Additional Nursing Procedures

Additional Nursing procedures ADMISSION PROCEDUES Whether routine or emergency admission, make him comfortable, introduce him to his roommates & staff; orient him to the surroundings & routine activities. (hospital rules)

• On admitting children Speak directly to the child and allow him to answer before obtaining more information from the parents. Tell patient not to take any medication from home unless ordered by the doctor.

AIRWAY OBSTRUCTION Sudden airway obstruction may occur due to foreign body, mucus or vomitus, when the tongue blocks the pharynx, trauma, bronchospasm or bronchoconstriction. Perform HEIMLICH MANEUVER – an upperabdominal thrust to create diaphragmatic pressure. Used only on conscious adults For unconscious patients use abdominal thrust. For obese and pregnant women or had abdominal surgery, a chest thrust should be used.

• If a patient is unconscious, grasp the tongue and lower jaw with your thumb and fingers, lift the jaw to draw the tongue away from the back of the throat and away from any foreign body. • If you can see the object, insert your indx finger into the throat using a hooking motion, remove the object. • Ventilate the patient. Do CPR if necessary

PROGRESSIVE AMBULATION • When the patient has adjusted to the upright position after dangling, prepare him to stand. • Put on his robe, hard slippers or shoes. • If alert, allow him to stand by himself. Place one hand under his axilla and one around his waist. • Encourage him to look forward and not the floor to maintain balance. • If a patient needs help position your knees at either side of his. • If he can walk safely with assistance , stand beside him with one hand under his axilla and one around his waist. • In case of falling protect his head from injury, let him slide down to the floor.

BACK CARE • Particularly important for bedridden patients. • Purpose is to cause cutaneous vasodilation and help prevent ulcers. • A gentle massage can be performed after myocardial infection. • Put patient on prone position along the side of the bed nearest you to prevent back strain. • Expose back and buttocks, minimize exposure with the use of drape & prevent chills. • Form a mitt, and lather the back. • Rinse and dry well, because moisture trapped between the buttocks can cause chafing and lead to pressure ulcer.

• Back massage gives the best opportunity to inspect the skin condition especially the bony prominences • Apply lotion on your hand and rub them together, then apply long firm strokes. • Lotion reduces friction, and makes the massage easier. • Begin from the base moving toward the shoulder.

• Squeeze the trapezius to help relax the patient. • Finish by removing excess lotion, and replace patient’s gown. • Use separate lotion for each patient to avoid contamination. Avoid lotion and powder together to avoid skin maceration. • Don’t massage the legs because you might dislodge a clot.

Bandage, Elastic • Used to minimize joint swelling after trauma, immobilize fracture, anchor dressing or as substitute to antiembolism stockings. • Check doctor’s order. • Elevate the extremity for 15 min. before application to facilitate venous return. • Do not allow two skin surfaces remain in contact when wrapped. • Do not unroll the whole bandage. • Use figure of eight for the foot.

• Never wrap toes and fingers together unless absolutely necessary to detect impaired circulation. • Check distal circulation regularly because elastic bandage may tighten as you apply it.

BED BATH • Sequence • Special considerations • Basin should be filled 2/3 full

BATH, SITZ • Immersion of the pelvic area in warm or hot water. • This promotes wound healing, by increasing circulation, and reducing inflammation.

BATH, THERAPEUTIC • Additives may be oatmeal powder, soluble cornstarch, or soybean complex. • Purpose is to soften crusts, scales, & debris, relieve inflammation, and relieve itching. • Sodium bicarbonate added to the water produces an alkaline bath that cools and help relieve pruritus.

• A medicated tar bath leaves a film of tar on the skin and works well in combination with ultraviolet light to prevent rapid cell turnover characteristics of psoriasis. • Duration 15 min. • Tepid bath.

USE OF BEDPAN OR URINAL • Warm under running water. • Serve tissue paper, and sponge towel after its use.

BINDERS Types 1. Straight 2. Scultetus 3. T binder 4. Breast binder They are also called self-closure; purpose is to provide support, secure dressing, reduce tension on suture lines and reduce breast engorgement. Wrap binder so it applies even pressure.

BREAST PUMP USE • It creates a suction to stimulate lactation. • Milk may be stored in sterile feeding bottles, • Have the mother pump her breast every 2-3 hrs.around the clock.

BURNS, BIOLOGICAL DRESSING • Biological dressing provide temporary covering for burn wounds and clean granulation tissue. • Organic materials as: pigskin cadaver skin amniotic membrane Synthetic material as Biobrane may be applied by the nurse.

• Gastric tube insertion • Gastric feeding • Gastric lavage – for patients with gastric bleeding, solution may be iced water or normal saline solution. Instill 250 ml. before allowing irrigant to flow out. If a syringe is used instill 50 ml at a time until 250 is reached,

NGT INSERTION • Special considerations

PAIN MANAGEMENT • Cognitive therapy 1.Distraction – let patient recall a pleasant experience or an enjoyable activity. Music may also be used 2.guided imagery- help him concentrate on a pleasant image, recalling details such as sight, sound, smell taste, and touch. 3. Deep breathing – have him stare at an object, then slowly inhale and exhale as he counts aloud to maintain a comfortable rate & rhythm, have him focus on the rise and fall of his abdomen, and to feel more weightless with each breath.

• Muscle relaxation- have the patient tense a particular muscle group and note the sensation. After 5-7 seconds, tell him to relax the muscles and concentrate on the relaxed state. Have him note the difference between the two states. Have him proceed to another muscle group, and then another, until he has covered his entire body. • Document response.

PAP SMEAR • Cytology • Many factors can interfere with pap test like menstruation, or use of vaginal douche or instillation of vaginal medication 48 hrs before specimen collection.

PERINEAL CARE • Downward stroke, front to back for the anal area. • For male clean shaft of penis from tip down using a circular motion. • Always pat dry.

POST MORTEM CARE • Place tags on the body, shroud, and patient’s belongings. • Collect valuables and place in a bag. Place towel under chin to prevent mouth from opening, remove before giving the body to the family.

STOOL COLLECTION • Never refrigerate stool to confirm the presence of ova and parasite.

T- tube care • The T- tube is placed in the common bile duct after cholecystectomy, facilitates biliary drainage during healing. • It stays for 7-14 days. • Normally daily drainage ranges from 500 to 1000 ml. of viscous, green brown liquid. • Report drainage that exceeds 500 ml in the first 24 hrs. after surgery. • This amount declines to 200 ml or less in 4 days