CHAPTER 3

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Meeting the Basic

Needs

of a Patient

LEARNING OBJECTIVES

LEARNING

OBJECTIVES

CHAPTER OUTLINE

• SECTION A : Physical Needs
• SECTION B : Hygienic Needs
• SECTION C : Elimination Needs
• SECTION D :

• SECTION D : Nutritional Needs
• SECTION E : Psychological and Spiritual Needs
• SECTION F : Care of terminally ill and Dying Patients

SECTION A :

PHYSICAL NEEDS

COMFORT

The word comfort has derived from the Latin word ‘comfortare,’ which means ‘strengthen greatly.’ To provide comfort is to strengthen the physical state or cheer up the mood of a person.

“Comfort can be defined as absence of

irritating stimuli that divert one’s attention

from the work to be done”.

Types of Comfort

Factors Influencing Comfort

Importance of comfort

• Stress and difficult are erased by comfort.
• A feeling of comfort can improve mood.
• Comfort relieves pain.
• Feeling comfortable gives the patient a sense of security and strength.
• It provides a feeling of care and value for the patient.

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REST AND SLEEP

REST AND SLEEP

Rest and sleep are essential for life as well as good health—a person’s body requires both sleep and rest, and rest is a vital element of restorative sleep. However, various factors may affect a person’s ability to get adequate sleep and/or find time for essential periods of rest.

Deficiencies in rest and/or sleep can have a negative impact on a person’s physiologic, mental, and emotional health.

Rest

According to Helvig et al. (2016), rest is a basic need in health and illness. Rest is a concept that is used in many disciplines.

Rest can be defined as a state in which the body is in a reduced activity, with the resultant feeling of being refreshed.

Sleep

“Sleep can be defined as a complex rhythmic state involving a progression of repeated cycles, each representing different phases of body and brain activity, and is crucial for physical, mental, and emotional wellbeing.”

---Buysse, 2014

Factors Affecting Rest and Sleep

Factors affecting

rest and sleep

Age

Motivation

Culture

Occupation

Dietary habits

Physical Activity and Exercise

Lifestyle and Habits

Alcohol

Caffeine

Smoking

Environme ntal factors

Psychologi cal stress

Disease conditions

Medications

PROMOTION OF REST AND SLEEP

Nursing intervention to promote rest and sleep :

• Skillfully and without delay attend to the needs of the patient.
• Make sure there is adequate ventilation.
• Set up the patient for rest at standard stretches.
• Incite rest by a steaming shower in the evening.
• Place the cushion and comfort devices correctly to ensure

a comfortable position.

• Offer bedpan or urinal not long prior to heading to sleep.

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EXERCISE – TYPES AND BENEFITS

• Exercise is defined as an active exertion of muscles involving the contraction and relaxation of muscle groups.
• Various types of exercise can produce different physiological and psychological benefits to a person.
• Exercise can be classified into two major types. One is based on the type of muscle contraction occurring during the exercise and the second is based on the type of body movement occurring and the health benefits achieved.

Importance and promotion

The human body was designed for motion, and regular exercise is essential

for its healthy functioning.

The effect of regular exercise on major body system are explained in

the following section :

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Respiratory System

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Over time, regular exercise leads to improved respiratory functioning .

Improvement in respiratory function includes :

• Decreased work of breathing
• Improved alveolar ventilation
• Improved diaphragmatic excursion

Cardiovascular System

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Over time, regular exercise results in improved cardiovascular functioning and produces the following advantages :

• Improved efficiency of the heart
• Improved venous return
• Decreased heart rate and blood pressure
• Increased circulation to all body parts
• Increased circulating fibrinolysin

Musculoskeletal System

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Regular exercise produces the following advantages :

• Increased coordination
• Improved efficiency of nerve impulse transmission
• Reduced bone loss
• Research studies have found that exercise has also been associated with minimizing bone loss during chemotherapy.

Continue…

Digestive System

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During exercise , blood is shunted away from the stomach and intestine to the exercising muscles. With regular exercise:

• Appetite is improved
• Increased gastric motility
• Intestinal tone is increased , thus improves digestion and elimination
• Weight may be controlled

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Metabolic Processes

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Advantage of exercise on the metabolic processes include:

• Increased triglyceride breakdown
• Increased production of body heat

Integumentary System

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Increased circulation resulting from regular exercise nourishes the skin. Thus, regular exercise aids in promoting the overall general health of the skin.

Urinary System

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• Regular exercise increases blood flow , including improved blood circulation to the kidney
• This allows the kidney to maintain the body’s fluid balance and acid-base balance more effciently and to excrete body wastes through urine.

Psychosocial Wellbeing

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Regular exercise also leads to psychological wellbeing.

These benefits includes:

• Improved sleep
• Increased energy and vitality
• Improved self-concept
• Improved general well being
• Improved appearance ( body image )
• Increased positive health behaviors

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Promotion of exercise

Following are the ways to promote exercise among patients:

• Exercise ought to be arranged by the age, sex and state of the patient.
• The room should be all ventilated .
• Over fatigue should be avoided.
• Put on loose garment.
• Assist the patient with perceiving the individual advantages of exercise.
• Recognize the boundaries to active work and how to beat them.
• Set little, attainable objectives.

BODY MECHANICS

Body mechanics is the utilization

of correct complete a

body task

muscles to safely and

efficiently, without undue strain on any muscle or joint.

PURPOSES OF BODY MECHANICS

PRINCIPLES OF BODY MECHANICS

PRINCIPLES OF BODY MECHANICS

PRINCIPLES OF BODY MECHANICS

PRINCIPLES OF BODY

MECHANICS

PRINCIPLES OF BODY MECHANICS

General Instructions in Moving and Lifting the Patients

• Patients should not be distracted / interrupted in their movement
• Sliding rather than lifting obese patients is the best way to move them
• Lift and move heavy patients with assistance
• Encourage the patient to use his abilities to the fullest extent feasible,

unless contraindications exist

• Because vital nerves and blood arteries may be injured , do not support

the patient beneath his armpit

Moving a Patient Up in the Bed with the Assistance of Another Caregiver

If the patients is fully able, caregiver assistance is needed to move a patient

up in bed and the patient may or may not use a positioning aid.

Allow the patient to complete the movement independently if able to do so,

under supervision.

The patient assist movement either by pushing with the feet flat against the

bed or by Using an over-bed trapeze . If only partially able, encourage the

patient to assist using a repositioning aid.

Articles Required

• Friction-reducing sheet or other friction- reducing devices.
• Clean gloves and other PPE, if needed.
• Additional caregivers to assist.
• Full-body sling lift and cover sheet, if needed.

• Producer of moving a patient up in bed with the assistance of another caregiver.

(Refer Page No. – 99-100 )

Documentation

• Document the time at which the patient’s position was changed , use of support

devices, and any relevant observation, such as including skin assessment : signs

of irritation, edema, or redness, etc.

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Moving a Patient from Bed to Stretcher

Moving a Patient from Bed to Stretcher

• Weighs less than 90 kg : If the patient is partially able or not

able to assist at all, use a friction-reducing device and /or

lateral-transfer board.

• Weighs more than 90 kg : If the patients is partially able or not

able to assist at all, a ceiling lift with supine sling , a mechanical

lateral-transfer device or air-assisted device, and three caregivers

are required.

• Unconscious patient : If the patient is unconscious or weakened ,

additional nurses are needed to support the extremities and the head.

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Articles Required

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• Transport stretcher
• Friction-reducing sheet/draw sheet
• Lateral-assist devices, such as a transfer board , roller board, or

mechanical lateral-assist device.

• Bath blanket
• Regular blanket
• At least two assistance, depending on the patient’s condition
• Clean gloves and/ or other PPE, as needed.

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For Procedure Refer Page No:- (100-101)

DOCUMENTATION

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• Document the time and method of transport, and patient’s

education, according to hospital protocol.

• For example, Patient transferred to stretcher via three-person
• assistance and lateral-assist transfer sheet. Patient was

transported to radiology department for CT scan.

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Moving a Patient from Bed to Chair

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Assess the patient’s ability to bear weight when determining the appropriate method

for transfer and the appropriate method for transfer and the appropriate transfer aid

Articles Required

• Chair or wheelchair
• Gait belt
• Stand-assist aid, if available
• Additional staff person to assist
• Blanket to cover the patient in the chair
• Clean gloves and / or other PPE, as required

For Procedure

Refer Page No (102-103)

Documentation

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• Document the activity, including the length of time the patient sits in the chair , any other relevant observations, the patient’s tolerance of and reaction to the activity

Moving a Patient to One Side of the Bed

Preliminary Assessment

• Check the determination and explicit safeguard in regards to

the development of the patient.

• Really look at the degree of cognizance and the capacity to

adhere to directions.

• Take a look at the capacity for taking care of oneself.
• Check for the presence of muscle, skin and bone injuries and

connections , for example, catheters and IV associations.

• Check for quantity of workforce required and accessible to

move the patient securely.

CONTINUE…

Preparation of Patient and Unit

• Privacy to the patient.
• Tell the procedure to the patient and look for his support.
• Change the bed to the functioning stature, lower side rails
• and lock the wheels of the bed.
• Fanfold the top cloth to the foot end of the bed.
• Change wet or dirty linen.
• Eliminate all solace gadgets utilized for the patients.
• Eliminate the pillow and spoil it against the head end of the bed.

For Step of Procedure

Refer page no (103-104)

After Care of the Patient

• Ensure that the patient’s body is aligned correctly and

that he or she is comfortable.

• As needed, replace the pillow and other comfort devices.
• Raise the side rails as needed for patient’s safety.
• Check for any uneasiness, torment, skin condition, so on .
• After assuming the desired posture , check the patient’s

vital signs.

• To prevent falls, stay close to the patient when changing

positions.

• Ascertain that the patient is safe and comfortable.

Turning a Patient to One Side of the Bed

Turning a Patient To One Side of the Bed

An immobile patient cannot turn in bed without assistance .

Nurses need to use their understanding and skills of correct

Alignment to turn the patient from the back onto the side,

from the back onto the abdomen, and from the abdomen onto

the back.

Equipment Required

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• Friction-reducing sheet or draw-sheet.
• Bed surface that inflates to aid in turning.
• Pillows or other devices to help the patient to

maintain the desired position.

• Additional caregivers and /or safe handling equipment

to assist.

• Gloves and other, if needed.

For Procedure

Refer Page no (104-105)

Assisting the Patient to Sit on the Side of the Bed

For Procedure

Refer Page no (105-106)

Position and Posture Maintenance

“Positioning is defined as placing the person in a

correct body alignment for the purpose of promotive

, preventive , curative and rehabilitative aspects of

health or placing the patient in proper body as needed

therapeutically.”

Principles of Positioning

• Maintaining good body alignment of self and patient.
• Maintaining good body mechanics.
• Changing position regularly ( after every 2 hourly )

and systematically.

• Inspection of pressure points during position change

for early identification of skin breakdown.

• Follow safety measures to prevent accidents.

Purposes of Positioning

• Ensure comfort
• Prevents decubitus ulcers
• Contractures prevention
• Prepares the patient for diagnostic procedures

and treatment

• Facilitate a patient’s recovery
• Enhances sleep
• Prevents complications related to immobility
• Stimulates nervous system
• Permits frequent skin assessment and

maintains skin integrity

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Equipment Needed For Positioning the Patient’s

THERAPEUTIC POSITIONS

THERAPEUTIC POSITIONS

• “Defined as placing the person in a correct body alignment for the purpose of promotive, preventive, curative and rehabilitative aspects of health or placing the patient in proper body alignment as needed therapeutically”.

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• Good body posture or normal body alignment is very vital for the proper functioning of the body. Body alignment refers to the condition of the joints, tendons, ligaments and muscles in various body positions- whether standing, sitting or lying.

Therapeutic Positions

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Supine Position

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Prone Position

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Fowler’s Position

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Cardiac/Orthopneic

or Tripod Position

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Dorsal Recumbent Position

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Lateral/Side Lying Position

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Sims’ or Lateral

Decubitus Position

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Trendelenburg’s

Position

Reverse

Trendelenburg’s

Position

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Lithotomy Position

The Knee- chest/Genu-Pectoral Position

Supine Position

• Supine position or horizontal recumbent position is defined as lying on the back with arms at sides.
• In this position the patient is made to lie on his/her back with arms and legs straight on the sides on a flat bed.
• Generally, the head is rested on a pillow, keeping the neck in a neutral position.
• The patient’s arms can be either tucked at their side or abducted to

Prone Position

• Prone position is defined as lying on abdomen with head turned to the side.
• In this position the patient is made to lie down on abdomen on a flat bed.
• To support the patient lying in prone, place a pillow under the head, one pillow under the waist and one under the ankle to release the weight of the toes.
• Patient lies with head turned to one side for comfort. Arms may be above head or alongside body.
• Cover with sheet or bath blanket.
• This is the only bed position that allows full extension of the hip and knee joints.

Fowler’s Position

• Fowler’s position is a semi-sitting position with various degrees of head elevation.
• Fowler’s position is a bed position wherein the head and trunk are raised 15°–90°.
• It is a standard patient position in which the patient is seated in a semi- sitting position and may have knees either bent or straight.
• This position is given to the patient with the support of back rest and pillows.
• The patient’s knees are slightly elevated with the help of small pillows or

rolled towel under the knees to prevent pressure on the back of the legs.

Types of Fowler’s Position

Cardiac/Orthopneic or Tripod Position

• Cardiac position is also known as orthopneic or tripod position.
• It is a sitting upright position with the head of bed elevated 90°.
• Patient may lean slightly forward with arms raised and elbows flexed.
• This position helps in easy breathing.
• Orthopneic position permits maximum lung expansion for gaseous exchange, because the abdominal organs do not pose pressure against the diaphragm.

Dorsal Recumbent Position

• Dorsal recumbent position is lying on the back with arms at sides, legs apart, knees bent, and feet flat on the bed with patient’s head and shoulders slightly elevated on a small pillow.
• This position is similar to supine position with knees are flexed and soles of feet flat on the bed.
• Used for physical examination of abdomen and genitalia.
• Dorsal recumbent position is used for perineal care, urinary catheterization and vaginal douche, vulval, vaginal and rectal examination.

Lateral/Side Lying Position

• Lateral position or side lying position is lying in the left or right side, supported behind back and between knees and ankles with pillows is a good body alignment.
• In this position the patient is made to lie on right or left side with both the knees slightly bent toward the abdomen but the upper knee is bent more than the lower knee.
• Lateral position helps to relieve pressure on the sacrum, coccyx and heels in people who sit for much of the day or confined to bed rest in Fowler’s or dorsal recumbent.

Sims’ Position

• Sims’ or lateral decubitus position is defined as lying on the left side in semi-prone position with right leg flexed and drawn up toward the chest; the left arm is positioned along the patient’s back.
• Sims’ position is a semi-prone position where the patient assumes a posture halfway between the lateral and prone position.
• The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the elbow. Both legs are flexed in front of the patient.
• Used for rectal examination or treatments of rectal area

Trendelenburg’s Position

• This position includes lying on back with arms at sides; bed positioned so foot end of bed is higher than head end of the bed.
• The body is laid flat on the back (supine position) with the feet higher than the head with approximately 30° below horizontal level.
• Use pillow to protect the head from the bed’s headboard.
• This is a standard position used in abdominal and gynecological surgery

Reverse Trendelenburg’s Position

• Reverse Trendelenburg’s position is the opposite of Trendelenburg’s

position.

• Patient lying on back with arms at sides, bed positioned so that head is higher than foot, but no flexion at waist.
• This is often a position of choice for patients with gastrointestinal problems as it can help to minimize esophageal reflux

Lithotomy Position

• Lithotomy position is defined as lying on back with knees flexed above the hips and legs supported in stirrups.
• Position is used for examination and diagnostic procedures of pelvic organs.
• This position is similar to dorsal recumbent position, except that the

patient’s legs are well separated and thighs are acutely flexed.

• Used during vaginal and gynecological examination and surgeries like hysterectomy

The Knee-chest/Genu-Pectoral Position

• In this position, the patient kneels on the bed with thighs vertical and chest resting on a firm pillow.
• The head is turned to one side and the hands are flexed around the head or on the bed.
• Thighs are straight and lower legs are flat on bed.
• Knee-chest position is used for rectal and vaginal examinations and as treatment to bring uterus into normal position.

MAINTENANCE OF NORMAL BODY ALIGNMENT AND MOBILITY

Body alignment or posture

Balance

Coordinated movement Postural reflexes

BODY ALIGNMENT OR POSTURE

• Alignment of body parts that allow optimal musculoskeletal balance and operation and promotes healthy physiological functioning.
• A person in correct alignment experiences no undue strain on the joints, muscles, tendons, or ligaments while the balance is maintained.

BODY ALIGNMENT OR POSTURE

BALANCE

• An object is balanced when its center of gravity (the point at which its mass is centered) is close to its base of support, the line of gravity goes through the base of support, and the object has a wide base of support.
• When the person is standing, the center of gravity is located in the center of the pelvis about midway between the umbilicus and the symphysis pubis.
• The base of support is the foundation that provides for an object’s stability. The wider the base of support and the lower the center of gravity, the greater the stability of the object will be.

COORDINATED MOVEMENT

• The ability of muscles to work together for purposeful movement.
• Coordinated movements are complex mechanisms, it includes proprioception, physical activity, exercise, and activity tolerance.

COORDINATED MOVEMENT

• Awareness of posture, movement, changes in equilibrium and knowledge of position, weight, and resistance of objects in relation to the body.

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• Body movement produced by musculoskeletal that required energy and produce health benefits.

• Type of physical activity defined by planned, structured and repetitive body movement done to improve or maintain body movement.

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• Type and amount of exercise individual is able to perform without experiencing adverse effect.

Proprioception

Physical activity

Exercise

Activity tolerance

COMFORT DEVICES

• In health care setting, various mechanical devices are used for numerous purposes.
• Commonly used comfort devices are special beds, pillows, back rest, knee rest, cardiac table, mattresses, bed cradle, cotton or rubber rings, trochanter rolls, hand rolls, footboard, trapeze bar, air cushion, sandbags, side rails, abductor pillow, and bed block, etc.
• It is necessary for the nurses to understand the use of each comfort device. Nurses must be quick in assessment of individualized patient needs for specific comfort device. It is mandatory to use comfort devices correctly for therapeutic outcomes.

PURPOSES OF COMFORT DEVICES

Comfort devices serve many roles in health care setting for patient comfort. Comfort devices are frequently used for following purposes:

• To relieve discomfort of the patient.
• To immobilize body part whenever required.
• To provide comfortable position to the patient.
• To relieve pressure on parts of body so that decubitus ulcers

can be prevented.

• To prevent patient falls and accidents.

Commonly used Comfort Devices in Health Care Setting for Patient Comfort

Special Beds

• Due to technological advancements, a variety of hospital beds has been manufactured so that maximum patient comfort can be ensured.
• Some of commonly used special beds are:
• Gatch bed
• Electric beds
• Clinitrol beds

A. Gatch Bed

Gatch beds are specialized hospital beds with a frame in three movable sections equipped with mechanical spring parts that permit raising the head end, foot end, or middle part as per need.

B. Electric Bed

Electric beds are similar to Gatch bed in term of functions. The only difference is the working as these beds are operated electrically. One of the benefits of electric bed over Gatch bed is that it can be managed by patients as well.

C. Clinitron Bed

Clinitron beds are the special bed available for the therapeutic treatment of patients with advance stage or/ and multiple pressure ulcers, burns, grafts and intractable pain. These beds support the patient body evenly.

Pillows

Pillows are most commonly usedcomfort devices in health care setting. These are mostly used to support various body parts to maintain correct body alignment and may use under head,arms,legs, back or abdomen.Pillows help to reduce pressure, so that prevents decubitus ulcers.

Mattresses

Mattresses are essential with patient beds. A perfect mattress is one that fits on bed frame. Mattresses can be of various types like standard bed mattress, egg crate mattress, air mattress and water mattress. Mattress provides comfort will resting on bed.

Back Rest

It is a mechanical device which provides a suitable support and rest for the back. It supports patients back at an angle, so that he may maintain a sitting or fowler’s position.

Cardiac Table

Cardiac table is also known as orthopneic table or bed table. It is a mechanical device designed as an over bed table and is placed in front of the patient while they are in fowler’s position.

Bed Cradle

• Bed cradle are the comfort devices that vary widely in size and material. Bed cradle can be of wooden or metal. These are semi- circular or rectangular in shape.

Air Cushion

• They are round in shape and made up of rubber.
• Uses of air cushion majorly include prevention of direct pressure on bony prominences and to improve blood circulation. For instance, nurses can use air cushion to lift the hip from bed to prevent bed sores.

Cotton Rings

• Cotton rings are made up of cotton wrapped with bandage.
• These can be placed directly under bony prominence such as heels and fastened in place if necessary.
• Cotton rings relieve pressure and help in prevention of decubitus ulcers. Plastic rings can also be used instead of cotton rings.

Trochanter Rolls

• are used to prevent the external rotation of the hip when the patient is in supine position.
• To make a trochanter roll, a cotton bath blanket/sheet is folded lengthwise placed from greater trochanter of femur to lower border of popliteal space.

Hand Rolls

• Hand rolls are made up of cloth that rolled into the cylindrical shape.
• It is about 2–3 inches in diameter and 4–5 inches long and stiffed firmly.
• Hand roll is placed against the palmer surface of the hand of the patient.
• It is used to keep the fingers slightly flexed and free from being held in a tight fist.

Sandbags

• These are canvas rubber or plastic bags filled with sand.
• These are used to immobilize the body parts.
• Sand bags provide support and shape to body contours. It can be used to immobilize extremities & maintain specific body alignment.

Hot Water Bags

• A water bag is a bag made up of leather, canvas or other materials, which are used for giving hot application.
• Water bags are commonly used to reduce inflammation, to relieve pain, to promote healing, and give warmth to the body.
• Always cover the hot water bag with cloth, as direct application can cause burn.

Ice Packs

• Ice packs are used to apply cryotherapy.
• These are plastic packs filled with ice cubes.
• Ice packs are used to relieve the pain from sprains, strains and soft tissue injuries. Ice packs are also used to reduce inflammation.
• Cryotherapy work by reducing blood flow to a particular area. Decreased blood supply reduces inflammation and thus relieves pain caused by swelling and inflammation.

Side Rails

• Side rails are the bars positioned along the sides of the length of the bed. Side rails ensure patient’s safety and are useful for increasing patient’s mobility in bed.
• It provides assistance to patient in rolling from side to side or sitting up in bed.

Footboard

• These are mechanical devices used to give rest to the feet.
• Foot boards are used to maintain the normal position of feet so that foot drop can be prevented in unconscious patients.
• These devices are placed toward the foot of patient’s bed to serve as support for patient’s feet.

Foot End Elevator

• It is a platform or an enclosure raised and lowered in a vertical shaft to provide elevated support for feet and ankles. It is ideal for postoperative and rehabilitation.

Wedge/Abductor Pillow

• Wedge or abductor pillow is a special triangular shaped pillow made of heavy foam. It is used to maintain legs in abduction following total hip replacement surgery.

Knee Rest

• This is a device placed under the knees to provide comfort. Knee rest provide relaxation and thus relieves pain on tendons beneath the knees.

Bed Blocks

• Bed blocks are made up of wood or metal and are used to raise the foot end or head end of the bed. Bed blocks aids in different therapeutic positions like Trendelenburg and reverse trendelenburg position.

Trapeze Bar

• Trapeze bar is suspended from an overhead frame that extends from the foot to head of bed. Patient can grasp the bar to raise the trunk off the bed surface or to move up in bed. It is also used as safety device

Balkan Frame

• Balkan frame is made of wood or metal that extends lengthwise above the bed and is supported at either ends by a pole. Trapeze may be attached to the frame just above patient’s head as an aid to the patient in lifting himself up in the bed.

Hand and Wrist Splints

• Hand and wrist splints are splints individually molded for the patient to maintain proper alignment of the thumb in slight adduction and wrist in slight dorsiflexion. These splints should be used only for the patient whom the splint was made.

BED MAKING

Bed Making

• “Bed-making is an act of arranging the bedsheets and other bedding on a bed, to prepare it for therapeutic use.”
• Bed-making is the technique of preparing different types of bed for placing patients in comfortable position suitable for a particular condition.
• Bed making is one of the basic nursing procedures to prepare various types of beds.

Purposes of bed making

• To promote cleanliness of the patient.
• To provide the patient with a safe and comfortable bed to take rest and sleep.
• To observe, identify and prevent complications like decubitus ulcers (bedsores).
• To establish an effective nurse-patient relationship.
• To provide physical and psychological comfort and security to the patient.
• To provide active and passive exercise.
• To give the unit or ward a neat appearance.

Principles of Bed Making

• Principles of patient comfort
• Principles of body mechanics
• Principle of order
• Principle of prevention of microorgansims spread
• Principle of patient and safety
• Principles of assessment

Body mechanics during bed making

cont.

Body mechanics during bed making

Types of Beds

• Unoccupied bed
• Close bed (Admission bed)
• Open bed
• Occupied bed
• Cardiac bed
• Fracture bed
• Operation bed
• Burn bed
• Amputation bed

Articles required in bed making

• Mattress cover
• Two sheets (bottom and top sheet)
• Blanket
• Draw sheet
• Mackintosh
• Pillow cover
• Counterpane
• Laundry bag
• Two Dusters/ sponge cloth - 1 for solution and 2^nd to dry
• A bowl with antiseptic lotion ( Savlon or Dettol solution)
• Kidney tray
• Various comfort devices like cardiac table, bed cradle, extra pillows, back rest, foot board, fracture board, sand bag etc.

Purposes: To give a suitable bed ready for the admission of a

Unoccupied bed

A bed prepared to receive a new patient is an unoccupied bed. There are two types of unoccupied beds: Closed bed and open bed.

new patient.

• To provide a clean and fresh environment.
• To reduce source of infection.
• To promote cleanliness.
• To give unit or ward a neat appearance.

Occupied bed

This bed is made with the patient in the bed and cannot get out of the bed. This bed is commonly used for immobile patients

Purposes:

• To make a bed with least possible discomfort to the

patient.

• To prevent skin breakdown due to soiled linen.
• To handle the bed linen skilfully while the patient

is on bed.

• To provide clean and tidy appearance.
• To establish effective nurse patient relationship.

Post- operative bed

Postoperative bed is also known as operation bed or surgical bed. It is a special type of bed made for the patient who is coming from the operation theater or from another procedure. The bed is made in such a way as to make it easy to transfer the unconscious or weak patient from a stretcher to the bed

Purposes:

• To receive the patient conveniently.
• To prevent shock.
• To meet any emergency.
• To provide warmth and comfort

Cardiac bed

A bed prepared for patients with cardiovascular and respiratory diseases

Purposes:

• To relieve dyspnea.
• To maintain the comfort of patients with

cardiovascular or respiratory diseases.

It is a bed in which top linen is divided into two parts to visualize the amputated part of lower limb without disturbing the patient.

Amputation bed

Purposes of Amputation Bed

• To watch stump for hemorrhage.
• To take the weight of the bed clothes of the patient.
• To keep the stump in position.

Purposes of Making Fracture Bed

Fracture bed

It is the bed, which is prepared for patients with fracture, bone diseases and deformity.

• To immobilize the fractured part.
• To restrict sudden jerky movements
• To prevent the undue sagging of mattress
• To keep the traction in position

It is a special type of bed designed for hospital patient who have suffered severe skin burn across large portion of their body.

Burn bed

Purposes of Making Fracture Bed

• To provide comfort to the patient
• To relieve pain
• To prevent infection
• To distribute the weight of top sheet equally over

the cradle

LINEN

Linen is a fabric made from fibres. It includes clothes, sheets, blankets, etc.

TYPES OF LINEN

IMPORTANCE OF MAINTAINING LINEN IN HOSPITAL

• To provide clean and tidy linens to the patients in the hospital.
• To provide comfort to the patient .
• To limit the cross-infection.
• To promotes cost-effectiveness of hospital by prolonging the life of the items.

SERVICE QUALITY STANDARDS FOR LINEN

• Linen must be stamped with ward and hospital name.
• Before use, wash all new articles.
• Damaged linen must be kept aside for repair and remove stains before they fix.
• Send contaminated linen to laundry as earlier.
• Sort the linen carefully, when returned from laundry and report for any problem noted in items and do accurate and frequent stock-taking to keep track of lost items.
• Sort dirty linen when sending to laundry.

CARE OF LINEN

DISINFECTION OF CONTAMINATED/SOILED LINEN

• Use a laundry box/hamper trolley for collecting contaminated linen and do not throw soiled linen on floor.
• Dip the soiled linen in 0.5% solution of chlorine for 10 minutes and rinse it in water and dry in sun and then send for autoclaving (sterilization).
• After disinfecting and washing the linen, store them in appropriate cupboards.

CARE OF BLANKETS

• Do not wash the blankets as they will shrink.
• Dust them in open place and then dry them in sunlight to disinfect.
• Do not expose the blanket to the dust.
• Protect the blankets from moth by using naphthalene balls and covering with dust proof sheet while storing.

CARE OF MATTRESSES AND PILLOWS

• Prevent them from getting wet and soil.
• Clean / brush at regular intervals to prevent dust collection.
• Use washable covers.
• Disinfect by exposing them to sunlight.
• If needed, wash them under running cold water.

SAFETY DEVICES

Safety devices are the devices that are used during a medical, diagnostic, surgical and nursing procedure or as a voluntary mechanical support used to achieve proper body alignment, balance or position to allow greater freedom of movement (helmet, side rails, grab bars, and non-skid slippers, etc.).

“Restraints are

defined as the

intentional restriction of a

person’s voluntary movement or behavior.”

—Counsel and Care, UK (2002)

Restraints

USE OF RESTRAINTS IN HEALTHCARE FACILITY

• Used to limit movement of the patient and prevent risk of self-harm and harm to others.
• There are variety of physical restraints that can be used for adults and children.
• Drugs that are used to control behavior and are not part of person’s normal medical regimen can be considered as chemical restraints.

​

​

​

TYPES OF RESTRAINTS

OBJECTIVES OF USING RESTRAINTS

• To prevent interruption in medical treatment.
• To prevent disoriented or combative patients from removing any life supportive equipment or tubes. To prevent the risk of injury to other patients and staff.
• Children may need to be restrained for some diagnostic or/and therapeutic procedures or during
• assessment.
• A physical restraint is used when a patient’s safety is at risk. For instance, a patient acting in an aggressive or violent way.

PRINCIPLES OF USING RESTRAINTS

PRINCIPLES OF USING RESTRAINTS

APPLICATION OF VARIOUS TYPES OF PHYSICAL RESTRAINTS

APPLICATION OF VARIOUS TYPES OF PHYSICAL RESTRAINTS

APPLICATION OF VARIOUS TYPES OF PHYSICAL RESTRAINTS

POSSIBLE RISKS OF RESTRAINTS USE

RESPONSIBILITIES OF THE NURSE DURING THE USE OF RESTRAINTS

RESPONSIBILITIES OF THE NURSE DURING THE USE OF RESTRAINTS

LEGAL IMPLICATIONS FOR USE OF RESTRAINTS

• Know the hospital’s restraint protocols.
• When assessing the need for a restraint, always assess the underlying cause for a patient’s restlessness, agitation, confusion or violent behavior.
• Apply restraints only when necessary for ensuring patient’s safety, not for self-convenience or to cope with understaffing.
• Avoid being influenced by a family member’s advice regarding not to restrain the patient, even when

the person offers to take care of patient.

• Receive a physician’s order before applying a restraint. If the patient needs to be restrained immediately, apply the restraint and then notify the physician as soon as possible.
• Nurses must identify competent adult’s right to make decisions regarding personal care and treatment,

and obtain appropriate consent.

• Keep in mind the principle of least restriction.
• Make sure that a physical restraint fits properly.
• Periodically re-evaluate the need for the restraint.

​

CHOOSING ALTERNATIVES TO RESTRAINTS

• Determine whether behavior pattern which can be harmful for patient or others exists.

• Rule out the reason for agitation and family in patient’s care.
• Reduce stimulation, noise, and light.

involve the

• Distract and redirect the patient by using a calming voice and use simple, clear explanations and directions while communicating with the patient.
• Check environment for potential hazards and use an electronic alarm system on a temporary basis (e.g., bed or position-sensitive alarms) to warn unassisted activity.
• Allow restless patient to walk after ensuring that environment is safe and ensure the use of glasses and hearing aids, whenever required.

​

CHOOSING ALTERNATIVES TO RESTRAINTS

• Use pillow wedged against the side of the chair to keep patient positioned safely or use full-length body pillow, a swimming pool noodle, or a rolled blanket to indicate the edge of the bed.
• Make the environment as home-like as much as possible; provide familiar objects and provide comfortable rocking chairs.
• Play music or video selections of the patient’s choice if requested by patient or offer diversional activities, such as games and newspaper, books, and magazines, etc.
• Encourage daily exercises and activities for relaxation

therapies.

• Consider relocation of the patient to a room safer and closer to the nursing station.

• Investigate possibility of discontinuing treatment devices, which are bothersome such as intravenous line, catheter, and nasogastric (NG) tube, etc.

NURSING CARE AND MONITORING OF

◤

PATIENT WITH RESTRAINTS

Reassessment of a restrained patient includes:

• Physical status, including vital signs, any injuries, nutrition, elimination, hydration, circulation, range of motion, hygiene and physical comfort.
• Psychological and emotional status, including psychological comfort and the maintaining of comfort, dignity, safety and patient rights.
• Skin assessment must include skin color, skin integrity, and circulation by checking peripheral pulses.
• Restraint need, discontinuation readiness and how the patient acts and reacts when the restraint is temporarily removed for ongoing care is assessed.
• Turning and repositioning the patient and range of motion exercises to the restrained body part unless the

person is sleeping.

• Meeting all physical needs such as toileting, hydration, and nutrition, etc.
• Meeting patient’s psychological needs, such as dignity, respect and freedom from anxiety.
• The correct and safe application, removal and reapplication of the restraint.

DOCUMENTATION OF RESTRAINING

OTHER SAFETY DEVICES

Safekeeper bed or Posey bed:

• Provides a least restrictive and safe environment for patients with traumatic brain injury and provides independence of movement.
• Used for patients who are potential or actual risk for accidental or unintentional injury secondary to confusion, agitation, disorientation, altered thought process, or fall related to their traumatic brain injury.

OTHER SAFETY DEVICES

Side rails (bed rails or cot sides):

• Special medical devices attached to patient bed for safety.

OTHER SAFETY DEVICES

Grab bars:

• Safety devices designed to enable a person to maintain balance, lessen fatigue while standing, hold some of their weight while maneuvering, or have something to grab onto in case of a slip or fall.

OTHER SAFETY DEVICES

Non – skid slippers (slip-not slippers):

• Ideal for patients to help prevent falls.
• Made from soft terrycloth, it features a latex – free rubber sole.
• Can assist patients on wet and slippery floor.

OTHER SAFETY DEVICES

Bed trapeze (medical trapeze or overhead trapeze):

• Safety devices designed to offer reliable assistance for moving, raising and lowering the body while in bed.

SPLINT

An injury to a musculoskeletal system can be temporarily supported or immobilized with splints.

Splints are used to treat fractures , sprains, strains, dislocations, lacerations, degenerative disorders, or patients who find it difficult to sustain a part in a functional position.

Purpose of Splints

• Keeping an injured part immobilized while allowing

easy treatment of that part.

• Deformities caused by muscle contractures may be

prevented or corrected as well as weak muscles are

supported.

• Prevent the movement of fragments during the healing

phase to protect bone or other tissues.

• Applying traction and maintaining reduction of the long

bone when it is fractured.

• Keeping an organ or part in its proper position.

Types of Splints

STRAIGHT

SPLINT

It’s a padded rectangular wooden splint. It’s commonly

Used in hospitals to support and immobilise limbs, such as

during an IV infusion.

THOMAS

SPLINT

It’s a traction splint that’s used to keep suspected

Or confirmed femur shaft fracture immobilised.

It can also be utilised alongside skeletal or

Cutaneous traction.

BRAUNS’S

SPLINT

It’s a metal frame that sits on top of the bed and

supports the leg with the knee flexed somewhat

The traction is provided by a pulley at the end.

It is used to treat lower leg femur fractures

slightly above the knee.

INTERNAL

SPLINTING

A stiff fixation across the fracture lie from one fragment

to the next is used to treat certain fractures.

Pins, nails, and plates are used to give this form of fixation.

CERVICAL

COLLARS

These are neck braces . They’re utilised to immobilise the neck

in suspected cervical spine fractures, treat neck muscular

spams, and support the head in degenerative cervical vertebrae

disorders, as well as following surgery or trauma.

​

PLASTER OF

PARIS SLABS

These are the cheapest of the material for making a stiff, contoured splint, and they may be precisely moulded to provide the finest support. Plaster splints,

on the other hand, easily cracked

or fractured , and difficult

to clean.

General Instructions

• Splints are worn on the component in its functioning position,
• Such as on the hands in a flexed elbow position.
• Before applying the splints, any bone prominences or hollows
• Should be cushioned.
• The splints are secured using bandages and straps that are
• applied away from the wondered area.
• Splints must be lengthy and wide in order to provide support

for the entire length of the immobilised component.

SECTION B:

HYGIENIC NEEDS

INTRODUCTION

Measures for maintaining a minimal level of personal cleanliness and grooming, is called personal hygiene. It promotes physical and psychological well-being.

Hygiene practices include caring for the skin, hair, nails, eyes, ears, nose, mouth, feet, and perineal area.

EFFECTS OF NEGLECTED CARE

EFFECTS OF NEGLECTED CARE

FACTORS INFLUENCING HYGIENE PRACTICES

FACTORS INFLUENCING HYGIENE

PRACTICES

FACTORS INFLUENCING HYGIENE

PRACTICES

▶Defined as many practices that help people stay and be healthy.

HYGIENIC NEEDS

ENVIRONMENTAL HYGIENE

According to Florence Nightingale ,

“Anything that, through modification,

aided in setting the individual in the

greatest possible situation for nature

to act is environment .”

Elements of

Environmental

Hygiene

Aesthetic

Factors

Room

Temperature

Ventilation

Elimination

Of

Unpleasant

odours

Purity

Of

Air

Lighting

Noise

Humidity

Role of Nurse in Providing Safe and Clean Environment

• Nurses should ensure the optimum temperature of the ward

or unit according to weather or season.

• Nurses must ensure that patient units are well ventilated.
• Nurses should ensure that noise is within prescribed level

during day and night time.

• The lighting must be adequate enough
• Frequent mock drills must be exercised.

BED BATH

EQUIPMENT:

🠶 Washbasin and warm water

🠶 Personal hygiene supplies (deodorant, lotion, and others)

🠶 Skin-cleaning agent (soap)

🠶 Emollient and skin barrier, as indicated

🠶 Towels—2

🠶 Washcloths—2

🠶 Bath blanket

🠶 Gown, pajamas, or appropriate clothing, Kidney

🠶 Tray and paper bag

🠶 Bedpan or urinal

🠶 Laundry bag

🠶 Nonsterile gloves, other PPE, as indicated

🠶 Bedsheet

The process of cleansing the body with the help of water and soap in therapeutic manner.

BED BATH

PRINCIPLES:

⯈ Patient should be warm all the time.

⯈ Spread linen near the patient and dispose off used linen immediately to reduce dispersal of

microorganisms and dead skin cells into the environment.

⯈ Avoid unnecessary exposure, only expose the area of the body being washed.

⯈ Change water if it becomes dirty or cold and always after washing the genitalia and sacrum and change wash cloth if it becomes soiled and after washing the genitalia and sacral area.

⯈ Check skin for pressure damage and avoid contaminating dressings and drains with water.

⯈ Pat the skin dry to reduce the risk of friction damage. Separate skin folds, and wash and pat them dry.

⯈ Use the correct manual handling procedures and equipment to avoid injury to yourself and the patient.

⯈ If the patient is unconscious, remember to talk to him through what you are doing; nurses should not talk over the patient. Always work from farther to nearer body part and cleanest to dirtiest.

BED BATH

CONTRAINDICATIONS

Patients with:

• Hypothermia
• Seizures/convulsions
• Congenital heart disease
• Burns
• Hemodynamically unstable patients

INDICATIONS

Patients who are confined to bed, for example:

• Comatose patients
• Post surgical patients
• Orthopaedic patients (hip fracture/femur fracture etc.)
• Mentally ill patients

BED BATH

PURPOSES

▶ To prevent bacteria from spreading on skin.

▶ To clean the patient’s body.

▶ To stimulate general muscular tone and joints.

▶ To make patient comfortable and help to induce sleep.

▶ To observe skin condition and objective symptoms.

PROCEDURE

Refer book (page no. – 150-152)

BED BATH

HAND, FEET AND NAIL CARE

▶ Feet and nail care is a part of the bed bath procedure.

ARTICLES

• Basin
• Towel/draw sheet and mackintosh
• Jugs with hot and cold water
• Lotion thermometer
• Wash cloths – 2
• Towel
• Nail cutter
• Emollient
• Kidney tray and paper bag

PROCEDURE

Refer book (page no. 145)

IMPORTANT CONSIDERATIONS DURING HAND/FEET AND NAIL CARE

• Apply a moisturizer to feet if they are dry. Patients with diabetes and peripheral artery disease should apply moisturizer on the top and bottom of the feet to keep the skin soft.
• Use an antifungal foot powder if necessary to prevent fungal infections, such as athlete’s foot.
• Patients with diabetes should file the nails; avoid using scissors or nail clippers, which may slip and injure tissues. Nondiabetic patients should avoid digging into or cutting the toenails at the lateral corners when trimming the nails.

IMPORTANT CONSIDERATIONS DURING HAND/FEET AND NAIL CARE

• Do not cut off corns or calluses. Avoid commercial removers because they may contain ingredients that can lead to development of infection and ulcers. Consult a podiatrist, a healthcare provider who treats foot disorders, when corns or calluses are present.
• Explain the dangers of going barefoot. Skin on the feet may be injured, or athlete’s foot may be acquired in public shower.
• Advise patients to wear appropriate footwear. Break in new shoes gradually. Ill fitting shoes can lead to corns, calluses, and blisters. The soles should be flexible and non-slippery and the heel heights should be safe and offer appropriate support.

IMPORTANT CONSIDERATIONS DURING HAND/FEET AND NAIL CARE

• Shoes with rough ridges, wrinkles, or tears in the linings should be discarded or repaired.
• Advise patients to wear cotton socks, which provide warmth and absorb perspiration.
• Teach patients to avoid wearing knee-high stockings, and to not sit with the knees crossed because this can obstruct the circulation to the lower extremities and feet.

IMPORTANT CONSIDERATIONS DURING HAND/FEET AND NAIL CARE

• Prop the feet up above the level of the hips for a few minutes several times a day if the feet swell.
• Avoid using heating pads and hot-water bottles because of the danger of blistering and burning the feet.
• Report any signs of foot problems to physician. This is especially important for patients with diabetes.

ORAL CARE

method cleaning

It is the of the

teeth and oral cavity of the patient.

INDICATIONS

• Conscious patient
• Patient with fever
• Intubated patient
• Post operative patients
• Bed confined patients
• Dehydrated patients
• Oral sores/ulcers
• Poor nutritional status
• Patient on oxygen therapy

ORAL CARE

PURPOSES

• Clean the mouth and maintain oral cavity functions.
• Provide hygiene care.
• Remove halitosis or bad breath and remove food debris.
• Improve appetite and digestion.
• Stimulate saliva production.

ORAL CARE

ARTICLES

• An oral hygiene tray containing:
• Toothbrush
• Toothpaste
• Emesis basin
• Glass with cool water
• Disposable gloves
• Additional PPE, as indicated
• Towel

• Mouth rinse
• Washcloth or paper

towel

• Lip lubricant (optional)
• Dentifrice—tooth paste/hydrogen peroxide (1:20)/potassium permanganate

(1:5000)

ORAL CARE

STEPS OF PROCEDURE (Simple mouth care)

Refer book (page no. 295)

ORAL CARE

ORAL CARE OF UNCONSCIOUS PATIENT (SPECIAL MOUTH CARE)

PROCEDURE

Refer book (page no. 147-148)

ORAL CARE OF VENTILATOR PATIENT (SPECIAL MOUTH CARE FOR MECHANICALLY VENTILATED PATIENTS)

ARTICLES

• A tray containing:
• Torch to visualize the oral cavity.
• Gown
• Drape sheet
• 10 mL syringe to measure the

chlorhexidine solution.

• Bowl with chlorhexidine.
• Oral care set (bowl and artery forceps)
• Suction catheter for suctioning.
• Sterile gloves.
• 100 mL normal saline to lubricate the catheter

PROCEDURE

Refer book (page no. 148-149)

PATIENT MONITORING AFTER ORAL CARE

CARE OF DENTURES

EYE CARE

DEFINITION

• Procedure of assessing, cleaning or irrigating the eye and/or instillation of prescribed ocular preparation.

PURPOSES

• To relieve pain and discomfort.
• To prevent or treat infection.
• To prevent or treat injury to the eye.
• To detect disease at an early stage.
• To detect drug-induced toxicity at an early stage.
• To prevent damage to the cornea in patient who is on sedation or unconscious patients.

EYE CARE

ARTICLES

Sterile tray containing:

• Cotton balls
• Thumb forceps
• Bowl
• Kidney tray
• Towel
• Sterile 0.9% sodium chloride.

PREPERATION OF THE PATIENT AND THE UNIT

• Explain the procedure to the patient. Explain how the client can cooperate during procedure.
• Adjust the bed to working level.
• Arrange the article conveniently on the bed side table.
• Keep the patient flat if the condition permits.
• Remove all pillows leaving one pillow under the head.
• Protect the pillow and the bed with a Mackintosh and towel placed under the head.

PROCEDURE

Refer book (page no. 143)

CARE OF THE UNCONSCIOUS PATIENT’S EYES

• Patients with diminished or absent blink (corneal) reflexes and patients whose eyelids remain open require frequent eye care, at least every 4 hours.
• If the eye is not kept moist, corneal ulceration may result from excessive drying of the eye.
• Nursing measures include using saline or artificial tears, based on the medical orders, to lubricate the eye and a protective eye shield to keep the eye closed.

AFTER CARE OF CLIENTS AND ARTICLES

EAR CARE

PURPOSES

• To maintain proper hearing aid function.
• Patient uses proper technique for cleansing the ears.
• Client follows preventive

Client with hearing

guidelines for hearing loss.

loss

communicates effectively

ARTICLES

• Cotton ball
• Warm liquid paraffin or vegetable oil
• Client hearing aid
• Soap, water, towel
• Damp cloth
• Pipe cleaner or tooth pick ( if needed).

EAR CARE

PREPARATION OF THE PATIENT

• Instruct the patient in a proper way to clean the outer ear, avoiding use of cotton-tipped applicators and sharp objects such as hairpins, which cause impact of cerumen deep in the ear canal or cause trauma.
• Tell the patient to avoid inserting pointed objects into the ear canal.
• Encourage the patient over age of 65 years to have regular hearing checks.
• Instruct family members of the patient with hearing loss to avoid shouting and instead

speak in low tone, and to ensure that the client is able to see the speaker’s face.

PROCEDURE

Refer book (page no. 144)

NOSE CARE

PURPOSES

• To prevent bacteria.
• To clean the patient’s nose.
• To prevent or treat injury to the nose.
• To prevent damage to the nose.

ARTICLES

• Cotton applicator/wet wipes/tissue paper
• Saline or water
• Towel

PREPARATION OF THE PATIENT

NOSE CARE

• Explain the procedure to the client. Explain how the client can cooperate during the procedure.
• Adjust the bed to the comfortable working level of the nurse.
• Arrange the articles conveniently on bedside table. Remove all pillows leaving one pillow under the head.

PROCEDURE

Refer book (page no. 144)

BACK CARE

Back care is the procedure of scientific form of massaging the back using different massaging strokes to provide cutaneous stimulation and thus promote comfort.

BACK CARE

PURPOSES

• To relieve muscle tension.
• To promote physical and mental relaxation.
• To relieve insomnia.
• To stimulate blood circulation.
• To assess the condition of skin.
• To prevent bedsores.

​

BACK CARE

BACK CARE

ARTICLES

• Lotion or oil
• Bath towel
• Bath blanket
• Soap
• Wash cloth
• Warm water in basin
• Mackintosh and draw sheet

EFFLEURAGE

MASSAGE TECHNIQUES

• Derived from French word effleurer, meaning “to glide”.
• Long sweeping strokes are done on back that alternate between firm and light

pressure and which can be performed using the palm of the hand.

• Along with long strokes, circular gliding motion is performed on scapula and buttocks, to relieve pressure.
• The knots and tension in the muscles tend to get broken with this massage technique.

EFFLEURAGE

MASSAGE TECHNIQUES

MASSAGE TECHNIQUES

PETRISSAGE

• Derived from the French word ‘patrir’, means ‘to knead’.
• Technique of kneading the muscles of the body to attain deeper massage penetration.
• The thumbs and the knuckles of the fingers are used to knead and squeeze the muscles of the body to prepare them for the other massage techniques that follow.

MASSAGE TECHNIQUES

PETRISSAGE

TAPOTEMENT OR

MASSAGE TECHNIQUES

RHYTHMIC TAPPING

• Consists of rhythmic tapping that uses the fists of the cupped hands.
• Helps to loosen and relax the muscles being manipulated and also helps to energize them.
• Helps to loosen the pooled up secretions in lungs.
• Performed with cupped hands or with ulnar edges of the palm. Both hands move rhythmically one touching skin surface at one time.

MASSAGE TECHNIQUES

TAPOTEMENT OR RHYTHMIC TAPPING

MASSAGE TECHNIQUES

FRICTION

• Create heat to bring about relaxation of the muscles.
• The palms of the hand are rubbed together vigorously with each other, or they are rubbed onto the skin of the person being massaged in order to produce heat by friction.
• Used as a warm up for the muscles of the body to be treated for deeper massage.
• Used for the areas where grasping of the tissue is difficult like on the areas where vertebral horns ( transverse and spinous process) put pressure.
• With thumbs massage is done over the vertebral horns and pressure is relieved.

MASSAGE TECHNIQUES

FRICTION

MASSAGE TECHNIQUES

VIBRATION OR SHAKING

• Helps to loosen up the muscles by using a back and forth action of the fingertips or the heel of the hand over the skin.
• The muscles of the body are literally shaken up to loosen and relax them.
• This is performed by keeping the palm flat on the skin surface with elbow straight and vibration is created from the shoulder.
• Loosen the secretions and also promotes relaxation.

HAIR CARE

INDICATIONS

• Bed ridden patients
• Patients with physical limitations like – arm fracture or arthritis
• Unconscious patient

PURPOSES

• To maintain clean scalp and hair.
• Promote tidy and clean look.
• Boost morale of the patient.
• Promote comfort & stimulate circulation of scalp.
• Promote hair growth and prevent dirt accumulation.
• Prevent tangles and promote sense of well being.

HAIR WASH

Special care of the hair that may be required for patients who are in bed for a prolonged period of time.

ARTICLES

Bath towels – 2 Face towel – 1

Long Mackintosh – 1 Cotton swabs – 2 Liquid soap or shampoo Hair comb

Kidney tray

Paper bag and news paper Bucket – 1

Mug – 1

Jugs – 2 (hot and cold water) Safety pins

PROCEDURE

Refer book (page no. 155-156)

PERINEAL CARE

Cleaning the external genitalia and surrounding with soap and water or with water alone or with any commercial solution.

PERINEAL CARE

PRINCIPLES OF PERINEAL CARE

• Clean the perineum from more clean to less clean area.
• Always use one swab for one stroke.
• Strokes are done from outer to inner area.

PERINEAL CARE

PRELIMINARY ASSESSMENT OF THE PATIENT (FOR FEMALE CLIENT)

• Assess the perineal area for itching, irritation, ulcers, oedema, drainage, etc.
• Assess the need and frequency of perineal care.
• Assess whether perineal care should be done under an aseptic technique or a clean technique.
• Check the order of the physician for any specific instructions.
• Assess the ability of the patient for self-care.
• Assess the patient mental state to follow instructions.
• Check the availability of the articles in the unit.

PERINEAL CARE

ARTICLES

PERINEAL CARE

PREPARATION OF THE PATIENT

• Explain the procedure to the patient.
• Provide privacy to the patient using screens and drapes. Drape the patient as same for the vaginal

examination.

• Remove the equipment that may interfere with the procedure like air cushion.
• Use extra pillows to raise the head of the patient.
• Spread the draw sheet under the patient to prevent soiling when bedpan is placed under buttocks,

over draw sheet.

• Offer bedpan to the patient.
• Untie the pads, if any and observe the discharge, its colour, odour, amount, etc.
• Provide some time for the patient so that she may pass urine or stool if necessary.
• Get the toilet tray and arrange the articles conveniently on bedside table.

PERINEAL CARE

PROCEDURE FOR PERINEAL CARE

Refer book (page no. 157-158)

PERINEAL CARE

PERINEAL CARE

PRESSURE ULCERS

• Also known as - bedsores, skin ulcers, wounds, decubitus ulcers.
• These tend to develop when soft tissues of the patient are compressed between the bony prominences or external surface (bed, chair) for a prolonged period of time.

CAUSES OF PRESSURE ULCERS

Causes

Poor nutrition

Skin moisture

Bedsheets

Excess massage

Poor skin hygiene

Immobile

Old age

CAUSES OF PRESSURE ULCERS

STAGES OF PRESSURE ULCER

STAGE 1

​

• Skin is intact and unbroken.
• Skin with non-blanchable redness

of a localized area

usually over a bony prominence.

• Patients complain of pain and discomfort at the site.
• Affects upper layer of skin, i.e., epidermis.

STAGES OF PRESSURE ULCER

STAGE 2

• Partial thickness skin loss that involves

the epidermis or dermis (or both).

• Dermis presenting as a shallow open ulcer

with a red pink wound bed, without slough.

• Some time blister formation also occurs.

STAGES OF PRESSURE ULCER

STAGE 3

• Full-thickness skin loss that extends into the subcutaneous tissue (below the skin).
• Full subcutaneous fat may be visible but bone, tendon or muscles are not exposed.

STAGES OF PRESSURE ULCER

STAGE 4

• Full thickness

loss with exposed

bone, tendon or muscle.

• Exposed bone/tendon usually directly visible and/ or palpable.
• The skin has turned black and shows signs of infection—red edges, pus, odor, heat, and/or drainage.

WARNING SIGNS OF DEVELOPING PRESSURE ULCER

• Prevention of pressure ulcers is the key treatment.
• Interventions:
• Skin assessment
• Repositioning techniques
• Skin hygiene and moisture control
• Pressure point care
• Use of proper pressure – relieving devices/ comfort devices
• Range of motion exercises
• Nutritional balance

SKIN ASSESSMENT

• Inspect all of the skin while repositioning the patient.
• Clean the skin promptly after the patient passes urine or stool.
• Avoid positioning an individual in an area of redness.
• Avoid rubbing or massaging skin too hard— especially over the bony parts of the body.
• Pat the skin dry with a soft towel.
• Keep the skin clean & dry.

SPECIFIC VULNERABLE PRESSURE POINTS

Assess specific vulnerable pressure points such as:

Supine: Occiput, sacrum, heels, shoulder

Sitting: Ischial tuberosities, coccyx

Side-lying position:

Trochanters

REPOSITIONING TECHNIQUES

The repositioning techniques are the simple and best method to prevent the occurrence of pressure ulcers.

REPOSITIONING TECHNIQUES

• For sitting position in bed head of bed should not be >30°.
• For the bedridden patient, it should be an oblique position inclined at 30 degrees. Use of 2-3 pillows is required to release the pressure from bony prominences.
• Schedule regular and frequent turning and repositioning at least every 2 hourly and 1 hourly in elderly patients (e.g., alternating supine, left lateral and right lateral positions or prone).
• Encourage the patient to move in the bed as far as possible.
• A well-written schedule is maintained by the caregiver for a regular position change.

SKIN HYGIENE AND MOISTURE CONTROL

• All patients should be screened for systematic skin inspection

at least once a day, paying particular attention to bony prominences. These observations should always be documented.

Inspection

• For obese patients, use materials to absorb moisture between skin folds such as cotton. Undergarments should be changed every day and immediately after passing urine or stool.

Absorb moisture

• This should occur at the time of soiling and at routine intervals. The frequency of skin cleansing should be individualized according to patient needs and preference.

Skin cleansing

Minimize irritation and dryness

​

SKIN HYGIENE AND MOISTURE CONTROL

• Avoid hot water, and use only mild cleansing agents that minimize irritation and dryness of the skin.

• Thorough cleaning at routine intervals and every time when the patient passes stool should be done. After diarrhea, cleanse the anal region with soap and water and pat dry the area after that only apply another diaper.

Skin hygiene

• This can make the skin more vulnerable to damage. The use of a topical moisturizer can help alleviate dry skin such as lotion and coconut oil.

Avoid dry skin

SKIN HYGIENE AND MOISTURE CONTROL

• Avoid massage over bony prominences area, and also keep nails cut short to discourage scratching.

Avoid massage

• Incontinence, perspiration or wound drainage can put the skin at risk for chafing irritation, cracking or infection of the skin and it is vital to minimize.

Minimize exposure to moisture

• Educate the patient and caregiver regarding wetness and encourage the patient to inform the caregivers whenever he/she has urge to pass stool.

Health teaching

Use diaper

• The diaper should be used and checked if the patient is unconscious.

• Use clean, dry bedsheets or draw sheet for the patient. Change the bedsheet as soon as it gets wet.

Bedsheet

CORRECT USE OF PRESSURE RELIEVING DEVICES/COMFORT DEVICES

Devices which help to redistribute the pressure from pressure points or bony prominences are comfort devices.

Section

SECTION C :

ELIMINATION NEEDS

HEALTH AND SICKNESS

DEFINITION

​

“State of complete physical, mental, and social wellbeing,

not merely the absence of disease or infirmity.”

~ World Health Organisation,1947

“Nursing is the therapeutic interpersonal process which functions

in coordination with human process of individuals in community.”

~ Hildegard Peplau

CONCEPT OF HEALTH

Factors Influencing Health

ILLNESS

Illnesses are classified as either acute or chronic .

Both the illness have the potential to be life

threatening.

TYPES OF ILLNESS

ACUTE ILLNESS

​

An acute illness usually has a rapid onset

Of symptoms and lasts only a relatively

Short time

CHRONIC ILLNESS

​

Chronic illness is the one which persist,

usually longer than 6 months.

​

​

Causes and risk factors for developing illness

EPIDEMIOLOGICAL TRAID

The triad consists of an agent, a susceptible host and an

environment that brings the host and agent together.

According to this model, disease results from the

interaction between the agent and the susceptible host

in an environment that supports transmission of the

agent from a source to that host.

ENVIRONMENT

AGENT

HOST

Fig.78: Epidemiological triad

AGENT

It refers to an infectious microorganism

or pathogens i.e., a virus, bacterium,

parasite or any other microbe

HOST

It refers to the human who can get the disease.

a variety of risk factors, can influence an

individual’s exposure, susceptibility or Response

to a causative agent.

ENVIRONMENT

It refers to external factors that affect the agent. These factors include physical factors , biological factors as well as socio-economic factors.

CONSTIPATION

• Constipation refers to a situation when a person passes stool less than three times a week.
• The stool may move extremely slow or may remain inside the large intestine for a longer period.
• The stool, if passed during the constipated stage, is very dry and hard, because when the stool stays longer in the large intestine, there is additional reabsorption of the water or fluids.
• During constipation, there is a feeling that the bowel is not completely evacuated.

CHARACTERISTICS OF CONSTIPATION

CAUSES OF CONSTIPATION

​

Diet restrictions

Insufficient fiber and roughage in the diet

​

Insufficient fluid intake

Any changes in the defecation habits

No establishment of defecation pattern, the timings

Lack of privacy, for instance in the hospitals

Excess use of laxatives, enemas or suppositories

CAUSES OF CONSTIPATION

​

Emotional instability

Exploitation of drugs like morphine, codeine

Intake of caffeine containing beverages in excess

​

Natural aging process

Any injuries or trauma to the anal canal

​

Conditions such as hemorrhoids

Embarrassment while using a bedpan

ROLE OF NURSE IN THE MANAGEMENT OF CONSTIPATION

Health education

The nurse must provide health education to the client about constipation, its side effects and further factors, which affect the bowel eliminations process.

Diet

If the diet is not sufficient, it may lead to constipation. Therefore, diet intake must be adequate so as to avoid or manage constipation.

Privacy

​

​

​

ROLE OF NURSE IN THE MANAGEMENT OF CONSTIPATION

Roughage and fiber

• Foods containing

roughage and fiber

such as vegetables and fruits should be included in the diet. In addition to

this, a healthy

breakfast should be included as a part of a healthy diet.

Elimination pattern

• It is essential that a defecation pattern is established to avoid constipation. Some people form

a pattern to

defecate

immediately after

breakfast while

some defecate

immediately after waking up.

• Providing privacy

to a patient while defecating is of

utmost importance

because privacy

helps to have a

bowel movement.

Therefore, the

patient must be left alone if provided

with a bedpan to spare him of the embarrassment.

ROLE OF NURSE IN THE MANAGEMENT OF CONSTIPATION

Emotional stability

• The patient without anxiety or depression is likely to have a better bowel movement than otherwise.

Position

• For the purpose of defecation, the squatting position is the most effective one since, in this position, intra- abdominal pressure can be increased by the client. This pressure is necessary for the expulsion of feces.

Physical activity

• Exercises and physical activities help to improve the muscle tone of the abdomen and perineum.

ROLE OF NURSE IN THE MANAGEMENT OF CONSTIPATION

Fluid intake

• On average, an

individual must take 2-3 L of water every day.

This can prevent the

feces from being dry and hard.

Laxatives

• Since laxatives are habit-

forming drugs; these

should not be taken in

excess. The use of these

drugs should be discouraged and avoided.

DIARRHEA

▶ Diarrhea refers to a condition in which liquid and watery stools are passed by an individual. In addition, the frequency of passage of stool also increases.

▶ In case of diarrhea, the gut mobility is increased, which results in the quick passage of the chyme. As the chyme passes rapidly, the large intestine cannot reabsorb the water and electrolytes. Due to this, there is an evident loss of water and electrolytes from the body.

▶ Diarrhea is definitive if the consistency of the feces is watery, and the frequency of passage of stool is not much significant.

▶ It is accompanied with an increased urge to defecate. Along with diarrhea, there may be some abdominal cramps, increased bowel sounds.

CAUSES OF DIARRHEA

ROLE OF NURSE IN THE MANAGEMENT OF DIARRHEA

URINARY RETENTION

• Urinary retention can be described as a situation when the process of bladder emptying can be impaired, which leads to the accumulation of urine inside the bladder.
• This results in the overdistension of the urinary bladder.
• As the overdistension worsens, the detrusor muscles become poorly contractible, which results in the further worsening of the urination process.
• The process of urination can be affected due to many factors.

CAUSES OF URINARY RETENTION

• cof urine can be due to obstruction present in

the urethra. The obstruction can be from inside or outside, and can be due to various reasons such as the enlargement of the prostate gland, etc.

Obstruction

• Muscle bladder stimulation is decreased due to various reasons such as paralysis, alcoholism, etc.

• The muscle tone of the bladder is decreased or is absent due to which the bladder cannot contract appropriately. As the bladder contractility is decreased or is absent, it causes problems in micturition.

Muscle bladder stimulation

Decreased muscle tone

CAUSES OF URINARY RETENSION

• The pressure imposed on the bladder due to pregnancy,

any tumor or fecal impaction can lead to urinary retention.

Pressure imposed

• When a person doesn’t consume enough fluids, urinary retention may occur. As the intake is less, the urine production is less, and the bladder takes time to fill.

Fluid volume deficit

• Retention can occur due to changes in lifestyles. Lack of exercise, hospitalizations, change in home, etc can cause retention.

Lifestyle

• Certain medications suppress urine production and interfere with elimination.

Medications

ROLE OF THE NURSE WHILE CARING FOR THE PATIENT WITH URINARY

RETENTION

ROLE OF THE NURSE WHILE CARING FOR THE PATIENT WITH URINARY RETENTION

URINARY INCONTINENCE

• Urinary incontinence is a symptom, not a disease.
• It is defined as the leakage of urine from the urinary bladder, involuntarily.
• Urinary sphincters are unable to control the urine passage and thus the urine leaks from the bladder.

CAUSES OF INCONTINENCE

• Old age: It is a common problem in the older population.
• Unconsciousness
• Neurological conditions leading to damage and inability to control
• Perineal muscle weakness can lead to incontinence

• In case of any tumors, such as prostate enlargement, can cause incontinence
• Effects of certain drugs that lead to lowered voiding sensation.

TYPES OF INCONTINENCE

TYPES OF INCONTINENCE

ROLE OF NURSE WHILE CARING FOR THE PATIENT WITH URINARY INCONTINENCE

ROLE OF NURSE WHILE CARING FOR THE PATIENT WITH URINARY INCONTINENCE

PROVIDING BEDPAN/URINAL

​

​

​

FACILITATING URINARY ELIMINATION

A bedpan or a urinal can be described as devices, which are used by patients who are unable to get out of bed to urinate or have a bowel movement. The reason for using a bedpan can be any, such as an injury or disease, which makes people unable to walk. A urinal is used by male patients to urinate while the bedpan is used for bowel movement. However, a female patient uses a bedpan for both purposes.

PROVIDING BEDPAN/URINAL

PROVIDING BEDPAN/URINAL

CLEANING AFTER USING BEDPAN/URINAL

• Clean patient’s buttocks and perineum with toilet paper.
• Clean the area with wet wipes or washcloth (wet).
• Soap and water can be used.
• Area is then dried.
• The nurse can then assess for any rash or lesions on the skin of the buttock region due to any irritation or moisture. Report to the physician, if any.
• After the patient is done defecating, the patient can wash his/her hands.
• The bedpan is then taken to the toilet and the contents are emptied.
• Then, it is cleaned using soap and water and dried. Other disinfectants can be used, as per institutional policies.

OBSERVING AND RECORDING ABNORMALITIES

​

Abnormality refers to any condition in which the

elimination of either urine or feces or both is

inconsonant. It is the role of the nurse to use her

knowledge, skills and judgement to rule out and

identify any abnormality in the patient while

offering a bedpan or while assisting The patient

to meet his/her elimination needs.

SUPPOSITORIES

Suppositories are defined as a form of medication,

solid melts

in nature, or dissolves

which inside

the body due to the body’s temperature.

SUPPOSITORIES

The suppositories are inserted inside the body’s cavities, such as the rectum, vagina, and urethra.

​

Since the suppositories are semisolid and meant to melt at room temperature, they are stored in cool places, such as refrigerators. If not kept inside the refrigerator, insertion becomes difficult.

​

There are several types of suppositories such as glycerine suppositories, and Dulcolax suppositories.

Suppositories

Procedure for administration of

Suppositories

(Refer page no -168

ADMINISTRATION OF SUPPOSITERIES (POST-PROCEDURE NURSING RESPONSIBILITY)

• It is the responsibility of the nurse to make the patient comfortable after the procedure.
• Clean and tidy up the patient.
• Observe the patient.
• Document about the type of suppository, timing of insertion and the effect of suppository, what is the timing of evacuation of bowel.

POST-PROCEDURE NURSING RESPONSIBILITY

• It is the responsibility of the nurse to make the

patient comfortable after the procedure.

• Clean and tidy up the patient
• Observe the patient
• Documentation about the type of suppository,

timing of insertion and the effect of suppository,

what is the timing of evacuation of bowel.

Fig 8: How to insert suppository

ENEMA

An enema can be defined as the fluid that is introduced inside the rectum to

the lower

clean bowel, insert

and/or to any

medications.

PURPOSES OF ENEMA

Treating constipation

Softening of fecal matter

Stimulate defecation

Administratio n of medications

To relieve gaseous distention of abdomen

Induction of peristalsis

To clean the bowel before surgeries

Diagnostic purposes, as in barium enema

​

TYPES OF ENEMA

BEFORE

GIVING

ENEMA

EVACUANT ENEMA (CLEANSING ENEMA)

• Given to clean the bowel
• Patient holds it for 5 to 10 minutes
• Most suitable position – left lateral position
• In case of high bowel enema, knee-chest position may be given.

SIMPLE ENEMA

MEDICATED ENEMA

The addition of some agent is done in the water like glycerine or oils.

RETENTION ENEMA

It is a type of enema that patient needs to hold for 30-minute or more. In case of a nutrient enema, the nutrients shall be absorbed through the intestine then only the enema will be effective.

Stimulant Enema

• Given to stimulate the patient in case of shock, collapse,

or opium

poisoning.

• Stimulating agents

such as black

coffee or brandy

can be given as retention enema.

Sedative Enema

• To induce sleep, sedative drugs such as potassium bromide or paraldehyde are given in the form of enema.

Anesthetic Enema

• Drugs such as

avertin (150– 300

mg/kg body weight) are administered to

induce an

anesthetic effect in a client.

Emollient Enema

• A bland solution is introduced in the rectum to assess if the patient is having diarrhea and for a soothing purpose.

• Starchy solutions are used for the enema.

Nutrient Enema

• In order to introduce food, and fluids inside the body, a nutrient enema is administered.

TYPES OF ENEMA SOLUTIONS

TYPES OF ENEMA SOLUTIONS

TYPES OF ENEMA SOLUTIONS

• Check for the diagnosis of the client.
• Look for the date of surgery, if performed or scheduled.
• Assess if the client is in sound mind to follow any instructions.
• Check the type of enema that has been ordered by the physician.
• See if the doctor has ordered to collect any sample or specimen.
• Examine the rectal area.
• See if any assistance is required, and if required, call a help.
• Gather all the articles required.

ADMINISTRATION OF ENEMA

ARTICLES

ADMINISTRATION OF ENEMA (PRE PROCEDURE PREPARATION)

ADMINISTRATION OF ENEMA

ADMINISTRATION OF ENEMA

• Procedure for the administration of enema: Refer to book (page no 172)

ADMINISTRATION OF ENEMA (AFTER CARE)

• The fluid should be retained inside the anal cavity for about 15–30 minutes.
• Provide bedpan when required. Assist the client in reaching the bathroom.
• Observe the client and the results of the enema.
• If the doctor has ordered for obtaining samples, collect them.
• Provide and assist the client in perineal care.
• Take all the articles and disinfect them. Store them in their appropriate place.
• Wash hands and document the procedure.

Bowel wash is defined as the procedure in which the colon is cleared off of fecal matter using large volumes of solutions. It is, basically, the washing of the colon.

​

​

BOWEL WASH

PURPOSES OF BOWEL WASH

▶ It can be done pre- or post-surgery to perform any diagnostic procedure.

▶ To relieve inflammatory responses.

▶ To initiate peristaltic movements.

▶ For the removal of toxins from the gut.

▶ In case of fecal incontinence.

▶ Wash off the feces or gas present in the gut.

▶ For the treatment of any other medical condition.

CONTRAINDICATIONS OF BOWEL WASH

Contraindications

• Anal fistula
• Anal fissures

Contraindications

• Infection
• Rectal tumor

Contraindications

• Damaged sphincters
• Hemorrhoids

BOWEL WASH

SOLUTIONS USED FOR BOWEL WASH

Tap or cold water

Normal saline

​

Alum 1:100

​

Tannic acid

Soda bicarb 1-2%

Boric solution 1-

2%

ARTICLES REQUIRED FOR BOWEL WASH

BOWEL WASH (PRE-PROCEDURE)

• Check if the patient has been ordered for the bowel wash.
• Assess the client’s general physical condition, along with the mental condition.
• See if there is any contraindication.
• Prepare all the articles before the procedure.
• Explain the procedure and the necessity of the procedure to the client.
• Using the curtains or screens, the client has to be provided with privacy.
• Gather all the articles near the bedside of the patient.
• Spread mackintosh and towel under the patient’s buttocks.
• Position the client in the left lateral position and remove any pillows if placed under the head or back.

BOWEL WASH

• Procedure for bowel wash: Refer to book (page no 173)

BOWEL WASH (POST PROCEDURE)

• Discard all the rag pieces.
• Provide the patient with a comfortable position.
• Offer the bedpan.
• Wash hands thoroughly.
• Document the procedure.

GASTRIC LAVAGE

GASTRIC LAVAGE

Gastric lavage, gastric irrigation or the stomach wash

is defined as the procedure of washing out and irrigating

the stomach using a prescribed solution . The solution washes the stomach off and makes the stomach free of harmful contents.

PURPOSES

​

• To remove ingested poisons.
• To wash the stomach before any surgery.
• To obtain epithelial cells for medical studies.

SOLUTIONS USED

​

• Plain water
• Normal saline
• Solution such as sodium bicarbonate , boric acid
• Antidotes specific to poison

​

Amount of Solution Used

• The process of gastric lavage continues unless the return

flow is completely clear.

• At first, about 500 mL is used.

For Procedure of Gastric Lavage

(Refer page no- 173-174)

FLATULENCE

Flatulence or tympanites can be defined

as the condition accumulated in

in which gas is the GI tract. The

accumulation of gas is excessive. The gas accumulated is called flatus. The accumulated gas can result in the distention of the abdomen.

FLATUS TUBE

genitalia and surrounding

PERINEAL CARE

with soap and with

water alone or

with

water or

in any

prepared

combination commercially peri-wash.

INDICATIONS FOR PERINEAL CARE

PRELIMINARY ASSESSMENT

• Assess the condition of perineal skin for any

itching, irritation, ulcers,

edema, drainage, etc.

• Assess the need and frequency of perineal care.

• Assess the patient’s ability for self-care.

PRELIMINARY ASSESSMENT

• Assess whether perineal care

should be done under an

aseptic technique or a clean technique.

• Check the physician’s order for any specific instructions.

• Assess the patient’s mental state to follow instructions.

URINARY CATHETERIZATION

Urinary catheterization is a procedure, where a catheter (hollow tube) is inserted into the bladder to drain or collect urine.

TYPES OF URINARY CATHETERIZATION

Types

Intermittent

Indwelling

Suprapubic

INTERMITTENT CATHETERIZATION

Intermittent Catheterization is defined as a procedure performed medically in a situation when a patient is in medical need

of catheterization, but for a

shorter period of time.

The intermittent catheterization is required for urinary bladder emptying. It can be done easily by the patient himself at home or by the nurse in hospital settings. The major indication for intermittent catheterization is neurogenic bladder.

INTERMITTENT CATHETER

BENEFITS OF INTERMITTENT CATHETERIZATION

INTERMITTENT CATHETERIZATION

• PROCEDURE

Refer book (page no. 176)

INTERMITTENT CATHETERIZATION CONSIDERATIONS

INDWELLING CATHETERIZATION

• An indwelling catheter, also called Foley’s catheter is defined as a device, which helps in the drainage of the urinary bladder.
• The catheter that is inserted inside is sterile in nature.
• The indwelling catheter consists of a catheter and a balloon that retains the catheter inside the bladder.
• The catheter is connected to the collecting device such as a drainage bag.

INDWELLING CATHETER

PARTS OF FOLEY’S CATHETER

SIZE OF THE FOLEY’S CATHETER

• For bladder emptying
• For collecting the sterile urine sample
• To relieve bladder distention
• To relieve urinary incontinence

INDWELLING CATHETERIZATION

SUPRAPUBIC CATHETERIZATION

• It is the placement of a drainage tube into the urinary bladder just above the pubic symphysis.
• This is typically performed for individuals who are unable to drain their bladder via the urethra.
• Suprapubic catheterization offers an alternative means to drain the urinary bladder when other methods are not clinically feasible, undesirable or impossible.

INDICATIONS FOR SUPRAPUBIC CATHETERIZATION

• Urinary retention when urethral catheterization is not feasible.
• When the urethra is damaged or injured.
• If the pelvic floor muscles are weakened, causing a urethral catheter to fall out.
• After surgeries that involve the bladder, uterus, prostate, or nearby organs.

• Nondistended bladder and bladder malignancy.
• Active skin infection, coagulopathy, osteomyelitis of the pubis.

COMPLICATIONS OF SUPRAPUBIC CATHETERIZATION

ROLE OF NURSE IN URINARY CATHETERIZATION

Role of nurse

Fluid

Diet

Hygiene

Catheter changing

Intake- output

FLUID

The nurse has to encourage the patient for the intake of a good amount of fluid orally. It is advisable to drink up to 3 L of fluids every day for a patient with an indwelling catheter, unless contradicted due to any disease condition. As the patient’s intake is high, accordingly the output will also be high. The urine thus helps to flush the bladder and urethra and prevents infection due to urinary stasis. The flushing of the bladder and urethra helps to remove any obstruction, if present.

DIET

• To reduce the risk of urinary tract infection, the urine must be acidic in nature. Also, acidic urine prevents the formation of calculi.
• Intake of food products that promote the urine to turn acidic must be promoted by the nurse.
• These items are eggs, meat, cranberry, plums, and prunes. On the other hand, milk and milk products turn the urine alkaline.

HYGIENE

• Perineal care is advised. However, no specific cleaning is required.
• Routine hygiene practices have to be followed by the patients.
• The nurse can guide the family or the patient on how to perform perineal and catheter care and if necessary, the nurse can even assist them with the procedure.

CATHETER CHANGING

The catheter or tubing is not changed regularly. If the catheter and drainage system is impaired, or there is some evidence of collection of certain salts in the form of sediments in the tube, the catheter can be changed. Regular insertion of a new catheter can injure the perineum and promote the chances of infections.

INPUT-OUTPUT

The nurse has to maintain the documentation where the accurate input and output is mentioned to assess the hydration status of the patient and the urinary functions.

REMOVAL OF THE URINARY CATHETER

REMOVAL OF THE URINARY CATHETER

CARE 0F PATIENT WITH DIAPER

​

• Diaper wearing may create optimal environment for microorganism

to grow, therefore meticulous monitoring monitoring is essential.

• Check the diaper for soakage and change it as and when urine or

stool is passed, long duration of wearing the diapers should be

discouraged.

• When changing the diaper back care and perineal care shall be

provided so that pressure points are attended and cleaning is done.

MAINTENENCE OF INTAKE AND OUTPUT RECORD

• Intake output chart helps to keep a track of ingestion and excretion.
• It also reflects the fluid management in body which helps to

understand the metabolic activity of body .

• Intake of fluid is assessed through thirst hunger and output is

measured through urine, stool & vomit from the body.

PURPOSE

​

• To ensure accurate record keeping
• Prevent circulatory overload
• Prevent dehydration
• Ensure normal renal and metabolic

working of body

IMPORTANCE

​

• It helps to determine patient’s fluid sttaus
• If patient is hydrated / overhydrated or dehydrated
• To identity any abnormalities

NURSES ROLE IN INTAKE AND OUTPUT MAINTENANCE

• Explain procedure and purpose of intake output

record volume for all fluids consumed

• Make sure that all fluids or tube feeding

administered is recorded

• Ensure IV fluids are added in intake
• Keep track of output from irrigation outflow
• Report major differences in intake output to

physician

• Always note/record the observation
• Record date and time

SECTION D:

NUTRITIONAL NEEDS

DIET IN HEALTH AND DISEASE

• Nutrition can be defined as the science, that deals with the ingestion of a well-balanced meal , which includes nutrients and other essential substances and their action on the body.
• Nutritional is one of the basic needs that is essential for the survival of a human being.
• Nutritional status is defined as the condition of human body, which is a result of use of essential nutrients.

��Growth and development

IMPORTANCE OF NUTRITION

Prevention of deficiency diseases

Illness and death

Infection prevention