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NUR 092 Fundamentals in Nursing

Microorganisms are naturally present in the This risk is a function of the:
environment. Some are beneficial, while others 1. probability of contamination
are harmful to many individuals, though some 2. vulnerability of the patients to infection
may be harmless to most people, and still others 3. potential for exposure (i.e., high-touch vs low-
are touch surfaces)
harmless in certain circumstances. Many
These three elements combine to determine low,
individuals are involved in maintaining a safe
moderate, and high risk—more frequent and
environment regarding microorganisms. Health
rigorous (with a different method or process)
personnel, citizens from all walks of life, and
environmental cleaning is required in areas with
family members contribute to making the
high risk. Risk determines cleaning frequency,
environment as free from harmful organisms as
method, and process in routine and contingency
possible.
cleaning schedules for all patient care areas.
Risk-Based Environmental Cleaning Frequency
PURPOSE OF DUSTING: Principles
1.For cleanliness Probability of contamination: Heavily
2.For comfort contaminated surfaces and items require more
3.To maintain a clean, healthful frequent and thorough environmental cleaning
environment for clients, visitors, and than moderately contaminated surfaces, which in
family members. turn require more frequent and rigorous
environmental cleaning than lightly or non-
Dust can act as a fomite, which is something contaminated surfaces and items.
that can potentially carry pathogens and possibly
transmit them to a susceptible host, leading to Vulnerability of patients to infection: Surfaces
disease. and items in care areas containing vulnerable
patients (e.g., immunosuppressed) require more
ENVIRONMENTAL CLEANING frequent and rigorous environmental cleaning
than surfaces and items in areas with less
Cleaning (in the healthcare setting) refers to
vulnerable patients.
the removal of visible dirt, dust, and debris.
Potential for exposure to pathogens: High-touch
Cleaning alone results in large reductions in
surfaces (e.g., bed rails) require more frequent
environmental contamination, including the
and rigorous environmental cleaning than low-
removal of many pathogens.
touch surfaces (e.g., walls).
A clean patient environment contributes to the Every facility should develop cleaning schedules,
prevention of healthcare-associated infection. including:
Cleaning in healthcare facilities aims to remove  Identifying the person responsible
visible dirt and dust, reducing levels of harmful  The frequency
micro-organisms in the patients’ surroundings.  The method (product, process)
Dust contains skin scales and micro-organisms,  Detailed SOP s for environmental cleaning
which can be spread in the environment and air of surfaces and noncritical equipment in
by sweeping or dry dusting. every type of patient care area.
The determination of environmental cleaning General environmental cleaning techniques
procedures for individual patient care areas, For all environmental cleaning procedures, always
including frequency, method, and process, should use the following general strategies:
be based on the risk of pathogen transmission.  Conduct Visual Preliminary Site Assessment
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NUR 092 Fundamentals in Nursing
Proceed only after a visual preliminary site microorganisms that may have fallen
assessment to determine if:  Proceed in a Methodical, Systematic Manner
o patient status could pose a challenge to safe Proceed in a systematic manner to avoid missing
cleaning areas—for example, left to right or clockwise. In a
o there is any need for additional PPE or supplies multi-bed area, clean each patient zone in the
(e.g., if there are any spills of blood/body fluids or same manner—for example, starting at the foot
if the patient is on transmission-based of the bed and moving clockwise.
precautions)
o there are any obstacles (e.g., clutter) or issues This is the general surface cleaning process:
that could pose a challenge to safe cleaning 1. Thoroughly wet (soak) a fresh cleaning cloth in
o there is any damaged or broken furniture or the environmental cleaning solution.
surfaces to be reported to 2. Fold the cleaning cloth in half until it is about
supervisor/management the size of your hand. This will ensure that you
can use all of the surface area efficiently
 Proceed From Cleaner to Dirtier (generally, fold them in half, then in half again,
Proceed from cleaner to dirtier areas to and this will create 8 sides).
avoid spreading dirt and microorganisms. 3. Wipe surfaces using the general strategies as
Examples include: above (e.g., clean to dirty, high to low, systematic
i. During terminal cleaning, clean low-touch manner), making sure to use mechanical action
surfaces before high-touch surfaces. (for cleaning steps) and making sure to that the
ii. Clean patient areas (e.g., patient zones) before surface is thoroughly wetted to allow required
patient toilets. contact time (for disinfection steps).
iii. Within a specified patient room, terminal 4. Regularly rotate and unfold the cleaning cloth
cleaning should start with shared equipment and to use all of the sides.
common surfaces, then proceed to surfaces and 5. When all of the sides of the cloth have been
items touched during patient care that are used or when it is no longer saturated with
outside of the patient zone, and finally to surfaces solution, dispose of the cleaning cloth or store it
and items directly touched by the patient inside for reprocessing.
the patient zone. In other words, high-touch 6. Repeat process from step 1.
surfaces outside the patient zone should be
cleaned before the high-touch surfaces inside For all environmental cleaning procedures, these
the patient zone. are the best practices for environmental cleaning
iv. Clean general patient areas not under of surfaces:
transmission-based precautions before those  Use fresh cleaning cloths at the start of each
areas under transmissionbased precautions. cleaning session (e.g., routine daily cleaning in a
general inpatient ward).
 Proceed From High To Low (Top To Bottom)  Change cleaning cloths when they are no longer
Proceed from high to low to prevent dirt and saturated with solution, for a new, wetted cloth.
microorganisms from dripping or falling and Soiled cloths should be stored for reprocessing.
contaminating already cleaned areas.  For higher-risk areas, change cleaning cloths
Examples include: between each patient zone (i.e., use a new
o cleaning bed rails before bed legs cleaning cloth for each patient bed). For example,
o cleaning environmental surfaces before in a multi-bed intensive unit, use a fresh cloth for
cleaning floors every bed/incubator.
o cleaning floors last to allow the collection of dirt  Ensure that there are enough cleaning cloths to
and complete the required cleaning session.
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 Never double-dip cleaning cloths into portable drug-resistant bacteria, tuberculosis, Clostridium
containers (e.g., bottles, small buckets) used for difficile.
storing
environmental cleaning products (or solutions). Damp dusting – method of dusting is employed in
 Never shake mop heads and cleaning cloths—it the care of hospital furnishings which are not
disperses dust or droplets that could contain upholstered, and for the removal of dust from all
microorganisms. surfaces above the floor.
 Never leave soiled mop heads and cleaning Dangers of Dusts
cloths soaking in buckets. Dust is a potent source of disease specially in
hospital. Hospital contains sand particles coming
High-Touch Surfaces: inside by foot-wear or blown in wind, scales from
The identification of high-touch surfaces and skin, dried infected matter like pus and other
items in each patient care area is a necessary debris of wound, dried threat and nasal
prerequisite to the secretions, particles of dried threat and nasal
development of cleaning procedures, as these will secretions. and food particles etc. As such various
often differ by room, ward and facility. Perform types of organism and specially virulent types
assessments and remain in dust. Therefore, dust can cause disease
observations of workflow in consultation with either by direct contact with wound, eyes, nose,
clinical staff in each patient care area to throat or by’ inhalation to lungs or it can
determine key high-touch surfaces. contaminate food or water. So proper cleaning of
Include identified high-touch surfaces and items dust becomes a major part of nursing care.
in checklists and other job aids to facilitate
completing cleaning procedures. Common high- 2 Types of Dusting
touch surfaces include: 1. Low Dusting – done to all places easily
 bedrails reached by standing on the floor; done daily.
 IV poles
2. High Dusting – refers to those areas over
 sink handles
windows, pipes, walls, and ceiling.
 bedside tables
 counters where medications and supplies are
Rules for Cleaning
prepared
 Dry dusting is never advisable. It spreads
 edges of privacy curtains
disease easily.
 patient monitoring equipment (e.g., keyboards,
 Dusting should be done after sweeping only.
control panels)
 Use a damp duster for collecting dust.
 transport equipment (e.g., wheelchair handles)
 Dost with clean duster.
 call bells
 Collect dust at one place to avoid flying from
 doorknobs
place to place
 light switches
 Dusting should be done without disturbing or
DAMP DUSTING
removing the parents on bed.
Routine cleaning is the standard, everyday
 Dusting should be done from top to bottom i.e.
procedure for cleaning of clinical areas, including
from upward Id downward direction.
mopping of floors, damp dusting of surfaces with
 While dusting, take care not to spoil the beds or
detergent, etc.
walls other fixers in room or hospital ward.
Terminal cleaning is performed when a
 While dusting, wounds or dressing should not
patient with a transmissible illness is discharged
be
(usually for isolation rooms), e.g. MRSA and other
opened other staff.
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 There should be a definite time for dusting daily half, then in half again, and this will create 8
sides).
Equipments:  Wipe surfaces using the general strategies
 Tray with basin of water making sure to use mechanical action and
 Several pieces of dusting cloth making sure to that the surface is thoroughly
 Laundry soap/dutch cleanser wetted to allow required contact time.
 Bottle of mineral oil
-General strategies follow clean to dirty (to
 Newspaper of glasses
avoid spreading dirt and microorganisms), high to
 Whisk broom
low (prevent dirt and microorganisms from
dripping or falling and contaminating already
Order of dusting:
cleaned areas), and systematic manner (to avoid
 Beds
missing areas).
 Bedside tables
 Chairs  Regularly rotate and unfold the cleaning cloth.
 Woodworks -To use all of the sides.
 Rinse the dusting cloth.
DAMP DUSTING -Never double-dip cleaning cloths into
Assessment portable
 Visual preliminary site assessment containers (e.g., bottles, small buckets) used for
-To determine if patient status could pose a storing
challenge to safe cleaning, there are any obstacles environmental cleaning products (or solutions).
(e.g., clutter) or issues that could pose a challenge  Continue the procedure until all the parts
to safe cleaning or if there is any damaged or have been dusted.
broken furniture or surfaces to be reported to Varnished Furniture:
supervisor/management.
 If the furniture is varnished, do not used soap
Preparation but dust only with damp cloth and wipe dry.
 Wear any needed PPE (e.g. masks, eye shield,  Follow dusting with oiled cloth.
gloves, apron, etc.)
 Wipe to dry
-To observe transmission-based precautions.
 Collect & bring supplies. Body Mechanics, Moving and Positioning
-To observe efficiency. Body Mechanics:
Implementation - The coordinated efforts of the musculoskeletal
Unvarnished Furniture: system and nervous system to maintain balance,
posture and body alignment during lifting,
 Place your preparation at a convenient place
bending, moving and performing ADL’s.
on the table or chair but not on the floor.
-Correct body alignment reduces strain on
 Thoroughly wet (soak) a fresh cleaning cloth musculoskeletal structures, maintains muscle
in the tone
environmental cleaning solution. and balance. (Muscle strain – stretching too much
 Fold the cleaning cloth in half until it is about causes tearing of muscles).
the size of your hand. Proper use of body mechanics will:
-This will ensure that you can use all of the conserve energy, reduce stress and strain on body
surface area efficiently (generally, fold them in structures, reduce the possibility of personal
injury. And produce movements that are safe.
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1. Maintain Proper Alignment this means, it reduces the incidence of muscle
2. Bend at the Hips and Knees strain and helps promote/maintain muscle
3. Keep the load close to your body tone and conserves energy.
4. Use your leg muscles The centre of gravity (COG) of the
5. Avoid repetitive motions human body is a hypothetical point
6. Use Proper Equipment around which the
7. Practice good posture force of gravity appears to act. (At
8. Use your core muscles pelvis)

What proper body mechanics guidelines do I

need to follow?
● Bend at your hips and knees instead of your
waist. This helps you maintain your balance
by dividing your weight evenly between your
upper and lower body.
● Spread your feet apart to create a foundation of
support. This helps you maintain your GRAVITY AND FRICTION
balance from side to side. GRAVITY: is the invisible force that pulls
● Keep your back, neck, pelvis, and feet aligned objects toward each other.
when you turn or move. Do not twist or FRICTION: is a force that occurs in a direction
bend at your waist. to oppose movement. The greater the surface
When you stand: area of the object that is moved, the greater the
● Keep your feet flat on the floor about 12 inches friction. It is usually a common dilemma
(30 cm) apart. especially for those immobile patients to develop
● Do not lock your knees. ulcers brought about by too much friction
● Keep your shoulders down, chest out, and back produced during improper moving and
straight. positioning or wrinkled bed sheets.
● When you lift an object:
● Your feet should be apart, with one foot slightly ANATOMY AND PHYSIOLOGY:
in front of the other. SKELETAL SYSTEM:
● Keep your back straight. ● The skeletal system provides attachments for
● Bend from your hips and knees. muscles and ligaments and the leverage
● Do not bend at your waist. necessary for mobility.
● Lift the object using your arm and leg muscles. ● Skeleton is the supporting framework as it
● Hold the object close to your body at your waist allows movement of the body as a whole.
level.
● Use the same process if you need to push or LEVERAGE: Bone acts as levers and form
pull something heavy. joints that allow muscles to pull on them
producing movements
Alignment and Balance ● Functions: supports the body, facilitates
● These 2 terms refer to the positioning of the movement, protects internal organs, produces
joints, tendons, ligaments, and muscles blood cells, and stores and releases minerals and
while standing, sitting and lying. fat
● To keep the body aligned, the individual’s ● Ribs: protects heart and lungs
center of gravity should always be stable, by ● Vertebral column (spine): protects
spinal cord
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NUR 092 Fundamentals in Nursing
● Cranium (skull): protects brain ROM = Range of Motion – The
● JOINTS are the connections between bones amount of movement that a
(cartilaginous, fibrous or synovial) particular joint or series of joints
● two bones joined each other can achieve in a specific direction.
LIGAMENTS
● white, shiny, flexible bands of tissue that bind
joints together, connect bones and cartilages and
aid joint flexibility and support. 1. Torticollis: Inclining head to affected side, in
● connects bone to bone which sternocleidomastoid muscle is contracted.
TENDONS
● are white, glistening, fibrous bands of tissue
that connect muscle to bone and are strong,
flexible and inelastic.
● connects muscle to bone
2. Lordosis: Exaggeration of anterior convex
CARTILAGE
curvature of lumbar spine.
● non-vascular, supporting connective tissue
located chiefly in the joints and thorax, trachea,
larynx, nose, and ear.
NERVOUS SYSTEM:
The NS regulates movement and posture.
Movement is impaired by disorders that alter
neurotransmitter production, transfer of impulses
from the nerve to the muscle, or activation of 3. Kyphosis: Increased convexity in curvature
muscle activity. of thoracic spine.

SOMATIC NERVOUS SYSTEM

Is the division of the NS that regulates activities
that are under conscious control.
Otherwise, the Autonomic NS, regulates 4. Scoliosis: Lateral-S or C-shaped spinal
involuntary movement of organs like heart, GIT. column with vertebral rotation, unequal heights
Example: of hips and shoulders.
● Brain growth and development
● Sensations
● Movement, balance and coordination

Pathological Influences on Mobility:

5. Congenital Hip Dysplasia: Hip
● Postural Abnormalities
instability with limited adduction
-congenital or acquired postural abnormalities
contractures(head of femur does not articulate
affect the efficiency of the musculoskeletal
with acetabulum because of abnormal
system and body alignment, balance and
shallowness of acetabulum).
appearance.
● NOTE: During assessment, observe body
alignment and ROM. (Knowledge about the
characteristics, causes and treatment of common
postural abnormalities is necessary for lifting,
transfer, and positioning)
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6. Knock-Knee (genu valgum): Legs the immune system attacks the protective sheath
curved inward so knees come together as a (myelin) that covers nerve fibers and causes
person walks. communication problems between your brain and
the rest of your body.
3. Myasthenia Gravis - is a long-term
neuromuscular disease that leads to varying
7. Bowlegs (genu varum): One or both degrees of skeletal muscle weakness. The most
legs bent outward at knee, which is normal until 2 commonly affected muscles are those of the eyes,
to 3 years of age. face, and swallowing.

Damage to the Central Nervous System:

● Damage to any component of the central
nervous system that regulates voluntary
movement results in impaired body alignment,
8. Clubfoot: 95% medial deviation and plantar
balance and mobility.
flexion of foot (equinovarus) 5% Lateral deviation
● Trauma from a head injury, ischemia from a
and dorsiflexion (calcaneovalgus).
stroke (CVA), or bacterial infection such as
meningitis can damage the cerebellum or the
motor strip in the cerebral cortex. Damage to the
cerebellum causes problems with balance, and
motor impairment is directly related to the
amount of destruction of the motor strip.
9. Foot Drop: Inability to dorsiflex and invert
foot because of peroneal nerve damage. Direct Trauma to the Musculoskeletal:
● Direct trauma to the musculoskeletal system
results in bruises, contusions, sprains and
fractures.
Fracture is a disruption of bone tissue continuity.
10. Pigeon Toes: Internal rotation of
● Some fractures/deformities may be due to
forefoot or entire foot; common in infants.
pathological factors like Osteoporosis, Paget’s
Disease (Paget disease is a localized disorder of
bone remodeling that typically begins with
excessive bone resorption followed by an increase
in bone formation.), Osteogenesis Imperfecta
(means imperfect bone formation. People with
Muscle Abnormalities: Injury and disease this condition have bones that break (fracture)
lead to numerous alterations in musculoskeletal easily, often from mild trauma or with no
function. apparent cause).
Examples: Elements of Body Mechanics:
1. Muscular Dystrophies - a group of 1. Body Alignment/Posture
inherited diseases that damage and weaken your a. Alignment of body parts that permits optimal
muscles over time. This damage and weakness is musculoskeletal balance and operation and
due to the lack of a protein called dystrophin, promotes healthy physiologic functioning.
which is necessary for normal muscle function 2. Balance
2. Multiple Sclerosis - disease of the brain a. An object is balanced when its center of gravity
and spinal cord (central nervous system). In MS, is close to its base of support, the line of gravity
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goes through the base of support, and the object that aids a person to reestablish erect posture
has a wide base of support. (e.g., straighten the knee).

3. Coordinated Body Movement ALWAYS REMEMBER: THE WIDER THE BASE OF

a. Using major muscle groups, rather than weaker SUPPORT AND THE LOWER THE CENTER OF
ones, and taking advantage of the body’s natural GRAVITY, THE GREATER THE STABILITY OF THE
levers and fulcrums facilitates the actions of OBJECT WILL BE.
lifting, carrying, pushing, pulling, and moving
objects. Major muscle groups include the flexors, Body Mechanics:
extensors, and abductors of the thighs; flexors ● Application of mechanical laws to the human
and extensors of the knees; and flexors and body, specifically in regard to structure, function,
extensors of the upper and lower arms. and position of the body.
4. Postural reflexes ● It includes proper body movement in daily
a. They keep the body upright and aligned. activities, the prevention and correction of
In humans, the COG when standing is located in problems associated with posture, and the
the center of the pelvis about midway between enhancement of coordination and endurance.
umbilicus and the symphysis pubis. ● Proper use of body mechanics will : conserve
● The Line of Gravity: is a vertical line that energy, reduce stress and strain on body
passes through the center of gravity structures, reduce the possibility of personal
● The base of support: is the foundation injury. And produce movements that are safe.
that provides for an object’s stability.
● FULCRUM: is the fixed point around which a 1. Maintain Proper Alignment
lever turns a. This means keeping your body in a neutral
● LEVER: rigid bar that moves on a fulcrum position where all of your joints are stacked on
top of each other. For example, when standing,
POSTURAL REFLEXES: your ears, shoulders, hips, knees, and ankles
Labyrinthine sense: This sense of position should all be in a straight line.
and movement is provided by the sensory b. When sitting, your feet should be flat on the
organs in the inner ear, which are stimulated ground, and your back should be straight.
by body movement (changes in head position) Maintaining proper alignment reduces the stress
and transmit these impulses to the on your joints, muscles,
cerebellum. and ligaments and improves your overall balance
Proprioceptor or kinesthetic sense: and stability.
This informs the brain of the location of a limb 2. Bend at the Hips and Knees
or body part as a result of joint movements a. When lifting heavy objects, the second
stimulating special nerve endings in muscles, principle of body mechanics is to bend at the hips
tendons, and fascia. and knees. This means keeping your back straight
Visual or optic reflexes: Visual and hinging at the
impressions contribute to posture by alerting hips and knees to lower your body down to the
the person to spatial relationships with the object.
environment (nearness of ceilings, walls, b. By doing this, you reduce the strain on your
furniture, condition of floor, etc.) lower back and engage your leg muscles to help
Extensor or stretch reflexes: When you lift the object. It is important to avoid
extensor muscles are stretched beyond a bending at the waist,
certain point (e.g., when knees buckle under), which puts excessive pressure on your back and
their stimulation causes a reflex contraction can lead to injury.
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3. Keep the load close to your body 2. Enlarging the base of support increases the
a. When carrying or lifting objects, it is essential stability of the body.
to keep the load as close to your center of gravity 3. A person or an object is more stable if the
as possible. This reduces the strain on your back center of gravity is close to the base of
and helps you support.
maintain your balance. 4. 4 Enlarging the base of support in the
b. Additionally, it is essential to avoid twisting direction of the force to be applied increases
your body while carrying or lifting objects, as this the amount of force that can be applied.
can cause injury to your back and spine. 5. Tightening the abdominal muscles upward
4. Use your leg muscles and the gluteal muscles of the back.
a. The muscles in your legs are much stronger
than the muscles in your back, so engaging them 6. Facing in the direction of the task to be
helps to reduce the strain on your back and performed and turning the entire body in one
prevent injury. When place(rather than twisting ) lessens the
lifting heavy objects, it is important to squat susceptibility of the back to injury.
down, engage your leg muscles, and use your legs 7. Lifting is better undertaken by bending the
to lift the object. legs and not using the back muscles. Because
5. Avoid repetitive motions muscles tire less quickly than smali muscles,
a. Repeating the same motion over and over you should use the large gluteal and femoral
again can cause strain and injury to your muscles muscles rather than smaller muscles of the
and joints. If you must perform repetitive back
motions, it is essential to 8. It is easier to move on a level surface than to
take frequent breaks and stretch your muscles to move it up a slanted surface against the force
prevent injury of gravity.
6. Use Proper Equipment 9. Less energy is required to move an object
7. Practice good posture when friction between the object and surface
a. Maintaining good posture helps to reduce the in which it rests is minimized.
strain on your back and neck and improve your 10. It takes less energy to hold an object close to
overall balance and stability. When sitting, it is the body that at a distance from the body; it is
important to keep your feet flat on the ground also easier to move an object that is close.
and your back straight. When standing, your Muscles are strongest when contracted and
shoulders should be relaxed, and your ears should weakest when stretched.
be over your shoulders. 11. The weight of the body can be used to assist
8. Use your core muscles in lifting or moving.
a. Your core muscles are the muscles that support 12. 12.Smooth rhythmical movements at
your spine and help to maintain proper moderate speed require less energy than
alignment. By engaging your core muscles, you rapid, jerky ones.
can reduce the strain on your back and improve 13. When an object is pushed, it absorbs part of
your balance and stability. the force being exerted, leaving only part of
the force available to do the moving.
HARD OBJECT =PUSH 14. It takes less energy to work on a surface at an
SOFT OBJECT= PULL appropriate height (usually waist level) than it
does to stoop or stretch to reach the surface
PRINCIPLES OF BODY MECHANICS
1. Weight is balanced best when the center of GAIT- a particular manner or style of
gravity is directly above the base of support. walking.
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Planning and Implementation:
HAND WASHING (Special Consideration)
Principles of Medical Asepsis
Hand washing is the rubbing together of all Microorganisms move through space on air
surfaces and crevices of the hands using currents because of his movement, avoid shaking
soap/chemicals and water. It is a component of all or tossing linens.
types of isolation precautions and is the most Microorganisms are transferred from one surface
basic and effective infection control measure to to another whenever objects touch.
prevent and control the transmission of infectious Microorganisms are transferred by gravity when
agents. Ex. Nosocomial infection (Hospital one item is held above another. Avoid passing
Acquired infection) dirty
linen over clean items or areas because it is
Medical Asepsis is the practice of possible for microorganisms to drop off into a
techniques and procedures designed to reduce clean item or area.
the number of microorganisms in an area or an Microorganisms are released into the coughing or
object and to decrease the likelihood of their sneezing dramatically increases the number of
transfer. This is also the synonym for “Clean microorganisms released from the mouth and
Technique” nose.
Microorganisms move slowly on the dry surface
Purposes by very quickly through moisture.
To help prevent the spread of pathogenic Proper handwashing removes many of the
microorganisms. microorganisms that would be transferred by the
hands
To reduce the numbers of microorganisms
from one item to another.
To deliver patient care with pathogens- free
hands
Hand washing should be done:
To protect patients from cross contamination
a. at the beginning and end of every work shift
To protect the Nurse from possible infection
b. before and after prolonged contact with the
patient
Equipment
c. before invasive procedures
1. Liquid, bar or powdered soap
2. Nail file or orange stick d. before and after contact with especially
3. Paper or cloth towels susceptible patients
4. Sink e. before and after touching wounds
5. Running water (preferably warm)
6. Trash basket Friction, running water, and cleansing agents are
necessary to remove microorganisms or other
Assessment materials that maybe present on the hand.
1. Assess the environment to establish if facilities
are adequate for cleansing the hands. Is the water OPEN GLOVING
clean? Is soap available? Is there a clean towel to Sterile gloves function as additional barrier
dry hands? to the transfer of microorganisms.
2. Assess your hands to determine if they have
open cuts, hangnails, broken skin, or heavily There are two methods of applying sterile gloves:
soiled areas. (a.) open gloving
(b) closed gloving.
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Nurses in general nursing areas commonly use

the open gloving method before performing
procedures such as dressing changing,
suctioning, and catheterization.
Nurses use the closed gloving method
usually after the application of 3. Trapeze Bar
sterile gowns, this is practiced in
operating rooms and special areas.
Selection of the proper glove size is important.
Care should be taken so that the glove is not too
tightly stretched to avoid tearing, but it should
also be tight enough so that picking up of objects
may be done with ease.

Purposes THERAPEUTIC POSITIONS AND THEIR

It acts as an additional barrier to bacterial transfer COMPLICATION:
It maintains the sterility of the equipment
This is to complete a sterile attire in order that 1. Low Fowler’s
the wearer may work close to a sterile field and – head of bed is at 15-30 degrees
handle - support lower lift.
sterile equipment freely. - use to maintain alignment of hip to prevent
Injury
This is to prevent clients at risk from becoming (trochanteric)
infected by microorganisms on the nurses’ hands 2. Semi Fowler’s
– HOB is at 30-45 degrees
Materials Required 3. Standard Fowler’s
– HOB is at 45-60 degrees
4. High Fowler’s
– HOB at 60-90 degrees
Hyperflexion – neck injury,over
Sterile gloves powder(if
necessary)

Body Positioning
Positioning Assistive Devices Complications to prevent - Fowler’s
1. Ankle-foot Orthotic (AFO) Position:
1. Flexion contracture of the neck
2. Exaggerated curvature of the spine
3. Dislocation of the shoulder
4. Flexion contracture of the waist
2. Trochanter roll 5. Edema of the hand
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6. Flexion contracture of the fingers and Complications to prevent - Prone
abduction of the thumbs Position:
7. External rotation of the hips 1. Flexion on the cervical spine
8. Foot drop 2.Hyperextension of the spine; impaired
respirations
“Utilize SUPPORTED FOWLER’S 3. Foot Drop
POSITION”
Supported Fowler’s Position 4. Side-lying / Lateral Position:
• Low Fowler’s (Semi Fowler) position
(supported)
• Note that are supported is omitted in
this instance.
• The amount of support depends on
the needs of the individual client.

2. Supine Position:
Complications to prevent - Side-lying
Position:
1. Lateral flexion of the neck
2. Inward rotation of the arm and
interference with respiration
3. Extension of the finger and abduction
of the thumbs
4. Twisting of spine
Complications to prevent - Supine
Position: 5. Sims’ Position:
1. Exaggerated curvature of the spine
and flexion of the hips
2. Flexion contracture of the neck
3. Internal rotation of the shoulders and
extension of the elbows (hunch
shoulders)
4. Flexion of the lumbar curvature
5. External rotation of the femurs Complications to prevent - Side-lying
6. Hyperextension of the knees Position:
7. Foot Drop 1. Lateral flexion of the neck
2. Damage to nerves and blood vessels
3. Prone Position: in the axillae of the lower arm
3. Internal shoulder rotation and
adduction
4. Twisting of spine
5. Foot drop

Other patient positions:

6. Jackknife Position
 DNE – digital Rectal Examination
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NUR 092 Fundamentals in Nursing

7.Orthopneic
 Difficulty breathing

Lifting a patient using a drawsheet:

Logrolling: