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IRRIGATING CYSTOCLYSIS Scientific Principles: Guidelines:

- Sterility and patency is maintained to

Anatomy and Physiology avoid infection
CYSTOCLYSIS The urinary bladder is a hollow muscular - NSS for infusion should be stored and
- “continuous bladder irrigation” organ shaped like a balloon, located in the infused at room temperature to avoid
- instilling sterile irrigation solution into the anterior pelvis. bladder spasms.
bladder, then allowing fluid to drain out. Chemistry - Strict Intake & Output is recommended
Solutions like normal saline solution are for all patients receiving CBI
introduced into the bladder. - Empty the drainage bag about every 4
hours, or as often as needed. Use
Physics sterile technique to avoid the risk of
Solution flows in the urinary bladder by contamination.
the force of gravity. The IV bag should be placed - Monitor vital signs at least every 4 hours
higher than the patient for the fluid to drip during irrigation; increase the frequency
through the IV line. if the patient becomes unstable.

Strict asepsis must be maintained
throughout the procedure because it is an
invasive procedure and to prevent infections.
Cast – a rigid device that immobilizes the
affected body part while allowing other body part
Psychology to move.
Explain the procedure to the patient to
reduce his/her anxiety about the procedure. Fixator – a device that provides rigid
immobilization of a fractured bone by means of
Time and Energy rods attatched to pins that are placed in or
Purpose: Prepare all materials needed for the through the bone.
procedure and do the procedure in a short
- To prevent urinary tract obstruction by flushing period of time if possible. Trabecular – (an open cell porous network also
out small blood clots that form after prostate or called cancellous or spongy bone) which is
bladder surgery. composed of a network of rod- and plate-like
-To dissolve certain bladder calculi with Identify the types of cystoclysis: elements that make the overall organ lighter and
chemolytic agents. allowing room for blood vessels and marrow.
Open System, the bladder is drained using a 60
Indications: ml syringe Close reduction – most common nonsurgical
- after prostate or bladder surgery - also called manual method for managing a simple fracture.
- Acute urinary retention irrigation which is
performed by the nurse
Open reduction – allows the surgeon direct
Contraindications: Closed System, the bladder drains directly into
visualization of the fracture site
- presence of traumatic injury to the lower the Foley Bag
urinary tract
- not for long term treatment Complications:
- Infection
- Bladder Distention
- Bladder rupture
PURPOSES OF CASTING TYPES OF CAST 4. Thumb spica cast –similar to
SAC with thumb casted in
-To maintain the integrity of the cast I. UPPER EXTREMITY CAST abduction
1. Short arm cast (SAC) – extend
-To prevent possible infections brought about by from below the elbow to part of USE: fractures of thumb
unsanitation. the hand

TYPES OF FRACTURES : USE: stable fractures of wrist

(metacarpals, carpals, distal
5. Shoulder spica cast – shoulder
is casted in abduction with
elbow flexed

USE: Unstable fracture of

shoulder girdle or humerus,
dislocation of shoulder

2. Long arm cast (LAC) –

includes upper arm to part of the

USE: unstable fracture of wrist

(distal humerus, radius, ulna)


1. Short leg cast (SLC)– from
below the knee to base of toes

USE: Fractures of ankle,

metatarsals or foot
3. Hanging-arm cast

USE: fractures in humerus that

cant be aligned by LAC
2. Long leg cast (LLC) – from
mid-upper thigh to base of toes
III. CAST BRACES 2. Risser’s cast – body jacket extends
USE: unstable fractures of tibia, from the shoulders to beyond the
fibula or ankle 1. Patellar weight-bearing cast- iliac crest and hips, with a larged
similar to SLC or leg cylinder opening over the anterior chest

3. Halo cast – body jacket contains a

halo brace
3. Walking cast – a walking
device on bottom of SLC or LLC

2. External polycentric knee hinge

cast- a hinge connects lower and
upper leg and allow 90 degrees of
4. Leg cylinder - similar to SLC,
but the ankle and foot are not Principles
IV. BODY CAST 1. Anatomy and Physiology – the health
USE: Stable fractures of distal
femur, proximal tibia or knee provider should know the different
1. Hip spica- extend from below the pressure points
nipple line down the affected leg
[single], down the leg and half of the 2. Physics - friction may cause skin
unaffected leg [1/2], or down both irritation, dryness and skin damage.
legs [double]
3. Microbiology – a clean environment
(cast) will prevent further complications
and decreasing the
5. Long leg cylinder- similar to chances of growth of microorganisms
LLC, but ankle and foot are not
casted 4. Body mechanics – proper
USE: midshaft or distal sharf positioning will help hasten the
fractures of the femur drying of the cast

1. Impaired blood flow 4. Compartment syndrome Skin color

- This is due to pressure in casted - A compartment syndrome develops - Inspect the area No change in
extremity when the space within a distal to the injury pigmentation
compared wit other
compartment is reduced. During
parts of the body
- Possible symptoms : exercise, the muscle swells, fluid
accumulates and cannot escape
Pulselessness ,Inadequate immediately, pressing on structures Skin temperature
capillary refill in nail beds,Pallor which become tense and painful
- palpate the area The skin is warm
or cyanosis of kin,Pain,Coldness
of skin,swelling - Possible symptoms distal to the injury (the
dorsum of the hands is
most sensitive to
2. Nerve damage Pain

- This is due to pressure on a nerve Paresthesia Movement The client can move
as it passess over a bony without discomfort
prominence Paralysis of the limb is usually a - ask the client to move
late finding the affected area or the
- Possible symptoms include : area distal to the injury
(active motion).
No difference in
Pain, increasing, persistent and comfort compared
localized - move the area distal to with active movement
the injury (passive

Feeling of deep pressure

Motor weakness No numbness or
- ask the client if
3. Infection Assessment of Neurovascular Status in numbness or tingling is
Clients with Musculoskelatal Injury present (paresthesia)
- This is due to skin breakdown
No difference in
- palpate with a paper
Assessment technique Normal findings clip (especially the web sensation in the
- Possible symptoms : affected and
space between the first
second toes or the web unaffedted
Musty, unpleasant odor over cast space between the thumb extremities. (loss of
or at ends of cast and forefinger). sensation in these
areas indicates
perineal nerve or
Sudden unexplained body median damage).
temperature elevation

- Don’t put anything inside the cast - Avoid showers; use the bathtub and hang the
- palpate the pulses Pulses are strong covered cast or injured body part outside of the
distal to the injury. and easily palpated; - Do not trim the cast or break off any tub while you bathe.
no difference in the rough edges because this may weaken - Do not lower the cast down into the water.
affected and or break the cast
unaffected Prevention of Complications
extremities. - Wear cast boot if walking is ok. The - Perform cast care at least once a day or
boot is to keep the cast from wearing as prescribed
out on the bottom and has a tread to
Capillary refill (least
keep people in casts from falling. - Prevent cast from getting wet
- If the cast is on the foot or leg, do not - Promote ROM exercises
- press the nail beds walk on or put any weight on the injured
distal to the injury until Blood returns (return
to usual color) within leg, - Report if cast is too tight or loosened
blanching occurs (or the
skin near the nail if nails 3 sec ( 5 sec for other
are thick and brittle). clients) Skin care

- Keep bed free of wrinkles and crumbs CARE OF PATIENTS WITH TRACTION

- Support leg with pillow to prevent Traction
constant pressure on the heel - is the application of a pulling force to an injured
- ask the client about Pain is usually part of the body or extremity to provide
localized and is often - Fingers or toes should be bathed, lightly reduction, alignment and rest.
the location, nature and
described as oiled and massaged at least once daily Countertraction
frequency of the pain
stabbing or - pulling force equal and opposite the traction
throbbing. (pain out - Frequent active exercise is encouraged weights
of proportion to the
injury and unrelieved Turning
by analgesics might - metallic plate or screw placed on the bone to
indicate compartment
- Turn patient from front to back and vice provide support.
syndrome.) versa every 2 hours Trapeze
- an overhead patient helping device to promote
- help in moving and turning a casted mobility in bed

- Never use cast braces to lift a casted PURPOSES :

- Always turn a casted patient away from
the injured or operated side; keep • immobilize a reduce fracture
weight off the fractured or operated side • to treat an unstable fracture
• to prevent or correct deformities
Handling new cast Toileting and Bathing
- keep cast dry and clean - Cover the cast with a plastic bag or wrap the B. FIXATOR
cast to bathe (and check the bag for holes
- Dont lean on or push on the cast before using the bag a second time). 1. EXTERNAL
because it may break.
• manage open fractures with soft tissue • hypersensitive skin
damage. • severe osteoporosis
• tprovide stable support for severe • osteomyelitis
comminuted fractures
• to facilitate patient's comfort, early 2. FIXATOR
mobility and active exercise or
alignment of a joint.
• open fracture with large fragments and
• to minimize complications related to is massively contaminated
• systematically ill patients

• hold the bone fragments in position until

solid bone healing occurs. • CERVICAL HEAD HALTER TRACTION –
• facilitate faster mobilization than for neck pain, neck strain and whiplash,
external fixator. traction can be applied to the cervical
1. RUNNING TRACTION- is a pulled in spine by means of a head halter.
one direction against the long axis of the
body or bone
combination of a running traction plus a
countertraction source other than the
1. TRACTION: body.

• fractures
• muscle contracture APPLICATION OF TRACTION:
2. EXTERNAL FIXATOR: 1. SKIN TRACTION – pull is applied to traction) - downward pull, as in Buck's
client’s skin which transmitted the pull to traction, may be applied to the leg, but
• complicated fractures of the forearm, the musculoskeletal structures. an additional overhead pulley system is
femur tibia and pelvis incorporated into the traction apparatus
• fracture fragment immobilization. with the leg supported by a sling.
• bony non-union TYPES OF SKIN TRACTION

3. INTERNAL FIXATOR: • BUCK’S TRACTION- is a running skin

traction used temporarily to immobilize a
fracture of the hip/femur until possible to
• fractures associated with complex soft
do surgery.
tissue injury.
• damaged nerves or blood vessels.

• PELVIC TRACTION – used in pelvic
fractures to support separated bones. It is
usually applied intermittently, on 2 hrs, off
1. TRACTION 2 hours, while the client ia awake.

1. Over distraction

2. Loss of position

3. Pressure sores

4. Pin track infection

-perform neurocirculatory checks every hour for
• BRYANT’S TRACTION- immobilize a the first 24-48 hours
fracture of the femur in children weighing
<40 lbs. A running traction in which legs -maintain elevation of area affected on bed
are raised at 90° angle to the body. TYPES OF FIXATOR

2. SKELETAL TRACTION- applied • EXTERNAL FIXATOR-is the device is

directly to the bone with wires and pins used to manage complex fractures that
surgically associated with soft tissue damage or with
open wounds in the fractures area
- assess the patients neuromuscular status.
• SKULL/HEAD TRACTION- by inserting - observe skin for irritation and breakdown.
a points of a skull tong device (such as
Vinke or Crutchfield tongs) into the 2. HANDLING NEW TRACTION
skull bone. It is used reduced a fracture - inspect traction apparatus frequently to ensure
of the cervical vertebrae. This type
traction is often used only temporarily
• INTERNAL FIXATOR- done through open the ropes are running straight and through the
reduction, the surgeon places a pin, wire, middle of the pulleys; the weights are hanging
until a halo device can be placed. free
screw, plate, nail or rod into or onto the
bone to keep it reduced (properly aligned), - check ropes frequently to be sure they are not
immobilized, or both. (ORIF) frayed.
- Avoid releasing weights from or altering the
line of pull of the traction.
- Avoid adding weight to the traction
- Avoid bumping into the bed or traction
- Be sure that weights are securely fastened to
their ropes
• BALANCED SUSPENSION TRACTION – - Avoid manipulation of pins
treat displacement or comminuted femoral 3. SKIN CARE
fractures. - encourage the patient to turn slightly from side
to side and to lift hip up on the trapeze to relieve
pressure on the skin on the sacrum and
scapulae - apply gentle pressure over the inner
- inspect skin frequently EYE INSTILLATION- administration of sterile canthus for 1min.
- keep skin areas around the pin sites clean and ophthalmic therapeutic agents (AFTER)
dry - instruct not to rub eyes
GUIDELINES - assess and document
4. TURNING - offer patient tissue paper to remove
- turning to any position as long as the integrity sol’n during the procedure
of the traction is not compromised and the - clean the eye of any drainage EYE IRRIGATION- flushing of irritant out of the
patient is comfortable. - tilt the patients head slightly (sitting), eye
place a pillow (lying down)
5. TOILETING - let the patient look up PURPOSE
- use a fracture pan with blanket roll or padding - hold dropper 1-2 cm above conjunctival - irrigate or remove foreign bodies of the
as support under the back sac eye
- protect the Thomas ring splint with water proof - ask the patient to blink - remove secretions, itching, pain
material when female patients are using the bed - apply gentle pressure over the inner - provide moisture
pan. canthus for 1min. - preparation for surgical procedure
- instruct patient not to rub eyes
PURPOSE - allergic conjunctivitis
- dilate or contract the pupil when - bacterial eye infection
examining the eye
- relieve pain, discomfort, itching and CONTRAINDICATION
inflammation - hypersensitivity
- to clean or lubricate the eye - who just had eye surgery

- glaucoma - stinging and burning sensation
- ophthalmic infection - scarring
- eye discomfort - visual impairment

- hypersensitivity to drug - direct irrigating fluid from inner to outer
NURSING RESPONSIBILITIES - avoid touching the eye
- place kidney basin at the side of the
(BEFORE) patient’s face to collect fluid
- verify physician’s order - dry the surrounding area with sterile
- place drape to protect clothes cotton ball
- assess for redness, location and nature - avoid rubbing
of discharges, complaints
- clean the eyelids and lashes NURSING RESPONSIBILITIES
- double check ophthalmic preparation (BEFORE)
- hold dropper 1-2 cm above conjunctival - position patient properly
sac - instruct patient to hold kidney basin
EYE - ask the patient to blink beside the eye
(DURING) EAR INSTILLATION- introduction of medication - let pt. remain in his position for 5-10
- instruct patient to look up to the ear mins
- irrigate from inner to outer canthus (AFTER)
along conjunctival sac PURPOSE - dry the surrounding area
- let patient close his eyes periodically - relieve pain - place cotton ball for 15 mins to absorb
(AFTER) - reduction of inflammation or destroy excess med.
- dry the surrounding area infective organism
- let patient close and open his eyes EYE IRRIGATION- flushing of external ear canal
- note patient’s reaction and response INDICATION with NSS or water.
- hardened earwax
COMMON OCULAR MEDS - pain / inflammation of ear canal PURPOSE
- otitis media / externa - clean external ear canal
1. TOPICAL ANESTHETIC - remove discharges or foreign objects
(Proparacaine Hcl) CONTRAINDICATION - soften cerumen
- anesthetic for severe eye pain - ruptured/perforated tympanic memb. - destroy organism or insects lodging the
- Pregnancy / breastfeeding (meds canal
2. MYDRIATICS (dilate) & contraindicated to pregnant women)
CYCLOPLEGICS ( paralyze iris - Hypersensitivity INDICATION
sphincter) - cerumen impaction
- instruct pt. to wear sunglasses COMPLICATION - local inflammation
- allergic rxn - presence of foreign body
3. ANTI-INFECTIVE (Gentamicin sulfate) - permanent hearing loss
- treat ocular infxn - worsening of pain CONTRAINDICATION
- ruptured/perforated tympanic memb.
4. CORTICOSTROID/NSAID GUIDELINES - Recent ear or head trauma
- for inflammatory conditions - wash hands before and after
- clean external ear with cotton balls b4 COMPLICATION
5. OCULAR IRRIGANT (Decroise) instilling med - dizziness, n/v
- position patient by tilting head to the - pain
- clean / irrigate external eye, eliminate side so that the affected area is
debris - tinnitus
- wait for 5-15 mins b4 instilling to the GUIDELINES
other side - warm sol’n 40°C / 105°F
- for dry eyes Keratoconjunctivitis sicca
- straighten auditory canal
- check medication (BEFORE)
- warm the eardrop to body temp (rolling - position patient properly
bottle in the hands) - position protective towel
- let pt. lie on his side w/ the affected ear - use cotton applicator to remove
- pull lobe up and back (adults) or down discharges
and back (children) - place kidney basin close to patient’s
EAR - instill 1cm away and avoid touching the head
ear with the dropper (AFTER)
- dry external ear with cotton ball NASAL INSTILLATION- administering - don’t share nasal instillation prep to
medication by spray or drops into nasal cavity other patients
OTIC AGENTS - let pt. remain in a supine position for 5-
SINUSES: 10 mins.
1. ACETIC ACID (Vosol) - ETHMOID – around bridge of the nose
- antibacterial and drying; eliminate and - MAXILLARY – around area of cheeks COMMON NASAL MEDS
prevent susceptible organism - FRONTAL- area of forehead 1. BACLOMETHASONE DIPROPRINATE
- SPHENOID – deep in the face behind - dec. nasal inflammation
2. BENZOCAINE (Otocain, Auralgan) nose. Sinus develops during
- otic anesthetic adolescence
- a/e: respiratory distress, cyanosis 2. EPINEPHRINE HCL (Adrenaline
PURPOSE - adrenergic
3. HYDROCARTISONE, NEOMYCIN - loosen secretion, facilitate drainage
SULFATE - shrink swollen mucous memb
- decrease inflammation - treat infxn 3. SODIUM CHLORIDE (Muconase)
- nasal decongestant
(Chloromycetin) - nasal congestion 4. NAPHOZALINE HCL
- antibiotic; bacteriostatic effect - sinusitis - local constriction of dilated arterioles
- rhinitis, allergy
- soften cerumen - neck and spine injury
- increase ICP
COMPLICATION - check medication
- epistaxis - inspect/ assess nose with penlight
- inflammation - instruct patient to blow/ clear his nose
with tissue unless contraindicated
POSITIONING - position patient
1. PROETZ – ethmoid and sphenoid (DURING)
- place pt in flat supine w/ shoulders - instruct pt to breathe through mouth and
supported w/ pillow to hyperextend neck not to speak or swallow
- avoid touching dropper to nose (1cm
2. PARKINSON’S – maxillary and frontal - instill drops toward midline of ethmoid
- pt. flat w/ shoulder supported w/ pillow bone
and head hyperextended and turned (AFTER)
toward affected side - let pt remain in position for 5-10 mins.

- position patient properly depending on
the affected side
NOSE - avoid touching the nose with dropper, it MOUTH
may cause patient to sneeze
MOUTHWASH – an fluoride compound
antiseptic added to drinking water 3. BETADIBE GARGLE (Povidine-iodine)
- antiseptic used in throat preparation
SALIVA - water (99.5%)
- digestive enzyme 4. PERIDEX
- lysozyme (enzyme that kills bacteria) -dec. redness, swelling and bleeding
- proteins gums
- antibodies (IgA)
Function: - lubricates mouth
- moistens food during chewing (BEFORE)
- protects mouth against pathogens - determine type and amount of
- chemical digestion sol’n to be used
- perform handwashing and don
- freshen mouth and prevent halitosis (DURING)
- keep teeth, mouth and gums in good [conscious]
condition - position pt. in sitting position
- provides comfort and improve appetite - place a towel on pts. chest and
kidney basin under his chin
INDICATIONS [unconscious]
- halitosis - position pt. with head tilted
- pt. w/ periodontal dse. towards the nurse
- place a towel on pts. chest and
CONTRAINDICATION kidney basin under his chin
- hypersensitivity to mouthwash - use padded tongue depressor to
open mouth and rinse w/ diluted
GOALS sol’n
- removal of excess secretion (AFTER)
- stimulate salivary gland - return pt. to comfortable position
- Record unusual bleeding or
GUIDELINES inflammation
- encourage client to establish regular
- enc. client to visit the dentist
- use dental hygiene products of pts.


1. BACTIDOL (Hexetidine)
-anti-infective and antiseptic

2. LISTERINE (Benzoic acid)

-anti-infective and antiseptic