health, help diagnose medical conditions, and monitor the effectiveness of treatments.

USES OF URINE TESTING

Here are some common uses of urine testing:

1. Drug Testing: Urine tests are frequently used to screen for the presence of drugs and their metabolites. This is common in workplaces, athletic organizations, and legal situations.
2. Medical Conditions: Urinalysis can help diagnose various medical conditions, such as diabetes, kidney diseases, urinary tract infections (UTIs), and liver problems. Abnormal levels of glucose, protein, blood cells, or other substances in the urine may indicate an underlying health issue.
3. Pregnancy Testing: Urine tests are often used to detect the presence of human chorionic gonadotropin (hCG), a hormone produced during pregnancy. Home pregnancy tests typically use urine samples for this purpose.
4. Kidney Function: Urine tests can provide information about kidney function by measuring levels of creatinine, urea, and other substances. Changes in these levels can indicate kidney problems.
5. Metabolic Disorders: Certain metabolic disorders, such as phenylketonuria (PKU) or maple syrup urine disease (MSUD), can be diagnosed through urine testing.
6. Monitoring Medications: Some medications can be monitored through urine testing to ensure that they are at therapeutic levels and not causing adverse effects.

URINE TESTING

Urine analysis methods comprise testing reaction, specific gravity, albumen, sugar, bile, acetone, pus, blood and yeasts microscopically

Purpose

• To detect reaction, in cystitis the reaction is alkaline
• To detect sugar, it is present in diabetes mellitus
• To detect – protein it is present in kidney damage, pre-eclampsia and is called proteinuria
• To detect acetone, it is present due to incomplete metabolism of fat
• To detect bile – it is seen in cases of obstructive jaundice or hemolytic diseases
• To detect pus cells – it is present due to urinary tract infection
• To detect blood – it is seen in snake bite, fracture pelvis, etc

Characteristics of Normal Urine

• Volume: 1,000 to 2,000 ml in 24 hours
• Appearance: clear
• Odor: aromatic color
• Color: amber or pale straw in color
• Reaction: normal urine is slightly acidic
• Specific gravity: 1.010 to 1.025
• Constituents of the normal urine: water 96 percent, urea 2% and uric acid, urates, creatinine, chlorides, phosphates, sulfates, oxalates – 2% 

Characteristics of Abnormal Urine

Volume

• Polyuria – increased in volume
• Oliguria – decreased in volume
• Anuria – total absence or marked decrease of urine
• Suppression – failure of the kidney to secrete urine

Color

• Green or brownish yellow – bile salts and bile pigments
• Reddish brown – urobilinogen
• Bright red – a large amount of fresh blood
• Smokey brown – blood pigment
• Milk white – chyluria due to filariasis

Appearance

• Mucus – appears as a flocculent cloud
• Pus – settles at the bottom as a heavy cloud
• Stones – as fine sand
• Uric acid – as grains of pepper

Odor

• Sweetish or fruity odor – seen in diabetes

Reaction

• Alkaline – cystitis
• Specific gravity
• Diabetes mellitus – increased specific gravity
• Renal disease – low specific gravity
• Constituents of urine
• Kidney damage – albumin

Types of Examination of the Urine

• Physical examination: color appearance, volume, reaction, specific gravity and color
• Chemical examination: routine tests such as for albumin and sugar. Special tests such as tests for acetone, bile pigments and bile salts. Microscopic examination – crystals, casts, RBC, pus cells, epithelial and bacteria

Preliminary Assessment

• The doctor order for any instructions
• Articles available in the unit
• General condition and diagnosis of the patient
• Self-care ability of the patient

Preparation of the Patient and Environment

• Explain the procedure to the patient
• Keep the urine sample ready
• Arrange the articles ready in the treatment
• Provide labeled container for collecting urine

Equipment

• Test tubes 4 to 6 on a test tube
• Test tube holder – 1
• Spirit lamp – 1
• Match box – 1
• Kidney tray with lining to discard the wastes
• Duster or rag piece – to wipe the outside of the test tube before heating
• Acetic acid – to test urine for albumin
• Nitric acid or sulfosalicyclic acid – to test urine for albumin
• Red and blue litmus paper – to test the reaction of the urine
• Urinometer – to measure the specific gravity of the urine
• Benedict’s solution – to test urine for sugar
• Ammonium sulfate crystals, sodium nitroprusside crystals and liquor ammonia to test urine for acetone
• Weak solution of Tr. Iodine to test for bile pigments
• Sulfur powder: to test for bile salts
• Glass jar: to measure the amount of the urine
• Pipette – 2 – to measure drops of urine and reagents
• A small bottle brush – to clean the test tubes

Procedure

Sugar Test

• Take test tube and fix in holder
• Pour 5 ml of Benedict’s solution into test tube
• Light spirit lamp and heat Benedict solution till it boils
• Holding test tube mouth facing away from nurse
• Add 8 drops of urine using dropper and allow boiling for few seconds
• Put off flame and cool test tube under running water

Observations

• Blue: Nil
• Green: +
• Yellow: ++
• Orange: +++
• Brick red: ++++

Albumin Test

A hot test

• Fill 2/3 of test tube with urine, secure test tube holder at very top
• Heat the upper third of test tube over flame
• If there is precipitation, it denotes the presence of wither protein or phosphate
• Add 2-4 drops of 2 percent acetic acid
• If precipitate dissolves it is due to phosphates present in normal urine
• If precipitate does not dissolve it denotes presence of albumin

Observation

• Trace: +
• Cloudy:++ (100mg/dL)
• Thick cloudiness: +++ (500 g/dL)

Cold Test

• Pour a small quantity of nitric acid or sulfosalicylic acid 3 percent in to a clean test tube
• Allow equal quantity of urine to trickle down the sides of the test tube
• If albumin present, a white precipitate will be seen where two fluids meet

Urine pH

• Collect and keep ready with urine sample
• Dip litmus strip in urine and keep for one minute
• Note color change
• Discard strip into container for infected waste

Urine Specific Gravity

• Fill 3/4 of jar with urine
• Gently place urinometer into jar
• When urinometer stops bobbing
• Read specific gravity directly from scale marked on calibrated stem of urinometer
• Make sure that instrument floats freely and does not touch sides of jar
• Read scale at lowest point of meniscus to ensure an accurate reading at eye level

Rothera’s Test (Acetone)

• Take 2 cm depth of ammonium sulfate crystals in a small test tube
• Add equal volume of urine and one crystal of sodium nitroprusside
• Close the test tube with a cork and shake the test tube
• Take liquor ammonia and add it to the urine, trickling through the sides
• Read the results immediately

Observations

If acetone is present permanganate purple colored ring is formed at the junction of urine and ammonia

Hays Test (Bile Salts)

• Take a test tube, half full of urine
• Sprinkle sulfur powder on the surface of the urine
• If the powder sinks down to the test tube, it indicates the presence of bile salts

Smith’s Test (Bile Pigments)

• Fill 3/4 of test tube with urine
• Add iodine drops along the sides of the tube, so as to form a layer on the surface of the urine
• A green color at the junction of the two liquids indicates the presence of bile pigments

After Care

• Discard the urine in the sluice room
• Wash the test tube with soap and water
• Dry the tube, holder and urinometer with jar
• Replace the article after cleaning
• Wash hands thoroughly

Record the procedure in the nurse’s record sheet and dietetic chart

The post URINE TESTING first appeared on Nurse Info.

UPDATED 2024

A clinical thermometer is a special instrument designed to measure the temperature of the body. Two thermometers – one oral and one rectal – are essential equipment which the nurse always carries in her bag. Elevation in temperature is an indication that the body is reacting to an infection

PRINCIPLES

• Meticulous cleaning of thermometer before and after use is essential to prevent the spread of infection
• Temperature is usually taken by mouth. Rectal temperatures are most accurate while auxillary temperatures are least accurate
• Shake the mercury to 95 degree F before taking the temperature
• Keep all thermometers in the shade and in the coolest part of the building
• Accuracy in temperature helps in effective treatment and medical decision

EQUIPMENT

• Ten small cotton swabs
• Kidney basin to hold moist cotton swabs
• Thermometer
• Lubricant for rectal temperature
• Paper bag

PROCEDURE

• Use bag technique as per standard precautions
• Remove the thermometer swab up to bulb and read
• Place the thermometer at proper site
• Rinse the thermometer thoroughly under cool running water after reading
• Replace it in the community bag and wash hands
• Record it in the TPR sheet

The post TEMPERATURE TECHNIQUES first appeared on Nurse Info.

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

The post CHOLECYSTOGRAPHY first appeared on Nurse Info.

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

The post ORAL HYGIENE first appeared on Nurse Info.

UPDATED 2024

A smear is prepared in a clean slide, spread with thin film of the material to be examined. In bacteriology, material spread on a surface as a microscopic slide

SPUTUM

Sputum is material from the mucous lining of the bronchial tubes and trachea. Its consistency varies from a thin, watery fluid to thick, purulent material, and it has a Ph of 6.6 to 7.1

PURPOSE OF SPUTUM EXAMINATION

An examination of sputum is made chiefly to reveal the presence of bacteria. Bacteria commonly looked for in sputum include those that cause tuberculosis or pneumonia

GENERAL INSTRUCTIONS

• The most favorable time to collect a sputum specimen is early in the morning to avoid having food particles mixed with it
• There is more sputum in the morning because it has not been coughed up during the night
• The container most commonly used for the collection is a disposable plastic cup
• If the sputum is not examined at once, sputum is kept at room temperature until it can be examined
• Instruct the patient to wash the mouth with plain water few minutes before taking the specimen
• Totally 3 consecutive specimens should be taken, spot smear A- 1^st day, early morning B-2^nd day and spot smear on next day C-3^rd day

PROCEDURE

• A 24 hours sample is better if not overnight sputum in a clean container
• Select a new unscratched slide using a broomstick
• Spread sputum on the slide using a broomstick
• Allow the slide to air dry for 15-30 seconds
• Fix the slide by passing it over the flame of spirit lamp
• The slide may be wrapped in clean paper and sent to the primary health center along with the request

The post PREPARATION OF SPUTUM SMEAR first appeared on Nurse Info.

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

The post SUTURE REMOVAL first appeared on Nurse Info.

UPDATED 2024

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

SUPINE & DORMANT  RECUMBENT

LITHOTOMY & PRONE

KNEE-CHEST/GENUPECTORAL & TRENDELENBURG’S

FOWLER’S & C-SHAPED

ROSE & RECOVERY

PATIENT POSITIONING

NURSING PROCEDURES LIST CLICK HERE

The post PATIENT POSITIONING – LATERAL & SIM’S POSITION first appeared on Nurse Info.