Clinical Nursing Body - Carter Center

LECTURE NOTESFor Nursing StudentsBasic Clinical Nursing SkillsAbraham Alano, B.Sc., M.P.H.Hawassa UniversityIn collaboration with the Ethiopia Public Health Training Initiative, The Carter Center,the Ethiopia Ministry of Health, and the Ethiopia Ministry of EducationNovermber 2002

Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00.Produced in collaboration with the Ethiopia Public Health Training Initiative, The CarterCenter, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education.Important Guidelines for Printing and PhotocopyingLimited permission is granted free of charge to print or photocopy all pages of thispublication for educational, not-for-profit use by health care workers, students orfaculty. All copies must retain all author credits and copyright notices included in theoriginal document. Under no circumstances is it permissible to sell or distribute on acommercial basis, or to claim authorship of, copies of material reproduced from thispublication. 2002 by Abraham Alano,All rights reserved. Except as expressly provided above, no part of this publication maybe reproduced or transmitted in any form or by any means, electronic or mechanical,including photocopying, recording, or by any information storage and retrieval system,without written permission of the author or authors.This material is intended for educational use only by practicing health care workers orstudents and faculty in a health care field

PREFACENursing is core part in health service delivery system in which healthpromotion, disease prevention; curative and rehabilitative healthstrategies are applied. The clinical nursing skills for the nurses areof paramount important not only to provide comprehensive care butalso enhance clinical competence. The purpose of preparing thislecture note is to equip nurses with basic clinical nursing skills, whichwill enable them to dispatch their responsibility as well as to developuniformity among Ethiopian Professional Nurse Training HigherInstitutions.The lecture note series is designed to have two parts: part-I iscomposed of most basic clinical skills, where as part two will becovering most advances clinical skills as well as fundamentalconcepts related to the skills. It is well known that no nursing servicecan be provided with out basic clinical nursing skills. For nurse toprovide health service at different settings; hospital, health center,health post and at the community level including home based carefor chronically sick patients, the course is very essential. It is alsohoped that other primary and middle level health professionaltraining institution will utilize the lecture notes to rational exercise theprofessional skills.The lecture note is therefore organized in logical manner thatstudents can learn from simpler to the complex. It is divided in tounits and chapters. Important abbreviations and key terminologiesi

have been included in order to facilitate teaching learning processes.On top of that learning objectives are clearly stated to indicate therequired outcomes. Glossary is prepared at the end to giveexplanation for terminologies indicated as learning stimulants atbeginning of each chapter following the learning objectives. Trial ismade to give some scientific explanation for procedure and somerelevant study questions are prepared to each chapter to aidstudents understand of the subject.To enhance systematicapproach in conducting nursing care the nursing process is alsoindicated for most procedures.ii

ACKNOWLEDGEMENTMy deepest appreciation is to The Carter Center, EPHTI andProfessor Dennis Carlson, senior consultant of the Center for histireless efforts to materialize the issue of staff strengthening andcurriculum development. Lecture note preparation is one of theactivities that got due attention to strengthen the teaching learningprocess in Ethiopia by Ethiopian staff. There fore, I congratulateProfessor Denis Carlson for the success you achieved withdedicated Ethiopian partners.I also extend many thanks to colleagues and staff of our School ofNursing particularly Ato Andargachew Kassa and Ato Aweke Yilmafor their valuable comments and criticism, other wise the lecture notewould have not been shaped this way.I would like to extend my thanks to Ato Asrat Demissie AcademicVice President of Defence University College and Ato DanielMengistu Head of School of Nursing in University of Gondar for theircritical review and valuable comments.My sincere gratitude is also to the staff members of schools ofnursing, sister Universities, (Ato Birara Tadeg, GU, Ato GetachewWorku, DUC, Sr. Netsanet Shiferaw, JU, Ato Tesfaye Abebe, HU)for their tireless and meticulous revision of the material otherwisedifficulties would have faced to shape this way.iii

Similarly, my felt thanks is to supportive staff of The Carter CenterEPHTI, Dr Hailu Yenenh, Ato Aklilu Mulugetta , W/rt MeseretTsegaw and all other staff for their devoted support through thepreparation of this lecture note.Next, I thank all our College authorities for permission to work onthis lecture note besides the routine activities of the college.Last but not least, my deepest gratitude is to W/rt Lemlem Adebabaywho has managed to write the document with in very urgency givingup her rest time and comfort.iv

TABLE OF CONTENTSContentPagePreface . iAcknowledgement . iiiTable of Contents. vList of Figures . xiiAbbreviation . xiiiUnit OneChapter 1 . 1Introduction . 1Definition of nursing . 1Historical background of nursing . 2History of nursing in Ethiopia . 8Nursing process and Critical thinking . 10Unit Two Safety in Health Care facilities . 18Chapter 2: infection control/ universal precaution . 18Nursing process application. 19Normal body defense . 22Chain of infection . 24Basic medical asepsis . 26v

Hand washing . 26Standard precaution . 29Surgical asepsis. 33Isolation. 37Chapter 3: Care of patient unit. 49The patient unit . 50Care of hospital and health care unit equipment . 54Unit Three Basic Client Care . 58Chapter 4: Admission, Transfer, and Discharge of client . 58Admission . 59Transfer. 61Discharge. 62Chapter 5: Vital Signs . 66Definition .Temperature . 69Pulse . 77Respiration. 82Blood pressure. 83Chapter 6: Specimen collection . 90General consideration for specimen collection. 91Collecting stool specimen . 92Collecting urine specimen. 94Collecting sputum . 99Collecting blood specimen. 101Chapter 7: Bed making . 109Closed bed . 110vi

Occupied bed. 110Post operative bed. 112Chapter 8: Personal hygiene and skin care. 120Mouth care . 120Bathing. 125Bed bath. 128Therapeutic bath. 131Back care . 134Giving and receiving bedpan and urinals . 138Perineal care. 140Hair cares. 145Pediculosis treatment . 150Chapter 9: Cold & heat application . 158Care of a patient with fever. 158Heat application . 159Cold application . 160Tepid sponge . 160Local application of cold and heat . 161Application of cold . 161Application of heat . 163Sitiz bath . 164Chapter 10: Body mechanics and mobility . 167Body mechanics . 168Basic principles of body mechanics. 168Turning the patient to a side lying position . 172Joint mobility and range of motion. 173vii

Body positioning . 177Guideline for positioning the client. 177Client positioning for examination & treatment. 179Crutch walking . 183Application of nursing process. 183Teaching technique for crutch walking . 184Teaching up stair and down stair walking withcrutch . 189Helping the client into wheel chair . 190Unit Four . 194Chapter 11 Nutrition and metabolism . 194Fluid and electrolyte balance. 194Acid base balance . 200Nutrition. 208Gastrostomy/jejunostomy feeding . 211Inserting a gastric tube . 211Nasogastric feeding . 217Total parentral nutrition. 221Unit FiveChapter 12Elimination of Gastro Intestinal and Urinary Tractoutputs.229Gastric lavage .230Gastric aspiration .234viii

Enema .236Cleansing enema .237Retention enema.241Rectal washout.242Passing flatus tube .243Urinary catheterization .244Catheterization using straight catheter .246Inserting indwelling catheter.249Unit SixChapter 13Medication Administration .252Definition of pharmacology.252Drug metabolism .253Factors affecting drug metabolism.255Drug administration .256Application of nursing process .257Oral drug administration.259Suppository .263Subcutaneous injection .267Intramuscular injection .269Intravenous injection .273ix

Intravenous therapy .275Blood transfusion .278Cut down .283Administration of vaginal medications.285Administration of ophthalmicmedication .287Administration of otic medications .290Inhalation.292Definition of inhalation.292Oxygen administration .292Giving oxygen by mask .292Giving oxygen by nasal catheter.294Giving oxygen by tent.295Steam inhalation .297Nelson’s inhalor.298Unit SevenChapter 14 Wound cares .303Definition .303Wound healing process.304Dressing a clean wound.304Dressing of septic wound .307Dressing with a drainage tube.309x

Wound irrigation .312Suturing .314Removal of stitch.316Clip application and removal .318Unit EightChapter 15 Perioperative nursing cares .321Preoperative care.321Care the day before surgery .325Care at the day of surgery.326Care just before surgery.327Intraoperative care .332Postoperative care .332Unit NineChapter 16 Care of the dying & Post-mortem care . 338Definition .338Stages of dying.340Spirituality of dying .339Assisting the dying .343Care after death .346Glossary .349References .363xi

LIST OF FIGURESFigure 1. Chain of infection . 24Figure 2. Site for radial pulse measurement . 80Figure 3. Horizontal recumbent position . 179Figure 4. Dorsal recumbent position . 179Figure 5. Prone position . 180Figure 6.Sim position. 180Figure 7. Fowler’s position . 181Figure 8. Knee-chest position. 181Figure 9. Lithotomy position . 182Figure 10. Four –point-gait . 185Figure 11. Three-point-gait. 186Figure 12. Two-point-gait . 187Figure 13. Sites for IM injection. 271Figure 14. Suture removal technique . 316xii

ABBREVATIONS & SYMBOLSABGArterial Blood GasAbAntibodyABCDEAirway, breathing, circulation, disability, expose andexamineA.C.Before meal (ante cibum)ACTHAdreno cortico trophic hormoneAD.As desiredADLActivities of daily livingAIDSAcquire immeno deficiency syndromeAIAdequate intakeAM.MorningAMALGAmalgam fillingAMAAgainst medical adviceA and PAuscultation and percussionAPCAspirin, Phenacetine & caffeineAPApical pulse or antero-posteriorAQAqueousA-RApical radial pulseAROMActive range of motion; artificial rapture ofmembraneAxBIDAxillaryTwice a day (bis in die)xiii

B.MBowel movementB.M.R.Basal metabolic rateB.PBlood pressureBPMBeat perminuliB.R.P.Bathroom privilegeBUNBlood urea nitrogenoCCentigradeC.B. CComplete blood countCCCubic centimeterC.N. S.Central nervous systemCo2Carbon dioxideC.S. F.Cerebro- spinal fluidCXRChest X-rayD and CDilatation and CurettageD/NSDextrose in normal salineDPTDiphtheria, pertusis, tetanusD/WDextrose in waterDxDiagnosisEEGElectro encephalogramE.E.N.T.Eye, ear, nose, g blood sugarF.H.B.Fetal heartbeatG.I.Gastro intestinalG or GmGramxiv

gr.Graingt.Drop (gutte)gtt.DropsG.U.Genito urinaryGYN.GynecologyHCLHydrochloric acidHbHemoglobinHSAt bed- time (hours of sleep)H2oWaterI.V.IntravenousI.V.PIntravenous pyelogramKI.Potassium iodideL. PLumbar punctureNaClSodium ChlorideNOCTEAt nightN.P.O.Nothing by mouth (nothing by os)O.P.D.Out Patient DepartmentO.R.Operating roomPMAfter noonPRNAs needed, when necessaryPt.PatientQ.EveryQ.D.Every DayQ.H.Every HourQ.I.D.Four times a dayQ.N.Every nightxv

Q.O.D.Every other dayR.B.C.Red blood count or red blood cellRh.Rhesus factorRxPrescription, takeSol.SolutionSOSIf necessarySTATImmediately -at onceS.CSubcutaneousT. I.DThree times a dayT.P.R.Temperature, pulse, respirationTspTeaspoon, tablespoonU.R.Upper rightWBCWhite blood cellsWt.WeightU.R.Q.Upper right quadrantU.L.Q.Upper lower quadrantUTIUrinary tract Infectionxvi