NURSING ENGLISH TEACHING

NURSING SCIENCE INSTITUTE OF MUHAMMADIYAH MANADO

BASIC NURSING SKILL
Bed making
a. Making an Un-occupied Bed
Definition: A bed prepared to receive a new patient is an un-occupied bed.
Purpose
1. To provide clean and comfortable bed for the patient
2. To reduce the risk of infection by maintaining a clean environment
3. To prevent bed sores by ensuring there are nowrinkles to cause pressure points
b. Changing an Occupied Bed
Definition
The procedure that used lines are changed to a hospitalized patient is an occupied bed.
Purpose:
1. To provide clean and comfortable bed for the patient
2. T reduce the risk of infection by maintaining a clean environment
3. To prevent bed sores by ensuring there are no wrinkles to cause pressure points
c. Making a Post-operative Bed
Definition: It is a special bed prepared to receive and take care of a patient returning from surgery
Purpose:
1. To receive the post-operative client from surgery and transfer him/her from a stretcher to a bed
2. To arrange client’s convenience and safety
Performing Oral Care
Definition: Mouth care is defined as the scientific care of the teeth and mouth.
Purpose:
1. To keep the mucosa clean, soft moist and intact
2. To keep the lips clean, soft moist and intact
3. To prevent oral infections
4. To remove food debris as well as dental plaque without damaging the gum
5. To alleviate pain, discomfort and enhance oral intake with appetite
6. To prevent halitosis or relieve it and freshen the mouth
❖Nursing Alert❖
Oral care for the unconscious clients
1. Special precautions while the procedure
The client should be positioned in the lateral position with the head turned toward the side.
( Rationale: It can not only provide for drainage but also prevent accidental aspiration.)
Suction apparatus is required. ( Rationale: It prevents aspiration.)
To use plain water for cleaning of oral cavity of unconscious clients may be
advisable.( Rationale: Potential infection may be reduced by using plain water when the solution
flows into the respiratory tract by accident.)
2. Frequency of care
Oral care should be performed at least every four hours. ( Rationale: Four hourly care will reduce the
potential for infection from microorganisms
Performing Bed Bath
Definition: A bath given to client who is in the bed (unable to bath itself)
Purpose:
1. To prevent bacteria spreading on skin
2. To clean the client’s body
3. To stimulate the circulation
4. To improve general muscular tone and joint
5. To make client comfort and help to induce sleep
6. To observe skin condition and objective symptoms
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NURSING SCIENCE INSTITUTE OF MUHAMMADIYAH MANADO

Performing Back Care

Definition: Back care means cleaning and massaging back, paying special attention to pressure
points Especially Back massage provides comfort and relaxes the client, thereby it facilitates the
physical stimulation to the skin and the emotional relaxation.
Purpose:
1. To improve circulation to the back
2. To refresh the mode and feeling
3. To relieve from fatigue, pain and stress
4. To induce sleep
Performing Hair Washing
Definition: Hair washing defines that is one of general care provided to a client who cannot clean the
hair by himself/herself.
Purpose:
1. To maintain personal hygiene of the client
2. To increase circulation to the scalp and hair and promote growing of hair
3. To make him/her feel refreshed
Caring for fingernails and toenails
Definition: Nail cutting that one of nursing care and general care for personal hygiene is to cut nails
on hands and foots.
Purpose:
1. To keep nails clean
2. To make neatness
3. To prevent the client’s skin from scratching
4. To avoid infection caused by dirty nail
Performing Perineal Care
Definition: Perineal care is bathing the genitalia and surrounding area. Proper assessment and care
of the perineal Area will need professional clinical judgment.
Purpose:
1. To keep cleanliness and prevent from infection in perineal area
2. To make him/her comfortable
Taking Vital Signs：
Temperature, Pulse, Respiration, Blood pressure
Definition: Taking vital signs are defined as the procedure that takes the sign of basic physiology
that includes temperature , pulse, respiration and blood pressure. If any abnormality occurs in the
body, vital signs change immediately.
Purpose:
1. To assess the client’s condition
2. To determine the baseline values for future comparisons
3. To detect changes and abnormalities in the condition of the client
a. Taking axillary temperature by glass thermometer
Definition: Measuring/monitoring patient’s body temperature using clinical thermometer
Purpose:
1. To determine body temperature
2. To assist in diagnosis
3. To evaluate patient’s recovery from illness
4. To determine if immediate measures should be implemented to reduce dangerously elevated body
temperature or converse body heat when body temperature is dangerous low
5. To evaluate patient’s response once heat conserving or heal reducing measures have been
Implemented
b. Measuring a Radial Pulse
Definition: Checking presence, rate, rhythm and volume of throbbing of artery.
Purpose:
1. To determine number of heart beats occurring per minute( rate)
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NURSING SCIENCE INSTITUTE OF MUHAMMADIYAH MANADO
2. To gather information about heart rhythm and pattern of beats
3. To evaluate strength of pulse
4. To assess heart's ability to deliver blood to distant areas of the blood viz. fingers and lower
extremities
5. To assess response of heart to cardiac medications, activity, blood volume and gas exchange
6. To assess vascular status of limb sc.
Counting Respiration
Definition: Monitoring the involuntary process of inspiration and expiration in a patient
Purposes:
1. To determine number of respiration occurring per minute
2. To gather information about rhythm and depth
3. To assess response of patient to any related therapy/medication
d. Measuring Blood Pressure
Definition: Monitoring blood pressure using palpation and/or sphygmomanometer
Purpose:
1. To obtain baseline data for diagnosis and treatment
2. To compare with subsequent changes that may occur during care of patient
3. To assist in evaluating status of patient’s blood volume, cardiac output and vascular system
4. To evaluate patient’s response to changes in physical condition as a result of treatment with fluids
or Medications
Performing Physical Examination
Definition：Physical examination is an important tool in assessing the client’s health status.
Approximate 15% of the information used in the assessment comes from the physical examination. It
is performed to collect objective data and to correlate it with subjective data.
Purpose:
1. To collect objective data from the client
2. To detect the abnormalities with systematic technique early
3. To diagnose diseases
4. To determine the status of present health in health check-up and refer the client for consultation if
needed
Principles of Physical Examination:
A systematic approach should be used while doing physical examination. This helps avoiding any
duplication or omission Generally a cephalo caudal approach (head to toe) is used, but in the case of
infant, examination of heart and lung function should be done before the examination of other body
parts, because when the infant starts crying , his/her breath and heart rate may change.
Methods of Physical Examination:
Inspection
Palpation
Percussion
Auscultation
Inspection means looking at the client carefully to discover any signs of illness. Inspection gives more
information than other method and is therefore the most useful method of physical examination.
2. Palpation
Palpation means using hands to touch and feel. Different parts of hands are used for different
sensations such as temperature, texture of skin, vibration, tenderness, and etc. For examples, finger
tips are used for fine tactile surfaces, the back of fingers for feeling temperature and the flat of the
palm and fingers for feeling vibrations.
3. Percussion
Percussion determines the density of various parts of the body from the sound produced by them,
when they are tapped with fingers. Percussion helps to find out abnormal solid masses, fluid and gas
in the body
and to map out the size and borders of the certain organ like the heart Methods of percussion are:
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NURSING SCIENCE INSTITUTE OF MUHAMMADIYAH MANADO
① Put the middle fingers of his/her hand of the left hand against the body part to be percussed
② Tap the end joint of this finger with the middle finger of the right hand
③ Give two or three taps at each area to be percussed
④ Compare the sound produced at different areas
4.Auscultation
Auscultation means listening the sounds transmitted by a stethoscope which is used to listen to the
heart ,lungs and bowel sounds.
Care for Nasal-Gastric Tube
a. Inserting a Nasal-Gastric Tube
Definition: Method of introducing a tube through nose into stomach
Purpose:
1. To feed client with fluids when oral intake is not possible
2. To dilute and remove consumed poison
3. To instill ice cold solution to control gastric bleeding
4. To prevent stress on operated site by decompressing stomach of secretions and gas
5. To relieve vomiting and distention
Administering a Nasal- gastric Tube Feeding
Definition: A nasal-gastric tube feeding is a means of providing liquid nourishment through a tube
into the intestinal tract when client is unable to take food or any nutrients orally Performing
Surgical Dressing:
Cleaning a Wound and Applying a Sterile Dressing
Definition:
Sterile protective covering applied to a wound/incision, using aseptic technique with or without
medication
Supplying Oxygen Inhalation
Definition: Method by which oxygen is supplemented at higher percentages than what is available in
atmospheric air.
Purpose:
1. To relieve dyspnoea
2. To reduce or prevent hypoxemia and hypoxia
3. To alleviate associated with struggle to breathe
Sources of Oxygen:
Therapeutic oxygen is available from two sources
1. Wall Outlets(; Central supply)
2. Oxygen cylinders
II. Administration of Medications
Administering Oral Medications
Definition: Oral medication is defined as the administration of medication by mouth.
Purposes:
1. To prevent the disease and take supplement in order to maintain health
2. To cure the disease
3. To promote the health
4. To give palliative treatment
5. To give as a symptomatic treatment
Administering oral medications through a Nasal-Gastric tube
Definition: Administering through a nasal-gastric tube is a process that administer oral medication
through a nasal-gastric tube instead of mouth.
Administering oral medications through a Nasal-Gastric tube
Definition: Administering through a nasal-gastric tube is a process that administer oral medication
through a nasal-gastric tube instead of mouth.
Removing medications from a vial
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NURSING SCIENCE INSTITUTE OF MUHAMMADIYAH MANADO
Definition: To remove medication form a vial defines that you prepare medication from an ampoule
for IV, IM or another administration of medication.
Purpose: To prepare medication for administration of medication by sterilized method
Prevention of the Needle-Stick Injuries:
One-handed Needle Recapping Technique
Definition: One-handed needle recapping is a method that place the cap to needle on clean and safe
place such as inside a big tray
Purpose: To prevent own finger or another person by needle from sticking accidentally
Giving an Intra-Muscular Injection
Definition: Intra-muscular injection is the injection of medicine into muscle tissue. To produce quick
action an patient as the medicine given by injection is rapidly absorbed. Intramuscular injections are
often given in the deltoid, vastus laterials, ventrogluteal and dorsogluteal muscles.
Purpose:
1.To relieve symptoms of illness
2. To promote and prevent from disease
3. To treat the disease accordingly
Starting an Intra-Venous Infusion
Definition: Starting intra-venous infusion is a process that gives insertion of Intra-venous catheter
for IVtherapy
Purpose:
1. To give nutrient instead of oral route
2. To provide medication by vein continuously
Maintenance of I.V. System
Definition: Maintenance of IV system is defined as routine care to keep well condition of I.V. therapy
Purpose:
1. To protect injection site from infection
2. To provide safe IV therapy
3. To make the client comfort with IV therapy
4. To distinguish any complications as soon as possible
Administering Medications by Heparin Lock
Definition: A heparin lock is an IV catheter that is inserted into a vein and left in place either for
intermittent administration of medication or as open line in the case of an emergency. Administering
medications by heparin lock is defined as one of IV therapy which can allow to be freedom Clients
while he/she has not received IV therapy.
Purpose:
1. To provide intermittent administration of medication
2. To administer medication under the urgent condition
Performing Nebulizer Therapy
Definition: Nebulizer Therapy is to liquefy and remove retained secretions from the respiratory tract.
A nebulizer is a device that a stable aerosol of fluid and /or drug particles.
Most aerosol medication have broncho-dilating effects and are administered by respiratory therapy
personnel.
Purpose:
1. To relieve respiratory insufficiency due to bronchospasm
2. To correct the underlying respiratory disorders responsible for bronchospasm
3. To liquefy and remove retained thick secretion form the lower respiratory tract
4. To reduce inflammatory and allergic responses the upper respiratory tract
5. To correct humidify deficit resulting from inspired air by passing the airway during the use of
mechanical ventilation in critically and post surgical patients
III. Specimen Collection
a. Performing Venipuncture
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NURSING SCIENCE INSTITUTE OF MUHAMMADIYAH MANADO
Definition： Venipuncture is using a needle to withdraw blood from a vein, often from the inside
surface of the forearm near the elbow.
Purpose:
1. To examine the condition of client and assess the present treatment
2. To diagnose disease
b. Assisting in Obtaining Blood for Culture
Definition: Collecting of blood specimen for culture is a sterile procedure to obtain blood specimen.
Sterile techniques is used in whole of the procedure.
Purpose:
1.To identify s disease-causing organisms
2. To detect the right antibiotics to kill the particular microorganisms
Collecting Urine Specimen
Definition: Urinalysis, in which the components of urine are identified, is part of every client
assessment at the beginning and during an illness.
Purpose:
1. To diagnose illness
2. To monitor the disease process
3. To evaluate the efficacy of treatment
a. Collecting a single voided specimen
b. Collecting a 24-hour Urine Specimen
Definition: Collection of a 24-hour urine specimen is defined as the collection of all the urine voided
in 24 hours, without any spillage of wastage.
Purpose:1. To detect kidney and cardiac diseases or conditions
2. To measure total urine component
c. Collecting a urine specimen from a retention catheter
d. Collecting a urine culture
Definition: Collecting a urine culture is a process that it obtain specimen urine with sterile technique
Purpose:
1. To collect uncontaminated urine specimen for culture and sensitivity test
2. To detect the microorganisms causes urinary tract infection (;UTI)
3. To diagnose and treat with specific antibiotic
Collecting a stool specimen
Definition: Collection of stool specimen deters a process which is aimed at doing chemical
bacteriological or parasitological analysis of fecal specimen
Purpose:
1. To identify specific pathogens
2. To determine presence of ova and parasites
3. To determine presence of blood and fat
4. To examine for stool characteristics such as color, consistency and odor
a. Routine test
Definition: Collecting a sputum specimen is defined as a one of diagnostic examination using sputum
Purpose:
1. To diagnose respiratory infection
2. To assess the efficacy of treatment to diseases such as TB
b. Collecting a sputum culture
Definition:
Collection of coughed out sputum for culture is a process to identify respiratory pathogens.
Purpose:
1. To detect abnormalities
2. To diagnose disease condition
3. To detect the microorganisms causes respiratory tract infections
4. To treat with specific antibiotics