Professional Caregiving Reviewer

Soft Tissue Injury

2014-06-15T08:06:00.000-07:00

WOUND – is a break in the continuity of a tissue of the body either internal/external. 2 CLASSIFICATION OF WOUNDS CLOSED WOUND Causes: Blunt object results in contusions/bruises. Application of external forces. Signs & symptoms: Pain & tenderness Swelling Discoloration Hematoma Uncontrolled restlessness Thirst Symptoms of shock Vomiting/cough up of blood Passage of blood in the unrine/stood Signs of blood along nose, mouth & ears. First aid management Ice application Splinting OPEN WOUND Classification of open wound: Puncture Abrasion Laceration Avulsion Incision Dangers Hemorrhage Shock infection Kinds of bleeding Arterial bleeding – bright red Venous bleeding – dark red Capillary bleeding – red FIRST AID MANAGEMENT Wound w/ severe bleeding Cover the wound using a dressing & secure with bandage. Control the bleeding Care for shock Consult a physician Wound w/ minimal bleeding Clean the wound w/ soap & water Apply mild antiseptics Cover wound w/ dressing/bandage BURNS – an injury involving the skin, including muscles, bones, nerves, & blood vessels. This result from heat, chemical, electricity, or solar & other forms of radiation. FACTORS TO DERTERMINE SERIOUSNESS OF BURNS DEPTH 1st degree burns 2nd degree burns 3rd degree burns The extent to the affected body surface area Location of the burns Victims, age & medical conditions. SECOND DEGREE Minor – less than 15% of the body Moderate – 15-30% of the body Severe – 30% of the body THIRD DEGREE Minor – 2% of the body Moderate – 2-10% of the body Severe – 10% of the body TYPES OF BURNS INJURIES Thermal Burns – not all thermal burns are cause by flames. Contact w/ hot objects, flammable vapor that ignites and cause a flash or explosion, & steams or hot liquid are other common cause of burns. CARE FOR THERMAL BURNS: CARE OF 1ST AND 2ND DEGREE BURNS Relieve pain by immersing the area in a cold water or applying a wet, cold cloth. If water is unavailable use only cold liquid you drink to reduce the burned skin temperature. Cover the burn w/ dry, non-sticking, sterile dressing or a clean cloth. CARE OF 3RD DEGREE BURNS Cover the burn w/ a dry, non-sticking sterile dressing or a clean cloth. Treat the victim for shock by elevating the legs & keeping the victim w/ a clean sheet or blanket. Chemical Burns – chemical will continue to cause tissue destruction until the chemical agent is removed. CARE FOR CHEMICAL BURNS: Immediately remove the chemical by flushing w/ water. Remove the victims contaminated clothing while flushing w/ water. Flush for 2 mins, or longer. Let the victim wash w/ mild soap before a final rinse. Cover the burned area w/ a dressing, for large areas use clean pillow case. If the chemical is in the eye, flood it for at least 20 mins, using low pressure. Seek medical attention immediately for all chemical burns. Electrical burns – exposure to electrical current depends on the type of current, the voltage, the area of the body & the duration of contact. CARE FOR ELECTRICAL BURNS: Unplug, disconnect or turn off the power. If that is impossible, call the power company for help. Check the (ABC) airway, breathing, circulation. Provide RB & CPR if necessary. If the victim fell check for spinal injury. Treat victim for shock Seek medical attention immediately. Electrical injuries are treated in burns centers. OTHER SOFT TISSUE INJURIES: NOSE BLEEDING FIRST AID : Let the pt. sit down w/ the head slightly titled forward. Pinch all soft parts of the nose together between the thumb & 2 fingers w/ steady pressure of 5 minutes. Apply an ice pack over the nose & neck.

Foreign Objects

2014-06-15T07:56:00.001-07:00

THE EYES FIRST AID: Flush the object by rinsing the eye gently w/ warm water. Examine eyelid by pulling it down gently. Examine the upper lid by grasping the lashes, placing a match stick or cotton tipped swab across the upper lid & roll the upper lid. EXTRUDED EYEBALL/KNOCKED-OUT EYED FIRST AID: Cover eyes loosely w/ sterile dressing moistened w/ clean water. Protect injured eye w/ a paper cup. Cover undamaged eye w/ a patch to stop movement of the damaged eye. Seek medical attention immediately. CARE FOR IMPALED OBJECTS FIRST AID: Do not remove the object. Control any bleeding w/ direct pressure. Stabilize the object by securing a bulking dressing or clean cloth around the object. DENTAL INJURIES FIRST AID: Have the victim rinse his mouth & put rolled gauze pad in the socket to control bleeding. Find the tooth and handle it by the crown, never the rooth. Take the victim and the tooth to the dentist immediately. AMPUTATION FIRST AID: Care for the victims injuries. Took care of the amputated body parts. Seek medical attention immediately. Amputated body parts should be saved, place in ice. Don’t cause further injury. Don’t use absorbent cotton.

Caregivers here in America

2014-05-19T18:10:00.001-07:00

I know, many of you are too excited to finish this course so that you can take the TESDA exam and finally apply for work abroad and become Caregivers. I was once too eager to graduate and become a Professional Caregiver and yep, apply abroad. But, what do you really have to expect if you aspire to work as a Caregiver here in US? By the way, the rate may vary from State to State. But here in Minnesota if you are a CNA certified the hourly pay is from $11.00-12.00 per hour. Caregivers in the Philippines is equivalent to Certified Nursing Assistant here in USA which other people get the short course for 12 weeks and pays $1000.00 or more. While if you apply in senior living for like housekeeping, if you are interested to become CNA you can get the training for 2 weeks and for free. I have friend who is working in a Housekeeping Services in a Senior Living and her co-workers advised her not to take CNA Training because its really difficult and requires a lot of work. Some of them were CNA before, but choose to do the Housekeeping jobs. It is more difficult if you are in-charge of bedridden clients or obese which are heavy to lift. What does a CNA/Caregiver does in a Senior Living? Usually, a CNA's/Caregivers job is mainly on the residents well being. Such as the care and assists residents of their ADL; complete clinical documentation; taking vital signs; making sure that her environment is safe and comfortable etc. Yeah, you don't do the laundry, cooking or cleaning because there are other people who are assigned to do those work. What ever is your job description, that will be the only thing that you will do. What about if you apply as a Caregiver in a Homecare Setting? They call it here as CNA HHA (Hospice Homecare. You may be doing all the duties of a CNA/Caregivers in a Senior Living Setting and other work that may includes preparing meals, running errands for the client, grocery shopping, housekeeping tasks, doing laundry. Don't worry, washing maching here in US is very different from what we have in the Philippines. You're hands will not even get wet when you do laundry. And when you wash the dishes, they also have dish washers here, so its easy. It is important though that you know how to drive so you can do the errands.

Mental Health

2012-07-28T18:41:00.002-07:00

- is a state of emotional, psychological & social wellness evidenced by satisfying interpersonal relationships, effective behavior & coping a positive self-concept & emotional stability.

Components of Mental Health
- Autonomy & independence
- Maximizing one’s potential
- Tolerating life’s uncertainties
- Self-esteem
- Mastering the environment
- Reality orientation
- Stress management

Factors influencing a Person’s Mental Health can be Categorized as:
1. Individual Factors
- Person’s biologic makeup
- Having a sense of harmony in one’s life
- Vitality
- Finding meaning in life
- Emotional resilience/hardiness
- Spirituality
- Positive Identity

2. Interpersonal Factors
- Effective communication
- Helping others
- Intimacy
- Maintaining a balance of separateness & connection

3. Social/Cultural Factors

Age, Growth & Development - A person’s age can affect how he or she copes with illness or expresses illness

Genetic & Biologic Factors – Not under our control & are a result of our biologic makeup

Physical Health & Health Practices
– The healthier a person is, the better he or she can cope with strss or illness
- Personal health practices can have an impact on the clients response to illness
Self-Efficacy – Belief that personal abilities & efforts affect the events in our
lives

Hardiness – Person’s ability to resist illness when under stress

Resilience – Defined as having healthy responses to tressful circumstances or risky situations

Resourcefulness – Involves using problem-solving abilities & believing that one can cope with adverse or novel situations.

Spirituality – involves the essesnce of a person’s being & his or her beliefs about the meaning of life & the purpose for living.

Social Factors
– Sense of community
- Access to adequate resources
- intolerance of violence
- Support of diversity among people

Sense of Belonging
– Feeling of connectedness or involvement in a social system or environment of which a person feels an integral part.
- Involves of both feelings of value & fit

Social Networks – Groups of people whom one knows & with whom one feels connected

Social Support – emotional sustenance that comes from friends, family members, & even health care providers who help a person when a problem arises.

Family Support – Source of social support can be a key factor in the recovery of
clients with psychiatric illnesses.

Mental Illness – Seen as a medical problem with symptoms causing dissatisfaction with one’s characteristics, abilities & accomplishments; ineffective or unsatisfying interpersonal relationships; dissatisfaction with one’s place in the world; ineffective coping with life events; & lack of personal growth.

A Person should be Able to Do the Following:
1. S – self-awareness
2. I – Interpersonal relationship
3. R – Reality
4. A – Activities of Daily Living

Factors Contributing to Mental Illness
- Biologic factors & anxiety, worries & fears
- Ineffective communication
- Excessive dependece or withdrawal from relationships & loss of emotional control
- Lack of resources
- Exposure to violence, homelessness, poverty & discrimination

Personality Components
1. Id (More on Pleasurable Desire)
- Part of one’s nature that reflects basic desires, such as pleasure seeking behavior, aggression & sexual impulses.
- Seeks instant gratification, causes impulsive, unthinking behavior & has no regard for rules or social convention.

2. Superego (Moralistic Principle)
- Part of one’s nature that reflects moral & ethical concepts, values, parental & social expectations; therefore, it is in direct opposition to the Id.

3. Ego (Realistic Principle)
- Balancing or mediating force between the id & the superego
- Thought to represent mature & adaptive behavior, which allows people to function successfully in the world.

3 Levels of Awareness

1. Conscious – refers to the perceptions, thoughts & emotions that exist in the person’s awareness.

2. Preconscious – not concurrently in the person’s awareness, but they can be recalled with some effort.

3. Unconscious – the realm of thoughts & feelings that motivate a person, even though he or she is totally aware of them.
- Include most defense mechanisms & some instinctual drives or motivation.

Ego Defense Mechanisms
- Unconscious methods of attempting to protect the self & cope with basic drives or emotionally painful thoughts, feelings or events.

1. Compensation – Overachievement in one area to offset real or perceived deficiencies in another area.

2. Conversion – Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature.

3. Denial – Failure to acknowledge an unbearable condition; faliure to admit the reality of a situation, or how one enables the problem to continue.

4. Displacement – Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings

5. Fixation – Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage.

6. Identification – Modeling actions and opinions of influential others, while searching for identity or aspiring to reach a personal, social, or occupational goal.

7. Introjection – acccepting another person’s attitudes, beliefs & values as one’s own.

8. Projection – Unconscious blaming of unacceptable inclinations or thoughts on an external object.

9. Rationalization – excusing own behavior to avoid guilt, responsibility, conflict, anxiety or loss of self-respect.

10. Reaction Formation – acting the opposite of what one thinks or feels

11. Regression – Moving back to previous develommental stage in order to feel safe or have needs met

12. Repression – excluding emotionally painful or anxiety-provoking thoughts & feelings from conscious awareness.

13. Sublimation – Substituting a socially acceptable activity for an impulse that is unacceptable.

14. Substitution – Replacing the desired grtification with one that is more readily available.

15. Suppression – Conscious forgetting, a deliberate process of thought blocking.

16. Undoing – an attempt to erase an act, thought, feeling or desire.

17. Intellectualization – the feelings use of rational explanations to justify unacceptable behavior.

18. Fantasy – conscious distortion of unconscious feelings or wishes.

Heirarchy of Needs
1. Physiological Needs – food, water, sleep, shelter, sexual expression & freedom from pain.

2. Safety & Security – protection, security & freedom from harm or threatened deprivation
3. Love & Belonging – enduring intimacy, friendship & acceptance
4. Self-esteem – need for self-respect & esteem from others.
5. Self-actualization – highest level; need for beauty, truth & justice

TRANSFERRING BETWEEN BED & CHAIR

2012-07-28T08:20:00.001-07:00

Purpose:
1. To strengthen the patient gradually
2. To provide a change in position

Equipments:
- Robe or appropriate clothing
- Slippers or shoes
- Chair or wheelchair

Assessment:
- The clients body size
- Ability to follow instructions
- Activity tolerance
- Muscle strength
- Joint mobility
- Presence of paralysis
- Level of comfort
- The technique with wich the client is familiar
- The skill & strength of the caregiver

Preparation:
- Plan what to do & how to do it.
- Obtain essential equipment before starting & check if it is functional
- Remove obstacles from the area used for the transfer

Performance:
1. Introduce self & verify the clients identity using the agency protocol. Explain the transfer process to the patient.

- This facilitates cooperation of the patient

2.Perform hand hygiene.
- Hand hygiene deters the spread of microorganisms.

3. Provide for client privacy.

4. Position the equipment appropriately.
- Lower the bed to its lower position so that the clients feet will rest flat on the floor. Lock the wheels of the bed.

- Place the wheelchair parallel to the bed as close to the bed as possible.

Put the wheelchair on the side of the bed that allows the client to move toward his or her stronger side.

- Lock the wheels of the wheelchair & raise the footplate.

5. Prepare & assess the client
- Assist the client to a sitting position on the side of the bed.

- Assess the client for orthostatic hypotention before moving the client from the bed.

- Assist the client in putting on a bathrobe & slippers

- Place a transfer belt snugly around the client’s waist. Check to be certain that the belt is securely fastened.

6. Give explicit instructions to the client;
Ask the client to:

- Move forward & sit on the edge of the bed. This brings the clients center of gravitycloser to the nurse’s

- Lean forward sligtly from the hips. This brings the clients center of gravity more directly over the base of support & positions the head & trunk in the direction of the movement.

- Place the foot of the stronger leg beneath the edge of the bed & put the other foot forward. In this way, the client can use the stronger leg muscles to stand & power the movement. A broader base of support makes the client more stable during the transfer.

- Place the client’s hands on the bed surface or on your shoulders so that the client can push while standing. This provides additional force for the movement & reduces the the potential for strain on the nurse’s back. The client should not grasp your neck for support. Doing so can injure the nurse.

7. Position yourself correctly.
- Stand directly infront of the client. Encircle the clients waist w/ your arms & grasp the transfer belt at the clients back if there is any. The belt provides a secure handle for holding on the client & controlling the movement.

8. Assist the client to stand & then move together toward the wheelchair.

- On the count of three, ask the client to push with the back foot, rock to the forward foor & extend the joints of the lower extremities. Push or pull up with the hands, while pushing w/ the forward foot, rock to the back foot, extend the joints of the lower extremities & pull the client into a standing position.

- Support the client in an upright standing position for a few moments. This allows the nurse & the client to extend the joints & provides the nurse w/ an oportunity to ensure that the client is stable before moving away from the bed.

- Together, pivot or take few steps toward the wheelchair.

9. Assist the client to sit.
Ask the client to:
a. Back up to the wheelchair & place the legs against the seat.
- Having the client place the legs against the wheelchair seat minimizes the risk of the client falling when sitting down.

b. Place the fot of the stronger leg sligtly behind the other.
- This supports body weight during the movement

c. Keep the other foot forward.
- This provides a broad base of support.

d. Place both hands on the wheelchair arms or on your shoulders.
- This increases stability & lessens the strain on the nurse.
• Stand directly infront of the client. Place one foot forward & one back.
• Tighten your grasp on the trasnsfer belt & tighten your leg, gluteal, abdominal & arm musles.
• On the count of three, have the client shift the body weight & lower the body onto the edge of the wheelchair seat by flexing the joints of the legs arms.

10. Ensure client safety.
- Ask the client to push back into the wheelchair seat.
- Lower the footplates & place the clients feet on them.
- Apply a seat belt as required.

11. Documentation
- Clients ability to bear weight & pivot
- Number of staff needed for transfer
- Length of time up in chair
- Clients response to transfer & being up in chair or wheelchair.

Possible Interview Questions Part 2

2012-07-28T08:18:00.000-07:00

1. How did you determine the inflation point in taking BP?
- Last pulse during inflation & add 30

2. Why do you encourage client to urinate prior to bathing?
- To pevent client from urinating during bed bathing

3. How will you undress the client w/ right sided paralysis?
- To undress the unaffected part first
- To dress the paralyzed part first

4. The purpose of plastic rubber draw sheet.
- Prevent bed sheet from being wet

5. Importance of indwelling urinary catheter care
- Prevent further infection
- Pevent ascending infection
- UTI silent killer

6. How would you change the position in immobilized patient?
- Several times

7. Why do we nneed to apply the principles of body mechanics when transfering immobilized/disabled client?
- Prevent injury
- Good blood circulation

8. Considerations in preparing meals in elderly client?
- Food that are nutritious & w/ proper diet
- Medical condition
- Ability to eat
- Preference

9. ABC’s in CPR
- Checking airway, breathing & circulation

10. Indication to stop CPR
- Physician takes over
- Operator exhausted
- Sign of life
- Turn-over to emergency medical service

Possible Interview Questions

2012-07-28T08:16:00.001-07:00

1. Importance of backrub to a bed ridden client?
- To stimulate circulation, prevent bedsore & promote relaxation

2. Basic comsideration in assisting client personal needs?
- Maintain persons privacy & dignity of the client

3. How could you help your client maintain his self-esteem & sense of independence?
- Encourage him to do as much function as possible.

4. Important safety precautions must be done when transferring client from bed to wheelchair.
- Lock the wheels of wheelchair & the bed.

5. Physical changes related to aging.
- Reflexes are slow
- hair turns gray & change in textue
- all body processes are slow
- loss of skin elasticicity
- fat becomes thin & more fragile
- senses becomes less accurate needs aid like eyeglasses, hearing aid.
- Posture become more stalk

6. Basic role to client w/ Alzheimer’s disease.
- Supervise closely don’t restrain the client
- Remind patient of time, date, names of all kind.

7. Effective way to control the spread of infection.
- Handwashing

8. Safety precautions to be observed when caring the client w/ diminidhed vision.
- Maintain a footlight during the night
- Arrange furnishing, personal items for convenient, confers & safety of client.

9. Prevent fall/slip in the bathroom?
- Keep the bathroom dry at all times
- Make a dry cloth available
- Use non-skid mats

10. How would you know if the bottle contents are poisonous?
- Symbol of skull or logo bonw
- If no date of expiration available
- If it is expired

11. Protectibe devices for infection control?
- Gloves
- Masks
- Gogles
- Gown
- Cap
- Apron
- Slippers

12. Common signs that a diabetic client has low blood sugar.
- Pale palm
- Drowsiness
- Sweating
- Tremors
- cold clamy skin
- diminished vision

13. Typical sign of impending heart attack?
- Chest pain
- Not relieved by rest (angina pectous)
- Increased Blood Pressure
- DOB
- Stiffness muscle

14. 1st comon sign of infection
- Fever (such as 38 C)
- Increased WBC/body malaise

15. Client has BP 150/100.
- Seek medical assistance call emergency hotline
- Advice client to take in usual medication

16. Respond to cancers patient who wish to die now?
- Allow client to release ventilate feeling
- Make client comfortable
- Be a good listener. Why? Because silence is therapeutic

17. How would you react when criticize by colleagues?
- Ignore them & do your job well
- Inform your head/supervisor

18. Recommended diet for an elderly w/ heart disease
- Recommended fat, low Na regular diet, decrease fat

19. Most immportant consideration when preparing meals for diabetic client.
- Calorie measures
- Sugar content of the foods
- Total caloric content
- Sugar in the diet

Cleaning Living Room & Bathroom

2012-07-28T08:14:00.000-07:00

Cleaning Living Room
1. Start w/ ceilings – using two tract technique. Start from the farthest to nearest area.

2. Walls – using two cleaning cloth 1 dry & the other is moist. Clean the walls using a circular motion , 1st w/ moisten cloth follow with dry, both hands are holding them at the same time. It is also advised to partition the walls to four parts so it will be easy.

3. Picture Frames – using a feather duster starting from top using circular motion.

4. Furniture – using a vacuum start from the top going down, then side, last throw pillows.

5. Floors – vacuum from farthest to nearest, don’t step on the vacuumed area.

Cleaning Bathroom
Bathroom – walls, (same as living room), lavatory, bowl, floors

Coverage of Exam

2012-07-28T08:01:00.002-07:00

Caregivers who are planning to take the TESDA exam needs to review on the following areas because this are all the possible topics that will appear on your exam. Not necessarily that all of this will appear, but you need to study in order to be ready on what the Assessor will tell you to conduct a demo or ask questions. Some Assessors are strict some are not. The difficulty level of the TESDA exam depends mainly if you did not study well and not prepare to take the exam. So, good luck to all of you my fellow Caregivers!.:)

Project 1 – Provide Care & Suport to Infants/Toddlers & Children
Perform Proper Procedure & Techniques in:
1. Taking vital sign for infant
2. Bathing of infant (Critical Aspect)
3. Dressing & Undressing
4. Changing Infants diaper
5. Cleaning & Sterilizing the bottles
6. Milk formula formulation
7. Feeding & burping
8. CPR for infant (critical aspect)
9. Choking for infant (Critical aspect)
10. Dressing the wound & fracture (splinting)
11. Prepare snacks for children

Project 2 – Assist Elderly & People w/ Special Needs in Meeting their Personal Needs
Perform Proper Procedure & Techniques in:
1. Taking vital sign
2. Shaving beard & mustache
3. Bathing
4. Dressing & Undressing
5. Perineal Care (w/ catheter, w/o catheter, flushing)
6. Bed Making (Occupied Bed make-up)
7. Transfering patient (from bed to wheelchair, wheelchair to bed) back to bed)
8. Adult CPR
9. Preparing Meanl for elderly

Project 3 – Perform Hhousekeeping Activities
Perform Proper Procedure & Techniques in:
1. Cleaning the comfort room (shower room & bath tub)
2. Cleaning the living room (using the vacuum cleaner wet & dry & portable vacuum cleaner)
3. Proper servicing
4. Dishwashing using the dish washer
5. Laundry (using the washing machine w/ spinner)
6. Drying up the cloth (using the dryer)
7. Ironing

Removing Indwelling Catheters

2012-07-28T07:58:00.000-07:00

Procedure:
1. Confirm the physicians order to remove. Assume handwashing & prepare the equipment needed such as receptacle for the catheter, clean disposable towel, clean gloves & sterile syringe to deflate the balloon, a large one.

2. Prepare the client. Explain the procedure & assist to a supine position. Optimal: Obtain a sterile specimen before removing the catheter. Check agency protocol.

3. Remove the tape or catheter securing device attaching the catheter to the client, put on gloves & then place the towel between the legs of the female client or over the thighs of the male.

4. Insert the syringe into the injection port of the catheter & withdraw the fluid from the balloon. If not all of the fluid can be removed report this fact to the nurse incharge before proceeding.

5. Do not pull the catheter while the balloon is inflated; doing so may injure the urethra.

6. After all of the fluid is withdrawn from the balloon, gently withdraw the catheter & place it in the waster receptacle.

7. Dry the perineal area w/ a towel.

8. Remove gloves.

9. Measure the urine in the drainage bag & record the removal of the catheter

- Time the catheter was removed

- Amount, color & clarity of the urine

- Intactness of the catheter

- Instructions given to the client

10. Provide the client w/ either a urinal (M) bedpan, commode or toilet collection device to be used w/ each subsequent unassisted void.

11. Following removal of the catheter, determine the time of the first voiding & the amount voided during the first 8 hours. Compare this output to the client intake.

12. Observe for dysfunctional voiding behaviors which might indicate urinary retention. If this occurs, perform an assessment of post void residuals using a bladder scanner if available. Generally postvoid residuals greater than 200 cc will require straight catheterization as needed.

Providing Special Oral Care For the Unconscious Client

2012-07-28T07:56:00.001-07:00

Purposes:
- To maintain the intactness & health of the lips, tongue & mucous membrane of the mouth.
- To prevent oral infections
- To clean & moisten the membranes of the & lips.

Equipment:
- Towel
- Curved basin
- Disposable clean gloves
- Tissue or piece of gauze
- Mouthwash
- Bite block to hold the mouth open & teeth apart
- Suction catheter with suction apparatus when aspiration is a concern
- Toothbrush
- Cup of tepid water
- Dentrifice
- Denture container
- Rubber tip bulb syringe
- Foam swabs & cleaning solution for cleaning the mucous membrane
- Water soluble lip moisturizer

Procedure
1. Introduce yourself.
2. Perform hand hygiene
3. Provide privacy
4. Prepare the client

- Position the client in a side-lying position w/ thehead of the bed lowered. – In this position the saliva automatically runs out of gravity rather than being aspirated into the lungs. This position is chosen for the uconscious client receiving mouth care. If the clients head cannot be lowered turn it to one side. – The fluid will readily run out of the mouth or pool in the side of mouth where it can be suctioned.

- Place the towel under the clients chin

- Place the curved basin against the client’s chin and lower check to to receive the fluid from the mouth.

- Put on gloves

5. Clean the teeth & rinse the mouth

- If the person has natural teeth brush gently & carefully to avoid injuring the gums. If the client has artificial teeth clean it the way w/ the dentures.

- Rinse the client’s mouth by drawing about 10ml of water or alcohol free mouthwash into the syringe & injecting it gently into each side of the mouth. – If the solution is injected w/ force, some of it may flow down the client’s throat & be aspirated into the lungs.

- Watch carefully to make sure that all the rinsing solution has run out of the mouth into the basin. If not suction the fluid from the mouth. – Fluid remaining in the mouth may be aspirated into the lungs.

- Repeat rinsing until the mouth is free of dentrifice, if used.

6. Inspect & clean the oral tissues.

- If the tissues appear dry or unclean, clean them w/ the foam swabs or gauze & cleaning solution following agency Policy.

- Picking up moistened foam swab, wipe the mucous membrane of one cheek. Discard the swab in a waste container, use a clean one to clean the next area. – Using separate applicators for each area of the mouth prevents the transfer of microorganisms from one area to another.

- Clean all mouth tissues in an orderly progression, using separate aplicators. The cheeks, roof of the mouth, base of the mouth & tongue.

- Observe the tissues, for inflammation & dryness

- Rinse the client’s mouth

- Remove & discrad the gloves.

7. Ensure client comfort.

- Remove the basin & dry around te client’s mouth w/ the towel. Replace artificial dentures.

- Lubricate the client’s lips w/ water-soluble moisturizer. – Lubrication prevents cracking & subsequent infection.

8. Document assessment of the teeth, tongue, gums & oral mucosa. Include any problems such as sores, or inflammation & swelling of the gums.

Providing Perineal – Genital Care

2012-07-28T07:53:00.001-07:00

Purpose:
- To remove normal perineal secretions & colors
- To promote client comfort

Assess for:
- Irritation, excoriation, inflammation swelling
- Excessive discharge
- Odor, pain or discomfort
- Urinary or fecal incontinence
- Recent rectal or perineal surgery
- Indwelling catheter

Determine:
- Perineal-genital hygiene practices
- Self-care abilities

Equipment:
- In conjunction w/ bed bath
- Bath towel
- Bath blanket
- Washcloth
- Clean gloves
- Soap
- Bath basin w/ water 43-46 degree Celsius

Special perineal-genital care:
- Bath towel
- Bath blanket
- Clean gloves
- Cotton balls or swabs
- Solution bottle, pitcher or container filled w/ warm water or a prescribed solution
- Bed pan to receive rinse water
- Moisture-resistant bag or receptacle for used cotton swabs
- Perineal pad

Procedure:
1. Introduce self
2. Perform hand hygiene
3. Provide client privacy
4. Prepare the client
- Drape the client
- Fold the top bed linen to the foot of the bed & fold the gown up to expose the genital area.
- Place a bath towel under the client’s hips. – The bath towel prevents the bed from becoming soiled.

5. Position & drape the client & clean the upper inner thighs.
6. Provide the patient a bed pan.

For Females:
- Position the female in a back lying position w/ the knees flexed & spread well apart.

- Cover her body & legs w/ the bath blanket positioned so a corner is at her head, the opposite corner is at her feet & the other two on the sides. Drape the legs by tucking the bottom corners of the bath blanket under the inner sides of the legs.

– Minimum exposure lessens embarrassment & helps provide warmth. Bring the middle portion of the base of the blanket up over the pubic area.

- Start cleaning from the cleanest to dirtiest.

- Pour on water starting from the farthest thighs, to the upper

For Males
- Position the male client in a supine position w/ knees slightly flexed & hips slightly externally rotated.

- Put on gloves; wash & dry the upper inner thighs.

7. Inspect the perineal area.
- Note particular areas of inflammation, excoriation or swelling, especially between the labia in females & the scrotal folds in males.

- Also note excessive discharge or secretions from the orifices & the presence of odors.

8. Wash & dry the perineal-genital area.

For Females

- Clean the labia majora. Then spread the labia to wash the folds between the labia majora & labia minora. – Secretions that tend to collect around the labia minora facilitates bacterial growth.

- Use separate quarters of the washcloth for each stroke & wipe from the pubis to the rectum. For menstruating women & clients w/ indwelling catheters, use clean wipes. Take a clean wipe for each stroke. – Using separate quarters of the washcloth or new wipes prevents the transmission of microorganisms form one area tot the other. Wipe from the area of least contaminated (the pubis) to that of greatest contaminated (the rectum)

- Rinse the area well. You may place the client on a bed pan & use a periwash or solution bottle to pour warm water over the area. Dry the perineum thoroughly, paying particular attention to the folds to the labia. – Moisture supports the growth on many microorganisms.

For Males:
- Wash & dry the penis using firm strokes.

- If the client is uncircumcised, retract the prepuce (foreskin) to expose the glans penis for cleaning. Replace the foreskin after cleaning the glans penis. – Retracting the foreskin is necessary to remove the smegma (thick, cheesy secretion) that collects under the foreskin & facilitates bacterial growth. Replacing the foreskin prevents constriction of the penis which may cause edema.

- Wash & dry the scrotum. The posterior folds of the scrotum may need to be cleaned when the buttocks are cleaned. - The scrotum tends to be more soiled than the penis because of its proximity to the rectum; thus It is usually cleaned after the penis.

9. Inspect perineal orifices for intactness.

- Inspect particularly around the urethra in clients w/ indwelling catheters. – A catheter may cause excoriation around the urethra.

10. Clean between the buttocks.

- Assist the client to turn onto the side facing away from you.

- Pay particular attention to the anal area & posterior folds of the scrotum in males. Clean the anus w/ toilet tissue before washing it, if necessary.

- Dry the area well.

- For post delivery or menstruating females, apply a perineal pad as needed from front to back. – This prevents contamination of the vagina & urethra from the anal area.

11. Document any unusual findings such as redness, excoriation, skin breakdown, discharge or drainage & any localized areas of tenderness.

Evaluation
- Relate current assessments to previous assessments

- Conduct appropriate follow-up such as prescribed ointment for excoriation.

- Report any deviation from normal to the primary care provider.

Providing Hair Care for Clients

2012-07-28T07:50:00.001-07:00

Purpose:
- To stimulate the blood circulation to the scalp
- To distribute hair oils & provide a healthy sheen
- To increase the clients comfort
- To assess or monitor hair or scalp problem.

Equipment:
- Clean brush & comb
- A wide tooth comb
- Towel
- Hair oil preparation

Procedure:
1. Introduce self.
2. Perform hand hygiene & other appropriate infection control procedures.
3. Provide privacy
4. Position & prepare client appropriately
- Assist the client who can sit to move to a chair. – Hair is more easily brushed & combed when the client is in a sitting position. If health permits assist a client confined to a bed to a sitting position by raising the head of the bed. Otherwise assist the client to alternate side-lying position & do one side of the head at a time.

- If the client remains in bed, place a clean towel over the pillow & the client’s shoulders. Place it over client’s shoulders. – The towel collects any removed hair, dirt & scaly materials.

- Remove any pins or ribbons in the hair.

5. Remove any mats or tangles gradually.
- Mats can usually be pulled apart w/ fingers or worked out w/ repeated brushings.

- If the hair is very tangled, rub alcohol or oil such as mineral oil, on the strands to help loosen the tangles.

- Comb out tangles in a small section of hair toward the ends. Stabilize the hair w/ one hand & comb toward the ends of the hair w/ the other hand. – This avoids scalp trauma.

6. Brush & comb the hair.
- For short hair, brush & comb one side at a time. Divide long hair into two sections by parting it down the middle from the front to the back. If the hair is very thick divide each section into front & back subsections or into several layers.

7. Arrange the hair as neatly & attractively as possible. Braiding long hair prevents tangle.

8. Document assessment & special nursing interventions. Daily combing & brushing of the hair is not normally recommended.

Providing Foot Care

2012-07-28T07:44:00.001-07:00

Purposes:
- To maintain the skin integrity of the feet
- To prevent foot infections
- To prevent foot odors
- To assess or monitor foot problems

Assess:
- Skin surfaces for cleanliness, odor, dryness & intactness
- Each foot & toe for shape, size, presence of lesions & areas of tenderness, ankle edema.
- Skin temperatures of both feet to assess circulatory status
- Pedal pulses: dorsalis pedis & posterior tibialis
- Self-care abilities

Equipment:
- Wash basin containing warm water
- Pillow
- Towels
- Washcloth
- Lotion/Foot powder
- Moisture resistant disposable pad
- Soap
- Toenail cleaning & trimming equipment
- Lotion/Foot powder

Procedure:
1. Introduce self.
2. Perform hand hygiene
3. Provide privacy
4. Prepare the equipment & the client
- Fill the washbasin w/ warm water at about 40 degree Celsius to 43 degree Celsius (105 degree F to 110 degree F). – Warm water promotes circulation, comfort & refreshes.

- Assist the ambulatory client to a sitting position in a chair or the bed client to a supine or semi-Fowler’s position.

- Place a pillow under the bed client’s knees. – This provides support & prevent muscle fatigue.

- Place the washbasin on the moisture-resistant pad at the foot of the bed for a bed client or on the floor infront of the chair for an ambulatory client.

- For a bed client pad the rim of the washbasin w/ a towel. – The towel prevents undue pressure on the skin.
5. Wash the foot & soak it.

- Place one of the clients feet in the basin & wash it w/ soap, paying particular attention to the interdigital areas. Prolonged soaking is not recommended for a diabetic clients or individuals w/ peripheral vascular disease. – Prolonged soaking may remove natural skin oils, thus drying the skin & making it more susceptible to cracking & injury.

- Rinse the foot well to remove soap. – Soap irritates the skin if not completely removed.

- Rub callused areas of the foot w/ the washcloth. – This helps remove dead skin layers.

- Clean the nails as required w/ an orange stick. – This removes excess debris that harbor microorganisms.

- Remove the foot from the basin & place it on the towel.
6. Dry the foot thoroughly & apply lotion or foot powder.

- Blot the foot gently w/ the towel to dry it thoroughly, particularly between the toes. – Harsh rubbing can damage the skin. Thorough drying reduces the risk of infection.

- Apply lotion or lanolin cream to the foot but not between the toes. – This lubricates dry skin & keeps the area between the toes dry or

- Apply a foot powder containing a nonirritating deodorant if the feet tend to perspire excessively. – Foot powder have greater absorbent properties than regular bath powders; some also contain menthol, which makes the feet cool.

7. If agency policy permits, trim the nails of the first foot while the second foot is soaking.

- Nail is cut or filed straight across beyond the end of the finger or toe. Avoid trimming or digging into nails at the lateral corners. This predisposes the client to ingrown toenails. Clients who have diabetes or circulatory problems should have their nails filed rather than cut; inadvertent injury to tissues can occur if scissors are used. After the initial cut or filling the nail is filed to round the corners & then cleans under the nail. Then gently pushes back the cuticle taking care not to injure it. Then the next finger.

8. Document any foot problems observed.

- Foot care is not generally recorded unless problems are noted.

- Record any signs of inflammation, infection, breaks in the skin, corns, troublesome calluses, & pressure areas. This is of particular importance for clients with peripheral vascular disease & diabetes.

Evaluation:

- Isnpect nails & skin after the soak

- Compare to prior assessment data.

- Report any abnormalities to the primary care provider.

Nebulization

2012-07-28T07:42:00.000-07:00

Definition:
-a process of adding mixture to inspired air by mixing particles of varying sizes w/ the air.
-a production of fog/mist used
-used often w/ bronchodilator drugs

Bronchodilator drugs – are agent that dilates the bronchioles of the lungs.

Effects of Bronchodilators
1. Tachycardia
2. Dyspnea
3. Palpitation
4. Nausea & Vomiting
5. Dizziness

Purposes of Nebulization
-To deliver medication in droplet form & to soothe irritated, inflamed & congested mucous membrane
-To loosen secretion in the respiratory

Equipment
1. Nebulizer machine
2. Nebulizer kit – cup, dome, tubing, t-piece, mouthpiece & mask
3. Drug ordered

Things to Remember Before the procedure
1. Check the doctors order
2. Make sure that the medication has a ticket
3. Identify the patient & explain the procedure
4. Always do handwashing & observe appropriate infection control measures

Procedure
1. Assemble all the equipment needed
2. Place ordered medication on the nebulizer bottle
3. Attach tubing to connector
4. Assess the patient to a Fowlers position
5. Instruct the patient on the following:
A. Mouthpiece
- Keep lips closed tightly around the mouthpiece
- Breath only through the mouth
-Observe the expansion of the chest
-Tell the patient to take a deep breath from the mouthpiece

6. Instruct the patient to breath slowly & deeply until all the medication is consumed.

7. On completion of medication
-Encourage patient to cough after deep breaths/do chest tapping

8. After the medication; remove the nebulizer kit to the nebulizer machine & make the client comfortable

9. Disassemble, clean the nebulizer machine kit after each use.
10. Do handwashing
12. Documentation/Record the assessment, observation during the procedure.

Oxygen Therapy

2012-07-28T07:39:00.000-07:00

-provision of therapeutic oxygen

Purposes
-To provide supplemental oxygen to patient needing an increased amount of oxygen for inspiration

-To prevent hypoxia (occurs if the amount of oxygen delivered to the body tissues is too low.

Signs & Symptoms
-Tachycardia
-Dyspnea
-cyanosis
-restlessness

Equipment
1. Oxygen supply (tank, built in O2)
2. Flow Meter Gauge – indicate the gas flow in liters
3. Cylinder Content Gauge – indicates the amount of oxygen in the tank
4. Humidifier Bottle – prevents dryness of oral & nasal mucous membrane
5. Nasal Cannula/Face Mask
6. “No Smoking” sign
7. Tape/micropore
8. Gauge

Things To Remember
-Oxygen can be delivered from wall outlet or portable cylinder
-Oxygen can cause drying of mucous membrane

Safety Measures
1. Avoid open flames in the patients room
2. Place “No Smoking” sign in the areas where Oxygen be used especially in the patients room & instruct the patient visitors the danger of smoking.
3. Avoid using oil or any clothing stained w/ oil
4. Receiving oxygen is a frightening experience for patient
5. The patient should wear clothes made of cotton
6. Make sure there are no short circuit on the nasal Cannula or nasal prong.

Procedure
1. Determine the need for oxygen therapy & verify the order for the therapy
2. Assemble all the equipment needed
3. Identify the patient & explain what you are going to do.
4. Wash hands.
5. Provide privacy
6. Set-up the oxygen equipment & the humidifier bottle

a. Attach the flow meter to the wall outlet or tank

b. Fill the humidifier bottle w/ distilled water

c. Attach the humidifier bottle to the base of the flow meter

d. Attach the prescribed oxygen tubing & delivery device to the humidifier bottle

7. Turn-on the oxygen at the prescribed rate & ensure proper functioning

a. Check that oxygen is flowing freely through the tubing by putting th outlet of the nasal cannula to the face or hands & feel if there is air coming out.

b. There should be bubbles in the humidifier bottle

c. Set the oxygen at the flow rate prescribed

8. Apply the appropriate oxygen delivery device

a. Nasal Cannula or Nasal Prong – Put the cannula over the clients face with the outlet fits into the narease & the elastic bond around the head. If the cannula will not stay in place, ask permission from the patient that you are going to put a tape; then tape it on the sides of the face. Pad the tubing & bond over the ears & cheek bones.

b. Face Mask – Guide the mask towards the clients face & apply it from the nose downward.

-Fit the mask to the contour of the clients face.

-Secure elastic bond around the clients head.

-Pad the bond behind the ears and bony prominences.

9. Assess the client regularly.
-Vital signs
-Anxiety level of the patient
-Color of the patient
-Ease of respiration
-Assess for signs of hypoxia

10. Inspect the equipment regularly
-Checking the flow meter & the level of the humidifier bottle

11. After care, handwashing then documentation.

Nasogastric Tube Feeding

2012-07-28T07:34:00.002-07:00

Definition: also known as gastric gavage; installation of especially prepared formula into the digestive tract through a tube that is inserted through one of the nostrils down to the alimentary tract.

Purpose:
- Prevent nausea, vomiting & gastric distention following surgery
- Remove stomach contents for laboratory analysis
- To lavage (wash) the stomach in cases of poisoning & overdose of medication
- To administer medication
- To administer supplemental fluid
- To provide feeding

Procedure:
A. Assess & Prepare the Client
1. Check the clients chart or confirm the physician’s order for NGT feeding, this is done for us to be sure that we are doing the right procedure to the right client/patient.

2. Assume handwashing..

3. Prepare the needed materials such as the correct amount of feeding solution as ordered by the physician, asepto syringe/bulb syringe, emesis basin/kidney basin, 60 to 80 ml of water, stethoscope & disposable pad.

4. After preparing the materials we are now ready to head to the clients room. Before entering knock on the door, greet the patient if he/she is conscious or significant other if the client is unconscious. Introduce self, ask the patient/client or significant others for any allergies if it is the first time to do the NGT feeding.

5. Provide privacy because NGT feeding is embarrassing to some people.

6. Assist client to a fowler’s position in bed or sitting position in a chair. – This position enhance the gravitational flow of the solution & prevent aspiration of fluid into the lungs.

7. Place a disposable pad on the area where you are working. – To prevent client’s gown from getting soiled or to avoid being messy.

8. Unpin the tube from under the pillow or from the client’s gown.

B. Assess the Patency of the Tubing

9. Inject 5-20 ml of air through the feeding tube while auscultating the left upper abdomen while listening to gurgling, whoosing & bubbling sound. If you hear gurgling, whoosing & bubbling sound we are now sure that the tube is patent.

C. Assess the Residual Feeding Contents

10. Aspirate all the stomach contents & measure the amount prior to administering the feeding. – This is done to evaluate the absorption of the last feeding. If >50 ml of undigested formula is withdrawn in adults & >10 ml in infants & its color is okey somewhat like yellow. Reinstill the gastric contents into the stomach. – Removal of contents disturb the clients electrolyte balance. If 50 ml or more of undigested formula is withdrawn in adults & 10 ml < in infants check w/ the nurse incharge before proceeding. The precise amout is usually determined by the Physician’s order or by Policy of the agency. At some agency it is withheld when the specified amount & more formula remains in the stomach. In other agencies, the amount withdrawn is subtracted from the total feeding & that volume is administered slowly. And feeding is also withheld if the color of the aspirated fluid is coffee ground. – There is bleeding in the stomach.

D. Administer the Feeding

11. Before administering the feeding add 20 ml of water. – To clean the tube & facilitate the smooth flow of the solution, be sure not to drain all the water.

12. When using the asepto syringe connect the syringe to a pinched or clamped nasogastric tube. – Prevent excess air from entering the stomach & causing distention.

13. Permit the feeding to flow slowly. Raise or lower the syringe to adjust the flow as needed. Pinch or clamp the tubing to stop the flow for a minute if the client experiences discomfort. Quickly administered feedings can cause flatus, crampy pain & reflux vomiting.

E. Rinse the Feeding Tube Immediately before all the formula has run through the tubing.

14. Instill the feeding tube w/ 60ml of water. – Water cleans the lumen of the tube, preventing future blockage by sticky formula.

15. Be sure to add water before the syringe or tubing is empty. – Prevents the instillation of air into the stomach or intestine which causes unnecessary distention.

F. Clamp & Cover the Feeding Tube

16. Clamp the feeding tube before all of the water is instilled. – Prevents leakage & air from entering the tube if done before water is instilled.

G. Ensure Client Comfort & Safety
17. Pin the tubing to the client’s gown. – This minimizes pulling of the tube thus preventing discomfort & dislodgement.

18. Ask the client to remain sitting in Fowler’s position or in slightly elevated right lateral position for at least 30 minutes. – These position facilitate digestion & movement of the feeding from the stomach along the alimentary tract & prevent potential aspiration of the feeding into the lungs.

H. Thank the client for the cooperation & dispose equipment properly, if it is to be reused, wash it thoroughly with soap & water so that it is ready for reuse. Afterwards do handwashing & document relevant information, kind, duration of feeding. Assessment of the client & record the volume of the feeding & the water administered on the clients intake & output record & lastly, monitor client for possible problem.
Removing NGT
1. Confirm the physician’s order to remove the tube. Assume handwashing to reduce the number and transmission of microorganisms. Prepare the materials/equipment needed such as tissues, clean disposable gloves, disposable pad, disposable plastic bag & asepto syringe/bulb syringe. After preparing the equipment we are now ready to head on to the client’s room. Knock on the door before entering the room, greet the patient upon entering. Introduce yourself & verify the client’s identity by asking the client’s fullname.

2. Prepare the client. Explain that the procedure will not cause any discomfort. Assist the client to a sitting position if health permit’s. Place disposable pad across the client’s chest to collect any spillage of mucous. Provide tissue to the client to wipe the mouth & nose upon removal of the tube. Unpin the tube from the client’s gown. Remove adhesive tape securing the tube to the nose.

3. Remove the tube.
- Put on disposable gloves. – Gloves prevent soiling the hand & clothing when handling secretions & excretions.
- Instill 50 ml of air into the tube. – Air clears the lumen of any contents such as food & gastric drainage.
- Ask the client to take a deep breath & hold it. – This closes the glottis, thereby preventing accidental aspirations of any gastric contents.
- Pinch the tube. – Pinching prevents any contents inside the tube from draining into the clients throat.
- Quickly & smoothly withdraw the tube. Place the tube in the plastic bag. – Prevents the transfer of microorganisms from the tube.

4. Ensure client’s comfort. Assist the client as required to blow the nose. – Excessive secretions may have accumulated in the nasal passages. Provide mouthwash. Thank the client for cooperation.

5. Dispose all the equipment appropriately. Place the pad, bag with the tube & gloves in the receptacle designated by the agency. – Correct disposal prevents the transmission of microorganisms.

6. Do handwashing & document relevant information. Record the removal of the tube & any relevant assessment of the client.

Intravenous Infusion

2012-07-28T07:30:00.000-07:00

- Intravenous Infusion is an efficient & effective method of supplying fluids directly into the intravascular fluid compartment.

Purposes
1. To supply fluid when client are unable to take in an adequate volume of fluids by mouth.
2. To provide salts needed to maintain electrolyte balance
3. To provide water-soluble vitamins & medications
4. To provide glucose the main fuel of metabolism
5. To establish a lifeline for rapidly needed medications.

Classifications
1. Isotonic – same concentration of solute to your blood plasma.
2. Hypertonic – greater concentration of solute to your blood plasma
3. Hypertonic – lesser concentration of solute to your blood plasma

Category of Solutions According to their Purpose
1. Nutrient Solutions – rich in calorie, carbo etc.
2. Electrolyte Solution – ions/cations
3. Alkalizing Solutions – To counter act metabolic acidosis
4. Acidifying Solutions – To counter act metabolic alkalosis
5. Blood Volume Expanders – use to increase the volume of blood following severe blood loss.

Intravenous Equipment
1. Solution Container – available in various sizes
2. Infusion set:

Insertion Spike – kept sterile & inserted into the solution container when the equipment is set up & ready to start

Chamber – Permits a predictable amount of fluid to be delivered.

Micro drip Chamber Set – has a needle

Roller Valve/Screw Champ – which compresses the lumen of the tubing , controls the rate of the flow

Protective Cap Over the Needle Adapter – Maintains the sterility of the end of the tubing so that it can be attached to a sterile needle inserted in the clients vein

IV Port – required to administer secondary infusions/medications

3. IV Pole/rod – needed to hang the solution container also called as IV stand.

For Demo
1. Confirm the physicians order or check the patients chart
-To check the right procedure to the right patient

2. Do handwashing

3. Prepare the needed materials
-dry cotton balls
-wet cotton balls
-bandage scissor
-plaster 3-5 inches long #3 pieces
-receptacle
-sterile cap for KSS (keep set sterile)
-new bottle of solution (for the termination/disposable)

4. Go to the patients room.
-Knock on the door; greet the patient; introduce yourself & verify the clients identity by asking the patients complete name.
-Explain to the patient what you are going to do and why it is necessary.
-Assist the patient to a comfortable position.

Termination/Discontinue IVF
5. First I am going to demonstrate how to terminate IVF & we do this whenever patient no longer need any solution or if the patient is going to be charge. We actually throw all the materials used.

6. Make the patient comfortable. Close the roller valve in order not to be messy.

7. if the patient has splint, cut the plaster & remove the splint.

8. Get wet cotton balls soaked in an alcohol, start removing the plaster by applying wet cotton balls on the plaster starting from the peripheral side of the IV. Then lastly, on the needle side. Then inform the patient that you are going to pull the needle, pull the needle slowly. Apply pressure on the area & get a dry cotton balls on the needle site and put a plaster on it to prevent bleeding.

For KSS (Keep Set Sterile)-client not to be discharge or there might be possible complication

1. Remove the needle from the insertion point then cover the needle adapter w/ sterile cap.
2. Then return the tubing & hang it on the IV stand.
3. Instruct the patient that someone will go to her to insert an IV needle on the other part or area.
4. Do after care, handwashing & document.

Follow-up IV (needs another solution)
1. Enter patient room w/ a new bottle
2. Close roller bulb
3. Get the IV bottle
4. Kink
5. Hold the IV solution in upright position using the non-dominant hand then remove the insertion spike from the IV solution using your dominant hand.
6. Get new bottle
7. Open bottle-insert-release
8. Place on IV pole
9. Open roller valve
10. Do after care, handwashing & document such as any sign of inflammation, edema, redness & pain.

DEMO ON VITAL SIGNS

2012-07-28T07:24:00.001-07:00

Definition: Vital signs or cardinal signs are body temperature, pulse, respirations & blood pressure, fifth is pain.

Times to Assess Vital Signs:
- On admission to a health care agency to obtain baseline data.
- When a client has a change in health status or reports symptoms
- Before & after surgery/invasive procedures
- Before & after administration of medications
- Before & after any intervention that could affect the vital signs

1. Check for the patients chart
- In order to check the condition of the patient & to check the last BP if there is any.
2. Do handwashing.

3. Prepare the needed materials.
- Stethoscope
- Sphygmomanometer
- Thermometer/Axillary & Digital
- Tissue Paper
- Wet Cotton Balls soaked in an alcohol
- Dry cotton balls
- Receptacle
- Ballpen
-Watch w/ second hand
- Paper
- Ballpen

*Patients Info*
- Name
-Age
- Sex
- Date
- Time
- Chief complaint
- Physician
- Temperature
- Radial Pulse
- Respiratory Rate
- Blood Pressure

4. Check the equipments if they are working properly in order to save time .

- Hold the thermometer in an eye level & check if there is any breaks, if there is none clean it with a wet cotton balls soaked an alcohol then dry it with the use of dry cotton balls. Then shake it away from the patient or any object because thermometer is very sensitive it could easily break, this is in order to lower the temperature to at least below 35 Degree Celsius.

- Check also the stethoscope, tap your finger lightly on the diaphragm if you can hear sound.

- Then check the sphygmomanometer for leaks. Pump up the cuff then deflate in order to determine if there is any leaks.

5. Go to patients room, knock on the door, greet the patient & introduce yourself & verify the patients identity by asking his/her complete name. Explain to the client what you are going to do & why it is necessary & how he/she can cooperate. Discuss how the result will be used in planning for further care or treatments.

- Also ask for the food, fluid intake as well as the activities done prior to getting the vital signs because it can elevate the results.

6. Provide for clients privacy.

7. Place the client in an appropriate position (lateral or sim’s position)

8. Start getting the vital signs.
- First I am going to get the body temperature w/ the use of an axillary thermometer. Firstly, get a tissue & pat dry the axillae. Do not rub it because it can elevate the result. Then place the thermometer appropriately, and then wait for 8-10 minutes for the result.

- While waiting for the body temperature result, I am going to get the radial pulse. Palpate and count the pulse for one full minute. Place two or three fingers lightly & squarely over the pulse point. Do not use the thumb because it has pulse that could be mistaken for the clients pulse. Assess pulse rate, rhythm & volume. Bear in mind that when you write the result it must include the units of measure which is beats per minute or bmp

Assessing an Apical Pulse
- This is in order to check the discrepancy of the result in the radial pulse. The units of measure is beats per minute or bmp Place client in a comfortable supine position or sitting position. Locate the apical pulse.
Adult (left side of the chest, 3 inches to the left of the sternum & at the 4th, 5th or 6th inter-coastal space)

Child 7-9 years old (4th or 5th inter-coastal space).

4 Years old (left of the mid-clavicular line)
- Auscultate & Count Heartbeats. Use antiseptic wipes to clean the earpieces & diaphragm of the stethoscope if their cleanliness is doubt. – The diaphragm needs to be cleaned & disinfected if soiled w/ body substances.

- Warm the diaphragm (flat-disc) of the stethoscope by holding it in the palm of the hand for a moment. – The metal of the diaphragm is usually cold & can startle the client when placed immediately on the chest. Tap your finger lightly on the diaphragm to be sure it is the active side of the head. Place the diaphragm of the stethoscope over the apical impulse & listen for the normal S1 & S2 heart sounds, which is heard as “lub-dub”. – The heartbeat is normally loudest over the apex of the heart. Each lub-dub is counted as one heartbeat. S1 (lub) occurs when the atrioventicular valves close after the ventricles have been sufficiently filled. S2 (dub) occurs when the semilunar valves close after the ventricles empty. If you have difficulty hearing the apical pulse ask the supine client to roll onto his/her left side or sitting client to lean slightly forward. – This positioning moves apex of the heart close to the chest wall. Count for 1 full minute. – A second count provides a more accurate assessment of an irregular pulse than 1 30 second count. Assess the rhythm & strength of the heartbeat.

After getting the apical pulse, get also the body temperature w/ the use of the digital thermometer. (Note: show the result to your Clinical Instructor before turning it off).

Assessing Respirations
- Then get the respiratory rate (note: do not mention this because you’ll get minus point from your clinical instructor) why? Because, patient can control his/her RR if you’re going to mention it. Unit of measure for RR is cycle per minute or cpm

- Observe or palpate & count the respiratory rate. Client’s awareness when counting the respiration rate could cause the client to purposely alter the respiratory pattern. If you anticipate this, place a hand against the client chest to feel the chest movements w/ breathing or place the client’s arm across the chest & observe the chest movements while supposedly taking the radial pulse. Count for 1 full minute. An inhalation & an exhalation count as one respiration. Observe the depth, rhythm & character of respirations. Depth by watching the movement of the chest. – During deep respiration, a large volume of air is exchanged, shallow, small volume of air is exchanged. Regular or irregular rhythm. – Normally, respirations are evenly spaced. Character of respirations – sound they produced & the effort they require. – silent & effortless.

Assessing Blood Pressure
Preparation:
- Make sure that the client has not smoked or ingested caffeine w/ in 30 minutes prior to measurement. – Smoking constricts blood vessels & caffeine increases the pulse rate. Both of these cause a temporary increase in blood pressure.

- Position the client appropriately. The adult should be sitting unless otherwise specified. Both feet should be flat on the floor. – Legs crossed at the knee result in elevated systolic & diastolic blood pressure.

- The elbow should be slightly flexed w/ the palm of the hand facing up & the forearm supported at heart level. – The blood pressure increases when the arm is below the heart level & decreases when the arm is above the heart level.

- Wrap the deflated cuff evenly around the upper arm. Then locate the brachial artery. Apply the center of the bladder directly over the artery. – The bladder inside the cuff must be directly over the artery to be compressed if reading is to be accurate. Approximately 2.5 cm (1 inch) above the antecubital space.

- If this is the client’s initial examination, perform a preliminary palpatory determination of systolic pressure. – The initial estimate tells the nurse the maximal pressure to which the manometer needs to be elevated in subsequent determination. It also prevents under estimation of the systolic pressure or over estimation of the diastolic pressure should an auscultatory gap occur.

- Palpate the brachial artery c/ the fingertips.
- Close the valve on the bulb.
- Pump up the cuff until you no longer feel the brachial pulse. At that pressure the blood cannot flow throw the artery. Note the pressure on the sphygmomanometer at which pulse is no longer felt. – This gives an estimate of systolic pressure (+30).

- Release the pressure completely in the cuff & wait 1 to 2 minutes before making further measurements. – A waiting period gives the blood trapped in the veins time to be released. Otherwise, false high systolic readings will occur.

- Position the stethoscope appropriately. Cleanse the earpieces w/ antiseptic wipes. Insert the ear attachments of the stethoscope in your ear so they tilt slightly forward. – Sound are heard more clearly when the ear attachments follow the direction of the ear canal.

- Ensure that the stethoscope hangs freely from the ears to the diaphragm. – If the stethoscope tubing rubs against an object, the noise can block the sounds of the blood w/ in the artery.

- Place the bell side of the amplifier to the stethoscope over the brachial pulse site. – Because blood pressure is a low-frequency sound, it is best heard w/ the bell-shaped diaphragm.

- Place the stethoscope directly on the skin, not on clothing over the site. – This is to avoid noise made from rubbing the amplifier against cloth.

- Hold the diaphragm w/ the thumb & index finger.
- Auscultate the client’s blood pressure. Pump up the cuff until the sphygmomanometer reads 30 mmHg above the point where the brachial pulse disappeared.

- Release the valve on the cuff carefully so that the pressure decreases at the rate of 2 to 3 mmHg per second. – If the rate is faster or slower, an error in measurement may occur.

- Deflate the cuff rapidly & completely. Wait 1 to 2 minutes before making further determinations.- This permits blood trapped in the veins to be released.

- Repeat the above steps to confirm the accuracy of the reading especially if it falls outside the normal range. If there is 75mmHg difference between the two readings, additional measurements may be taken & the result averaged.

- If this is the client’s initial examination repeat the procedure on the other arm. There should be no more than 10 mmHg difference between the arms. Arm with higher BP should be used for subsequent examinations.

- Remove the cuff & wipe w/ an approved disinfectant. – Cuffs can become significantly contaminated.

- Document & report pertinent assessment & data.

- Read the result of the axillary thermometer (let your clinical instructor see the result before putting it down.

10. Write the results.
11. Inform the patient of the result because they have the right to know.
12. Do after care.
13. Don’t forget to say thank you to the patient before the leaving the room.

Note: Sequence
1. Body temperature (Axillary thermometer 5. Body Temperature (digital thermometer)
2. Radial Pulse 6. Blood Pressure
3. Respiratory Rate
4. Apical Pulse

Cleaning the Feeding Bottles/Sterilizaton/Feeding an Infant

2012-07-28T07:04:00.002-07:00

Cleaning the Feeding Bottles

1. Clean the surface/area you are going to work.
2. Gather the materials such as the basin, soap, brush for cleaning the feeding bottles & the dirty nipples.
3. Do handwashing
4. Put a warm water on the basin then put a soap
5. Then form a soapy sud
6. Clean the bottles, cap & teats thoroughly
7. Stand the bottles on a clean surface

Sterilization
8. Put the feeding bottles in a sterilizer
9. Put the cap & teat on a separate container then fill in w/ water
10. Put water on the sterilizer preferably ¾ (75%)of the entire container/sterilizer
11. Wait until the water is boiling then start timing for 30 minutes. But only 2-3 minutes for caps & teats.

12. After 25 minutes, get the feeding bottles from the sterilizer & place them in a clean tray

Feeding
13. In preparing a formula, read the label/instructions of the milk
14. Then fill I the bottle w/ water following instructions of the prescribe amount

15. Loosely held the scoop w/ milk powder & level it off without compacting it.

16. Add the milk power to the water. Making up a feed w/ too much powder can give your baby constipation.

17. Hold the edge of the teat put it on the bottle

18. Screw the remaining ring into the bottle.

19. Cover the teat w/ a cap. Shake the bottle until the powder is dissolved.

20. If you want to cool your baby’s milk, hold the bottle of the cap covering the teat under cold running water.

21. Test the temperature of the feed by dropping a little into the inside of your wrist.

22. When feeding the baby, keep the teat full of milk otherwise your baby will take in air.

23. Hold your baby in a semi-upright position with the head a little higher than the rest of the body

24. Never feed the baby lying down, formula may flow into the ear causing infection.

25. Hold the bottle in such a way that the nipple & the neck are filled w/ the formula

26. Check the nipples hole to make sure that milk is flowing uniformly. The baby should not be gulping.

27. Feed the baby on demand & do not force here to finish the entire bottle if she is full.

28. Burp your baby by draping her over your shoulder, or laying her on her back. This will help remove the air so that the baby has taken in while drinking milk.

PRINCIPLES OF BATHING AN INFANT

2012-07-28T06:55:00.000-07:00

- NBs receive a complete bath w/in six hours after birth
- They are bathed once a day
- Wear gloved when handling NBs until a first bath to avoid exposing your hands to body secretions
- Babies of HIV (+) mothers should be bathed immediately to decrease the possibility of HIV transmission.

Purpose:
- Hygiene (wipe off dirt)
- Afford an excellent opportunity for making observation

Principles:
- The room should be about 75 degree F (24 degree C) to prevent chilling.
- Bath water should be around 98-100 degree F (37-38 degree C)
- Temperature that feels pleasantly warm to the elbow or wrist
- If soap is used it should be mild & w/o a Hexachlorophene Base.
- Bathing should take place before not after, a feeding to pevent spitting up or vomiting & possible aspiration
- Teach parents that when giving a bath, it should proceed from the cleanest to the most soiled areas of the body, that is from the eyes, face, ears, scalp, neck, upper extremities, trunk lower extremities & finally the buttocks last to the diaper area.
- Items should be assembled beforehand, so the baby is not left unattended.
- Until the umbilical cord & circumcision if any are healed, tub baths are still not advisable
- NO matter what the room temperature is don’t take off baby’s diaper until its time to wash the bottom; a naked baby is considered armed & dangerous

Equipment:
- Basin of water
- Soap
- Washcloth
- Towel
- Comb
- Clean diaper and shirt
- Cotton wool
- Baby shampoo
- Baby powder

Note:
Head
Face
Neck & chest
Arms
Back
Legs
Diaper Area

Donning & Removing Personal Protective Equipment (Gloves) OPEN METHOD

2012-07-28T06:48:00.000-07:00

Definition: Protective equipment worn during many procedure to maintain the sterility of equipment & to protect from contact w/ blood & body fluids

Purpose:
- To enable the nurse to handle or touch sterile objects freely and contaminating them.
- To prevent transmission of potentially infective organisms from the nurses hands to clients at high risk for infection
Equipment:
- Packages of sterile gloves

Procedure:
1. Prior to performing the procedure introduce self & verify the clients identity using agency protocol. Explain to the client what you are going to do & why it is necessary & how he/she can cooperate. Discuss how the results will be used in planning further care or treatments.
2. Observe appropriate infection control procedures.
3. Provide for client privacy
4. Open the packages of sterile gloves
- Place the package of gloves on a clean dry surface – Any moisture on the surface could contaminate the gloves

- Some gloves are packed in an inner as well as outer package. Open the outer packages without contaminating the gloves or the inner package.

- Remove the inner package from the outer package.

- Open the inner package according to the manufacturer’s directions. Some manufacturer’s provide a numbered sequence for opening the flaps & folded tabs to grasp for opening the flaps. If no tabs are provided, pluck the flap so that the fingers do not touch the inner surfaces – The inner surfaces which are next to the sterile gloves will remain sterile.

5. Put the first glove on the dominant hand.
- If the gloves are packaged so that they lie side by side, grasp the gloves for the dominant hand. Touch only the inside of the cuff – The hands are not sterile. By touching only the inside of the glove, the nurse avoids contaminating the outside.

- If the gloves are packaged one on top of the other, grasp the cuff of the top glove as above, using the opposite hand.

- Insert the dominant hand into the glove & pull the glove on. Keep the thumb of the inserted hand against the palm of the hand during the insertion. – If the thumb is kept against the palm, it is likely to contaminate the outside of the glove.

- Leave the cuff in place once the unsterile hand releases the glove. – Attempting to further unfold the cuff is likely to contaminate the glove.

6. Put the second glove on the non-dominant hand.
- Pick up the other glove w/ the sterile gloved hand inserting the gloved fingers under the cuff & holding thumb close to the gloved palm. – This helps prevent accidental contamination of the glove by bare hand.

- Pull on the second glove carefully. Hold the thumb of the gloved first hand as far as possible from the palm. –In this position, the thumb is less likely to touch the arm & become contaminated.

- Adjust each glove so that it fits smoothly & carefully pull the cuffs up by sliding the fingers under the cuffs.

Removing:
1. Remove the first glove by grasping it on its palmar surface taking care to touch only glove to glove. – This keeps the soiled parts of the used gloves from touching the skin of the wrist or hand.

- Pull the first glove completely off by inverting or rolling the glove inside out.

- Continue to hold the inverted removed glove by the fingers of the remaining gloved hand. Place the first two fingers of the bare hand inside the cuff of the second glove. – Touching the outside of the second soiled glove with the bare hand is avoided.

- Pull the second glove off to the fingers by turning it inside out. This pulls the first glove inside the second glove. – The soiled part of the glove is folded to the inside to reduce the chance of transferring any microorganisms by direct contact.

- Using the bare hand, continue to remove the gloves which are now inside out & dispose them in the garbage container.

2. Perform proper hand hygiene.

HANDWASHING

2012-07-28T06:44:00.000-07:00

Definition: The most effective infection control measure.

Purpose:
1. To reduce the number of microorganism on the hand.
2. To reduce the risk of transmission of microorganisms to clients
3. To reduce the risk of cross-contamination among clients
4. To reduce the risk of transmission of infectious organisms to oneself.

Equipment:
- Soap
- Warm running water
- Disposable or sanitized towels

Implementation/Rationale:
Assess Hands:
1. Nails should be kept short
- Short natural nails are less likely to harbor microorganisms, scratch a client or puncture gloves.

2. Remove all jewelry
- Microorganisms can lodge in the settings of jewelry & under rings.

3. Check hands for break in the skin
- A nurse who has open sores may require a work assignment w/ decreased risk for transmission of infectious organisms.

4. Explain to the client what are you going to do and why it is necessary.

5. Turn on the water and adjust the flow - Warm water removes less of the protective oil of the skin than hot water.

6. Wet your hands & wrist w/ warm water & apply soapfrom a dispenser. Don’t use bar soap, it allows cross-contamination.

7. Wet hands thoroughly holding the hands lower than the elbow under running water so that the water flows from the arms to the fingertips & to prevent water from running up your arms & back down, thus contaminating clean areas, then apply soap.
- The water should flow from the least contaminated to the most contaminated area; the hands are considered more contaminated than the lower arms.

8. Use firm rubbing & circular movements.
- The circular action helps remove the microorganisms mechanically.
Work up a generous lather for at least 10 seconds. Soap & warm water loosen surface microorganisms, which wash away in lather.
Palm to palm
Palm to dorsal
Dorsal to dorsal
Interlace fingers
Sides of the fingers
Inside of the nails
Knuckles
- Interlacing the fingers & thumbs cleans the inter-digital spaces. The nails & finger tips are commonly missed during handwashing.

9. Avoid splashing water on yourself or on the floor, microorganisms spread more easily on wet surfaces & slippery floors are dangerous.

10. Avoid splashing water on yourself or the floor, microorganisms spread more easily on wet surfaces & slippery floors are dangerous.

11. Don’t touch the sink or faucets; they are considered contaminated.
12. Rinse hands & wrists well, so running water flushes suds, soil & microorganisms away.

13. Pat hands & wrists dry with paper towels. Avoid rubbing, which can cause abrasion & chopping.
- Moist skin becomes chapped readily, chapping produces lesions.

14. Use a new paper towels to grasp a hand operated control.
- This prevents the nurse from picking upmicroorganisms from the faucet handles.

15. Use a new towel to dry the other hand & arm.
- A Clean towel prevents the transfer of microorganisms from one elbow to the other hand.

16. After Care- wash, clean & dry all the re-usable equipments. Discard all the disposables. Return the re-usable equipments on their designated places.

Catheterization

2012-07-19T05:14:00.002-07:00

Definition:
- Introduction of a catheter to the urethra into the urinary bladder to remove urine.

Purposes:
- To relieve discomfort due to bladder distention or to provide gradual decompression of a distended bladder.
- To assess the amount of residual urine if the bladder empties incompletely.
- To obtain a sterile urine specimen.
- To empty the bladder completely prior to surgery.
- To facilitate accurate measurement of urinary output for critically ill clients whose output needs to be monitored hourly.
- To provide for intermittent or continuous bladder drainage & or irrigation.
- To prevent urine from contracting an incision after perineal surgery.
- To manage incontinence when other measures have failed.

Equipment:
- Sterile catheter of appropriate size (extra catheter)
- Catheterization Kit or individual Sterile items:
• 1-2 pair sterile gloves
Waterproof drapes
Antiseptic Solution
Cleansing balls
Forceps
Urine receptacle
Specimen container
Water-soluble lubricant

•For an indwelling catheter
Syringe prefilled w/ sterile water in amount specified by catheter manufacturer
Collection bag & tubing
• 2% Xylocaine gel
• Disposable clean gloves
• Supplies for performing perineal cleansing
• Bath blanket or sheet for drapping the client
• Adequate lighting (flashlight or lamp)

Procedure:
1. Introduce self.
2. Perform hand hygiene
3. Provide privacy

4. Place the client in appropriate position & drape
a. Female: Supine w/ knees flexed, feet about 2 feet apart & hips slightly externally rotated.

b. Male: Supine, thighs slightly abducted or apart

5. Establish adequate lighting. Stand on clients right if right-handed, left if left-handed.

6. If using a collecting bag & it is not contained within the catheterization kit open the drainage package & place the end of the tubing within reach. – Since one hand is needed to hold the catheter once it is in place, open the package while two hands is still available.

7. If agency policy permits, apply clean gloves & inject 10-15ml Xylocaine gel into the urethra of the male client. Wipe the underside of the shaft to distribute the gel up the urethra. Wait at least 5 minutes for the gel to take effect before inserting the catheter. Remove gloves.

8. Open the catheterization kit. Place a waterproof drape under the buttocks (f) or penis (m) without contaminating the center of the drape w/ your hands.

9. Put on sterile gloves.

10. Organize the remaining supplies
- Saturate the cleansing balls w/ the antiseptic solution
- Open the lubricant package
- Remove the specimen container & place it nearby w/ the lid loosely on top.

11. Attach the prefilled syringe to the indwelling catheter inflation hub & test the balloon. – If the balloon malfunctions, it is important to replace it prior to use.
12.Lubricate the catheter (1 to 2 inches Female) or (6 to 7 inches Male) & place it w/ the drainage end inside the collection container.

13. If desired place the fenestrated drape over the perineum exposing the urinary meatus.
14.Clean the meatus:

a.Women – Use nondominant hand to spread the labia. Establish a firm but gentle position. The antiseptic may make the tissues slippery but the labia must not be allowed to return over the cleaned meatus. Pick up a cleansing ball w/ the forceps in your dominant hand and wipe one side of the labia majora in an anteroposterior direction. Use great care that wiping the client does not contaminate this sterile hand. Use a new ball for the opposite side. Repeat for the labia minora. Use the last ball to cleanse directly over the meatus.

b. Men – Use your nondominant hand to grasp the penis just below the glans. If necessary retract the foreskin. Hold the penis firmly upright, w/ slight tension. – Lifting the penis in this manner helps straighten the urethra. Pick up a cleansing ball w/ the forceps in your dominant hand & wipe from the center of the meatus in a circular motion around the glans. Use a new ball & repeat three more times. The antiseptic may make the tissues slippery but the foreskin must not be allowed to return over the cleaned meatus nor the penis be dropped.

15. Insert the catheter.
- Grasp the catheter firmly 2 to 3 inches from the tip. Ask the client to take a slow breath & insert the catheter as the client exhales. Slight resistance is expected as the catheter passes through the sphincters. If necessary, twist the catheter or hold pressure on the catheter until the sphincter relaxes.
- Advance the catheter 2 inches further after the urine begins to flow through it, to be sure it is fully in the bladder. For male client’s some agency’s policy & procedures indicate to advance the catheter to the “y” bifurcation of the catheter.
- If the catheter accidentally contracts the labia or slips into the vagina, it is considered contaminated & a new sterile catheter must be used. The contaminated catheter maybe left in the vagina until the new catheter is inserted to help avoid mistaking the vaginal opening for the urethral meatus.

16. Hold the catheter w/ the nondominant hand. In males lay the penis down onto the drape, being careful that the catheter does not pull out.

17. For an indwelling catheter, inflate the retention balloon w/ the designated volume.
- Without releasing the catheter, hold the inflation valve between two fingers of your nondominant hand while you attach the syringe & inflate w/ your dominant hand. If the client complains of discomfort, immediately withdraw the instilled fluid, advance the catheter further & attempt to inflate the balloon again.

- Pull gently on the catheter until resistance is felt to insure that the balloon has inflated & to place it in the trigone of the bladder.

18. Collect a urine specimen if needed. Allow 20 to 30ml to flow into the bottle without touching the catheter to the bottle.

19. Allow the straight catheter to continue draining. If necessary attach the drainage end of an indwelling catheter to the collecting tubing & bag.

20. Examine & measure the urine. In some cases only 750 to 1000ml of urine are to be drained from the bladder at one time. Check agency policy for further instructions if this should occur.

21. Remove the straight catheter when urine flow stops. For an indwelling catheter, secure the catheter tubing to the inner thigh for female clients or the upper thigh/abdomen for male with enough slack to allow usual movement. Tape or a manufactured catheter securing device should be use to secure the catheter tubing to the client. This prevents unnecessary trauma to the urethra. Also secure the collecting tubing to the bed linens & hang the bag below the level of the bladder. No tubing should fall below the top of the bag.

22. Wipe the perineal area of any remaining antiseptic or lubricant. Replace the foreskin if retracted earlier. Return the client to a comfortable position & thank for the cooperation.

23. Discard all used supplies in appropriate receptacles & wash hands.

24. Document the catheterization procedure including catheter size & results in the client record using forms or check list supplemented by narrative noted when appropriate.

Blood Clots / Stroke – They Now Have a Fourth Indicator, the Tongue

2012-03-20T17:55:00.001-07:00

Hello administrators!

I just thought of sharing this article that was sent to me by a colleague through e-mail as this could be helpful to us nurses in saving lives.

STROKE: Remember the 1st Three Letters.. ..S. T. R.

STROKE IDENTIFICATION:

During a BBQ, a friend stumbled and took a little fall – she assured everyone that she was fine (they offered to call paramedics). She said she had just tripped over a brick because of her new shoes.

They got her cleaned up and got her a new plate of food. While she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening

Ingrid’s husband called later telling everyone that his wife had been taken to the hospital – (at 6:00 pm Ingrid passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today. Some don’t die. They end up in a helpless, hopeless condition instead.

It only takes a minute to read this…

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke…totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE

Thank God for the sense to remember the ’3′ steps, STR.

Read and Learn!

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.

Now doctors say a bystander can recognize a stroke by asking three simple questions:

S *Ask the individual to SMILE.

T *Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently – i.e. It is sunny out today.)

R *Ask him or her to RAISE BOTH ARMS.

If he or she has trouble with ANY ONE of these tasks, call emergency number immediately and describe the symptoms to the dispatcher.

New Sign of a Stroke ——– Stick out Your Tongue

NOTE: Another ‘sign’ of a stroke is this: Ask the person to ‘stick’ out his tongue.. If the tongue is ‘crooked’, if it goes to one side or the other, that is also an indication of a stroke.

Author: zaza

This article was submitted by the Filipino Nurses community. All articles are views of their respective authors and not necessarily of Filipino Nurses'.