Basic Nursing

Procedures
Basic Nursing Procedures
• Nursing procedures are classified into two categories: Basic and Advanced. Basic
procedures involve simple tasks while advanced procedures deal with more
complex ones.
• B. Nursing procedures can be broadly classified under two categories: Direct
Care and Indirect Care. Direct care procedures involve direct engagement with
the patient, while indirect care procedures support patient care without direct
patient contact.
• C. Nursing procedures are divided into Medicinal and Non-Medicinal
procedures.
• D. Nursing procedures are classified into Administrative and Non-administrative
procedures. Administrative procedures are paperwork and documentation
while non-administrative procedures involve patient
• Orthopedics is concerned with disorders/injuries involving bones,
joints, muscles, tendons and nerves – the skeletal system and all that
makes it move.
• • The important symptoms that patient may exhibit include: pain,
stiffness, swelling, deformity, altered sensibility and loss of function,
muscle weakness which may be associated with any joint dysfunction
and may also suggest a more specific neurological disorder or
instability where a joint gives way or moves out of position repeatedly
• Orthopedic nursing is a specialty that focuses on musculoskeletal
diseases and disorders. These orthopedic issues include conditions
like arthritis, bone fractures, broken bones, joint replacements,
genetic malformations, arthritis, and osteoporosis.
• Orthopedic nurses are familiar with traction, casting, mobility devices,
and pain management. When musculoskeletal conditions require
surgery, orthopedic nurses assist physicians with preparation for the
procedure and assists patients with their postoperative recovery.
Some orthopedic nurses may even work in the operating room.
• Orthopedic nurses work a variety of shifts dependent on their
employment facility. Office and outpatient nurses usually work during
the day, but orthopedic nurses on hospital inpatient units have the
ability to work day, evening, or night shift.
• Orthopedic nurses assist and educate those with orthopedic
conditions and complications. They provide support to the office,
outpatient, and inpatient procedures.
• Orthopedic nurses provide an imperative role to patients during a
time where they advocacy, encouragement, and education.
• The orthopedic nurse performs musculoskeletal health exams, assists
with casting and traction, and administers pain medication.
• An orthopedic nurse spends time encouraging patients to increase
their mobility, educates about how to protect their joint and bone
health, and implements strategies to minimize their pain and
complications.
• As an orthopedic nurse, you must be empathetic when working with
patients dealing with chronic pain and mobility concerns. An
orthopedic nurse has impeccable communication skills to ensure the
healthcare provider is aware of patient needs and facilitate the
appropriate follow-up. Some orthopedic nurses take care of
postoperative orthopedic patients, which opens a whole new world of
nursing skills!
• Education is the most important aspect of being an orthopedic nurse
to promote patient health, prevent disease, encourage patient
understanding of troubling symptoms, and promote compliance with
ongoing treatments
• An orthopedic nurse is an excellent educator that gives patients
extensive, comprehensive information. They also educate patients
and family members who have questions and concerns about
medications, pain management, and discharge service coordination.
• Orthopedic nurses are well versed in educating patients on the risks
and complications of orthopedic treatment and surgery. Orthopedic
nursing is a worthwhile, significant, and stimulating career.
ORTHOPEDIC NURSING
CHALLENGES
• a. The challenge in caring for the orthopedic patient is in carrying out
basic nursing care procedures while understanding and working with
orthopedic devices used in the treatment of musculoskeletal diseases
and injuries. To avoid self-injury, those engaged in orthopedic nursing
must also understand and apply principles of good body mechanics.
• b. Many orthopedic patients are immobilized by casts, traction, or
other means for long periods of time. Orthopedic nursing includes
maintaining muscle tone and circulation to prevent contractures,
deformity, and pressure sores by frequently changing the position of
immobilized patients.
• c. Often confined to bed and in many cases immobile, the orthopedic
patient may require a great deal of assistance with daily living activities. His
bedding should be kept clean, dry, and wrinkle free. Because he is
susceptible to skin breakdown and pressure sores, he should be assisted
and encouraged to change positions within the limits prescribed by the
physician. He should be encouraged to be as independent as possible
within the limits of his immobility and personal hygiene should be
emphasized.
• d. Immobility, fear of deformity, and a potentially long hospitalization may
cause the patient to become depressed or discouraged. The understanding
and encouragement of nursing personnel can increase morale.
• Encourage self-reliance, but give help willingly and cheerfully when
the patient needs assistance. Continuous teaching will help the
patient understand his condition and his limitations and enable him to
become more independent as his condition improves and he is
rehabilitated.
THE HOSPITAL

12
Definition
Hospital: Comes from the French word “hospitale”. It
is an institution in which the sick or injured persons
are treated.

Steadman’s Medical Dictionary: It is an institution for

the care, cure and treatment of the sick and
wounded; for the study of diseases and for the
training of doctors and nurses

13
World Health Organization (WHO): It is an integral
part of a social and medical organization, the function
of which is to provide for the population complete
health care, both curative and preventive and whose
output services reach out to the family and its home
environment. The hospital is also a center for the
training of health workers and for biosocial research.

14
 DEFINITION OF HOSPITAL  :

• HOSPITAL is defined as:

• “An INSTITUTION of COMMUNITY HEALTH/ a SPECIALIZED COMPLEX
ORGANIZATION, that makes use of PHYSICIANS, SURGEONS & team of TECHNICAL
STAFF, in order to provide facilities for DIAGNOSIS, THERAPY, REHABILITATION,
PREVENTION, EDUCATION & RESEARCH…………”
Functions of the Hospital
Patient Care: Care for the sick and the injured and
restoration of the health of a diseased person without
any discrimination.
Diagnosis and treatment of diseases
Medical Education and Training: Provides professional
and technical education for health personnel
Medical and Nursing Research: It provides the basis
for scientific investigations into causes, diagnosis,
treatment and nursing management of diseases and
hospital administration
Prevention of diseases and promotion of health
16
 FUNCTIONS OF HOSPITAL  :

1. To UPLIFT QUALITY OF LAW and GENERAL STANDARDS of MEDICAL PRACTICE

2. To PROVIDE FACILITIES & GUIDANCE , by which persons can work in GROUPS,
with the intention of BETTERMENT of HOSPITAL DEPARTMENT, PATIENT &
COMMUNITY
3. To REDUCE DISEASE OCCURRENCE by early DIAGNOSIS and TREATMENT
4. To ESTIMATE needs for FACILITIES, SUPPLIES & EQUIPMENTS, and their
UTILIZATION for EVALUATION, CONTROL & MAINTENANCE
5. To ESTIMATE DEPARTMENTAL NECESSITIES
6. To PROVIDE a COMMON LINK between GENERAL PUBLIC & POLICY MAKERS
7. To SUGGEST POLICIES & PROCEDURES to maintain ADEQUATE & COMPETENT STAFF
8. To DEVELOP & MAINTAIN an effective system of CLINICAL & ADMINISTRATIVE
RECORDS & REPORTS
9. To HARNESS growth of MEDICAL SCIENCE, by PROPER TRAINING of DOCTORS &
NURSES in large training hospitals
10. To CREATE & DEVELOP FINANCIAL PLAN for the OPERATION OF HOSPITAL
11. To provide facilities for continuing EDUCATION of all the people
12. To PARTICIPATE & IMPLEMENT SAFETY PROGRAMMES of HOSPITAL
13. To INITIATE, UTILIZE & PARTICIPATE in RESEARCH PROJECTS, aimed at
IMPROVEMENT of PATIENT CARE, and other hospital services……………………….
Classification of
Hospitals
Each hospital is distinct in its characteristics as it
differs in structure, functioning, performance and the
community it serves. They are therefore classified
according to:
1. Length of Stay of Patient
Short – term/acute care
Patient stays for a short term for treatment of the
disease, acute in nature e.g. pneumonia, peptic ulcers
Long – term/chronic care
Treat diseases or conditions chronic in nature e.g. TB,
cancer
20
 2. Clinical Basis
They are licensed as general hospitals. Treat all kinds of
diseases but major focus on severe medical conditions
like heart diseases
3. Ownership
This category includes: Public, Voluntary, Private, or
Corporate – Public limited company , under companies
act
4. Size
Classification is adopted according to bed strength
(capacity)
21
 5. Objectives
Teaching/Research
It is a hospital to which a college is attached for
medical/nursing/dental/pharmacy education. The
main objective is to teach based on research

General
Provide treatment for common diseases and
conditions, provide active medical and nursing care
for more than one category of medical discipline

22
Specialized Hospitals
Provide medical/nursing care primarily for only one
discipline or specific diseases or conditions of one
system

Isolation Hospitals
Admit patients suffering from infections or
communicable diseases requiring isolation

23
Hospital Departments
OUTPATIENT (OPD)/ CASUALTY
It is the point of contact between hospital and
community. Its activities influence those of all other
departments
Some space can be utilized for emergency services
(casualty)
It is effective to have pharmacy, rehabilitation center,
injection room
The number of clinics depends on the needs of
patients. It has the Ear, Nose and Throat (ENT),
Dental, Medical, Surgical, Obs/Gyn, Pediatrics and
Mental Health 24
MEDICAL UNIT
In general hospitals, they are usually headed by
physicians and their associates whereas in teaching
hospitals by professors, assistant professors, lecturers
and clinical instructors
They admit patients for treatment other than surgery
and certain exceptions.
The services are further subdivided into
subspecialties e.g. cardiology, neurology, nephrology,
dermatology, thoracic

25
SURGERY UNIT
This has various subspecialties: orthopedics, urology,
ENT, neurosurgery, gynecology and thoracic surgery
Operation theatre has the following facilities: receiving
room, anesthesia room, lay up room, wash room and
scrubbing room
MATERNITY/ OBSTETRIC UNIT
Serves to provide care for the expectant mother and her
newborn. It has the following departments:
Ante – natal – Provides systematic medical supervision
of women during pregnancy.
Labor ward/delivery unit
Post natal – Provides care for the mother who has just
delivered 26
GYNECOLOGY UNIT
The following services are provided in this unit:
Routine “well woman” exams. (Medical examination
of women’s reproductive organs, looking out for
abnormalities and possible problems and ensuring
overall wellness).

Treatment of conditions or problems that involve the

female reproductive system.

27
PEDIATRIC UNIT
The clients in this unit are aged between 1 day old
and 15 years
New Born Unit (NBU) is part of this unit. The basic
need of children are best met when they are grouped
and located in quiet area of the hospital
There is need for large play rooms and school room
There should be an isolation room and facilities for
mothers

28
DENTAL UNIT
It is concerned with the dental welfare of the clients.
The services of hospital dental specialists are needed
for collaboration with the orthopedic or general
surgeon in treatment of fracture of elbow
RADIOLOGY/ X –RAY
It provides diagnostic services for inpatient,
outpatient and casualties.
PATHOLOGY/LABORATORY
Primary function is assisting in diagnosis of diseases
and treatment. Specimen examined include stool,
urine, sputum, blood, cerebrospinal fluid, tissues and
bone marrow
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PSYCHIATRY/MENTAL HEALTH
It should have the following services: outpatient,
liaison services for contact with mental hospitals, day
and night treatment services, inpatient units and
psychiatry communication services
PHARMACY
The functions include stocking of drugs and medical
supplies, distribution of drugs to departments
LAUNDRY
Ensures availability of microbe – free washed linen

30
DIETARY
Preparation of nutritionally adequate meals
CENTRAL STERILE SUPPLY SERVICES DEPARTMENT
It stores, sterilizes, maintains and issues instruments,
materials and garments which are required to be
sterilized. Air condition in this department is essential
to avoid contamination through air
NURSING DEPARTMENT
Major force in health and in medical team which is so
essential for providing services to the hospital
Nursing personnel consist of professional nurses,
practicing nurses and nursing assistants

31
Hospital Hygiene
The hospital is kept clean by:

Sweeping
Not a very common method of cleaning in the ward,
but if necessary ensure the following:
 Windows are open
 Sprinkle water before sweeping
 Sweep the dust into one place
 Collect using a dust pans, NEVER use hands

32
Scrubbing
Surfaces like walls, floors, sinks require scrubbing
frequently.
It is done using scrubber, disinfectant and water
Washing
It is the method of choice of cleaning linen, towels,
gowns
Done using soap and water
Note: Materials made of rubber should not be dried
under the sun
Mopping
A method of cleaning where a mopper, water, soap
and disinfectants are used 33
Damp Dusting
It is done after other methods of cleaning
Its purpose is to remove dust that had settled on the
ward surfaces
Need a trolley whose top shelf should be having:
antiseptic solution, three dusters and disposable
gloves
The bottom shelf should be having: receiver for
rubbish, clean water, container for dirty water
Procedure
Preparation
Inform the patients about the procedure
34
Open the windows and ensure there is enough work
space
Arrange trolley as above
Put on an apron and gloves
Method
Mix disinfectant solution with water in the
recommended ratio
Deep a clean duster into the water to wet it
Squeeze out the water
Dust from the higher surfaces downwards
Change dusting water as it gets dirty and also the
towel as necessary
Arrange instruments and items as you proceed 35
 Documentation
Record what you have done
Note: Cleaning walls, floors, beds and lockers is done
by ward attendants but the nurse remains
accountable to the ward cleanliness and s/he should
ensure that:
Ward attendants have good teaching and orientation
on how to clean
Appropriate disinfectant is used in strength and
amount
Scrubbing is done at least once a week
Floors should be dried to prevent accidents
36
Care of Ward Equipment
It is done to ensure cleanliness and safety which
minimizes damage and increases durability of
equipment
Bed, Mattresses and Pillows
Bed frameworks should be dusted daily.
Mattresses and pillows should always be covered
with mackintosh
Beds should always be kept neat with clean linen
After discharge/death of patient, they should be
cleaned with disinfectant
37
Lockers
They should be dump – dusted daily and checked for
the presence of insects and other vectors
Items in the lockers should always be neatly arranged
Trolleys
They should always be disinfected before every
procedure and cleaned with soapy water, rinsed and
disinfected after every procedure
Ensure wheels are in good working conditions
Furniture
Should be dump – dusted daily
38
Rubber Items (Mackintosh, hot water pots, airways)
Should be disinfected and washed daily with warm
soapy water, rinsed and dried under a shed
Airways and hot water bottles should be stored with
little air left inside to prevent their surfaces from
touching each other and sticking together
Dispensing Boxes
Should be neatly arranged and cleaned daily
Empties should be disposed off

39
Clean Linen
On collection from the laundry, they should be counted
and counter – checked, then recorded in linen book
Sort and send the torn ones for mending
Linen should be arranged neatly in the linen cupboard
Dirty linen
Never place on the floor. Should be collected using a
trolley and disinfected before sending to laundry
Sluicing is scrubbing of the soil using a brush and
running water
Count the linen and record before sending to the
laundry

40
 HOSPITAL/WARD EQUIPMENTS
[Link] pans- container used to collect urine or feces, and it is shaped to fit under a
person lying or sitting in bed.

[Link] scale-Measure weight

Adult and infant weighing scale

[Link]-listening to sounds produced within the body, chiefly in the heart or lungs.
Examples: lung sounds, Heart sounds and bowel sounds
[Link]-it is a Bp machine-used to take blood pressure
[Link]-used to measure body temperature
[Link]-warming the room
[Link]-used by someone with limited mobility who may not be able to walk unaided
[Link] or height board
9. Emesis basin-used to collect vomitus for patients
heater
• Bedside commode-a portable toilet most often used by individuals recovering from a
medical event that inhibits their ability to use the ward toilet.
• Glucometer-a small, portable device that lets you check your blood sugars glucose
levels
• Pulse oximeter-noninvasive test that measures the oxygen saturation level of your
blood. It can rapidly detect even small changes in oxygen levels
• Stop watch-counts the time to the millisecond that passes after you click the "Start"
button
glucometer Stop watch Bedside
Pulse oximeter commode
[Link]-a bottle for urination
[Link] bed-to provide safety, comfort, and mobility for a broad range of patients
with varying conditions and treatment plans.
Type of hospital beds
1. Manual: These beds use hand cranks to adjust the bed's height and raise and
lower the head and the foot. ...
2. Semi-electric: An electric motor raises and lowers the head and foot parts of the
bed.
Sanitary
chair mattress
 Patient locker-to store
Medication trolley
patient belongings
Drip stand-to
hang
intravenous
fluids for
infusion

Overbed table-to place

Ward screen-to provide privacy to the patient patient food during feeding
when carrying out procedures such as bed Bed Cradle-used for burn patient
batg,bed making,catheterization to avoid direct contact of the skin
with the bed lines
 Safety boxes-used for safe
Waste disposal bins-used for disposal of sharps and
hospital waste management Oxygen cylinders- needles e.g scalpels,staples
storage for oxygen
 Emergency tray
Urinal -urine bottle, or female/ male urinal is a
bottle for urination

Nebulizer machine-turns liquid

medicine into a mist to help treat Bin liners-used for holding and storing hospital wastes
your asthma. for disposal
Emesis basins are kidney-shaped
containers that are used to collect
the vomit (emesis).
 THE SIX ELEMENTS OF TOTAL PATIENT
CARE
1. Physical elements
2. Emotional/psychological elements
3. Social elements
4. Cultural elements
5. Spiritual elements
6. Environmental elements
Physical elements
These are closely related to body functions and are some sometimes referred to as primary or
physiological drives. They include:
a. Food
b. Water
c. Oxygen
d. Elimination needs-passing stool and feaces
e. Clothing and shelter
f. Activity-passive exercise
• Emotional and psychological elements
Closely interwoven with physical needs and are met through interaction
with significant other. They include:
a. Love
b. Importance
c. Productivity-ability to do something productive, be independent
d. Respect
e. Coping response
f. stress
Social elements
• This are conditions in which people are born,grow,live,work and age.
They include:
• Education
• Work
• Recreation /play
• Social support-family ,relatives etc.
• Access to health care
• Cultural elements
Influence of culture on health is vast. Culture affects health, illness and
death, beliefs about causes of disease and approaches to health.
• spiritual elements-
involves possessing a set of guiding beliefs, principles or values
characterized by sacred things, the church and religion. E.g. Jehovah
witness don’t accept blood transfusion, Hindu male cannot be nursed
by female nurse
• Environmental elements
A good environment influences the health of the patient and promotes
quick recovery
MASLOWS HIERACHY OF NEEDS
Maslow's hierarchy of needs is a motivational theory in psychology comprising a five-tier
model of human needs

53
ways in which you would help the patient
achieve wellness of all the six elements
• Allow visitation for the patient
• Provide balanced diet
• Allow bed rest for the patient if fatigued
• Allow for spiritual time and respect their religion
• Provide a peaceful environment to promote sleep and rest
• Make the patient feel loved.
• Alleviate their fears, anxiety through psychological care
• Ensure patient’s hygiene, self care activities are tended to.
• Ensure confidentiality and patients privacy to safe guard their emotional aspect
• Counselling session for the grieving patients/ help them adapt to their health deviation
status
• Physical therapy / physiotherapy/ exercise
How to enhance the environment of
the patient
• Allow patient to sun bath
• Offer clean beddings
• Offer clean water
• Enhance proper sanitation-keep the environment clean
• Adequate fresh air
• Avoid noise to aid in healing of patients
ENSURING PATIENT PRIVACY
• Drape properly during procedures-covering a patient and surrounding
areas with a sterile barrier to create and maintain a sterile field during
a surgical procedure
• Use curtains or screens during procedures
• Only expose the part that is in need – e.g during bed bathing
• Knock on the door before entering
• Close the bathroom door when the person is using it
Draping
You have been allocated to work in a ward .what
are some of the examples of patient care you can
carry out to your patient
1. BED MAKING 10. Assisted feeding
2. Bed bath 11. Drug administration
3. Back massage 12. Assist a patient to dress
4. Perineal/catheter care 13. Catheterization
5. Oral care 14. Assisting a patient with a bed
6. Pressure area care bath
7. TAKING VITAL SIGNS
8. Positioning patients
9. Lifting patients
 HAND WASHING
(World health ORG)
• Washing hands with plain or antimicrobial soap and water. Action of performing hand
hygiene for the purpose of physically or mechanically removing dirt, organic material,
and/or microorganisms. Transient bacteria refers to microorganisms that are usually not
found in the body. Normal flora are the microorganisms that live on our skin without
causing disease
Types
1. Social Handwashing-it is performed to render the hands physically clean and to remove
transient micro-organisms with soap and water
2. Clinical/Antiseptic Handwashing-Antiseptics, or skin disinfectants, are chemicals for
cleaning the skin and wounds. They can kill or prevent the growth of microorganisms.
chlorhexidine, povidone-iodine, chloroxylenol, isopropyl alcohol, hexachlorophene,
benzalkonium chloride, and hydrogen peroxide
3. Surgical Handwashing-sterilize the hands prior to gowning and gloving for surgery. An
ideal surgical scrub agent would have a broad spectrum of antimicrobial activity against
pathogenic organisms.
Examples of antiseptics
• Chlorhexidine (hibitane)
• povidone-iodine(betadine)
• Chloroxylenol
• isopropyl alcohol
• Hydrogen peroxide
• salvon
 THE 5 Moments for Hand Hygiene as per the world health organization

1. Before touching a patient,

2. Before clean/aseptic procedures,

3. After body fluid exposure/risk,

4. After touching a patient, and.

5. After touching patient surroundings.

DONNING AND DOFFING GLOVES
• The procedure of putting on gloves is called DONNING while the
procedure for putting off gloves is called DOFFING.
Types of gloves:
1. Sterile gloves-used in sterile procedures like surgery, wound
dressing, stitching, delivery of a baby, vaginal exam, catheterization
2. Clean gloves-used in clean procedures like bed bathing, bed making,
perineal care, taking vital signs.
3. Household or utility gloves
4. Nitrile gloves(resistant to chemicals and disinfectants such as
chlorine and glutaraldehyde
5. Paper gloves
TAKING VITAL SIGNS
Definition:
• Vital signs are defined as the procedure that takes the sign of basic
physiology
• that includes: temperature ,pulse oximetry, pain, pulse, respiration
and blood pressure. If any abnormality occurs in the body, vital signs
change immediately.
Importance /Purposes of taking vital signs

1. To assess the client’s condition

2. To determine which immediate measures that should be
implemented
3. To determine the baseline values for future comparisons
4. To detect changes and abnormalities in the condition of the client
5. To evaluate patient’s response to changes in physical condition as a
result of treatment with fluids or medication
6. To evaluate patient’s recovery from illness
They are vital because they are governed by the vital organs in body (cardiorespiratory). They include:

• Temperature (T)
• Pulse Rate(PR) and apex beat
• Respiratory Rate (R)
• Blood Pressure (BP)
• Pulse Oximetry (SpO2)
• Pain (p)
Vital signs should be assessed at least every four hourly in: which kind
of patients??

• hospitalized patients with elevated temperatures, high or low BP

• Those with respiratory difficulty
• Patients who are taking medication that affect cardiovascular or
respiratory function
• Those who have had surgeries.(2 HOURLY)
• Severely ill patients may have their vital signs taken more often.
• Critical care patients are connected to monitors that continuously
asses the patients vital signs.
 FACTORS AFFECTING VITAL SIGNS
1. Age
• The normal values and variations in vital sign measurements are usually based on
age.
2. Gender
• Women usually experience greater temperature fluctuations compared to men
because of hormonal changes. Males generally have a higher blood pressure than
females of the same age.
3. Race
• Some ethnic groups are more susceptible than others to hemodynamic alteration
4. Medications
• Some medications can directly or indirectly alter pulse, respirations or blood
pressure. Digitalis preparation decrease pulse rate while narcotic analgesics can
depress the rate and depth of respirations and lower blood pressure
[Link]
• Factors like cigarette smoking cause chronic changes in the lungs
manifested by impaired ventilation. Stimulants like caffeinated beverages
and tobacco elevate the heart rate
6. Pain
• With acute pain, there is sympathetic stimulation increase heart rate
which increases cardiac output and vasoconstriction, causing an increased
peripheral vascular resistance. These changes result in increased pulse and
respiratory rates, respiratory depth and blood. Chronic pain causes
parasympathetic stimulation which decreases pulse rate
[Link]-
exercise may exaggerate vital signs. May raise the pulse rate and cause high
energy production hence elevated temperatures
Equipment's required FOR vital signs

1. Oral/ axilla / rectal thermometer (1)

2. Stethoscope (1)
3. Sphygmomanometer with appropriate cuff size (1)
4. Watch with a second hand (1)
5. Spirit swab or cotton (1)
6. Sponge towel (1)
7. Paper bag (2): for clean (1)
for discard (1)
8. Record form
9. Ball- point pen: blue (1)
black (1)
red (1)
10. Steel tray (1): to set all material
TEMPERATURE
Temperature Is the hotness or the coldness of the body
Temperature can be taken from the following parts of the body:
• Axillary-anatomical region under the shoulder joint where the arm
connects to the shoulder.
• Groin -area of your hip between your stomach and thigh
• Rectal-anal region(MORE acurate in babies)
• Oral-mouth
• Ear/Tympanic
• Forehead/temporal artery
high temperature is termed as hyperthermia, or pyrexia and low
temperatures is called hypothermia
Types of thermometers
• Mercury and alcohol thermometer
• Digital thermometer
• Forehead thermometer
• Temperature sensor probe
NB.
• The pads of the fingers provide the best sense of tactile sensations,
which makes them most suited to palpation of the skin and
subcutaneous tissues. The dorsal surface of the hand has the highest
concentration of thermo-receptors, and is found by many people to
provide the best sense of temperature
Body temperature-normal range should be
between 36.5 to 37.5 degree Celsius
Converting temperature from
degree celcius to Fahrenheit.
To convert Fahrenheit to degree Celsius, subtract 32 and multiply by
0.5556 or 5/9
Example :82.4
82.4-32=50.4 x5/9=28
Points to note
• Temperature readings vary depending on which one you use
• Temperatures taken from the armpit are usually the least accurate.
For older children and adults, oral readings are usually accurate as
long as the mouth is closed while the thermometer is in place.
• The normal axillary temperature is usually a degree lower than the
oral (by mouth) temperature.
• Rectal temperatures are generally thought to be the most accurate for
checking a young child's temperature.
• Never take the temperature right after a bath or if he or she has been
bundled tightly for a while — this can affect the temperature reading
Oral method (in the mouth)

• Carefully place the tip of the thermometer under your child's tongue.
• With your child's mouth closed, leave the thermometer in place for about
1 minute until you hear the “beep”
• Remove the thermometer and read the temperature.
Rectal temperature
• wash the end of the thermometer with soap and water and rinse with
water.
• Moisten the tip of the thermometer with a lubricant, such as petroleum
jelly
• insert the lubricated thermometer into the anal opening about ½ inch to 1
inch (about 1.25 to 2.5 centimeters), or until the tip of the thermometer is
fully in the rectum. Stop if you feel any resistance.
Forehead/temporal artery
• Place the sensor head at the center of the forehead. Slowly slide the
thermometer across the forehead toward the top of the ear. Keep it in
contact with the skin. Stop when you reach the hairline.
PULSE
• Pulse assessment is the measurement of pressure pulsation created
when the heart contracts and ejects blood into the aorta creating a
wave of expansion and recoil in the arteries.
• It can be felt by palpation on a point where an artery crosses a bone
close to the surface
• Pulse assessment provides clinical data regarding the heart’s
pumping action and the adequacy of peripheral artery blood flow
• Checking presence, rate, rhythm and volume of throbbing of artery.
Purpose:
1. To determine number of heart beats occurring per minute( rate)
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
• Palpation should be done using the fingertips and intensity of the
pulse graded on a scale of 0 to 4 +:
0 indicating no palpable pulse
1 + indicating a faint but detectable pulse
2 + suggesting a slightly more diminished pulse than normal
3 + is a normal pulse and
4 + indicating a bounding pulse.
Tachycardia refers to a high resting heart rate. Bradycardia is a slower
than normal heart rate
PULSE POINTS INCLUDE:
1. Carotid pulse-neck
2. Temporal pulse-temporal bone
3. Apical pulse -5th intercoastal space
4. Branchial pulse–elbow joint
5. Radial pulse –wrist joint
6. Ulnar pulse-wrist joint
Respiratory rate
• Is the measurement of breathing pattern and rate in one minute.
Assessment of respirations provides clinical data on the pH of arterial
blood.
Sites for Respiratory Assessment
• Normal breathing is slightly observable, effortless, quiet, automatic
and regular. It can be observed by observing chest wall expansion and
bilateral symmetrical movement of the thorax
• It can also be assessed by placing the back of your hand next to the
client’s nose and mouth to feel expired air
• Tachypnea is the term that your health care provider uses to describe
your breathing if it is too fast, especially if you have fast, shallow
breathing from a lung disease or other medical cause. The term
hyperventilation is usually used if you are taking rapid, deep breaths.
• Bradypnea is an abnormally slow breathing rate
 PULSE OXIMETRY
• This is the measurement of arterial oxygen saturation using non –
invasive light. The amount of hemoglobin saturated with oxygen is an
important indicator for patients, especially in intensive care and
emergency situations.
Measurement
• A sensor is placed on a thin part of the patient's body, part of the body
that is relatively translucent and has good arterial pulsed blood flow,
usually fingertip, toe, earlobe, or in the case of an infant, across a foot.
• The percentage of oxygen saturation thus calculated is referred to as the
percentage SpO2
• An SpO2 of between 95-100% is considered normal
• An SpO2 of 92% or less (at sea level) suggests hypoxemia
BLOOD PRESSURE
• Sometimes referred to as arterial blood pressure, is the pressure exerted by
circulating blood upon the walls of blood vessels.
• "blood pressure" usually refers to the arterial pressure of the systemic
circulation
Measured directly or indirectly
[Link] Measurement: An invasive procedure in which an invasive catheter
with an electric sensor is inserted into an artery. The pulsatile BP signals
produced are typically fed to a data acquisition system for recording and
analysis.
[Link] Measurement:
Requires use of sphygmomanometer and stethoscope for auscultation and
palpation as needed or a digital sphygmomanometer.
Blood pressures of between 90/60-120/80 mmhg are considered to be normal.
Types of blood pressure machines
• Digital sphygmomanometers
• Manual sphygmomanometers
Aneroid
sphygmomanometer
Blood pressure sites
STETHOSCOPE
The bell of head of stethoscope
• The bell has cup-shaped and is used to collect low-frequency sounds,
such as abnormal heart sounds.
The diaphragm of head of stethoscope
The diaphragm is flat side of the head and is used to test high-
frequency sounds: breath, normal breath, and bowel sounds.
Sphygmomanometer-to measure blood pressure
 mmHG

NB:The top number (systolic) is the

pressure of the blood flow when your
heart muscle contracts,
pumping blood.
The bottom number (diastolic) is the
pressure measured between
heartbeats.
SYSTOLLIC AND DIASTOLLIC
• Blood pressure is measured using two numbers: The first number,
called systolic blood pressure, measures the pressure in your arteries
when your heart beats. The second number, called diastolic blood
pressure, measures the pressure in your arteries when your heart
rests between beats.
procedure
1. Wear Protective gears after hand washing according to technical services to be offered
1. Prepare Perioperative Theatre environment in accordance with standard operating procedure
1. Gather required materials and apparatus according to the technical service to be provided
1. Check condition of the required materials and equipment according to their user manuals and
manufacturer’s instructions
1. Prepare the patient, introduced self and gain consent according to the Sops
1. Expose the arm to be assessed, apply the Bp cuff according to the instructions manual
1. Locate the brachial pulse, and place the stethoscope according to the clinical manual
1. Inflate the cuff and then deflate slowly listening to the koroktfs sounds according to the
clinical manual
1. Give the client a feedback according to the Sops
1. Dispose any waste with due regard to environment protection regulations
1. record the results according to the Sops
DIFFERENCE BETWEEN HYPERTENSION AND
HYPOTENSION
• hypotension is low blood pressure and hypertension is high blood pressure.
Causes of Low Blood Pressure:-
• Severe diarrhea and vomiting
• diabetes insipidus-excessive urination
• Bleeding
• shock
• Inappropriate use of drugs
Treating Low Blood Pressure may include :
administration of intravenous fluids, administering adrenaline, noradrenaline
and dopamine infusions may be used to treat severe hypotension/shock.
• Causes of High Blood Pressure:
• High serum thyroxin, Cortisol, Adrenaline and Noradrenaline
• Renal failure-kidney unable to filter out water and sodium causing
circulatory overload,.
• cardiac failure and
• certain drugs
• Treating High Blood Pressure:
• Angiotensin receptor blockers,
• ACE inhibitors,
• loop diuretics, thiazides, spironolactone and ethanol promote water
loss and lowers blood pressure.
Symptoms of low blood
pressure
• lightheadedness or dizziness.
• feeling sick.
• blurred vision.
• generally feeling weak.
• confusion.
• fainting.
Symptoms of Severe High Blood Pressure

• Severe headaches.
• Nosebleed.
• Fatigue or confusion.
• Vision problems.
• Chest pain.
• Difficulty breathing.
• Irregular heartbeat.
Factors That Can Exaggerate Blood Pressure Readings and also lead to errors

Can be patient related, procedure related or equipment related

Patient related
• Stress and Anxiety.
• A Full Bladder.
• Crossed Legs.
• Eating (Or Not Eating)
• Alcohol, Caffeine and Tobacco.
• Too Much Talking.
• Cold Temperatures.
Equipment related
1. Leakage on the hose/bladder
2. Low battery
3. Malfunctioned equipment
Procedure related
4. Incorrect patient position-Improper positioning of patient arm
lower than heart level or higher than heart level
5. Incorrect cuff placement
6. Placement of cuff over clothing
7. Using the wrong sized cuff
PAIN ASSESMENT
• Since pain is subjective, self-report is considered the Gold Standard
and most accurate measure of pain.
• The PQRST method of assessing pain is a valuable tool to accurately
describe, assess and document a patient’s pain. The method also aids
in the selection of appropriate pain medication and evaluating the
response to treatment.
• P = Provocation/Palliation
What were you doing when the pain started? What caused it? What makes it better
or worse? What seems to trigger it? Stress? Position? Certain activities? What
relieves it? Medications, massage, heat/cold, changing position, being active,
resting? What aggravates it? Movement, bending, lying down, walking, standing?
Q = Quality/Quantity
What does it feel like? Use words to describe the pain such as sharp, dull, stabbing,
burning, crushing, throbbing, nauseating, shooting, twisting or stretching.
R = Region/Radiation
Where is the pain located? Does the pain radiate? Where? Does it feel like it
travels/moves around? Did it start elsewhere and is now localized to one spot?
S-severity
how severe is it?
T-time –what time? Is it there all the time or does it come and goes?
PHYSICAL EXAM
• physical examination, medical examination, or clinical examination is where a medical
practitioner examines a patient for any possible medical signs or symptoms of a medical
condition.
STEPS:
1. Inspection-involves looking for at the patient body for any abnormal finding. It is a
head to toe exam. Looking for pallor(paleness in the eyes, palms and
toes),jaundice(yellowness in the eyes),skin dryness,dehydration,rashes, hair for lice,
head for swelling or wound, stomach for swelling. Eyes for discharge, redness or
swelling
2. Palpation-feeling the body with fingers or hands. The health care provider touches and
feels your body to examine the size, consistency, texture, location, and tenderness of an
organ or body part
3. Auscultation –listening to sounds using a stethoscope. Bowel sounds, lung sounds,
heart sounds
4. Percussion-a method of tapping body parts with fingers, hands, or small instruments as
part of a physical examination. It is done to determine: The size, consistency, and
borders of body organs. The presence or absence of fluid in body areas.
Vital sign chart
auscultation percussion
The doctor may want to do physical
examination of a patient and may need:-
• A tongue depressor (sometimes called spatula) is a tool used in medical practice
to depress the tongue to allow for examination of the mouth and throat for
example tonsilitis. Also called tongue spatula.
• Ophthalmoscope-handheld device used to examine your eye's interior structure,
including the retina.
• Otoscope-a tool which shines a beam of light to help visualize and examine the
condition of the ear canal and eardrum
• Laryngoscope-designed for visualization of the vocal cords and for placement of
the ETT into the trachea under direct vision
• Penlight torch-provides a source of light and has become the most common used
tool to assess the pupil diameter.
• Vital signs equipment's/tray- Blood pressure machine, stop watch,
pulse oximeter thermometer….
• Anthropometric equipment- weight, height, tape measure - weighing
machine
• Reflex hammer- to elect reflexes
 Tongue depressor ophthalmoscope otoscope

laryngoscope
Penlight torch

Reflex harmer
Adult weight scale Infant weighing scale

Infant length board

Height board
HISTORY TAKING
• a way of eliciting relevant personal, psychosocial and symptom
information from a patient with the aim of obtaining information useful
in formulating a diagnosis and providing medical care to the patient.
Steps
1. Chief complaint
2. Past medical history
3. Family history
4. Present medical history
5. Past surgical history
6. Drug and allergy history-medication,food,weather,latex
7. Social history-education,work,lifestyle,housing
Points to note
• demonstrate proper hygienic practices whenever examining a patient.
• position the patient and self properly for each part of the physical
examination
• use language appropriate for each patient.
• use non-verbal techniques to facilitate communication and pursue
relevant inquiry.
THE PATIENT MONITOR
• The patient monitoring system is a very critical monitoring system hat is
used to measure physiological systems of the body to include
a. Electrocardiograph
b. Blood pressure
c. Oxygen saturation in human blood
d. Body temperature
e. Respiration
Multiple sensors and electrodes are used to receive the physiological
signals like ECG electrodes,spo2 finger sensors, blood pressure cuff,
temperature probe
• During treatment ,it is very important to continuously monitor the
vital physiological signs of a patient.
Procedures to be done in skills lab
Taking vital signs:
a. Blood pressure
b. Temperature
c. Pulse rate
d. Respiratory rate
e. Pulse oximetry(Blood oxygen concentration levels)
 BED MAKING
There are three types of bed making:
[Link] Un-occupied bed
• A bed prepared to receive a new patient is an un-occupied bed.
a. Closed method
b. Open method
c. Admission bed
[Link] Occupied Bed
The procedure that used lines are changed to a hospitalized patient is an occupied bed
[Link] a Post-operative Bed
It is a special bed prepared to receive and take care of a patient returning from
surgery
PARTS OF A BED
IMPORTANCE OF BED MAKING
1. To provide clean and comfortable bed for the patient
2. To reduce the risk of infection by maintaining a clean environment
3. To provide warmth for the patient.
4. To allow immediate admission.
5. To prevent bed sores by ensuring there are no wrinkles to cause
pressure points
6. To receive the post-operative client from surgery
7. To arrange client’s convenience and safety
POINTS TO CONSIDER DURING BED
MAKING
• Do not let your uniform touch the bed and the floor not to
contaminate yourself.
• Never throw soiled lines on the floor not to contaminate the floor.
• Staying one side of the bed until one step completely made saves
steps and time to do effectively and save the time
Special bed making appliances
Special beds are used on many occasions for the comfort of the patient, protection
of bed linen, prevention of pressure sores, facilitation of easier putting of patients
in bed and care of patients with certain conditions
Extra appliances may be added to the requirements for a simple bed in the
preparation of special bed
These appliances include:
1. Mackintosh
• Water proof material used to protect the bottom sheets, pillows and mattress
from getting wet. Made of rubber.
[Link] Cradle
• Appliance used to keep the weight of the linen off the patient e.g. in patient with
burns to protect linen from touching the area with wound
3. Bed Rest/Back Rest
• Help the patient sit in upright position. May be attached to or separate from the bed and
can be adjusted to different degrees
[Link] Boards
• They are boards (wooden) placed under the mattress to provide a firm rigid foundation to
the bed and prevent the mattress from sagging. Aid in immobilization on affected part of
the body.
5. Sand Bags
• Small bags made of impermeable material filled with sand. They are used to support
patients legs to prevent foot drop. May also be used to immobilize a fractured limb
[Link] Blocks
• Made of wood and used to raise the bed on one side e.g. to supply blood to vital organs
like the brain
7. Ripple Mattresses
• Have segments and uses electricity to put air pressure. Used to relieve pressure
[Link] – Rings
• Rubber ring placed beneath the patient’s buttocks to keep them from direct contact with
the bed. Relieve pressure hence prevent pressure sores.
8. Bed Tables
• Specially made tables which can be drawn up in front of the patient and may be used during
meals or for leaning slightly forward incase the patient has difficulty in breathing
9. Hot Water Bottles
• Bottles of rubber used to give warmth to the patient. They may also be used to relieve pain
[Link] Boards
• Used to secure and support the patients foot to prevent foot drop. Keep feet in proper
position. Causes of foot drop include stroke, peroneal nerve injury,
11. Water Beds
• They are just like mattress though have a place to fill with hot water. a bed whose mattress
is a watertight bag filled with water.
12. Air Beds
• These are mattresses that are filled with air
 mackintosh
cradle Air matress

Sand bag
Back board
134
 Overbed table Hot water bottle
Air ring

Air bed
Foot board
BED MAKING
Requirements • Top sheet
• Linen trolley • Blanket(if contaminated or needed to
• Water and soap/hand sanitizer change)
• Hand paper towels • Bed cover
• Clean gloves • Pillow and pillow case
• Disinfectant e.g jik,salvon or • Mosquito net
hibitane .detol if available • Laundry bag of basket
• bowls for cleaning and rinsing
• Wiping cloth
• Bottom sheet
• Mackintosh(if contaminated or needed
to change)
• Draw sheet
HOW TO MAKE MITERD CORNERS
Post operative bed
• Bottom sheet • Adhesive tape
• Top sheet • Kidney tray
• Draw sheet • Trolley
• Mackintosh or rubber sheet • IV stand
• Blanket • Oxygen cylinder with flow meter
• Hot water bag with hot water (104- 140 • O2cannula or simple mask
℉)if needed • Suction machine with suction tube
• Tray • Airway
• Thermometer, stethoscope, • Tongue depressor
sphygmomanometer
• SpO2monitor
• Spirit swab
• ECG
• Artery forceps
• Infusion pump, syringe pump
• Gauze pieces
PROCEDURES TO BE DONE IN
SKILLS LAB
1. Making un-occupied bed
2. Making occupied bed
3. Making post-operative bed
 BED BATH
A bed bath is given to a client who is in the bed (unable to bath itself).always ensure privacy and cover
the patient to minimize exposure to cold or heat loss via convection. Doors and windows can be kept
closed .
TYPES
Complete bed bath-no assistance from the patient
Partial bed bath-assistance from patient in areas he/she cannot reach
Importance
1. Remove bacteria from the skin
2. Relaxes patients
3. Stimulates blood circulation
4. Improves self image
5. Build rapport and good relation between nurse and patient
6. to make client comfort and help to induce sleep
7. To observe skin condition and inspect for any symptoms
*DO a demonstration/video
DRESSING PATIENTS
• Does after a bed bath or after a gown has soiled (become
dirty).a wet gown is uncomfortable to the patient and may
cause heat loss by conduction.
• Ensure privacy
• Normal patient
• Patient with a weak arm-when removing clothing or
undressing start with unaffected side first And When
dressing start with affected side or weak arm
 BACK MASSAGE/BACK CARE
• Back care means cleaning and massaging back, paying special attention to pressure points.
• Shoulder level to the buttock level
• back massage provides comfort and relaxes the client, thereby it facilitates the physical stimulation
to the skin and the emotional relaxation
• It should take 5- 10 minutes
• Can be given during a bath ,during bed time or any time during the day
importance
1. Decrease muscle tension
2. To inspect skin condition.
3. Promote relaxation
4. Increase circulation to the area
5. Provide cleanliness and prevent dryness
6. To relieve from fatigue, pain and stress
7. To induce sleep
Perineal care
• 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
[Link] prevent bad odour
Equipment's required:

1. Gloves( non- sterile) (1 pair)

2. Sponge cloth (1)
3. Basin with warm water (1)
4. Waterproof pad or gauze
5. Towels (1)
6. Mackintosh (1)
7. Soap with soap dish (1)
8. Toilet paper
9. Bed pan (1): as required
MOUTH/ORAL CARE
• Mouth care is defined as the scientific care of the teeth and mouth.
• Oral hygiene should be performed before breakfast,after meals and at bedtime.
• If conscious-fowlers position
• If unconscious, semi fowlers
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 bad odour or relieve it and freshen the mouth
Equipment required:
1. Tray up cotton ball after squeezed
2. Gauze-padded tongue depressor: to 7. Cotton ball
suppress tongue 8. Kidney tray
3. Torch 9. Mackintosh : small size
4. Appropriate equipment's for cleaning: 10. Middle towel
- Tooth brush 11. Jug with tap water
- Foam swabs 12. Paper bag(2): for cotton balls (1)
- Gauze-padded tongue depressor for dirt(1)
- Cotton ball with artery forceps (1) and 13. Gauze pieces as required: to apply a
dissecting forceps (1) lubricant
5. Oral care agents: 14. Lubricants: Vaseline/ Glycerin/ soft white
Tooth paste/ antiseptic solution paraffin gel/ lip cream (1)
6. If you need to prepare antiseptic solution 15. Suction catheter with suction apparatus
as oral care agent: two Gallipots needed: one (1): if available
to make antiseptic solution and second to set 16. Disposable gloves
Assisted feeding
Nasogastric tube feeding
Indications
 Feeding
 Drug administration
 Gastric lavage/washout
 Management of gastric retention
 Diagnostic purposes
 Pre – operative and post - operative management of gastric
operations
POSITIONING PATIENTS IN BED

Purpose of positioning patients

• To facilitate examination
• To maintain muscle tone
• To maintain airway
• Patients are positioned to provide comfort
• To promote good body alignment
• To improve circulation
• To stimulate postural reflexes
• To facilitate various nursing and medical procedures example delivery,surgeries
• For first aid measures
• To relieve pressure on specific points of the body
The different position include:
• Supine
• Prone
• Lithotomy
• Dorsal recumbent
• Lateral position
• Sims/recovery position
• Semi fowlers, fowlers and high fowlers
• Cardiac/orthopenic position
• Trendelburg
• Reverse trendelburg
• Kidney position
• Knee chest
• Jack knife
• Wilson frame
 COMPLICATIONS OF POOR PATIENT
POSITIONING
• Pressure ulcers
• Muscle injuries and bone pain
• Joint dislocation
• Postural hypotension(decreased blood supply to the pain)
• Airway obstruction
• Prolonged head down can cause swelling of the face
• Skin and nerve tissue injury
• Perioperative vision loss-due to improper blood circulation to the
optic nerves in general anesthesia.
1. SUPINE position

• The patient is placed flat on back with legs extended or slightly flexed.
• A bath blanket is placed over patient lengthwise.
• Pillows should be placed under the neck to prevent neck
hyperextension
• Arms should be placed (pronated) along the trunk.
• Extra pillows should be placed at the pelvis to prevent hyper rotation
Purpose:
• General examination.
• Abdominal surgery.
• Surgery on head and extremities.
• Other procedures requiring anterior part of the body
Contraindication:
• Spinal injury
PRONE POSITION

• Patient lies on his/her abdomen. The head is turned to either side for
comfort.
• Pillow is placed under the lower chest, pelvis and ankles for comfort.
• Arms may be placed on the side or flexed near the head
Purpose:
• For treatment on the back and spine.
• To facilities drainage from wound.
• To secure drainage of pus to front of abdomen.
• To relieve pressure on the buttocks and hips
 LATERAL/SIDE LYING

• Patient is placed on the side with the head supported on low pillow.
• Use pillow to support the body anteriorly
• Another pillow is tucked at the waist from the back to support the patient in
the position
• Flex the two leg forwards and place a pillow lengthwise between the legs to
separate them and support the top leg
Purpose:
• To provide comfort to bedridden patients
• To prevent pressure sore (patient is turned 2 hourly)
• To apply enema
•
• Also used for surgical access to the thorax, kidney, retroperitoneal
space, and hip
 SIMS/RECOVERY/SEMI PRONE
POSITION
• Place patient on left side somewhat obliquely across the bed with buttocks to
edge of mattress.
• Incline the body forward, draw the left arm back under patient and place the
right arm free in front.
• The knees should be flexed upon the body—the right more than the left.
• A pillow is placed under the head
Purpose
• Unconscious patients to prevent aspiration of fluids
• Post – operative patients (recovery period)
Contra – indications
• Injured legs
• Hip fracture
• Arthritis
FOWLERS (SEMI – SITTING),
SEMI –FOWLERS/ HIGH FOWLERS
POSITION
Fowlers position:
• The patient is placed in a semi-upright sitting position (45-60
degrees), supported with a pillow or back rest and may have knees
either bent or straight.
• Such a position is maintained during procedures that involve either
the nasal or oral passageways as it prevents aspiration during the
introduction of feeding tubes and also promotes a slight gravitational
pull in peristalsis when swallowing..
Semi – Fowlers Position: The bed is tilted to an angle of 15 – 30 degrees
High Fowlers Position

• Used when the head of the bed needs to be elevated as high as

possible.
• The upper half of the patient's body is between 60 degrees and 90
degrees in relation to the lower half of their body. The legs of the
patient may be straight or bent.
• Also called sitting position
• This position is required postoperatively for respiratory and cardiac
conditions.
Purpose:
• To localize infection in the pelvis and prevent its spread to the
peritoneum
• To prevent strain to the abdominal muscles
• To obtain good pelvic drainage
• To facilitate breathing in patients with cardiac or respiratory
problems, post-operative nasal cases and/or thyroidectomy cases.
• Assisted feeding
 ORTHOPNEIC/CARDIAC POSITION

• Orthopnea is the sensation of breathlessness in the lying position,

relieved by sitting or standing
• Patient sits and leans forward on the over bed table which is placed
across his/her laps
• Patient’s head and arms rest on the table with a pillow
Purpose:
• Patients with cardiac or breathing problems
TRENDLENBURG POSITION

• Client lies in supine position on an adjustable bed or operating table

• S/he is then secured and supported using straps on the table before
adjusting the bed/table
• The bed/table is then tilted to lower the head at an angle of 45
degrees below the horizontal plane
• The patient’s arms should be tucked at their sides
Purpose
• Gynecological surgery and suprapubic
• prostatectomy cases.
• To prevent shocks.
• In neonates to drain secretions
• To prevent or relieve post-partum hemorrhage.
Reverse Trendelenburg
It is a patient position wherein the head of the bed is elevated with the foot of the bed
down. It is the opposite of Trendelenburg’s position.
Purpose:
•Gastrointestinal problems. Reverse Trendelenburg is often used for patients with
gastrointestinal problems as it helps minimize esophageal reflux.
•Prevent rapid change of position. Patients with decreased cardiac output may not
tolerate rapid movement or change from a supine to a more erect position. Watch out
for rapid hypotension. It can be minimized by gradually changing the patient’s position.
•Prevent esophageal reflux. Promotes stomach emptying and prevents reflux for clients
with hiatal hernia.
The patient must be constantly monitored while in this position .The circulation of the
blood can be compromised in this position as well.
7. Dorsal recumbent
• A position in which the patient lies on the back with the lower
extremities moderately flexed and rotated outward. It is employed in
the application of obstetrical forceps,catheterization,IUCD insertion,
repair of lesions following parturition, vaginal examination, and
bimanual palpation.
LITHOTOMY POSITION

• The patient is placed in supine position on adjustable bed/

examination table/operating table
• Client’s buttocks are placed as close as possible to the edge of the
bed/table
• Flex both the knees simultaneously and support on stirrups to prevent
injury when each leg is lifted singly
• Drape as for dorsal recumbent.
• Similar to dorsal recumbent except the legs are more separated and
flexed
Purpose:
• Vaginal and rectal examination.
• Operative procedures on the vagina, rectum and perineum.
• Deliveries (spontaneous vertex delivery)
By use of stirrups
KNEE – CHEST
• Client is positioned in prone position
• The client then assisted to kneel on the bed raising hips to the air and
resting her weight on her chest and knees.
• turn head to one side, supported on a pillow and flex her arms at the
elbows extending, then to the bed in front of her.
• Ensure the thighs are perpendicular to the level of the head.
• Monitor pulse and general condition of the patient.
Purpose:

• To obtain better exposure of the vagina, cervix, and rectum.

• To help correct retroversion of the uterus.
• To administer caudal and sacral anesthesia.
• Vaginal and rectal examinations.
• Operative procedures on the vagina, rectum and perineum.
• Cord presentation/Cord prolapse in labor
 JACK KNIFE OR KROASKE OR BOZEMAN

• Place patient on a prone position with the hips directly over the band
of the examining table.
• Tip the table with the head lower than the hips.
• Lower the foot part of the table so that the patients feet are below
the level of his head.
• Place pillow under the pelvis and abdomen to relieve the strain.
Purpose:
Operation on the rectum and coccyx
THE KIDNEY POSITION
• The kidney position resembles lateral position, except the patient's
abdomen is placed over a lift in the operating table that bends the
body to allow access to the retroperitoneal space.
• patients are placed on their side and arched over a 'kidney rest
• Used for surgeries of the retroperitoneal space and kidney surgeries
Fracture table
The park-bench position
• The park-bench position is a variation of the lateral position. In this
position, the dependent shoulder and arm are positioned outside the
operating table and the arm is supported by a sling.
• Most common position in neurosurgery. used for cranial procedures,
carotid endarterectomies, and for anterior approaches to the
cervical and lumbar spine.
Wilson frame position
• The Wilson supporting frame provides a convenient and stable
method of maintaining patients in a flexed position for spinal surgery.
It has two curved full-length pads, which provide continuous support
for chest and pelvis and adjust laterally to improve ventilation and
relieve pressure from the abdomen.
LIFTING,MOVING AND
TRANSFERRING PATIENTS
What Does It Mean to Lift Patients?
• This process transports patients from their beds to a chair or wheelchair.
Healthcare workers may perform this task when helping their patients
adjust their bodies or when helping them develop and regain strength in
specific areas of their bodies.
Proper lifting technique
1. Keep your head and neck in proper alignment with your spine.
2. Keep your feet shoulder-width apart to maintain your balance.
3. Bend and lift with your knees
4. Maintain the natural curve of your spine; do not bend at your waist.
5. Avoid twisting your body when carrying a person.
6. Always keep the person who is being moved close to your body.
 Principles to apply when lifting
patients
• Be realistic on how much one can lift
• Keep your body in alignment with a good base of support
• Use stronger and larger muscles
• Keep objects/ patient close to your body when you lift, move or carry
them
• Avoid unnecessary bending and reaching-raise the bed to acceptable
levels
• Bend knees to lift patients rather than back
• Know patient’s capabilities and weakness
SHOULDER WIDTH APART
When is it important to lift patients
• Changing a patient’s linens
• Cleaning their bedpan
• Changing patients positions
• Assisting them to the bathroom
• Helping patients adjust their bodies
• Helping patients perform exercise
Potential Risks or Complications of Lifting Patients
• Head trauma
• Fractures
• Musculoskeletal injuries (i.e. nurses performing manual lifts)
TYPES OF PATIENT TRANSFERS
1. Independent transfer-patient requires no assistance
2. Assisted transfer-some patient participation is required
a. Two person lift
b. Sliding board transfer
c. Push up transfer
d. Squat pivot transfer
e. Standing pivot transfer
[Link] transfers-no assistance from patient
a. Sliding transfer
b. Three person carry
c. Dependent stand pivot transfer
d. Hydraulic lift transfer
1. Hydraulic lift transfer
2. Dependent stand pivot
transfer
[Link] pivot technique
[Link] person carry
[Link] transfer technique-using a
slide board
[Link] persons lift
[Link] up transfer
[Link] transfer
9. sitting Up in Bed

• To move a person who is lying in bed to a wheelchair, put the chair close to the bed
and lock the wheels.

• If the person is not strong enough to push up with his or her hands to a sitting
position, place one of your arms under the person's legs and your other arm under
his or her back.

• Move the person's legs over the edge of the bed while pivoting his or her body so
that the person ends up sitting on the edge of the bed.

• Keep your feet shoulder-width apart, your knees bent, and your back in a natural
straight position.
10. Orthodox (cradle lift)
• Two people should be available. The third person may be necessary to help flex
patient’s knees
• Greet and explain the procedure to the patient
• Lock the wheels of the bed
• Place a pillow against the bed head, so that the patient’s head does not hit the bed
frame
• The two nurses stand on either side of the bed between the patient’s hip and waist,
facing each other
• Both nurses hold their hands under the widest part of the patient’s hip and below
his shoulders
• Patient’s knees are flexed and his hands cross in front of him
• The nurses keep their feet apart slightly and slightly flex the knees
• Then move the patient on signal from one nurse
11. Arm Lift

• One or two nurses may do the procedure

• Greet the patient an explain the procedure
• Lock the wheels of the bed
• Place a pillow against the bed head
• Nurse then puts arm under the patient’s axilla
• Nurse places the other hand on the bed behind the patient
• Patient is asked to put his hand on the bed behind him/her
• Patient is asked to flex his knees and to keep his head forward
• Patient is instructed to support himself with his heels and hands and
to lift himself as you help him with your arm under his axilla.
[Link] up method

• The goal is to pull, not lift, the patient toward the head of the bed. The 2
people moving the patient should stand on opposite sides of the bed. To pull
the person up both people should:
• Position patient’s arms to cross the chest
• Grab the slide sheet or draw sheet at the patients upper back and hips on the
side of the bed closest to you.
• Put one foot forward as you prepare to move the patient. Put your weight on
your back leg.
• On the count of three, move the patient by shifting your weight to your front
leg and pulling the sheet toward the head of the bed.
• You may need to do this more than once to get the person in the right position.
• If using a slide sheet, make sure to remove it when you are done.
• If the patient can help you, ask the patient to:
• Bring the chin up to the chest and bend the knees. The patient's heels
should remain on the bed.
• Have the patient push with the heels while you pull up.
13. Large Sheet “Pull”

• This may be used to move a helpless or unconscious patient up in bed

• Remember to roll the sides of the sheet close to the patient, so that
they can be grasped easily and firmly
[Link] rolling

This maneuver is used to

move a patient without flexing
the spinal column. The patient
is carefully rolled in the
desired direction without
twisting or bending the body
Stretcher transferring techniques
[Link] from bed to stretcher
• Prepare to move. Put the head of the bed down and adjust the bed
height to the stretcher height. Lock the bed
• Pull stretcher to edge of bed and lock it. Grasp the draw-sheet on
both sides of the bed.
• Position stretcher. Have the helper “cradle” the patient in the draw-
sheet .
• Slide onto stretcher
2. Transfer from stretcher to bed
• Position stretcher beside the bed on the side closest to the patient,
with stretcher slightly lower.
• Apply brakes.
• two health care providers grasp the sheet on the opposite while two
remain on the other side.
• The lead person is at the head of the bed and will grasp sheet.
• Position patient hands across the chest.
• Carefully slide the patient to the bed and position comfortably