AIMS AND OBJECTIVES OF BEDSIDE NURSING CARE

AIMS

• To prepare care giver (nurse) with a sound educational program in nursing to enable them to

function as efficient members of the health team, beginning with the competencies for the first

level position in all kinds of healthcare settings.

• To help care giver/nurse to develop ability to co-operative and co-ordinate with members of
the
health team in the prevention of disease, promotion of the health and rehabilitation of the sick.

• To help care giver/nurse in their personal and professional development, so that they are able

to make maximum contribution to the society as useful and productive individual, citizen as

well as efficient care giver/ nurses.

• To prepare care giver / nurse to keep pace with latest professional and technological

developments and use these for providing nursing care service.

OBJECTIVES

• Demonstrate competency in providing health care to individual, sick or well, using nursing

process.

• Assess the nursing need of client

• Provide effective nursing care for maintaining best possible level of health in all aspects.

• Promote self-care in people under their care.

• Apply problem solving techniques in nursing practice.

• Apply knowledge from the humanities, biological and behavioral science in functioning as a

nurse. Participate as member of the health team in delivery of curative preventive, promotive

and rehabilitative health care service.

• Mobilize community resources and their involvement in working with the communities.

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• Demonstrate use of ethical values in their personal and professional organization.

• Demonstrate interest in activities of professional organization.

• Recognize the need for continuing education for professional development. Demonstrate basic

skills in teaching patient and giving nursing care to them.

• Demonstrate basic skills in administration and leadership while working with other members of

health team and community and assist in research activities.

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BEDSIDE NURSING CARE
Is the direct patient care, practiced in a clinical settings, such as hospitals, homes, and residential care
facilities (nursing home, continuing care retirement communities?)

What bedside care involves.

• Assessing and recording patients’ signs and symptoms.

• Observing patients’ conditions
• Administering medicine
• Taking patients’ vitals and chat
• Updating patients record
• Operating medical equipment
• Performing diagnostic tests
• Educating patients about at-home treatment plans
• Working with doctors to diagnose illness and deliver care
• Feedback
• Changing bed linens
• Maintain the patients’ personal hygiene

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Qualities of a good bedside nurse/caregiver

• Caring
• Communication skills
• Empathy ( our feeling of awareness toward other people’s emotions and an attempt to
understand how they feel)
• Compassion (an emotional response to empathy or sympathy).
• Attention to detail
• Creative Problem solving
• Stamina / confidence
• Commitment to patient advocacy
• Willingness to learn
• Critical thinking
• Time management
• Leadership
• Experience
• Self-discipline
• Good assessment abilities
• Sense of humor ( positive attitude towards your career)
• Endurance (perseverance)

Benefits of bedside nursing care to patients

• Improve patient prognosis (outcome)

• Building of good relationship
• Build patient trust and promote healing
• Create a full filling and rewarding career
• Prolong life
• Helps to identify other conditions
• It helps find out patients’ like and dislike
• Dedicated care

1. MOUTH (ORAL) CARE OF PATIENTS Why is

mouth care important?

Mouth care is important for everybody as poor oral hygiene can impact health, wellbeing and quality of
life. Poor oral health has been associated with chest infections, heart conditions, stroke and diabetes. It
can also impact people’s ability to eat and drink and can lead to soreness, bad breath and social
embarrassment. Evidence shows that hospital admissions are often associated with a deterioration in
oral health so mouth care is particularly important during hospital stays. People who are nil by mouth
are at increased risk of poor oral hygiene and require regular mouth care

How often should mouth care be completed?

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 In healthy adults, mouth care should be completed at least twice per day using toothbrush and
toothpaste. In addition to this, patients should be encouraged to rinse their mouth using a mouthwash
twice daily, but at differing points in the day to teeth cleaning. Patients who are nil by mouth or
approaching end of life should receive oral care every two to four hours. Dentures should be removed
overnight, cleaned with toothbrush and toothpaste and soaked in diluted mouth wash solution.

Healthy oral cavity

A healthy oral cavity looks clean and moist.

The lips, tongue and roof of the mouth should be pink. There should be no sign of decay or red/white
patches. If the person has dentures, these should fit properly.

Unhealthy oral cavity Signs of an unhealthy oral cavity include dryness due to a lack of saliva, gum
disease (redness, inflammation, bleeding), oral thrush/candida (a white coating), excessive drooling,
mouth ulcers and dental decay. All of these symptoms can be improved by careful and thorough mouth
care.

Risk factors

The following factors increase the risk of developing poor oral hygiene: nil by mouth / limited oral
intake, dementia, frailty, learning disabilities, palliative care, mental health difficulties, stroke, physical
disability and medical interventions including oxygen/ventilation, immunosuppressant, steroids and
chemo/radiotherapy.

2. CARE OF HAIR
Care of hair is part of the personal hygiene. It is another way of helping the patient feel good about him
and maintain a good mental attitude. A patient’s hair should be combed daily. In addition, other care is
necessary to enhance morale, stimulate circulation of the scalp and prevent tangled, matted hair

Purposes of Hair Care

• Hair care improves the morale of the patient

• It stimulates the circulation of the scalp
• Shampooing removes bacteria, microorganisms, oils, and dirt that cling to the hair

Objectives

• To maintain cleanliness of the scalp and hair

• To prevent matting of hair
• To promote comfort and to stimulate circulation of the scalp
• It gives an opportunity of observation of the scalp and hair
• It maintains a glossy and healthy appearance of hair and gives satisfaction to the patient

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Scientific Principles

• Well-combed and attend hair provide comfort to the patient and make appearance more
attractive
• Neglected hair and scalp contain dirt and microorganism and also produce infection of the scalp
Unbroken skin acts as a barrier to infection

Types of Hair Care

• Daily care: the hair should be thoroughly combed and brushed daily. A woman usually needs more
attention to the hair due to its length
• Hair shampoo: shampooing the hair in order to maintain its cleanliness
• Treatment of hair: pediculosis treatment – it is the treatment given with DDT 5% of carbolic lotion
1:40 applied thoroughly on the scalp and it is left for overnight, and the next day a thorough bath is
given and the linen is change

MAINTAINING HAIR CARE

Care of hair means maintaining cleanliness of hair, i.e. free from dandruff, dirt, nits, lice, flakes, dryness
and irritation

Purpose

• To keep hair clean and healthy

• To promote growth of hair
• To have a neat and tidy appearance
• To prevent itching, infection, dandruff, lice, flakes, dryness and irritation
• To prevent loss of hair
• To prevent accumulation of dirt
• To stimulate circulation
• To prevent tangles
• To promote comfort

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• To have a sense of well-being

Three Aspects of Hair Care

1. Daily care by brushing and combing

2. Head bath in order to maintain to cleanliness

3. Treatment of hair for lice infestation

Factors Influence on Hair

• General health of a person

• A well-balanced diet
• Light and fresh air
• Daily practices (hair wash and combing)
• Hair brushing and massage
• Endocrine disorder

Factors Affecting Hair

• Altered level of consciousness

• Physical weakness or disease condition
• Immobility and aging
• Insect bite and infestations
• Accumulated secretions
• Hormonal changes
• Physical and emotional stress
• Poor health practices
• Effects on drug

Common Hair Scalp Problems

• Dandruff – sealing of scalp accompanied by itching

• Pediculosis – lice infestation
• Alopecia – hair loss
• Tangled and matted hair
• Dryness
• Flakes

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 • Irritation

HAIR COMBING

The hair can be combed and washed in the morning so that the patient can feel refreshed and appear
well-groomed before starting daily activities

General Instructions

• Hair needs to be brushed daily in order to be healthy

• Long air should be combed at least once a day to prevent it from matting
• Teeth of the comb should be dull to prevent scratching of the scalp
• Hair must be kept free from snarls, combed and brushed without hurting the patient

Preliminary Assessment

Check

• Doctors order for specific precautions

• General condition and self-care ability
• Condition of the scalp and hair
• Mental status to follow directions
• Articles available in the unit

Preparation of the Patient and Environment

• Explain the procedure

• Arrange the article at the bedside
• Provide privacy and adequate light
• Make the patient to sit on a bedside chair or stool
• Protect the bottom sheet and pillow case with a towel
• Protect the nurse’s uniform by wearing aprons

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Equipment

• Clean comb
• Mackintosh and towel
• Coconut oil in a container
• Kidney tray and paper bag
• Kidney tray with carbolic lotion 1:20 to destroy the lice and to disinfect the comb

Procedure

• Wash hands and take required articles at bedside

• If possible as patient to sit on a stool otherwise side lying or fowler’s position
• Place the Mackintosh under the head of the patient
• Each half of the hair is treated separately without causing strain on the patient
• Separate the hair in small strands. To prevent pulling hold strands above the part being combed,
so that there will be no pain to the patient
• Comb the tangle out from the ends first and then go up gradually. Use oil to remove tangles
• After combing the hair thoroughly, use ribbon to tie the hair
• Discard loose hair into the paper bag

After Care

• Place the patient comfortable and tidy

• Replace the articles to the utility room
• Wash hands thoroughly
• Record and report the procedure in nurse’s record sheet

Problems of Neglected Hair Care

Neglected hair care cause sticky and heavy and acquires a sour, unpleasant odor, which may be quite
distressing the patient. Pediculosis is associated with poor hygiene, crowded living condition and
exposure to other individuals.

The people with pediculosis have complaints of severe itching of the scalp and scratch the head
continuously giving rise to abscess formation. The lice are blood suckers and cause anemia. They also
spread disease, e.g. typhus fever, relapsing fever, trench fever.

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HAIR WASH/BED SHAMPOO

The patient confined to bed will require a cleansing shampoo at least every two weeks. With the
approval of the medical officer, plan the shampoo for a time when the patient feels rested and has no
conflicting treatments or appointments. If the patient can be moved to a stretcher, do so and take him
to a convenient sink. If this is not possible, do the shampoo in bed

Definition

Hair wash/bed shampoo is a special care of the hair may be required for patients who are in bed for a
prolonged period of time

Shampooing the hair should be performed whenever the hair and scalp are dirty

Principles of Shampooing the Bed Patient’s Hair

• The supine position is preferred for weaker patients
• Patients with significant heart or lung disease will not tolerate being supine; they must be in a
sitting position
• Hair care should be given regularly during illness, just as it would be normally Purpose

• To keep hair and scalp clean and healthy

• To promotes sense of comfort and self-esteem
• To complete the treatment of pediculi

General Instructions

• The patients are given hair wash at least once a week for bedridden patients
• Avoid hair wash for patients who have just taken meals at least for an hour
• Avoid exposure and chilling by keeping the patient covered with top clothes
• If the patients are very sick, note pulse before and after the hair wash
• Do not let the patient exert and try to avoid exertion to the patient as far as possible

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Preliminary Assessment

Check

• Doctors order for specific precautions

• General condition for the patient
• Self-care ability
• Patients preference for soap, shampoo, oil, etc
• Patients mental state to follow instructions
• Availabilities of ward article

Preparation of the Patient and Environment

• Explain the procedure

• Arrange the articles at the bedside
• Provide privacy
• Position the patient (flat) comfortably to the edge of the bed (if condition permits)
• Remove the extra pillows and back rest
• Make an improvised through (Kelly’s pad) and place it under the hand to facilitate the drainage
of water in to receptacle
• Place the bucket on the low stool close to the side of the bed. The distal end of the Mackintosh
(trough) is received in to it
• Plug the ear with cotton balls

Equipment

• A tray contains bath towels – 2

• Face towel – 1
• Long Mackintosh – 1
• Cotton swabs – 2
• Liquid soap or shampoo
• Hair comb
• Kidney tray
• Paper bag and news paper
• Bucket – 1
• Mug – 1
• Jugs – 2 (hot and cold water)
• Safety pins

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Procedure

Following is the procedure for administering a shampoo to a patient in bed

• Place a newspaper on the chair and the bucket on the newspaper. Place the patient of water,
shampoo, comb, brush, and one of the two bath towels on the bedside cabinet
• Move the patient to the near side of the bed. Lower the bed to a level position
• Pull the pillow down under the patient’s shoulders to assisting extending the neck. Fold one
bath towel around the neck
• Place the narrow side of the rubber sheet under his head and over the edge of the pillow. Roll
the sides of the sheet to improvise a trough, and place the free end in the bucket
• Give the patient a washcloth for his eyes and face
• Check provisions for water drainage before pouring any water
• Wet his hair and apply shampoo. Lather and rinse it
• Reapply shampoo and rinse the hair again repeatedly until his hair is “squeaky clean”. (a woman
will require more rinse water than a man, but otherwise the procedure is unchanged)

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 Slip a dry towel under the patient’s bed. Then roll and remove the rubber sheet. Pull the pillow
up into its normal place
Dry the hair by gently rubbing it with a clean towel
• Remove the equipment and wipe up any water spilled on the floor
• Assist the patient to comb and brush his hair with a clean comb and brush

After Care

• Place the patient in comfortable position

• Dry the hair, comb and arrange hair when completely dry
• Change linen if wet
• Replace the articles into utility room
• Wash hands thoroughly
• Record and reporting the procedure in nurses record street

3. CARE OF NAILS

Care of nails includes trimming the nail short periodically and keeping the nails clean through frequent
washing. Nail care is important in the maintenance of personal hygiene and is an essential aspect of
patient care

Purposes of nail care

• To make the nail clean and harmless

• To prevent from infection and injury to the body
• To prevent accumulation of dirt and microorganisms underneath the nails
• To detect or examine the abnormalities
• To maintain the skin integrity around the nail
• To make the patient look smart

4. SKIN CARE

Skin care in hospital

During a stay in hospital, your skin may be affected by the hospital environment, staying in bed or sitting
in one position for too long, whether you are eating and drinking enough and your physical condition.
Ask hospital staff to regularly check your skin, particularly if you feel any pain.

There are some things that you can do to look after your skin, including:

• Keep your skin clean and dry.

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 • Avoid any products that dry out your skin. This includes many soaps, body washes and talcum
powder. Ask for skin cleansers that are non-drying. Ask nursing staff or your pharmacist to give
you options.
Use a water-based moisturizer daily. Be careful of bony areas and don’t rub or massage them.
Ask staff for help if you need it.
Check your skin every day or ask for help if you are concerned. Let a doctor or nurse know if
there are any changes in your skin, especially redness, swelling or soreness.
• If you are at risk of pressure sores, a nurse will change your position often, including during the
night.
• Always use any devices given to you to protect your skin from tearing and pressure sores. These
may include protective mattresses, seat cushions, heel wedges and limb protectors.
• Drink plenty of water (unless the doctor has told you not to).
• Eat regular main meals and snacks. Sit out of bed to eat if you can.
• Try to maintain your regular toilet routine.
• If you have a wound, a plan will be developed with you and your family or carers before you
leave hospital. It will tell you how to dress and care for the wound.

Risks of pressure sores in hospital

A pressure sore (also called a ‘bed sore’ or ‘pressure ulcer’) is a painful wound that affects the skin and
the flesh under it. If you sit in a chair or lie in a bed a lot, over time, the weight on the bony parts of your
body stops blood from flowing.

Pressure sores can particularly occur over bony areas such as:

• hips
• knees
• tailbone (sacrum) Heels.

Pressure sores can begin to form in as short a time as two hours and can be serious, potentially leading
to infection that spreads to the bloodstream, if untreated.

Pressure sores are more likely to develop in people who are undernourished or who leak urine or faeces
involuntarily (are incontinent). Being undernourished makes the skin thin, dry, rigid, and more likely to
tear or break. Being incontinent exposes the skin to moisture from urine and faeces, which can lead to
irritation and pressure sores.

Reducing your risk of pressure sores in hospital

Keeping mobile and moving is important for your skin. Movement increases blood supply to tissue and
means you are not staying in bed in one position for too long. To avoid pressure sores, try to move
regularly and check your skin.

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Try to:

• Do what you can for yourself, as long as you can do it safely, such as showering, dressing and
walking to the toilet.
• Walk around the ward every few hours if you can. If you have been advised not to walk by
yourself, change your position every one to two hours, particularly moving your legs and ankles.
Whenever possible, sit out of bed rather than sitting up in bed, as this puts pressure on your
tailbone.
Move as frequently as possible. Even small changes in how you sit or lie make a difference.
• Ask staff if you need an air mattress, cushions, pillows or booties to ease sore spots. Staff
will help if you if can’t do these things yourself.

Check your skin regularly for signs such as:

• Is your skin red, blistered, or broken?

• Do you have any pain near a bony area? Are your beds or clothes damp?

Let staff know if you see any changes to your skin that could lead to pressure sores.

Eating healthyfood and drinking enough water are also important in maintaining healthy skin and play a
key role in wound healing. Make sure you eat regular main meals and snacks, and drink plenty of water
(unless your doctor has told you not to).

5. PRESSURE SORES
Damage to an area of the skin caused by constant pressure on the area for a long time. This pressure can
lessen blood flow to the affected area, which may lead to tissue damage and tissue death. Bedsores
often form on the skin covering bony areas of the body, such as the back, tailbone, hips, buttocks,
elbows, heels, and ankles. Patients who are not able to get out of bed or change their position, or who
always use a wheelchair have an increased risk of bedsores. Signs and symptoms include changes in skin
color and swelling, warmth, tenderness, and pain in the affected area. If untreated, the skin may crack,
blister, or break open and form a sore or ulcer, which may have pus-like drainage. Bedsores often heal
slowly and if not treated can damage tissues deep under the skin, including fat, muscle, and bone. Also
called decubitus ulcer, pressure sore, and pressure ulcer.

How to care for pressure sores

Causes

Pressure sores occur when there is too much pressure on the skin for too long. This reduces blood flow
to the area. Without enough blood to nourish the skin, the skin can die and a sore may form.

You are more likely to get a pressure sore if you:

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• Use a wheelchair or stay in bed for a long time
• Are an older adult
• Cannot move certain parts of your body without help
• Have a disease that affects blood flow, including diabetes or vascular disease
• Have Alzheimer disease or another condition that affects your mental state
• Have fragile skin
• Cannot control your bladder or bowels
• Do not get enough nutrition

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Symptoms

Pressure sores are grouped by the severity of symptoms. Stage I is the mildest stage. Stage IV is the
worst.

• Stage I: A reddened, painful area on the skin that does not turn white (blanch) when pressed.
This is a sign that a pressure ulcer may be forming. The skin may be warm or cool, firm or soft.
• Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
• Stage III: The skin now develops an open, sunken hole called a crater or ulcer. The tissue below the
skin is damaged. You may be able to see body fat in the ulcer.
• Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and
sometimes to tendons and joints.
• There are two other types of pressure sores that don't fit into the stages.
• Sores covered in dead skin that is yellow, tan, green, or brown. The dead skin makes it hard to tell
how deep the sore is. This type of sore is "unstageable."
• Pressure sores that develop in the tissue deep below the skin. This is called a deep tissue injury. The
area may be dark purple or maroon. There may be a blood-filled blister under the skin. This type of
skin injury can quickly become a stage III or IV pressure sore.

Pressure sores tend to form where skin covers bony areas with less tissue under the skin to pad the
area. These include:

• Buttocks
• Elbow
• Hips
• Heels
• Ankles
• Shoulders
• Back
• Back of head Skin folds

Caring for a Pressure Sore

Stage I or II sores will often heal if cared for carefully. Stage III and IV sores are harder to treat and may
take a long time to heal. Here's how to care for a pressure sore at home.

Relieve the pressure on the area.

• Use special pillows, foam cushions, booties, or mattress pads to reduce the pressure. Some pads
are water- or air-filled to help support and cushion the area. What type of cushion you use
depends on your wound and whether you are in bed or in a wheelchair. Talk with your health
care provider about what choices would be best for you, including what shapes and types of
material.

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 • Change positions often. If you are in a wheelchair, try to change your position every 15 minutes.
If you are in bed, you should move or be moved about every 2 hours.

Care for the sore as directed by your provider. Keep the wound clean to prevent infection. Clean the
sore every time you change a dressing.

• For a stage I sore, you can wash the area gently with mild soap and water. If needed, use a
moisture barrier to protect the area from bodily fluids. Ask your provider what type of moisture
barrier to use.
• Stage II pressure sores should be cleaned with a salt water (saline) rinse to remove loose, dead
tissue. Or, your provider may recommend a specific cleanser.
• Do not use hydrogen peroxide or iodine cleansers. They can damage the skin.
• Keep the sore covered with a special dressing. This protects against infection and helps keep the
sore moist so it can heal.
• Talk with your provider about what type of dressing to use. Depending on the size and stage of
the sore, you may use a film, gauze, gel, foam, or other type of dressing.
• Most stage III and IV sores will be treated by your provider. Ask about any special instructions for
home care.

Avoid further injury or friction.

• Powder your sheets lightly so your skin doesn't rub on them in bed.
• Avoid slipping or sliding as you move positions. Try to avoid positions that put pressure on your
sore.
• Care for healthy skin by keeping it clean and moisturized.
• Check your skin for pressure sores every day. Ask your caregiver or someone you trust to check
areas you can't see.
• If the pressure sore changes or a new one forms, tell your provider.

Take care of your health.

• Eat healthy foods. Getting the right nutrition will help you heal.
• Lose excess weight. Get plenty of sleep.
• Ask your provider if it's OK to do gentle stretches or light exercises. This can help improve
circulation.

Do not massage the skin near or on the ulcer. This can cause more damage. Do not use donut-shaped or
ring-shaped cushions. They reduce blood flow to the area, which may cause sores.

When to Call the Doctor

Call your provider if you develop blisters or an open sore.

Call immediately if there are signs of infection, such as:

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 • A foul odor from the sore
• Pus coming out of the sore
• Redness and tenderness around the sore
• Skin close to the sore is warm and/or swollen Fever

Diagnosis

Your doctor will likely look closely at your skin to decide if you have a pressure ulcer and, if so, to assign
a stage to the wound. Staging helps determine what treatment is best for you. You might need blood
tests to assess your general health.

Questions from the doctor

• When did the pressure sore first appear?

• What is the degree of pain?
• Have you had pressure ulcer in the past?
• How were they managed, and what was the outcome of treatment?
• What kind of care assistance is available to you?
• What is your routine for changing positions?
• What medical conditions have you been diagnosed with, and what is your current treatment?
• What is your normal daily diet and fluid intake?

Treatment

Treating pressure ulcers involves reducing pressure on the affected skin, caring for wounds, controlling
pain, preventing infection and maintaining good nutrition.

Treatment team

Members of your care team might include:

• A primary care physician who oversees the treatment plan

• A physician or nurse specializing in wound care
• Nurses or medical assistants who provide both care and education for managing wounds
• A social worker who helps you or your family access resources and who addresses emotional
concerns related to long-term recovery
• A physical therapist who helps with improving mobility
• An occupational therapist who helps to ensure appropriate seating surfaces
• A dietitian who monitors your nutritional needs and recommends a good diet
• A doctor who specializes in conditions of the skin (dermatologist)
• A neurosurgeon, vascular surgeon, orthopedic surgeon or plastic surgeon

Reducing pressure
The first step in treating a bedsore is reducing the pressure and friction that caused it. Strategies include:

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 • Repositioning. If you have a bedsore, turn and change your position often. How often you
reposition depends on your condition and the quality of the surface you are on.
• Using support surfaces. Use a mattress, bed and special cushions that help you sit or lie in a way
that protects vulnerable skin.

Cleaning and dressing wounds

Care for pressure ulcers depends on how deep the wound is. Generally, cleaning and dressing a wound
includes the following:

• Cleaning. If the affected skin isn't broken, wash it with a gentle cleanser and pat dry. Clean open
sores with water or a saltwater (saline) solution each time the dressing is changed.
• Putting on a bandage. A bandage speeds healing by keeping the wound moist. It also creates a
barrier against infection and keeps skin around it dry. Bandage choices include films, gauzes,
gels, foams and treated coverings. You might need a combination of dressings.

Removing damaged tissue

To heal properly, wounds need to be free of damaged, dead or infected tissue. The doctor or nurse may
remove damaged tissue (debride) by gently flushing the wound with water or cutting out damaged
tissue.

Other interventions include:

• Drugs to control pain. No steroidal anti-inflammatory drugs — such as ibuprofen (Advil, Motrin
IB, others) and naproxen sodium (Aleve) — might reduce pain. These can be very helpful before
or after repositioning and wound care. Topical pain medications also can be helpful during
wound care.
• A healthy diet. Good nutrition promotes wound healing.

Surgery

A large bedsore that fails to heal might require surgery. One method of surgical repair is to use a pad of
your muscle, skin or other tissue to cover the wound and cushion the affected bone (flap surgery).

Coping and support

People with bedsores might experience discomfort, pain, social isolation or depression. Talk with your
care team about your needs for support and comfort. A social worker can help identify community
groups that provide services, education and support for people dealing with long-term care giving or
terminal illness.

Parents or caregivers of children with pressure ulcers can talk with a child life specialist for help in
coping with stressful health situations.
Family and friends of people living in assisted living facilities can be advocates for the residents and work
with nursing staff to ensure proper preventive care.

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 6. TRIAGE
Is the preliminary assessment of patients or casualties in order to determine the urgency of their need
for treatment and the nature of treatment required?

What is done at triage?

• Weight taking
• Height taking
• Temperature
• Blood pressure
• Pulse rate
Respiratory rate
Importance of Triage

• Saves as many lives as possible.

• help patients get to the right care more quickly
• To ensure that they receive appropriate attention, in a suitable location, with the requisite
degree of urgency..
• Identify and prioritize those with the most urgent needs to use the emergency service

Weight – A body relative mass or the quantity of matter contained by it, giving rise to a downward force
Heaviness of a person or things

Importance of taking weight of a patient

• Helps to assess fluids and nutrition status of a patient

• To determine drug dose
• To calculate BMI
• To assess growth and development
• For diagnosis purpose
• Height- The measurement of someone or something from head to foot or from base to
top Importance of taking weight of a patient

• Helps to assess fluids and nutrition status of a patient

• To determine drug dose
• To calculate BMI
• To assess growth and development
• For diagnosis purpose

Vital observation / monitoring Blood pressure

This is the pressure of blood pushing against the walls of your arteries.

Importance of taking blood pressure of a patient

• To determine how agency the patient need care
• For diagnosis
• To develop a treatment plan

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 • To evaluate prognosis (outcome of treatment)
Temperature – The degree of internal heat of a person’s body.

Importance of taking temperature

• To analyzed the effectiveness of treatment

• To arrive at the diagnosis
• To assess the patient’s condition
• To determine the medicine to use
• Helps the medical personnel to develop a treatment care plan.

7. Hand washing
Action of performing hand hygiene for the purpose of physically or mechanically removing dirt,
organic material, and/or microorganisms

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8. Positioning

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 9. PERSONAL PROTECTIVE EQUIPMENT (PPE)

Components of Personal Protective Equipment (PPE)

Information on specific components of PPE. Including gloves, gowns, shoe covers, head covers,
masks, respirators, eye protection, face shields, and goggles.
Gloves
Gloves help protect you when directly handling potentially infectious materials or contaminated
surfaces.
Gowns
Gowns help protect you from the contamination of clothing with potentially infectious material.
Shoe and Head Covers
Shoe and head covers provide a barrier against possible exposure within a contaminated
environment.
Masks and Respirators
Surgical masks help protect your nose and mouth from splattered of body fluids, respirators filter
the air before you inhale it.
Other Face and Eye Protection
Goggles help protect only your eyes from splatters. A face shield provides splatter protection to
facial skin, eyes, nose, and mouth.
Apron
Protect you from getting contact with patient’s body fluids

10. Nutrition
Is the process of consuming, absorbing, and using nutrients needed by the body for growth,
development, and maintenance of life? It’s the process of providing or obtaining the food necessary for
health and growth. It is what the cells and tissue s receive.

To receive adequate, appropriate nutrition, people need to consume a healthy diet, which consists of a
variety of nutrients. Diet is what we eat. A good diet is the first step to ensuring our bodies receive the
proper balance of nutrients necessary for optimal health.. Better nutrition is related to improved infant,
child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of
noncommunicable diseases (such as diabetes and cardiovascular disease), and longevity.

Nutrients needed:

Carbohydrates, Proteins, fats, Vitamins, minerals, Fiber and water.

Below are 10 signs that tell you that you are on the right track:

• Healthy Cholesterol Levels. ...

• Blood Pressure Level. ...
• Healthy Weight. For height. ...
• Healthy Skin and Shiny Hair. ...
• Clear Vision. ...

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 • Mental Alertness. ...
• Restful Sleep. ...
• Regular Bowel Movements.
Why is good nutrition important?
• Improve your well-being.
• Improve your ability to fight off illness.
• Improve your ability to recover from illness or injury.
• Reduce the risk of some diseases, including heart disease, diabetes, stroke, some cancers, and
osteoporosis.
• Reduce high blood pressure.
• Lower high cholesterol

Here are just a few of the negative health consequences caused by poor nutrition in your daily life.

• Decreased energy levels. ...

• Reduced immunity. ...
• Disrupted sleep quality. ...
• Affected mood. ...
• Increased risk of memory problems.
• Reduced appetite.
• Lack of interest in food and drink.
• Feeling tired all the time.
• Feeling weaker.
• Getting ill often and taking a long time to recover.
• Wounds taking a long time to heal.
• Poor concentration.
• Feeling cold most of the time. Gut problems Skin rashes.
• depression

Six stages of digestion.

1. Diet – selecting the food we choose to eat, understanding this enables one to know how
to control one’s health
2. Digestion-the process by which complex foods are broken down into simple substances
that the body can utilize. Carbohydrates- sugar/glucose, proteins-amino acids, fats-fatty
acids.
3. Absorption- the process by which the products of digestion pass through the lining of the
intestinal walls are taken to the blood stream. Adequate amounts of nutrients may be
eaten or digested but may not still be available to the cells due to poor absorption….due
excess mucus along the intestinal walls, excess amount of un eliminated waste.
4. Assimilation: - process by which cells assimilate nutrients from the blood stream. This
occurs in every cell of the body to help develop new cells & repair them.

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 5. Circulation: carrying of absorbed nutrients to each cell is the role of the blood,
therefore the quality of blood is important. Impaired circulation will not enable nutrients
to reach the cells.
6. Elimination: excretion of waste product. E.g. sweat, urine, feaces.
One main cause of illness is auto intoxication ;poisoning of the body by the waste
materials absorbed by the intestinal lining back into the blood stream., or metabolic
waste from the tissues back into the blood stream. Reabsorption of wastes at any level
and an overloaded system will fail to have sufficient energies for maintaining optimal
health and degeneration starts to occur.

FOOD FOR THOUGHT.

1. We are what we eat.

2. Most people say they don’t need supplements because of “they eat well and watch their
diet”. The question is, how bioavailable are these foods that we eat and how possible is it
to get all the right nutrients we need with an already compromised bio ecosystem?
3. If you don’t take food for your medicine, then you will end up taking medicine for your
food”

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 11. Wound Management:

An Overview

A wound is a disruption in the continuity of the epithelium. A normal physiological wound healing
process consists of four stages namely homeostasis, inflammation, proliferation, and remodeling. In a
chronic wound, the wound healing mechanism is disrupted which results in prolonged and protracted
healing. Several complex etiologies can be the causative factors behind delayed wound healing.
Therefore, a systemic approach to wound management and assessment is necessary to streamline the
diagnostic process.

I. Objectives

• Decrease pain
• Apply compression for homeostasis
• Protect the wound from soiling with body fluids or waste
• Immobilize the injured body part
• Promote wound healing
• Protect wound from dirt
• Protect wound from flies and other organisms
• Promote comfort ability of a patient
• Prevent bad smell
II. Assessment of the Wound

The initial and most important step in the management of the wound is a comprehensive and detailed
assessment of the characteristics of the wound and patient factors. A useful mnemonic that can help
clinicians in wound assessment is the TIME principle. It involves the assessment of wound tissue,
presence of infection, moisture, and edge of the wound respectively.

The Wound Pros deploys licensed, qualified health care professionals (Physicians, Surgeons, Physician
Assistants and Nurse Practitioners) providing advanced surgical wound consultation and treatment
services at the patient's bedside in long-term care facilities. Our specialty-trained health-care providers
deliver wound care expertise, to develop treatment plans, to consult and guide patient treatment, and
to provide in-service education to nursing staff.

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It is important to note the size, location, and depth of the wound as these can provide diagnostic clues
that will aid in further management. For instance, diabetic ulcers are more likely to occur in regions of
the foot which sustain high pressure. On the other hand, the medial malleolus or the gaiter region is
considered to be the typical location for venous ulcers. A chronic, non-healing wound can also be
suggestive of malignancy. Therefore, a tissue biopsy might be needed if a wound fails to heal despite
intensive treatments.

III. Cleaning of the Wound

Wound cleansing helps to reduce bacterial load, decreases wound infection rates and optimizes the pH
at the wound site. In addition, it also helps to remove external contaminants. Irrigation of the wound
with normal saline should be carried out after each dressing change if possible. Normal saline is an
isotonic solution and does not interfere with normal, healthy granulation tissue. In clinical settings,
wound irrigation is carried out using a fluid jet that removes bacterial contaminants and debris from the
wound surface. Some studies have also demonstrated the use of tap water as a wound cleanser can
help to reduce bacterial colonization.

IV. Regular Dressing Change

Timely dressing changes help clinicians to regularly review and inspect the wounds, and help to reduce
infection rates. All contaminated or soiled dressings need to be changed. As dressing changes can be
quite painful for some patients, patient comfort should be ensured by giving them analgesics. Moreover,
care should be taken while removing adhesives. Soaking the dressings can also aid in their removal. To
protect the per wound skin, barrier films can be used. These improve the adherence of the dressing
material and minimize skin trauma caused during dressing removal.

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 V. Selection of Appropriate Wound Dressing

A wide-range of dressing materials are currently available in the market. This can complicate the
selection of appropriate wound dressing. Knowing the characteristics of an ideal wound dressing can
help wound care specialists and podiatrists in the selection of an appropriate dressing. An ideal dressing
is non-toxic, hypoallergenic, easy to use, cheap and readily available. Moreover, it should cause minimal
discomfort and pain during dressing removal. It is also important for clinicians to take patient wishes
into consideration during dressing selection. This helps to improve compliance.

VI. Antibiotic Use

Wounds should be thoroughly inspected for signs of infection before prescription of antibiotics. It is
common for healthcare professionals to prescribe indiscriminate use of antibiotics even in patients with
little evidence of clinical infection. It is important to carefully assess the signs and symptoms of clinical
infection before an antibiotic is prescribed. This is because regular use of antibiotics can result in an
increased risk of antibiotic-resistant infections. The clinical signs and symptoms that point towards a
likely wound infection include fever, increased wound exudation, odor, and skin redness.

Antibiotics should not be used for a long period and should be targeted towards the likely bacterial
cause of infection. For chronic wounds with biofilms, irrigation with an antimicrobial is recommended.

VII. Conclusion

Wound care is increasingly becoming complex with the introduction of advanced wound technology.
However, the entire wound care can be distilled into five basic principles. These five principles include
wound assessment, wound cleansing, timely dressing change, selection of appropriate dressings, and
antibiotic use. These basic principles of wound management can be used by any member of the
healthcare team to provide systematic and comprehensive management to the patients with chronic
wounds.

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 12. Dehydration

Is a condition that occurs when the loses too much water and other fluids that makes the normal
functioning of the body.

Signs and symptoms

• Feeling very thirsty

• Dry mouth
• Little or no urine and sweat
• Dark-coloured urine
• Dry skin
• Feeling tired
• Dizziness
• Drinking eagerly
• Sunken eyes
• pale

Physical examination of dehydration

Signs & symptoms Mild dehydration Severe dehydration
Heart rate Slightly increased Very increased
Respiratory rate / pattern Normal Increased and hyperpnoea
Blood pressure Normal Decreased
Pulse Normal Very fast
Skin pinch Springs back Goes back very slowly
Mucus membrane Moist Parched
Lips Slightly dry Very dry

13. Blood sugar

Overview

What is a blood glucose (sugar) test?

A blood glucose test is a blood test that mainly screens for diabetes by measuring the level of glucose
(sugar) in your blood.

There are two main types of blood glucose tests:

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Capillary blood glucose test: A healthcare professional collects a drop of blood — usually from a fingertip
prick. These tests involve a test strip and glucose meter (glucometer), which show your blood sugar level
within seconds.

Venous (plasma) blood glucose test: A phlebotomist collects a sample of blood from a vein
(venipuncture).

Venous blood glucose tests are generally more accurate than capillary blood glucose tests.

Healthcare providers often order fasting blood glucose tests to screen for diabetes. Since eating food
affects blood sugar, fasting blood glucose tests show a more accurate picture of your baseline blood
sugar.

What is blood glucose (sugar)?

Blood glucose, or blood sugar, is the main sugar found in your blood. It is your body's primary source of
energy

Glucose (sugar) mainly comes from carbohydrates in the food and drinks you consume. It’s your body’s
main source of energy. Your blood carries glucose to all of your body’s cells to use for energy.

Several bodily processes help keep your blood glucose in a healthy range.

Insulin, a hormone your pancreas makes, is the most significant contributor to maintaining healthy blood
sugar.

If you have elevated blood glucose levels (hyperglycaemia), it usually indicates diabetes. Diabetes
develops when your pancreas doesn’t make any insulin or enough insulin or your body isn’t responding
to the effects of insulin properly.

The most common use of a blood glucose test is to screen for Type 2 diabetes (T2D), which is a common
condition. Certain people are at risk for developing Type 2 diabetes. If you have risk factors, your
provider will likely recommend regular screening no matter your age. The American Diabetes Association
recommends regular screening for anyone age 35 or older.

Your provider will also order a blood glucose test if you have symptoms of high blood sugar
(hyperglycaemia) or low blood sugar (hypoglycaemia).

Symptoms of diabetes and high blood sugar include:

 Feeling very thirsty (polydipsia).

 Frequent urination (polyuria).

 Fatigue.

 Feeling very hungry (polyphagia).

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  Unexplained weight loss.

 Blurred vision.

 Slow healing of cuts or sores.

If you or your child have these symptoms in addition to vomiting, deep labored breathing and/or
confusion, go to the nearest emergency room as soon as possible. You may have diabetes-related
ketoacidosis, which is a life-threatening condition.

Symptoms of low blood sugar include:

 Shaking or trembling.

 Sweating and chills.

 Dizziness or light headedness.

 Faster heart rate.

 Intense hunger.

 Anxiousness or irritability.

You need to consume carbohydrates (sugar) to treat hypoglycaemia, such as a banana or apple juice.
Severe hypoglycaemia can be life-threatening.

 The glucometer will show your blood glucose level within seconds.

What is a normal glucose level in a blood test?

A healthy (normal) fasting blood glucose level for someone without diabetes is 70 to 99 mg/dL (3.9 to 5.5
mmol/L). Values between 50 and 70 mg/dL (2.8 to 3.9 mmol/L) for people without diabetes can be
“normal” too.

There are a few different types of diabetes. The most common forms are:

 Type 2 diabetes (T2D): T2D happens when your pancreas doesn’t make enough insulin or your
body doesn’t use insulin well (insulin resistance), resulting in high blood glucose levels. This is the
most common type of diabetes.

 Type 1 diabetes (T1D): T1D is an autoimmune disease in which your immune system attacks the
insulin-producing cells in your pancreas for unknown reasons. Your pancreas can no longer
produce insulin. At diagnosis, people with Type 1 diabetes usually have very high blood glucose
(200 mg/dL, or 11.1 mmol/L, or higher).

 Gestational diabetes: This condition can develop in pregnant people — usually appearing during
the middle of pregnancy, between 24 and 28 weeks. The high blood sugar (diabetes) goes away
once the pregnancy is over. Pregnant people have screenings for gestational diabetes with a
glucose challenge test and/or glucose tolerance test.

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Other causes of high glucose levels

Other causes of high glucose levels include:

 Issues with your adrenal glands, such as Cushing syndrome.

 Issues with your pancreas, such as pancreatitis.

 Hyperthyroidism.

 Experiencing significant stress, such as from surgery or trauma.

 Certain medications, especially corticosteroids.

What does a low blood glucose level mean?

A blood sugar result of 70 mg/dL or lower is usually considered low.

Low blood sugar (hypoglycaemia) episodes are common in people with Type 1 diabetes and people with
Type 2 diabetes who take certain medications. They’re much less common in people who don’t have
diabetes.

If you don’t have diabetes, low blood glucose levels may be a sign of:

 Liver disease.

 Kidney disease.

 Hypothyroidism.

 Addison disease (adrenal insufficiency).

 Alcohol use disorder (AUD).

 Insulinoma (a rare tumor).

These conditions typically cause frequent low blood sugar episodes. A single low blood sugar test result
usually isn’t a cause for concern in people who don’t have diabetes.

RANGES

4.4-7.2mmol/l (80-130) mg/dl

INTERPRETATION OF RESULTS

A fasting blood sugar of 3.3mmol/L (59mg/dL) to 6.9mmol/L (124mg/dL) is considered normal;

values greater or equal to 7mmol/L (126mg/dL) indicate elevated blood glucose levels.

A random blood sugar 0f 3.3mmol/L (59mg/dL) to 11.0mmmo/L (198mg/dL) is normal, values greater
or equal to 11.1mmol/L (200mg/dL) is an indication of high blood glucose levels.

 NOTE: To convert mmol/L to mg/dL multiply by 18

To convert mg/dL to mmol/L divide by 18

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 14. Assessment of Anemia
Anemia is a condition of having low (not enough healthy) red blood cells or haemoglobin to carry oxygen
to the body tissues.

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 15. Assessment of Jaundice

This is a medical condition with yellowing of the skin or whites of the eyes, arising from excess of the
pigment bilirubin and typically caused by obstruction of the bile duct, by liver disease or by excessive
breakdown of red blood cells

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 16. Assessment of Oedema

Oedema is a build-up of fluid in the body which causes the affected tissue to become swollen. The
swelling can occur at one particular part of the body

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 17. Waste Segregation
Is the sorting and separation of waste types to facilitate recycling and correct onward
disposal.
Different categories of medical waste

I. Non Infectious waste – This is the type of waste which is disposed in black bin with a
black liner
• Plastic Bottles
• Disposable caps
• Papers
• Peelings eg, cassava etc
• Polythene etc

II. Infectious waste - This is the type of waste which is disposed in yellow bin with a yellow
liner
• Used gloves
• laboratory waste
• Dressings
• Swabs
• Tube and intravenous sets
• Aprons
• Masks etc.

III. Highly Infectious waste - This is the type of waste which is disposed in red bin with a red
liner

• Blood
• Sputum
• Urine
• Placenta
• Amputated limbs etc
• Pus etc

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IV. Safety Box (Sharp box) – This is for disposing sharp objects
 Needles
• Surgical blade
• Broken glasses
• Ampoules
• Vials etc

18. Bed appliances

• Bed block or bed elevator- for elevating or raising the foot of the bed
• Trapeze – helps patient to lift him or herself of the bed
• Hot water bottle – for providing extra warm to the patient
• Bed cradle- To lift off weight of bed linens from coming in contact with the patient’s
body eg in burns
• Air ring – help patient from sitting directly on the bed to reduce pressure sores.
• Side rail – protect patient from falling off the bed
• Drip stand _ for hanging fluids eg normal saline
• Dirty linen container- for collecting dirty linen
• Table – helps for putting patient’s food

19. Common term medical terms used in drug prescription and administrations

• Tds – giving drug three times a day or after every 8 hours (8hourly)
• Bd- giving drug two times a day or (12hourly)
• Od – giving drug once a day or (after every 24 hours)
• Nocte- taking drug only at night
• Po – per oral (administering drug only through mouth)
• I.V- intravenous (administering drug through vein)
• I.M- intramuscular (administering drug through muscle)
• SC- subcutaneous or under the skin
• I.D – intradermal – under the skin
• Topical- applying on the skin
• Pessaries – administration of drug through vagina
• Suppositories- administering drug through rectum (anus)
• 3
/7- taking medicine for three days in a week
• 1
/52 or( 7/7) taking medicine for 1 week
• 1
/12 – taking medicine for one month
• Sublingual – administering drug under the tongue

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• NPO nill per os ( no food or drink to enter through mouth for recommended period of
time)
• Dx – stands for diagnosis
• Rx- treatment
• R/o – means rule out
• O/E- on examination
• P/A- per abdomen
• V/E- vaginal examination
• Qid- giving drug 4 times a day or after every 8 hours

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