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1.Roles and Functions of Health Care Team

Health Care Team: The health care team comprises individuals dedicated to providing care and services to patients.
Key members include:
Head of Department (HOD): Leads executive, judicial, and administrative departments in local government.Responsible
to the government for hospital functions.Achieves goals through planning, budgeting, and coordination.
Post Graduate Trainee: Conducts research and assists in management.
Medical Officer (MO): Senior physician managing all aspects of patient care.Physicians:Qualified practitioners
specializing in medical diagnosis and treatment.
Head Nurse: Oversees nursing operations with skills in patient care and management.
Staff Nurse: Assesses patient needs, creates nursing care plans, and provides direct care.
Student Nurse: Promotes, maintains, and restores patient health under clear outpatient procedures.Requires approval before
administering care.
Ward Boy: Delivers and retrieves specimens, reports, and equipment as advised by nursing staff.
Dresser: Surgical assistant specializing in bandaging and dressing wounds and injuries .

2.Functions of different departments in a hospital

There are three main Departments in a hospital
Outpatient Department (OPD): This is a section of a hospital where patients receive medical care without being admitted to
the hospital. Outpatient services include consultations, diagnostic tests, and minor treatments that do not require an
overnight stay.
Emergency Department (ED): Also known as the Emergency Room (ER) or Casualty Department, this is a medical facility
specializing in the treatment of acute conditions and injuries that require immediate attention. It operates 24/7 and is
equipped to handle critical and life-threatening situations.
Indoor Block: This term is often used interchangeably with “Inpatient Block” or “Hospital Ward.” It refers to the section of
a hospital where patients are admitted for overnight stays or longer durations. In this area, patients receive continuous
medical care and treatment, including surgeries or procedures that may require recovery time.
Indoor departments further includes:
Surgical Department: This department focuses on surgical procedures, including various types of
surgeries and related medical interventions.
Medical Ward: A designated area within a hospital where patients receive medical care and treatment.
It’s often used for patients who do not require surgery but need medical attention.
Rehabilitation Department: This department is dedicated to helping individuals recover from injuries,
surgeries, or illnesses through various therapies and exercises to regain functional abilities.
Nutrition Department: This department is concerned with providing nutritional support and advice to
patients, considering their specific medical conditions and dietary needs.
Pharmacy Department: Handles the storage, preparation, dispensing, and monitoring of medications
to ensure safe and effective use.
Operation Theatre Complex: Also known as the operating room, it’s a facility within a hospital where
surgical procedures are performed.
Radiology Department (X-rays): Utilizes imaging techniques like X-rays to diagnose and treat diseases
by visualizing the internal structures of the body.
Neurology Department: Specializes in the diagnosis and treatment of disorders affecting the nervous
system, including the brain, spinal cord, and nerves.
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Haematology Department: Deals with the study and treatment of blood-related disorders, including
diseases of the blood and bone marrow.
Ophthalmology Department: Focuses on the diagnosis and treatment of eye-related conditions and
diseases.
Urology Department: Specializes in the medical and surgical treatment of conditions affecting the
urinary tract and male reproductive system.
General Surgery Department: Covers a wide range of surgical procedures that are not limited to a
specific organ or system.
Burn Centre Department: Provides specialized care for patients with burn injuries, including medical
treatment, wound care, and rehabilitation.
Cardiology Department: Specializes in the diagnosis and treatment of heart-related conditions and
diseases.
Maternity Department: A department dedicated to the care of pregnant women, including prenatal
care, childbirth, and postnatal care.
Intensive Care Unit (ICU): Provides specialized care for critically ill patients.

3.Physical Setup of a Ward:

A typical ward consist of an administrative desk and office, a number of patient rooms, stations for
the nurses, offices for sectaries storage and medication rooms, bathroom and a living room for the
patient.
There are 16 rooms in paediatric surgical ward.
•Consultant office •Duty doctor office •Head Nurse office •Patient Counselling room •Procedure
room •Library •Dressing room •Store room •Record room •Infected room •Stoma room •High
Dependency Unit I for sick Patient (From 6 months to 13 years) •High dependency Unit II for sick
patient (Below 6 months) •Pro Operative room 1,2 •Post operative room 1,2 •Isolation room

Equipment:
Emergency trolley ••Panels which contain oxygen flow meter, •suction points and nebulisation.
•Blood pressure measuring apparatus •Suction Machine •Temperature tray •Blood sampling tray
•Glucometer •Oxygen cylinder •Defilrilator •Cardiac monitor •Pulse oximeter •Beds( with bed
linen)

4.What Is Therapeutic Communication?

Therapeutic communication involves techniques that prioritize patients’ well-being, fostering a
supportive nurse-patient relationship. It aims to provide emotional, mental, and physical support
while maintaining professional boundaries.
Therapeutic Communication Techniques:
Using Silence: Purposeful pauses allow reflection, giving patients space to express thoughts.
Accepting: Acknowledging patients’ statements without necessarily agreeing, conveying
understanding.
Giving Recognition: Highlighting patients’ positive actions without using overt compliments.
Offering Self: Demonstrating empathy by offering time, companionship, or assistance.
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Giving Broad Openings: Allowing patients to guide conversations with open-ended prompts.
Active Listening: Engaging with patients, using verbal and nonverbal cues to show genuine interest.
Seeking Clarification: Requesting further explanation when patients express unclear or ambiguous
thoughts
Placing the Event in Time or Sequence: Asking about the timing of events to understand their
chronological order
Making Observations: Noting and addressing patients’ behaviors, appearances, or conditions.
Summarizing: Reviewing and condensing key points of a conversation to ensure mutual
understanding
Reflecting: Encouraging patients to think about their own solutions and actions
Focusing: Concentrating on specific issues raised by patients during conversations.
Confronting: Challenging patients’ assumptions or behaviors after trust is established
Voicing Doubt: Expressing doubt gently to prompt patients to reconsider their ideas.
Offering Hope and Humor: Providing reassurance and humor to alleviate stress and maintain a
positive atmosphere.

5.Data Collection Through Interview:

Data collection is the systematic process of gathering information about a client’s health status, which includes subjective
and objective data.
Types of Data:
Subjective Data:
Description: Information verified only by the affected individual. Examples: Symptoms like itching, pain, and feelings of
worry.
Objective Data:
Description: Observable or measurable data that an observer can detect.Examples: Signs like skin discoloration, blood
pressure readings.
Interviewing: An interview is a purposeful conversation, such as obtaining or providing information and identifying mutual
concerns
Approaches to Interviewing:
Directive Interview: It is highly structured and client specific information. The control the interview and give specific
direction to client answers. The nurse asks close ended questions.
Non-directive Interview: The nurse allows the client to control the purpose. The nurse encourages the communication by
asking open ended question.
Types of Interview Questions:
Close-ended Questions: Restrictive, requiring “YES or NO” answers.
Open-ended Questions: Allow clients to provide more information.
Neutral Questions: Elicits answers without pressure
Leading Questions: Suggests the expected answer.

Planning the Interview and Setting:

Time: Schedule when the client is comfortable and free of pain.
Place: Well-lit, ventilated, quiet room with no distractions.
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Seating Arrangement: Chairs at a right angle, a few feet apart.
Distance: Maintain 3-4 feet for comfort.
Interview Phases:
Preparatory Phase: Collect background information.Ensure a comfortable environment.Arrange seating at a 45-degree angle
with 3-4 feet distance.
Introductory Phase: Introduce self.Clarify the purpose and ensure confidentiality.Attend to patient needs before starting
Working Phase: Gather subjective data using excellent communication skills.Employ active listening, eye contact, and
open-ended questions.
Termination Phase: Ensure the patient understands the next steps with the information provided.

6.Observe the coordination of patient care between health team members.

Care coordination involves deliberately organizing patient care activities and sharing information among all of the
participants concerned with a patient’s care to achieve safer and more effective
There are two ways of achieving coordinated care:
 Using broad approach
 Using specific care coordination activities
Example:
Broad care coordination includes:

Health care team members:

• Team work
• Care management
• Medication management
• Health information technology

Health Team Members:

Team work among the members of the hospital can result in a better patient care and a more enjoyable work environment. If
everyone remembers that the goal is same like quality health care better patient.
•Doctor •Nurse •Pharmacist •Nutritionist •Occupational therapist •Physiotherapist •Dresser
Physician:
The physician is responsible for medical diagnosis for determining therapy which is required by person who is ill and
injured.
Surgeon:
 The surgeon is responsible for the preoperative diagnosis of the patient, for performing the operation, and for providing
the patient with postoperative surgical care and treatment.
 The surgeon is also looked upon as the leader of the surgical team.
 Surgeon performs minor as well as major surgeries.
 A surgeon has specialty in a specific department of surgery.
NURSE:
 The role of a nurse in caring for the patient is a diverse one that encompasses multiple responsibilities.
 A registered nurse is a multidimensional professional whose licensure can be distinguished in several subspecialties.
 A ‘pediatric nurse chooses to work with children, while a geriatric nurse works with the elderly.
 Public health nurses work with community populations and harness the greatest outcome for the most people in a
population.
 Oncology nurses are trained to provide chemotherapeutics via IV therapy, while a diabetic nurse educator focuses on
client education.
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Pharmacist:
 A key role in a hospital pharmacist’s job is determining which form of medication best suits each patient. Each decision
must be made in a timely and efficient manner and requires significant input from doctors, nurses and other healthcare
professionals.
 Hospital pharmacists will often monitor the effects of the medications they prescribe and counsel their patients on the
effects of the drugs.
 Another aspect of this role is to recommend administration routes and dosages, all of which are dependent on an
individual’s ne
Nutritionist:
 Proper nutrition is essential to healthy living and overall well-being
 A nutritionist can play an important role in your health by evaluating your diet and offering you personalized advice
 Based on your health goals or medical needs, the nutritionist can make recommendations and put together meal plans
 Nutritionists work in many settings, including hospitals, schools, health departments and private practices.
Occupational therapist:
 Occupational therapy is a client-centered health profession concerned with promoting health and well-being through
occupation
 It refers to the practical and purposeful activities that allow people to live independently and have a sense of identity. The
primary goal of occupational therapy is to enable people to participate in the activities of everyday life, which include
day-to-day tasks such as
self-care, work or leisure.
 Occupational therapists work with people and communities to enhance their ability to engage in the occupations they
want to, need to, or are expected to do, or by modifying the occupation and/or the environment to better support their
occupationalengagement.
Physiothrapist:
 Physiotherapists are experts in human movement and have a key role in prevention, identification, assessment,
treatment
 When movement and function are threatened or affected by ageing, injury, diseases, conditions or environmental factors.
 Physiotherapists support people at all stages of life to recover from injury, reduce pain and stiffness, increase mobility
and movement and maximise function and quality of life, incorporating physical, psychological, emotional and social
wellbeing

Physiotherapy Techniques

Dresser:
 Dressing boils, wounds, sores, and cuts, among others.
 Cleaning sores, cuts, wounds with antiseptic solution/ cream/ointment.
 Preparing patients for surgeries.
 Helping patients with pain-relieving drops in ears, eyes, or nose
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7.Identify different forms used for documentation in patient’s care. Common forms used
for documentation in patient’s care
•Admission form •Consent form •Medication sheet •Vital signs/Intake-Output Record •History sheet •DPN (Daily
Progress Notes) •Nursing notes •X-Ray request form •Inter departmental consultation •Pre-Op Forms
Admission Form: A hospital admission form tracks patient information, demographics, and treatment details while securing
consent for planned treatments.
Consent Form: A legal document fostering ongoing communication between patients and healthcare providers, ensuring
informed decisions about treatment options.
Medication Sheet: Used in aged-care facilities, it communicates medicine details, including name, dose, and administration
times, facilitating coordination among healthcare professionals.
Vital Signs/Intake-Output Record: Captures information on fluid intake/output and vital signs, aiding proper charting in
medical records.
Medical History Form: A questionnaire collecting a patient’s medical history, disclosing allergies, illnesses, surgeries, and
other relevant details.
DPN (Daily Progress Notes): Essential for presenting a patient’s latest information, clinical progress, and the ongoing
evaluation by the healthcare provider team.
Nursing Notes: Records kept by nurses during hospitalization, detailing patient care and recovery progress.
X-Ray Request Form: Used by hospitals and physicians to refer patients for radiological investigations, crucial for diagnosis
and treatment.
Inter-Departmental Consultations (IC): Meetings for patient care, teaching, and transferring specialty care, enhancing
collaboration among professionals.
Pre-Op Forms:
Patient’s Informed Consent Form: Informs patients about procedures and associated risks, ensuring voluntary agreement.
Anaesthesia Consent Form: Informs about risks associated with anesthesia administration.
Surgery Pre-Op Assessment Notes: Identifies potential complications during surgery and includes pre-op orders.
Operation Notes: Records surgical details and provides a medico-legal record of patient care.
Checklist: Enhances patient safety by providing pre-op nurses with critical information.
Discharge Slip: Crucial for post-hospitalization safety, providing a treatment plan, follow-up instructions, and reasons to
return to the emergency department.

8.Utilization of appropriate hospital forms for documentation

(According to Nephrology Department Documentation)
 Admission/emergency slip (Right after admission)
 History sheet (subjective and objective history of patient)
 Diagnosis sheet (problem of patient)
 IOP chart (vital signs and intake output sheet)
 Continuation sheet (for detailed physician’s prescription)
 Labs,reports(CBC, LFTs, RFTs, Blood culture, urine examination, protein level, uric acid level, sugar level etc.)
 Investigation sheet (for diagnosis and investigation of patient’s recovery and complications)
 Medication sheet (for medicines prescription)
 Nurse notes for sick patient (for nursing care plan)
 Daily progress report/notes (daily improvement from disease)
 Blood transfusion Performa
 Special consent for: PD, Renal Biopsy, SCVP Catheter, for haemodialysis (for attendants and patients permission)
 Haemodialysis flow sheet
 Treatment ticket (daily prescribed medicine dose)
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 Blood/drug reaction Performa
 Nephritic flow sheet
 PD chart (for peritoneal dialysis dosage)
 Lama form (leave from hospital on attendants own responsibility)
 Incidence form
 Death certificate
 Discharge slip and documentation (doctors give discharge permission to client if there is no need for further supervision
of hospital)

9.Develop a problem list based on patient’s assessments and rationalize each problem
identified.
A problem list is a document that catalogues a patient’s health problem including non transitive illness, injuries and
anything else that has or is affecting the patient
After viewing patient’s data and record, we construct following list
1.Date: 7-11-2021
Problem: ineffective breathing pattern
Intervention:
I thought the patient about pursed lip breathing, abdominal breathing performing relaxation technique that enhances the
breathing pattern.
Rationale:
Pursued lip breathing control shortness of breath and make each breath effective Diaphragmatic/Abdominal breathing
strengthen your diaphragm. Relaxation technique calms the patient.
2.Date: 8-11-2021
Problem: Muscle Twitching
Intervention:
Stretched the area that has the muscle spasm can usually help improve or stop from occurring muscle spasm. I massaged the
area affected.Rationale:
● A massage can reduce muscle spasm. We can use 3 types of massage i.e.
 Deep tissue massage
 Remedial massage
 Swedish massage (Increase Circulation)
3.Date: 2-11-2021
Problem:Vomiting
Intervention:
 I provide an emesis basin within the reach of the patient. I ask the patient to drink clear or ice chilled drink.
 I ask to eat light, blandfood that helps in stopping vomit.
Rationale:
● Emesis basin shallow kidney shape basin in which client can vomit. Drinking cold water can reduce nausea and vomiting.
4.Date: 31/10/2021
Problem:Confusion
Intervention:
 Modulate sensory exposure.
 I provide a calm environment; eliminate extraneous noise and stimuli to reduce confusion.
Rationale:
● Calm environment can relax client.
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10.Document assessment of patient’s problems/needs by using Maslow’s Hierarchy of

human needs at a beginning level.
Maslow’s Hierarchy human needs:
A progression from simple physical to more complexes emotional needs as follows “this is defined by psychologist
Abraham Maslow
•self actualization •Self esteem •Love and belongings
•Safety and security •Physiological needs
1.Basic physiological needs:
First level needs are called physiological needs ‘survival needs are primarily needs without them, a person or animal will
die. They take procedure over higher level
•Water and fluids •Food and nutrition •Elimination of waste products •Activity and exercise •Oxygen •Sexual
gratification
•Temperature regulation •Nursing intervention •Administering oxygen •Assisting with oxygen • Assisting with feeding
a client
•Assisting with hygiene and elimination •Maintaining a warmth for newborn
2.Safety and security:
At this level these are both physical and physiological needs. There must be met by helping client ambulate being using a
walker.
Nursing interventions:
 Checking identification of client before administrating medication.
 Taking defective equipment from a client’s environment and reporting defect.
 Client’s safety monitoring while in shower, ambulating in hall or getting in or out of beds.
 Performing a safety check in home environment for a child or an elderly adult.
 Reporting abuse to paper authority.
3.Love, Affection and belongings:
Nurses and doctors try to provide sympathetic and lovely environment to patient. This provides comfort to patient otherwise
they may get aggressive to their belonging.
Nursing Intervention:
 Allowing the clients family to visit in a hospital.
 Encouraging a family to participate in the care of client.
 Allowing religious leaders and friends to visit to perform rights.
4. Self Esteem:
Self-esteem is first priority in nursing. The dignity and worth of an individual should maintain.
Nursing Intervention:
 Promoting positive self image after surgery.
 Encourage an individual progress in rehabilitation.
 Providing an opportunity for bounding with new infant.
5.Self actualization:
It also includes respect for client that need must be fulfilled.
Nursing Intervention:
 Acknowledge the accomplishment of individuals.

11.Admission of a patient in a hospital:

Allowing a patient to stay in hospital for observation, investigation, and treatment
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Types of admission:
1.Emergency admission: In that patient are admitted in acute condition required immediate treatment
e.g
•Burn •Accident •Poison •Foreign body ingestion and other medical emergency
2.Routine admission: In that patient are admitted for observation, medical treatment and surgical treatment, that is given
according to patient problem such as
•Hypertension •Diabetes •Bronchitis

Preparation:
EQUIPMENTS:
• Prepared bed •Thermometer tray •Weighing machine
•Admission advisory form •Kidney tray •Tissue paper

Documents for admission:

Admission slip ( OPD/ Emergency) •Consent form •History sheet
•Investigation form •Progress form •Medicine sheet •Nursing notes •TPR/Intake,output sheet •Specific flow sheet
Purpose of admission:
•To provide immediate care •To be ready for any emergency
•To investigate the problem •To establish a patient nurse relationship
•To assist patient in adjusting to hospital environment
•To provide comfort and safety to the client

13.Orient a patient to Hospital Environment

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Patient’s environment in hospital:
The characteristics of the physical environment in which a patient receive care affects patient outcomes patient satisfaction
patient safety staff efficiency staff satisfaction and organizational outcomes
Characteristics of a therapeutic environment;
A health care environment is therapeutic when it does all of the following,
• Supports clinical excellence in the treatment of physical body
• Support the psycho-social and spiritual needs of patient
• Produces measureable positive effect on patient’s clinical outcomes and staff effectiveness.
Patient unit:
It is the area of hospital in which the patient receives medical and nursing care and treatment as well as the place he/she
lives during his/her stay.

Maintenance
• It must be maintained as a safe pleasant clean and orderly environment for the patient for physical and mental wellbeing
• Constant effort is needed to achieve and maintain the necessary high level of order and sanitation
Components of basic patient unit:
•Furniture •Linen •Toilet equipment •Other articles
Components:
•Furniture •Table •Over bed table •Television •Telephone •Bed •Bedside •Nurse call signal •Linen •Mattress
pads •Sheets
•Pillow cases •Bed spread •Blanket •Bath robe •Wash clothes •Face towel •Linen hamper •Toilet equipments
•Wash basin •Toothpaste •Tooth brush/toothbrush container • Mouthwash •Disposable tissues •Denture cup •Other
equipments •Drinking glass •Wash jug •Trash container •Blood pressure setup
Therapeutic environment:A therapeutic environment is an environment which helps a patient to return to good health.
Factors contributing to therapeutic environment: •Temperature •Concurrent and terminal cleaning •Colour
•Ventilation •Lightening •Noise control •Climate control •Odour •Privacy

14.Assist in transfer of patient from one unit to another unit or department:

Transfer is defined as preparing patient completing necessary records and shifting patient to another
department within the hospital or to another hospital/home
Types oftransfer of patient:
External transfer: To transfer the patient from one hospital to other hospital for the purpose of special
carei.e.; from General hospital to specialized hospital cancer centres.
Internal transfer: To transfer the patient in a unit that provide Special care or care suited to his
need .i.e.; from General ward to ICU and from ward to HDU.
Purpose:
• To obtain necessary diagnostic tests and procedure • To provide treatment and nursing • To
provide specialized care
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Preliminary assessment:
1: Asses the method for transport inform receiving nurse.
2: Maintain patient physical well being during transporttonew nursing unit.
3: Provide verbal report about patient’s condition to the receiving unit nurse.
4:Check the chart for complete recording of vital signs nursing care and treatment given
5: Collect patient X-ray medicine and other belongings.
6: Cancel the hospital diet.
7: Assist the relative to collect other belongings.
8:Record time- mode of transfer and general condition
9: Assist in transferring silk patient to wheel chair/stretcher and accompany patient to new area.
10: Handover patient documents –belongings and report verbally to the in charge nurse.
11: Collect the ward articles.

15.Assist patients with different type of positions:

1.Supine position: (horizontal recumbent position) Patient lying on his back with legs extended. Arms
may alongside the body or folded on the chest.
• To provide comfort to the patient. •To perform assessment. •Check vital signs. •To perform the
physical examination. •Undergoing anaesthesia. •Lung biopsy.

2.Dorsal recumbent position: Patient is on his back with knees flexed and soles of feet flat on the bed.
Fold a sheet crosswise over the thighs and legs so that the genital area is easily exposed.
Purpose:
To provide comfort to the patient. •To perform genital examination. •To perform assessment. •To
check vital signs. •To provide perineal care. •To perform urinary catheterization.
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For PV examination.

3.Fowler’s position: In fowler’s position head rest is adjusted to a desired height and bed is slightly
raised under patient’s knees.
•Low fowler’s position. (30 degree) •Semi fowler’s position. (45 degree) •High fowler’s position.(90
degree)
4.Low Fowler’s position: In this position head of the bed is elevated at 30 degree with flexion at the
level of waist.
Purpose:
•To provide comfort to the patient. •To relieve abdominal dissention. •To relieve pressure on
abdominal sutures. • To promote lung expansion. •Paracentesis

5.High Fowler’s position: In this position head of the bed is elevated at 90 degree with flexion at the
level of waist.
Purposes
•To relieve pressure on the back. •To relieve dyspnoea. •To prevent the risk of chocking. Pleural
effusion.Emphysema

6.Lithotomic: This is similar to dorsal recumbent position except that the patients legs are well
separated and thighs are acutely flexed fetes are usually placed at stirrups. Fold sheet and bath
blankets crosswise over thighs and legs so that the genital area is easily exposed. Keep patient covered
as much as possible.
Purpose
•To perform examination of pelvic organs. •To perform vaginal examination. •During
child birth. •To perform genitourinary operations. |Transurethral resection of prostrate.
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7.Prone position: The prone position is lying face down or on your stomach. It’s commonly used in
medical settings, like during certain surgeries or for patients with respiratory issues, as it can improve
oxygenation. In other contexts, it’s a resting or sleeping position.
Purposes:
•To provide comfort to the patient. •To examine the spine and back. •Renal biopsy •To
asses posterior thorax. •To relieve pressure on the back and coccyx. •Recovery position after
anaesthesia. •Position after spinal surgery and haemorrhoidectomy
Contraindication: An unconscious patients or one with an abdominal incision or breathing difficulty
usually cannot lie in this position

8.Sims’s position: In this position patient lies on left side with right knee flexed against abdomen and
left knee slightly flexed .left arm is behind the body and right arm placed comfortably.
Purpose:
•To provide comfort to the patient. •To perform the vaginal examination. •To perform rectal
examination. •To administer enema. •To prevent aspiration.
Contraindication: Patient with leg injury or arthritis usually cannot assume this position.

9.Lateral position:In this position patient lies on his/her side with head, neck and back in straight line.
Upper most arms may be flexed across patient’sabdomen. Pillow is placed under the head and neck to
maintain alignment. A small pillow is placed under the uppermost leg for support
Purpose:
•To perform pelvic examination. •To perform operations on pelvic organs. •To treat shock patients.
•Hypertensive patients. •To promote venous return. •Cord prolapsed patients.
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10.Reverse Trendelenburg position: The head and shoulders are at a higher level than the hips ,legs
and feet.
Purposes:
•To minimize the gastroscopy heal reflex.
•For reducing intracranial pressure.

Mouth care of unconscious patients:

Mouth Care: Mouth care or oral hygiene is the practice of keeping the mouth clean and healthy by
brushing and flossing to prevent tooth decay and gum disease.
OR
Maintaining cleanliness of the oral cavity is known as the oral hygiene.
OR: The scientific care of teeth and mouth.
Purposes:
•Taking good care of mouth, teeth and gums positively affect our overall health.
•Good oral and dental hygiene can help prevent bad breathe, tooth decay and gum disease.
•It helps to keep your teeth strong as you get older.
•Oral health affects both physical and emotional well being as it impact upon appearance,
interpersonalrelations, diet, nutrition and speech.
•A disease of mouth can also affect the rest of the body and is a contributing factor to number
secondary conditions.

Unconscious State: Unconsciousness is a state when a person is unable to respond to people and
activities.
E.g. Coma
•It is caused by nearly any major illness or injury.
•It is also caused by any substance(drug) or alcohol use.
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•Choking on an object also results in unconsciousness.
Importance of mouth care in unconscious patients:
•Care for unconscious patients is an important parts of Mouth their all over care.
•Unconscious patients are at a risk for developing mouth problems such as dryness, plaque and fungal
infections. It is important to keep the mouth clean and moist to prevent these problems.
•It is also important to keep lips moist, this can be done by lip balm or petroleum jelly. This is done to
prevent their lips from cracking.

Material required for mouth care in unconscious patients:

•Glass or feeding cup •Mouth wash solution •Jug of water •Kidney tray or Emsis Basin •One
artery forcep •One dressing forcep •Applicator| or Oral swab •Boroglyceriene in Bottle •One small
towel •Tongue depressor or Scrapers •Hand sanitizer •Gloves •Tooth paste •Tooth Brush
Procedure:
 The procedure should be informed to the patient if conscious.
 Bed side screen is placed for privacy.
 The patient is placed in comfortable position depending upon the type of patient- conscious,
unconscious or semi-conscious sitting or lying sidewise.
 Bring the tray to the bedside.
 Place the towel under the chin of the patient to protect the bed from soiling.
 If artificial denture, remove and clean.
 Take a swab firmly holding by an artery forcep dipped in mouth wash solution, squeeze it well
against the side of the bowel inside and out and then swab the teeth gums. The swabs are changed
one after another as per requirement.
 The inside of the teeth and tongue is cleaned in the same manner. The conscious patient rinses his
mouth by himself .Hold a kidney tray under his chin with support of the head with other hand.
 Wipe the mouth and dry.
 Apply Boro-glycerine paint over tongue and lips if required. •Remove and keep all items tidy in
proper place.
 Special care should be taken to remove sores and crusts very gently to avoid bleeding underneath
mucous membrane.
 Patients on milk diet, mouth are cleaned after every milk feed.
 Conscious patients should be encouraged to take more water by mouth unless otherwise restricted
by doctor.
 Sticky diets or sweets should be avoided by patient as a part of mouth care.
 Use a padded tongue blade to open the patient’s mouth and separate the upper and lower teeth.
Mouth wash solutions:
•Normal saline solution:This is a solution of common salt with water in proportion of 4gm in 500cc of
water. This is commonly used in wards.
• Hydrogen Peroxide(H2O2): Solution is readily available in market as a deodorising agent. 5 to 20cc
can be used for mouth purpose.
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• Potassium Permanganate(kmno4): This is available in crystal form. 4cc of Potassium
Permanganate(kmno4) solution(1:700) in a glass of water can be used for mouth wash. Alternately,
one small crystal can be put in glass of water. This is a powerful disinfectant deodorising agent.
• Soda-Bicarb Solution: The solution is made with 4gms of soda bicarb powder in pint of water.
• Thymol solution: One fourth to half teaspoon of thymol is put in one cup of water (100-150 cc of
water). It acts As an antiseptic agent.
•Lemon Juice: Two tea spoons of lemon juice in a cup of water can be used as an improvised method
for mouth wash.
°Never use dettol as mouth wash antiseptic.
Role of Nurse:
•Nurse plays an important role in providing effective oral care and promoting oral hygiene of an
unconscious patient.
•Nurse should be aware of risk factors associated with poor oral health be able to asses and help
patients maintain oral hygiene.

16.Assist in preparing patients and family for discharge.

1.Ask the patient to have the primary caregiver at home come into the hospital so that you can talk to
them together.
2.Teach the patient and family member about how to handle the care at home.
3. Tell the patient and family what the patient can and cannot do
4.Discuss the need for adequate fluids and a nutritious diet.
5.Tell the patient and family about medication the patient will need to take.
6.Discuss the need for adequate fluids and a nutritious diet.
7.Discuss with the patient and family what they may need to make home safer And measure for the
patient.
8.It is particularly important to give the patient and family clear instructions for Dealing with
patient’s pain.
10.Give the patient te materials or equipment’s him or her Will need or give instructions about how to
get what is needed.
11.If patient will be on bed rest, teach family how to position the patient in bed, turn him or her head
and help the patient to move from bed to chair.
12.If the patient needs follow up care at home, make the referral before the patient leaves the hospital.

17.Document the discharge of patient from hospital. Admission date: Discharge date:
Admission diagnosis: Initial diagnosis based onpresenting information,orreason for admission based
on symptoms if tentative diagnosis not possible.
Discharge diagnosis: Concluding diagnosis based on testing, studies, examination etc.
Consults: Any consultation had during stay, including dates, speciality involved findings or
recommendations.
Procedures: Any procedure had during stay, including dates, speciality involved findings or
recommended.
17
History of present illness: Summary of previous medical history and what prompted the admission.
When referencing the history and physical in the HPI, indicate who completed the history and
physical if not done by you.
Hospital course: Consider what information would be important for you as the primary, or receiving
physician seeing the patient in follow-up. Be succinct and only include patient information.
Discharge to: Home or facility, include homecare if applicable.
Discharge condition: One line summary of patient’s condition.
Discharge medications: Include doses, frequency, length of therapy and any changes to pre-existing
medication.
Discharge instructions: List all instructions that were written on patient’s discharge form.
Pending labs: List all lab results have not yet arrived at time of dictation, as well as any lab results
that arrived between time of discharge and time of dictation.
Follow-up: List all follow-up appointments with dates, times, names of physicians/services involved,
and contact information.
Copy to: Request a copy sent to the Primary Care Provider (PCV) which includes PCP’s fax, address
and phone number.

18.Observe patients reaction to hospitalization and give assistance as needed.

Hospitalization: The act of taking someone to hospital and keeping them there for treatment is called
hospitalization.
Purpose
•Scheduled tests •Procedure, surgery •Emergency medical treatment •Administration of
medication •To stabilize or monitor an existing condition

Patient reaction to hospitalization:

The specific issues that seem to be threatening to traumatisation patients include the following:
•Helplessness •Humiliation •Blurring of body image
•Gaps in memory filled with distortions

Patient reaction change with age group

Reaction of infants
Stressors

Responses
Separation anxiety - Sleep—wake cycle disrupted Stranger anxiety -
Feeding routines disrupted Painful,invasive procedures - Displays excessive irritability
Immobilization
18
Reaction of toddler
Stressors Responses
Separation anxiety - Cries parents leave the beide
Loss of self control - Is frightened if forced to lie supine
Fear of dark - Wanders why parents don’t come
To the rescue
Bodily injury ar mutilation - Asociates pain with punishment
Reaction of adolescent
Stressors Responses
Loss of control - Displays denial, regression,
Fear of altered body image, - Intellectualization, projection,
Disfigurement, disability and - displacement
Death
Separation from peer group
Nursing assistance for hospitalized patient
•Completes admission process •Take vital sign •Nursing assessment and intervention •Observe
patient and record any relevant information to aid in treatment decision- making process
•Administer medication •Conduct frequent medical examination •Record detailed medical history
•Perform diagnostic test •Operate medical equipments •Provide comfort •Nurses provide
emotional support to patient and family •Educate and counsel to patient for treatment •Discharge
patient according to physician order
Beneficial effects of hospitalization
• Although hospitalization can be and usually is stressful for patient, it can also be beneficial.
• The most obvious benefit in the recovery from illness , but hospitalization also can present an
opportunity for children to master stress and feel competent in their coping abilities
• The hospital environment can provide children with new socialization experiences
• The psychological benefits need to be consi

19.Demonstrate occupied and unoccupied bed making.

Bed making:
It is technique of preparing different types of bed in making a patient comfortable or his/ her position
suitable.

Purpose of bed making:

• The purpose of a well made hospital bed , as well as an appropriate chosen mattress
• To give neat and tidy appearance to the unit.
• To prevent pressure ulcer.
• To promote rest and sleep.
• To promote cleanliness .
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• To economize time, material and energy.
• To provide patient active and passive exercises to the patient
• To observe the patient.
• To relief fatigue.
Principles of Bed making
• Barrier nursing to prevent cross infection.
• Clean and comfortable bed to ensure rest and sleep and prevent complications.
• Appropriate body mechanics to maintain body alignment
• Making all beds in a nursing unit alike for uniformity of appearance
• Handle all linen in order to reduce dust and spread of micro organism.

Material for bed making

1.Bed: Length: 78 inch Breadth: 38 inch Height: 28 inch
2. Mattress: Firm, smooth with washable covers that are bigger than the mattress made of cotton
Length: 190cm Breadth: 90cm Bed spread Length: 3mts Breadth: 90cms
3.Draw sheet: Drawn from side to side length: 150cm Breadth 110cms Foot sheet: Length: 108inch
Breadth: 110cms
4. Pillows: Space between cots: 3 to 3.5 feet

Guidelines for Bed Making

• Gather all the required linen and accessories before making bed.
• Work systematically.
• Plan the work.
• Collect equipment in the order that they are to be used
• Accomplish a task with each movement Avoid use of torn linen
• Always keep linen away from you Fold linen and prevent it from touching thefloor Shake gently, do
not flap
• Face direction of work.
• Do not alter the shape of mattress.
• Ensure the client comfort and safety.
• Ensure your own personal safety
Types of bed
1.Open bed/Occupied bed 2.Closed bed/Unoccupiedbed Admission bed 3.Cardiac bed 4.Amputation
bed 5.Fracture bed 6.Post operative bed 7.Occupied bed 8.Therapeutic bed
1.Occupied Bed: An occupied bed is making the bed where the patient physically available in the bed or
the bed is being retained for the patient. An occupied bed is made while patient in still in the bed .The
patient may not be able to move him or herself out the bed
Purpose of occupied bed making
•To promote the client comfort. •To provide clean environment for the client. •To minimize the source
of orientation.

Equipment: •Bottom sheet

•Cotton draw •Sheet mattress •Top sheet Rubbersheet Pillowcase Gloves
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2.Unoccupied (closed) Bed: An unoccupied bed is one that is made when not occupied by a patient. This
is an empty bed in which the top covers are arranged in such a way that all linen beneath the
counterpane or bedspread is fully protected from dust and dirt until the admission of new patients
Procedure for making an unoccupied bed: 1.Gather
necessary linens in the order to be used 2.Wash your hands. 3.Put a gloves 4.Explain what you are
going to do. 5.Raise adjustable bed to high position, lower bed rails 6.Remove the pillow case and place
the pillow on the bed side chair . 7.Place solid linen in the linen hamper.

20.Asses the needs of personal hygiene care for selected patients and provide care
accordingly.
Personal hygiene: Maintaining good personal hygiene is crucial for both physical and mental well-being.
It involves caring for various aspects, such as dental, body, hand washing, and nail hygiene.
Types of Personal Hygiene:
•Dental: Brush teeth for 2 minutes at least twice a day, floss daily, and use ADA-accepted fluoride
toothpaste.
•Body: Wash regularly, paying attention to areas prone to sweat. Shampoo hair at least once a week and
apply deodorant when dry.
•Hand Washing: Follow a thorough handwashing routine, including lathering for at least 20 seconds and
drying hands properly.
•NAIL CARE: Trim nails with sanitized tools regularly and use a nail brush during handwashing.
How to maintain good hygiene
Maintaining good personal hygiene is essential for establishing a routine. Basic knowledge of various
hygiene types is key
•Dental Hygiene :Brush teeth for 2 minutes at least twice a day, using ADA-approved fluoride toothpaste.
•Replace the toothbrush every 3–4 months and incorporate daily flossing.
•Hand Washing: Wet hands with clean water, apply soap, and turn off the tap.
•Lather hands thoroughly, reaching backs, between fingers, and under nails.
•Scrub hands for at least 20 seconds (humming “Happy Birthday” twice)
•Rinse hands under clean, running water.Dry hands with a clean towel or air dry.
•Body: Focus on sweat-prone areas like armpits, between toes, and groin during washing.
•Shampoo hair at least once a week, applying deodorant when fully dry to prevent body odors.
•Nails: Trim nails with sanitized tools regularly to avoid dirt accumulation.
•Use a nail brush to scrub the underside of nails as part of handwashing routine.
Teaching Children Hygiene
•Introduce dental care early, starting with toothpaste at 12 months and incorporating flossing as gaps
close.
•Encourage children to participate in their hygiene routine.
Factors Affecting Hygiene:
•Poverty and lack of clean water can impact personal hygiene.
•Mental health conditions may hinder maintaining a hygiene routine.
Negative Effects of Poor Personal Hygiene:
•Isolation and potential health issues, including athlete’s foot, tooth decay, and various infections.
 21
Hygiene Routine Tips:
•Cultivate habits through daily practice.
•Set reminders, use rewards (e.g., sticker charts), and invest in pleasant toiletries.
Summary: Good personal hygiene positively influences social life, physical health, and mental well-
being. Developing and maintaining a routine is essential for a healthy body and mind.

21.Document patient’s assessment and care provided

Documenting a patient’s assessment in the notes is something that all the nursing students need to
practice. This guide discusses the SOAP Framework (Subjective data, Objective data, Assessment and
Plan), which would help you to structure your document in a clear and consistent manner.
Subjective Data: The subjective data section of your documentation should include how the patient is
currently feeling and how they have been since last review in their own words.
As a part of assessment you may ask:
•“How are you today?”
• “How have you been since the last time I reviewed you?”
•“Have you currently got any troublesome symptoms?”
•“How is your nausea?”
Patients remarks on it that:
• “I feel weak all over when I exert myself”
• “I feel sick to my stomach”
• “I’m short of breath”
If the patient mentions multiple symptoms you should explore each of them, having the patient describe
them in their own words.
Objective Data: The objective data section needs to include your objectives observations which are
things you can measure, see, hear, feel, or smell.
Objective observations:
Appearance: Document the patient’s appearance (e.g. the patient appeared to be very pale and in
significant discomfort.)
Vital signs:
Document patient’s vital signs:
• Blood pressure •Pulse rate • Respiratory rate • Temperature •SpO2 (also document supplemental
oxygen if relevant).
Fluid balance:
An assessment of patient’s fluid intake and output including:
•Oral fluids •Nasogastric fluids/ feed • Intravenous fluids •Urine /stool output •Vomiting •Drain/
Stoma output
Clinical examination findings:
Some examples of clinical examination findings may include:
•“Widespread expiratory wheeze on auscultation of the chest.”
•“The abdomen was soft and non-tender.”
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•“The pulse was irregular.”
•“There was no cranial nerve deficits noted.”
Investigation results:
Some examples of investigation results may include:
• Recent lab results (e.g. blood test/ microbiology)
• Imaging test (e.g. chest X-ray/CT scan)
Care Provided Plan: With the information gathered from the start of shift assessment, the plan of care
can be developed in collaboration with the patient and family/cares to ensure clear expectations of care.
Nursing Hub: The nursing hub is a shift planning tool and provides a timeline view of the plan of care
including, ongoing assessments, diagnostic tests, appointments, scheduled medications, procedures and
tasks.
•The orders will populate the hub and nurses can document directly from the hub into Flow sheets in
real-time.
•O Orders are visible by the multidisciplinary team.

Management: Management of orders is crucial to the set up and usability of the hub. It must be ‘cleaned
up’ before handover takes place – too many outstanding orders are a risk to patient safety.
Additional Task:
Additional tasks can be added to the hub by nurses as reminders.
Flow sheets:
•All patient documentation can be entered into Flow sheets (observations, fluid balance and LDA
assessment) throughout the shift.
•Clinical information that is not recorded within flow sheets and any changes to the plan of care is
documented as a real time progress note
This may include:
•Abnormal assessment,
E.g. uncontrolled pain, tachycardia, poor perfusion, hypotensive, febrile etc.
•Change in clinical state,
E.g. Deterioration, improvements, neurological status, desaturation, etc.
•Adverse findings or events,
E.g. IV painful, inflamed or leaking requiring removal, vomiting, rash, incontinence, fall, pressure
injury; wound infection, drain losses, electrolyte imbalance, +/-fluid balance etc.
•Patient outcomes after interventions
E.g. dressing changes, pain management, mobilization, hygiene, overall improvements, responses to care
etc.
•Family cantered care
E.g. Parent level of understanding, participation in care, child-family interactions, welfare issues, visiting
arrangements etc.
•Social issue
e.g. Accommodation, travel, financial, legal etc
 23
22.Utilize skill to maintain healthy nails and feet.
Nail Care: Nail care means manicuring and pedicuring natural nails or performing artificial nail
services.
Purposes of nail care:
•To keep nails harmless
•To prevent accumulation of dirt under the nails and reduce occurrence of infection.
Care of nail and foot:
•Inspect the daily including the tops and soles of the feet and the area between the toes.
•Wash and soak the feet daily using lukewarm water. •If the feet perspire, apply a bland foot powder.
•If dryness is noted along the feet, apply soft oil and rub gently •File the toe nails straight across and
square. •Avoid wearing elastic stockings. •Wear clean socks
daily •Do not walk barefoot •Wear properly fitted shoes.
•Exercise regularly to improve circulation to the lower extremities.
•Immediately wash minor cuts and dry them thoroughly. •Mild antiseptics may be applied to skin.

Risk factors for foot and nail ailments:

1. Patients with peripheral vascular disease, e.g. diabetes mellitus.
2. Patients with neuropathy.
3. Poor ill fitting foot wear.
4. Poor knowledge of foot and nail care.

Common problems:
•Callus. •Corns. •Plantar warts. •Athletes’ foot (tineapedis) •Ingrown nails. •Paronychia. •Foot
odour
Equipment used for nail care:
•A pair of scissors or nail clipper. •Wet swabs in small bowl •A jug with water. •Kidney tray with
Dettol 1:40 solution. •Soft nail brush. •A paper bag. •A towel. •Wash basin. •Wash cloth.
•Mat. •Mackintosh and draw sheet.
Procedure for nails care:
• Keep fingernails dry and clean. This prevents bacteria from growing under your fingernails.
• Practice good nail hygiene. Use a sharp manicure scissors or clippers.
• Use moisturizer.
• Apply a protective layer.
• Ask your doctor about biotin.

23.Demonstrate the use of side rails:

Definition: One of the long narrow members connecting the headboard and footboard of a Bed rails
are metal rails that normally hang on the side of patient’s bed.
24
Types:
•L-shaped legless bed rails •Fold-down bed rails. •bed rails that provide safety on both sides of the
bed. •Crossbar bed rails with multiple handholds.
Benefits:
1: Uncontrolled body movements that lead to falling out of bed are common causes of injury among
seniors and people who take certain medications. They often suffer from restlessness in sleep, leading
to situations where the patient falls out of bed while dreaming. .
2: For people with mobility issues and physical weakness, getting in and out of bed can be challenging.
They may slip or lose their balance when moving on to or off their bed. A bed rail adds stability,
guidance, and a place to put their hands, reducing their risk of falling. A well-installed rail can work
as rigid support on which the user can put their weight when moving to get off the bed; they can also
hold more health and support supplies.
For example, hospital bed assist rails help those with mobility issues get in and out of bed and protect
them from rolling off the sides. Clients can also attach an overhead trapeze helper bar for additional
assistance when they must reposition themselves in bed.
Side rails a restraint:
• Side rails are commonly used in the care of the older person. They can be classified as a physical
restraint if they restrict the movement of an individual and also if the individual has an inability to
have them removed/lowered at will. Advanced age should not be an indicator for side rail use and an
individualized approach in patient. Patients, who are able to get out of bed, from performing routine
activities such as going to the bathroom or retrieving something from a closet is advised
Risks related to bed rails:
•Skin bruising, cuts, and scrapes
•Feeling isolated or unnecessarily restricted.
•Preventing patients, who are able to get out of bed, from performing routine activities such as going
to the bathroom or retrieving something from a closet.

24.Demonstrate the use of restraints

The international restriction of a person’s voluntary moment or behaviour. These are physical,
chemical or environmental measures used to control the physical or behavioural activity of person or
portion of his body.

Types of Restraints:
 25
Purposes:
• To carry out the physical examination
• To provide safety
• To protect from injury
• To complete the diagnostic and therapeutic procedures
• To maintain the patient in prescribed position
General principles:
• It should be selected to reduce client’s moment only as much as necessary.
• It should carefully explain type of restraint and reason for its use
• It should not interfere with treatment
• It bony prominences should be padded before applying it
• It always selects the safe and appropriate restraint
• It always maintains comfort and maintain body alignment
• It should change when they become soiled or damp
• It should be removed a minimum of every 2 hours
• You can do recording and reporting properly
• It should be attached to bed frame not to side rails
Physical restraint: Physical restraint is anything near or on the body which limits a client’s movement.
This may be attached to a person’s body or create physical barriers. E.g. table fixed to a chair or a bed
rail that cannot be opened by a client
Environmental restraint: Environmental restraints control a client’s mobility. E.g. secure unit or
garden, seclusion
Chemical restraint: Chemical restraints are any form of psychoactive medication used not to treat
illness, but to internationally inhibit a particular behaviour or movement.
Potential Risks and side effects of restraint use:
Psychological/Emotional
• Increased agitation and hostility
• Feelings of humiliation loss of dignity
• Increased confusion
• Fear
Physical:
• Decreased muscle tone, strength, endurance
• Reduced heart and lungs capacity
• Obstructed and restricted circulation Impaired circulation
• Reduced appetite, dehydration
• Death
Restraint guideline:
• Use only after written order by the physician unless emergency situation occur
• New order is required after 24 hours
• Types of Restraints to be used
• The projected time restraint is to be employed
Role of nurse:
• Check circulation, condition of limbs
• Attention should be given to the patients need including
• hydration, elimination and nutrition
• Vital signs
 26
• Follow instructions direction
• Calms in control
• Maintain comfort of the patient
• Release the patient turn and position frequently
• Follow institute and a trial of restraint release
• Proper reporting and document

25.Demonstrate hand washing:

Hand washing is the act of cleaning one’s hands with the use of any liquid with or without soap for the
purpose of removing dirt or microorganisms. It is the most effective measure in reducing the risk of
transmitting infectious diseases.
Purpose:
The purposes of hand hygiene are:
• Hand washing can prevent infection
• Avoid pathogenic microorganisms and to avoid transmitting them

Supplies Needed/ Materials:

The following materials or equipment are needed to perform hand washing:
• Soap or detergent •Warm running water •Paper towels
• Alcohol
• Optional: Antiseptic cleaner, fingernail brush, plastic cuticle stick
Steps of Hand washing:
The use of alcohol-based hand rubs.
1. Ensure jewellery has been removed
2. Apply quantity of alcohol-based hand hygiene product as per manufacturer’s recommendations
into cupped hand.
3. Rub hands palm to palm
4. Right palm over left dorsum with interlaced fingers and vice versa.
5. Palm to palm with fingers interlaced
6. Backs of fingers to opposing palms with fingers interlaced
7. Rotational rubbing of left thumb clasped in right palm and vice versa
8. Rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and
vice versa
9. Rubbing hands together until hands are dry before continuing with patient care, do not rub off
excess product.
Advantages of Hand washing:
• Germs from unwashed hands can be transferred to other objects, like handrails, table tops, or toys,
and then transferred to another person’s hands.
 27
• Removing germs through hand washing therefore helps prevent diarrhoea and respiratory infections
and may even help prevent skin and eye infections.

26.Demonstrate application of body mechanism when moving and lifting patient?

Body mechanism is a term used to describe the ways we move as we go about our daily lives. As a nurse, we
may be required to move and lift patients.
Importance of body mechanism:
Proper body mechanism allow individuals to carry out activities without excessive use of energy and helps
prevent injuries for patients and health care providers.
Moving upward and downward:
 Two nurses are required to do this.
 One nurse places her hand under the shoulder and the other hand under the lumber region.
 The second nurse stands on other side of the bed and does the same as the first nurse.
 The patient if he is able is asked to flex the knee and pushed against the mattress with heels.
 Both are nurses together bring the patient up.

Assisting patient up in bed:

 Explain procedure to the patient and perform and hygiene.
 Raise bed to the comfortable position.
 With two nurses on opposite side of the bed lower side rails.
 Remove pillows and place it at head of bed.
 Place draw sheet on bed under patient’s midsection.
 Fold patients arm across and instruct patient to flex neck with chin or chest.
 Stand opposite patient’s centre with your feed spread and turned toward the head of bed.
 Fold or bunch draw sheet close to patient prior to grasping it securely and preparing to move patient.
 Shift your weight back and forth from back to leg to front leg and on count of three, move patient upward
in bed.
 Assist patient to comfortable position. Repositioning pillow. Raise side rails and adjust bed position.
 Perform hand hygiene.

Moving from one side of the bed to another:

 Move pillow towards the side of the bed.
 28
 Place your one arm under the shoulders and other under the lumber region.
 Move upper part of the body to the side of the bed.
 Then keep one arm under the lumber region and other arms under the thighs and move other the middle
part of the body of the side of the bed.
 Last replace one arm under the thighs and other under the ankles and move the lower part of the body to
the side of the bed.
 See whether the whole body is straight and in good alignment.

Turning on sides:
 Before turning move the patient a little away from the central.
 Keep his right arm crossed on the chest and right leg crossed over the left leg.
 Flex the right knee slightly.
 Keeps one hand on the patient’s right shoulder and the other hand on his right hip and gently roll him to
left lateral position.

27.Demonstrate range of motion exercises on a patient

The movement of a joint to the extent possible without causing pain.

Purposes:
• Promote and maintain joint mobility
• Prevent contractures and shortening of muscles and tendons
• Increase circulation to extremities
• Facilitate comfort for the patient.

Patient preparation:
• Explain steps and advantages exercises.
• Remove all restrictive clothing, linen, splint, and dressings.
• Drape appropriately
• Raise the bed to comfortable height
• Position the patient comfortably –preferably supine position.

Joints movement:
• Abduction-moving a body part away from the midline of the body.
• Adduction-moving a body part toward the midline of the body.
• Extension-straightening a body part.
• Flexion-bending a body part.
• Rotation-turning the joint.
• Internal rotation- turning the joint inward.
• External rotation-turning the joint outward.
• Planter flexion – bending the foot down at the ankle.
• Pronation- turning the joint downward.
• Supination- turning the joint upward.
 29
• Inversion- turning the sole of the foot towards the midline.
Eversion- turning the sole of the foot away from the midline.

Temporo mandibul •Open •Close •Protrusion •Opening mouth •Closing mouth

•Retraction •Lateral deviation •Bringing lower jaw forward. •Taking
lower jaw inside .• jaw to a side
•Flexion •Extension
•Hyperextension •Look the toes •Look straight ahead
Neck • flexion •pronation •Look up ceiling •Look straight ahead,
tilt head to shoulder •Turn lower hand
so palm is down
Forearm •Flexion •Extension
•Hyperextension •When standing- bend forward from the
waist Straighten up •Bend backward
•Bend to the side •Twist from the waist
Spine •Lateral flexion
•Rotation

Contraindications to ROM: Any illness/disorder where increased use of energy or increased

circulation is hazardous. Example: Myocardial infarct

Elbow •Flexion Bend elbow •Straighten elbow •Bend

•Extension lower arm back as far as possiible
•Hyperextension
 30

Wrist •Flexion •Bend wrist forward

•Extension •Straighten wrist (fingers, •wrist & arm
•Hyperextension in same plane)
•Abduction •Bring dorsal surface of hand as far
•Adduction back as possible
•Bring wrist medially towards the thumb
•Bend wrist laterally towards fifth finger

Bend fingers and thumb into palm make

a fist
Fingers and •Flexion •Straighten fingers and thumb •Bend
Thumb •Extension fingers as far back as possible •Spread
•Hyperextension fingers apart/extend thumb laterally
•Abduction •Bring fingers together/thumb back to
•Circumduction hand •Move fingers/thumb in circular
•Opposition motion •Touch thumb to each finger of
same hand

•Move leg forward

•Move leg back beside other •leg Move
leg backwards
Hip •Flexion •Move leg laterally away from body
•Extension
•Hyperextension
Abduction

28.Provide back care to bed ridden patient

Definition: “Back care means cleaning and massaging back paying special attention to pressure
points.” Especially back care provides comfort and relaxes the client; thereby it facilitates the physical
stimulation to the skin and the emotional relaxation.
Purpose:
• To improve circulation to the back •To refresh the mood and feeling •To relieve muscle tension •To
decrease pain intensity •To induce sleep •To prevent bed sore •To promote physical and mental
relaxation
Required positions:
• Side lateral position a•Sitting position •Prone position
Indications:
• Unconscious patient •Prolonged bed ridden patient
• Patient with restricted movement •Patient with BMI >30kg/m^2 •Patient suffering from chronic
back pain
Contraindications: •Any redness or pressure sore in the back
 31
• Surgeries in back, spine •Burn injury in back •Trauma or fracture in rib cage •Spinal injury
•Patient suffering from clotting disorder •Restricted movement after surgery
Articles:
• A big towel To wipe the back •Oil/ Talcum powder To prevent skin friction •Kidney tray To collect
wet waste •Screen and top sheet To maintain privacy •Mackintosh with draw sheet To protect bed
from soiling •Soap with soap case To clean and remove dirt from back •Two big steel trays To hold
all articles
• Two big jugs To hold warm and cold water
Procedure:
• Approach the patient safely •Identify the correct patient
• Explain the procedure to the patient •Perform hand hygiene
• Provide for client privacy •Adjust the bed at comfortable height •Establish which position the
client prefers
• Expose the back from the shoulder to the sacral area. Cover the remainder of the body. •Perform
hand hygiene
• Warm the lotion or oil in your hands before touching the client
• Massage the back in an orderly pattern using a variety of strokes and appropriate pressure.
Do Effleurage:
• Effleurage is a type of massage consisting of long, slow, gliding strokes.
• This rub has relieving and sedative effect.

Do Friction:
• These movements are in circular nature.
• It is performed with the help of thumb and finger pads.

Do Kneading:
• Kneading is a part of Swedish massage tradition and involves grasping and lifting of a tissue.
 32
• It is usually performed with the palms, first pressing down on the muscular tissue and then lifting it
with the fingers in rhythmic and churning action.

Do Vibration:
• The vibration is given by rhythmically moving the heel of the hand, the side of the hand or finger tips.
• Vibrating hand should move constantly.
• It increase the circulation

Do Tapotement:
• It is a rhythmic movement done with the edge of the hand, cupped hand and or the tip of the fingers.
• The movement used can be beating, slapping and hacking.
• Repeat above for 3 to 5 minutes, obtaining more lotion as necessary
• While massaging the back, assess for skin redness and area of decreased circulation.
• Pat dry any excess lotion with a towel.

Documentation:
• Document that a back massage was performed.
• Document the client response.
• Record any unusual finding.
 33

29.Transferring a patient from bed to bed, to a stretcher, to a chair

Definition of transferring: Transferring means moving a patient from bed to bed, to a stretcher, to a
chair with comfort.
Purpose of Transferring:
To transfer supine client from one location to another. Transferring the patient is done to patients who
can’t help themselves and need Equipment: Stretcher Sheet or blanket Sliding board
Methods of transferring:
• Following are the methods of transferring the Patient from bed to bed, to stretcher, or to chair. Draw
sheet method Patient is lifted by three persons Mechanical devices like hydro-uretre lift
• Steps of transferring patient from bed to stretcher Explain procedure to patient Perform hand
hygiene Move bed and equipment in room for stretcher Make sure that assistants are available Close
door and curtains Raise bed to the same height as the stretcher and adjust the head of the bed to flat
position if patient can tolerate it. Lower side rails Place dawn sheet under patient Position the
stretcher next to the bed Secure the patient on the stretcher until side rails are raised Assist the
patient to a comfortable position Perform hand hygiene

Purpose: To outline the procedure for transferring immobile patient from bed to chair. Equipment:
Chair At least 2 staff members
Nursing Action:
Assess the patient for following:
•Muscle strength •Joint mobility •Presence of paralysis •Orthostatic hypotension •Activity
intolerance •Level of consciousness •Level of comfort •Ability to instruction

Explain procedure to the patient:

• Wash hands
• Place chair parallel to the bed before transferring patient
• Transfer patient from bed to chair in low position
• One staff member gets behind the patients shoulders and upper body from the other side of the bed.
The other staff member will be lifting the patient’s hip and leg.
• In unison good body mechanics , staff members should lift the patients shoulders and legs
• Lower the patient into the chair and position the patient in good body alignment using pillows and
other devices as needed
Steps in preparing to ambulate the patient :
• Review the patient’s medical record for an authorizing physicians orderr
• Review the patient nursing care plan for the information regarding the following:
• Physical limitations
• Mechanical equipment being utilized like IV infusion pumps ,chest drainage set and urinary drainage
set
• Distant patient is to ambulate
• Length of the time , patient is out of the bed
• Review the nurses notes to identify the patients previous tolerance
• Explain the rationale for getting out of the bed to the patient
 34
• Pre-medicate for plan prior to getting out of the bed.
Management of the falling patient:
• Patient who collapse:
• Assume a board stance with one foot slightly forward , grasp the patient’s body at the waist and
under the axilla and allow to slide against your legs
• Ease the patient slowly to the floor using your body as incline
• Lower your body along with the patient, if necessary
• Utilize proper body mechanics.
The patient who loses balance:
• Attempt to stabilize the patient by bracing him against you
• Guide the patient to the bedside or chair , if possible
• If fall begins to occur, guide him slowly towards the floor.

30.Utilize different Comfort devices in different patients’ care.

Comfort:The absence of irritating stimuli that distracts one’s attention from the task at hand.
Comfort devices: Comfort devices are the mechanical devices planned to provide optimal comfort to
an individual.
• Pillows •Back rest •Bed cradle •Cardiac table •Mattresses •Foot board •Sand bags •Side
rails Trapeze bar •Trochanter rolls •Wedge/abductor pillows •Knee rest •Air cushion • Rubber
and cotton rings •Hand roll
Pillows:
 Used for support to maintain correct body alignment
 Used under head, arms, legs and along spine or abdomen
Back rest:
 Supportpatients back at an angle, so that he may maintain a sitting position.
 Can be adjusted to desired angles.
 Extra pillows are needed.
Bed cradle:
 It is a frame used to hold the bed linen from touching the patient.
 Cradle is a semicircular or rectangular frame of metal.
 May be made of wood or bamboo.
 Used to prevent pressure from the weight of linen.
 To allow air circulate around the lower limbs.

Cardiac table:
 Bed table placed in front with a pillow on it, patient can lean forward and take rest.
 Table without pillow is used for writing and meals.
35
 Used for patient with cardiac conditions and asthma.

Mattresses:
Mattresses are mainly of two types.
 Air mattress
 Water mattress
 To provide comfort.
 Used for very thin and very obese patients and those who are prone to pressure sore?

 Foot board:
 Device that is placed towards foot of the patient bed to serve as support for his feet.
 usually made of plastic or heavy canvass

Sand bags:
 They are sand filled plastic bags that can be shaped body contours.
 Can be used in place of or in addition to trochanter rolls
 Side rails are the bars positioned along the side of length of the bed.
 Ensure patients safety and are useful for increasing mobility
 Provide assistance in rolling from side to side or sitting up in bed.
 Provide support and shape to body.
 Immobilize extremities and maintain specific bodyalignment.
36

Side rails:
 Side rails are the bars positioned along the side of length of the bed.
 Ensure patients safety and are useful for increasing mobility
 Provide assistance in rolling from side to side or sitting

31.Characteristics of Professional Nurse

Professional nurse is a autonomous and collaborative care of individuals of all ages’ families groups
and communities sick or well and in all settings.
Characteristics of professional nurse
•Caring •Empathy •Leadership •Integrity •Critical thinking •Problem solving •Humility
•Attention to detail •Compassion •Time management •Honesty •Experience •Reliability

Caring: Caring is emphasized as a critical component of nursing delivery; however opportunities

must be presented to student to integrate skills such as caring.
Empathy: Empathy is an essential character of a nurse. Empathy is the ability to see understand and
share others viewpoints without judgement.
Integrity:
Leadership:Nurse can motivate herself or a group to work toward achieving a specific goal.
Critical thinking: Nurse having a strong willingness to learn important skills and putting that
knowledge into successful practice.
Time management: Setting time aside for self-care is also a crucial component to time management.
Honesty: Honesty is an important character to look for in a nurse.
Reliability: A nurse is one who can be depended upon for a faithful discharging of her duties the
patients under her care.
37
Experience: Experience involves constantly learning. The article offers how; Nurses build their own
experience.
Humility: This means recognizing that you don’t know everything and that you make mistakes and its
okay to acknowledge that put in duty.
Problem solving: Effective work for Head nurse requires good organization and a methodical rational
approach to ensure that the process can be completed.
Compassion: Nurses must be empathetic and try to understand the problems of their patient.
Attention to detail: Having a strong attention to detail is one of the nurse personality traits that can
easily and quickly determine how successful in their roles.

32.Assist patient in maintaining proper body Alignment In bed

Body alignment: Alignment refers to how the head, shoulders, spine, hips, knees and ankles relate and
line up with each other. Proper positioning is also vital for providing comfort for patients who are
bedridden or have decreased mobility related to a medical condition.
Purpose:
 To provide comfort to client
 To perform physical examination.
 To prevent deformities.
 In this way, the nurse prevents injury to client.
 To relieve pressure.
Common Positions:
 Prone position •Lateral position •Sim’s position •Supine position •Fowler’s and semi fowler’s
position
Prone Position: The Prone position is a patient position used during surgical procedures that provide
surgical access to the dorsal aspects of the patient’s body. 1. In the prone position, the patient is
positioned face-down with their head in a neutral position without excessive flexion, extension, or
rotation

Technique
• Collect the equipment. •Wash your hand. •Approach and identify the patient and explain the
procedure. •Provide privacy. •Raise the bed to the working height. •Lower the side rails. •Turn
the patient onto his side and then onto his stomach. •Roll toward you. Continue to roll until he is
on his stomach. •Head is turned to one side. •Arms in flexed position; hand is near the head.
•Legs are straight •Place Small pillow under the head.
• A pillow under the abdomen. •A pillow is placed under both ankles. •Raise and secure the side
rails. •Place the call light within reach. •Leave the bed in low position.
• Report significant nursing observations to nursing in-charge nurse.
38
Lateral and sim’s position: Sim’s position is similar to the lateral position except that the patient’s
weight is on the anterior aspects of shoulder girdle and hip. The patient’s lower arm is behind him and
the upper arm is flexed at the shoulder and elbow.

Technique:
•Collecttheequipment. •Wash your hand. •Approach and identify the patient and explain the
procedure . •Position the bed. •Turn the patient onto side. Obtain assistance, if needed. •Flex the
distal knee and place the distal arm across chest. •Log rolls the patient towards you by placing one
hand on the shoulder and the one on the distal hip and pulling. •Reach behind the
patient’s back with both hands, placing one on the proximal hip and lift slightly outward and roll the
body towards you. •Align the patient in good body position. •Ensure the patient no lying on arm.
•Place a pillow under patient’s head and neck. •Place a pillow under the upper most leg. •Use a
pillow to support the back. •Replace the bedding neatly. •Raise and secure the side rail. •Place
call light within reach. •Leave the bed in low position. •Report significant observation to in-
charge nurse.·

Sim’s position: Sims’ position or semi-prone position is when the patient assumes a posture halfway
between the lateral and the prone positions.

Technique:
• The lower arm is positioned behind the client, and the upper arm is flexed at the shoulder and the
elbow. •The upper leg is more acutely flexed at both the hip and the knee than is the lower one.
•Head and neck are in a straight line and arms at the patient side.
•Place a pillow under the head and shoulder. •Put a footboard at the back of the foot and place the
feet flat against it (at right angles against legs) •Place a pillow under each forearm. •Place a call
light within the reach. •Leave the bed in low position. •Report significant nursing
observations to the in charge nurse.

Supine position: In supine position, the patient is face up with their head resting on a pad positioner
or pillow and their neck in a neutral position
 39
Technique:
 Collect equipment(pillows) •Wash your hands. •Approach and identify the patient and explain
the procedure. •Explain procedure. •Position the bed(place the bed at working height and lower
the side rails.) •Move the patient from a side to a supine position. •Remove the supportive
pillows. •With one hand on the patient’s shoulder and one on the hip, roll his body in one piece
over onto his back. •Place a pillow under head and neck. •Place a pill0w under both arms for
support. •Place a pillow under both ankles. •Secure the side rails. •Leave the bed in
low position. •Report significant nursing observation to the in-charge nurse.

Fowler’s and semi fowler’s positions: In fowler’s position head is adjusted to a desired height and bed
is slightly raised under patient’s knees.

Technique:
 Collect equipment. •Pillows •Wash your hand. •Approach and identify the patient and explain
the procedure. •Provide privacy. •Be sure that patient in supine position. •Elevate the head
of bed. •Elevate 60 to 90 degree for the fowler’s position. •45 to 60 degree for
semi fowler’s position. •Place a pillow behind head and shoulder and a pillow behind lower back.
•Under thighs. •Place a foot board to maintain the feet at right angles to the legs. •Place the
patient in good body alignment. •Raise and secure the side rails. •Report significant nursing
observations to the in-charge nurse.

33.Observation for Different Vital Signs/ Patterns:

We use different techniques to take vital signs and after observed this pattern.
Vital signs:
•Temperature •Blood Pressure •Pulse •Respiration •Oxygen Saturation •Pain
I take different measures to take vital signs.
First of all,
• I introduce myself to the patient attendants and discuss with them, why I have come here.
• I use thermometers to take temperature First of all, wash my hands wear gloves, make temperature
tray including cotton buds, antiseptic, thermometer, and kidney tray and tape water.
• I disinfect the place to take temperature (axilla) disinfect thermometer then place thermometer for 2
to 3 minutes for record temperature.
• For taking B.P and Respiration per minute, I adjust the patient’s position to exact position. I counted
patients respiration per minute and recorded by using Stethoscope, Sphygmomanometer bladder with
bulb.
 40
• Then, I documented the taking data and readings on vital signs file.
• I took the vital signs daily and record those on file, this recording daily helped me to identifying
variation in vital signs to check the patient’s progress.

Temperature:
It is the hotness or coldness of the body.
OR
It is balance between the heat produced by the body and heat lost from the body.
Heat produced – Heat lost = Body temperature

Types:
There are two kinds of temperature:
1. Core Temperature 2.Surface Temperature

Regulation of body Temperature:

The system that regulates body temperature has 3 main parts:
1. Sensors in the periphery and in the core,
2. An integrator in the hypothalamus, and
3. An effector system that adjusts the production and loss of heat.

Most sensors or sensory receptors are in the skin. The skin has more receptors for cold than warmth.
Therefore, skin sensors detect cold more efficiently than warmth.
When the skin becomes chilled over the entire body, three physiological processes to increase the body
temperature take place:
1. Shivering increases heat production.
2. Sweating is inhibited to decrease heat loss.
3. Vasoconstriction decreases heat loss.

Body temperature is regulated by balancing the amount of heat the body produces with the amount of
heat the body loses. Body heat is produced as a by-product of metabolism, which is the sum of all
biochemical and physiological processes that take place in the body.
The hypothalamus, a gland located in the brain, acts as a thermoregulator. It is able to adjust body
temperature that results in either increasing or decreasing heat production throughout the day.

Normal Range of body temperature:

Alteration in body Temperature:
Sites to measure Body Temperature:
•Oral •Rectal •Axillary •Tympanic membrane •Temporal artery

Condition of resident determines which is the best site for measuring body temperature.
Thermometer:
 41
Two parts of thermometer-bulb and stem
• Blub is fragile part, containing mercury, sensitive to temperature.
• Stem is hollow tube in which mercury can rise.

There are two scales, Fahrenheit and Celsius

Mercury, a liquid metal, with silvery appearance is used in thermometers, because it is very sensitive
to a small changes in temperature, expansion of mercury is uniform, easily visible.

Pulse:
The pulse is an index of the heart’s rate and rhythm. Pulse provides valuable data about person’s
cardiovascular status.
DEFINITION- “The pulse is a wave of blood created by contraction of the left ventricle of the heart.”
Physiology of Pulse:
Blood flows through the body in a continues circuit. Electrical impulses originating from the SA node
travel through heart muscle to stimulate cardiac contraction.
Approximately 60 to 70 ml (stroke volume) of blood enters the aorta with each ventricular
contraction.
With each stroke volume ejection, the wall distends, creating a pulse wave that travels rapidly toward
the distal ends of the arteries.
When a pulse wave reaches a peripheral artery, it can be felt by palpating the artery lightly against
underlying bone or muscles.

Regulation Of Pulse:
Pulse is regulated by the Autonomic Nervous System through the Sino-atrial node.( Often called pace-
maker.)
• Para sympathetic stimulation decreases the heart rate
• Sympathetic stimulates increase the heart rate.
The quantity of blood forced out of the left ventricle during each contraction is called stroke volume.
(70 ml for an average adult).
Cardiac output = Stroke volume × Pulse rate =70ml × 80 BPM =5600 ml =5.6 L/min
The number of pulsing sensation occurring in 1minute is the pulse rate.
The volume of blood pumped by the heart during 1 minute is the Cardiac output.
Pulse rate X Stroke Volume = Cardiac out put
70 beats per minute X 70 ml / beat = 4.9 L/min
60 beats per minute X 85 ml / beat = 5.1 L/min

Pulse Assessment:
A pulse is commonly assessed by palpation (feeling) or auscultation using stethoscope. A pulse is
normally palpated by applying moderate pressure with the three middle fingers of the hand. The pads
on distal aspects of the finger are the most sensitive areas for detecting a pulse with gentle pressure. A
 42
stethoscope is used for assessing apical pulse. While palpating a pulse a nurse should assess the
followings…….
Pulse Rate •Pulse Rhythm •Pulse Volume •Character •Bilateral Equality

Pulse Rate :
It is stated as number of pulses or beats per minute. Count the pulses for not less than half minute.
BPM
• Normal 60-100 b/min (80/min)
• Adult PR > 100 BPM is called tachycardia
• Adult PR < 60 BPM is called bradycardia
Types Of Pulse:
1. Peripheral pulse is a pulse located away from the heart, for example, in the foot or wrist. Assessed
via fingers
2. The apical pulse, in contrast, is a central pulse; that is, it is located at the apex of the heart. It is also
referred to as the point of maximal impulse (PMI).

√ Assessed or taken via stethoscope

Pulse Sites:
Variations in Pulse by Age:

Respiration:
Respiration is the mechanism the body uses to exchange gases between the atmosphere and the blood
and the blood and the cell. Respiration involves the following processes….

Ventilation:
The movement of gases between in and out of the lungs (inspiration and expiration).
The respiratory center (medulla oblangata) in the brain stem regulates the involuntary (adults
normally breathe in a smooth, uninterrupted pattern, 12- 20 times / min) control of respiration.
Ventilation is regulated by CO2, O2, and hydrogen ion concentration (PH) in the arterial blood.
The most important factor in the control of ventilation is the level of CO2 in the arterial blood.
An elevation in the Co2 level causes the respiratory control system in the brain to increase the rate
and depth of breathing.
The increased ventilatory effort removes excess CO2 by increasing exhalation.

Mechanizm of breathing:
1. Inspiration/ inhalation ( active process)
2. Expiration / exhalation ( passive process)
3. Pause

Characteristics of Respiration:
 43
When the respiration rate is taken, several characteristics should be noted:

• Rate,
• Rhythm,
• Depth, and
• The quality or characteristics of breathing.
• Respiratory Rate:
• It is the number of respirations per minute. The normal respiration rate for healthy adults at rest is
12 to 20 cycles per minute. Children have a more rapid rate of breathing than adults. Respiratory
Rate Ranges of Various Age Groups
• Newborn 30–50
• 1–2 years old 20–30
• 3–8 years old 18–26
• 9–11 years old 16–22
• 12–Adult 12–20
• Respiratory Rhythm:
It refers to the regular and equal spacing of breaths. In a regular respiratory rhythm, the cycles of
inspiration and expiration have about the same rate and depth. With irregular breathing patterns, the
depth and amount of air inhaled and exhaled and the rate of respirations per minute will vary.

• Respiratory Depth:
The depth of respiration is the volume of air that is inhaled and exhaled. It is described as either
“shallow” or “deep.” Rapid but shallow respirations occur in some disease conditions, such as high
fever, shock, and severe pain.
Hyperventilation refers to deep and rapid respirations, and hypoventilation refers to shallow and slow
respirations.

• Respiratory Quality: Respiratory quality or character refers to breathing patterns — both normal
and abnormal. Labored breathing refers to respirations that require greater effort from the patient.

Dyspnea—difficult and labored breathing during which the individual has a persistent, unsatisfied
need for air and feels distressed
Orthopnea—ability to breathe only in upright sitting or standing positions

Breath Sounds: Normal respirations do not usually have any noticeable sounds. However, certain
diseases and illnesses can cause irregular respiration sounds.

Alteration in Respiration:
Apnea: Absence of breathing.
Eupnea: Normal breathing
Orthopnea: Only able to breathe comfortable in upright position (such as sitting in chair), unable to
breath laying down.
Dyspnea: Subjective sensation related by patient as to breathing difficulty.
Paroxysmal nocturnal dyspnea attacks of severe shortness of breath that wakes a person from sleep
 44
Hyperpnea: Increased depth of breathing
Tachypnea: Increased frequency without blood gas abnormality
Bradypnea: is a respiratory rate that is lower than normal for age.
• Hyperventilation: Increased rate or depth, or combination of both.
• Hypoventilation: Decreased rate or depth, or some combination of both.
• Kussmaul’s Respiration: is a deep and labored breathing pattern often associated with severe
metabolic acidosis, particularly diabetic ketoacidosis (DKA) but also kidney failure.

Blood Pressure: Blood pressure (BP) is one of the most important vital signs because it aids in
diagnosis and treatment, especially for cardiovascular health. Blood pressure readings are almost
always taken at every medical visit, even if it is the only vital sign obtained.
Definition: Blood pressure is the amount of force exerted on the arterial walls while the heart is
pumping blood— specifically, when the ventricles contract.

Blood pressure is measured by gauging the force of this pressure through two specific readings:
Systolic and Diastolic.
Systolic blood pressure is the highest pressure that occurs as the left ventricle of the heart is
contracting.
Diastolic blood pressure is the lowest pressure level that occurs when the heart is relaxed and the
ventricle is at rest and refilling with blood.

Pulse pressure: PP is the difference between the systolic and diastolic readings and calculated by
subtracting the diastolic reading from the systolic reading. If the blood pressure is 120/80, the pulse
pressure is 40.
In general, a pulse pressure that is greater than 40 mmHg is considered widened, and one that is less
than 30 mmHg is considered to be narrowed.

Physiology and regulation:

There are two basic mechanisms for regulating blood pressure:
(1)short-term mechanisms, which regulate blood vessel diameter, heart rate and contractility
(2) long-term mechanisms, which regulate blood volume

Blood Pressure Assessment:

Equipment used are:
Blood pressure cuff, a sphygmomanometer, and a stethoscope.

Types of sphygmomanometers:
• Mercury
• Aneroid
• Electronic
 45
1. Direct method (invasive, arterial blood pressure monitoring)
2. Indirect method
3. Auscultatory method
4. Palpatory method

1.Direct method- A monitor is used for this method. This is a continuous method which measures
mean pressures. A needle or catheter is inserted into the brachial, radial or femoral artery and a
monitor displays arterial pressure in wave form.
Direct (invasive) blood pressure monitoring is recommended in sick and compromised patients, those
who are at risk of developing major blood loss during surgery or for whom abnormal blood gases are
anticipated (patients with respiratory disease or undergoing thoracotomies).
2.Indirect method- Taking blood pressure by using sphygmomanometer.

Palpatory method
• In the palpatory method of blood pressure determination, instead of listening for the blood flow
sounds, the nurse uses light to moderate pressure to palpate the pulsations of the artery as the
pressure in the cuff is released. The pressure is read from the sphygmomanometer when the first
pulsation is felt
• The auscultatory method is most commonly used in hospitals, clinics, and homes. External pressure is
applied to a superficial artery and the nurse reads the pressure from the sphygmomanometer while
listening with a stethoscope. When carried out correctly, the auscultatory method is relatively
accurate.

When taking a blood pressure using a stethoscope, the nurse identifies phases in the series of sounds
called Korotkoff’s sounds. The systolic pressure is the point where the first tapping sound is heard
while the diastolic pressure is the point where the sounds become inaudible .
Blood Pressure sites:
1. Upper arm 2.Thigh 3.Leg 4.Forearm
Upper arm (using brachial artery (commonest)
Thigh around popliteal artery
Fore -arm using radial artery
Leg using posterior tibial or dorsal pedis
Alteration in Blood Pressure:

1.Hypertension
2.Hypotension:
Orthostatic Hypotension or Postural Hypotension

34.Nursing Care Plan

Patient Name:Abu-Bakr
 46
Age:40 year
Care Plan by: Shamim Akhter
Date : 23.11.2022
Diagnosis :Typhoid Fever

Assessment Nursing Planning Nursing Rational Evaluation

Diagnosis intervention
Subjective data;
Hyperthermia Short Goal Patient Self-introduction To develop therapeutic
Therapeutic relationship
Patient verbalized that “I related to will be able to extended to relationship.
developed.
am feeling warm, Not increased resume and patient and her
Client will be able to report and
feeling well” and lethargic metabolic rate maintain normal family.
show Clinical manifestations
secondary to body temperature
that fever is relieved ,
Objective data; Typhoid Fever after 4 hours. Independent
temperature of 98.6F per axilla,
as evidence by Observation of To check the fever pattern
respiratory rate of 12- 18
40 years male patient hot flushed vital signs every 1 and onset.
breaths per minute, pulse rate
lying on bed in supine skin and a hourly.
of 72- 78 beats per minute after
position, Conscious alert high grade Long Goal To determine the hydration
4 hours of nursing care.
and oriented to time place fever 104F, Patient will not have level.
Observation for
and person. Well WBC are spike of fever after
signs of
groomed. Skin intact, poor 16000/ml and 72- 90hours. Fluid resuscitation may
dehydration.
skin turgor. .Coated positive The patient will be require correcting the
tongue. Breathing Typhoid IgM free from hydration level.
Monitor fluid
spontaneously. and IgG complication of
intake strictly.
Intravenous line of 20G typhoid fever. To assess the kidney function,
intact . and retention of fluids.
Admitted with typhoid Measure the

fever. Weight 65 kg. Urine urine output of

analysis and other blood fluid (fluid Room temperature may be

test are negative. WBC’s balance). familiar to near normal body
are 16000/ml. temperature and blankets
Vital signs are Adjust and and linens may be adjusted as
Temp 104F , 96 /m, Res monitor indicated to regulate
20/min, Blood pressure environmental temperature of client.
145/70 mmhg factors like room
Pain score 2/10 . temperature and
bed linens as Sponge bath cools the skin

indicated. too rapidly, causing shivering.

Adequate fluid intake will

Apply tepid
reduce the sign of
sponge bath.
dehydration.

Provide and Will help to keep an eye on

encourage the electrolytes.
family to drink a
47
lot more than
2000 – 2500 ml
per day.

Collaborationwit
Antipyretics acts on the
h physicians in
hyperthermia.
fluid therapy,
laboratory tests
electrolyte.

Electrolyte levels may be

Dependent
affected during excessive
Administer
diaphoresis , dehydration ,
antipyretics as
low sodium , levels can cause
prescribed by the
mental changes and other
physician,
complication.
utilizing the
Continuous
rights of drug
hyperthermia and lack
administration.
of information about
typhoid fever . Involving
Monitor
the patient in the
electrolyte and
treatment plan
laboratory levels.
increases compliance .

Psychotherapy
and educate the
patient about the
disease process
and treatment
48
49
50