Fundamentals of Nursing PDF

# Outlines ## Procedures | Pages ------- | -------- Universal precautions & Hand Hygiene| 1 Vital signs: | 12 Body temperature | 23 Pulse and respiration | 31 Blood pressure | 35 Pain | 36 Positioning | 55 Hygienic care | 68 Administration of medication: | 80 Oral administration of medication | 85 P...

# Outlines ## Procedures | Pages ------- | -------- Universal precautions & Hand Hygiene| 1 Vital signs: | 12 Body temperature | 23 Pulse and respiration | 31 Blood pressure | 35 Pain | 36 Positioning | 55 Hygienic care | 68 Administration of medication: | 80 Oral administration of medication | 85 Preparing medication from vial and ampoule | 89 Intramuscular injection | 91 Subcutaneous injection | 94 Intradermal injection | 98 Intravenous injection | 101 IV cannulation | IV infusion | # Fundamentals of Nursing ## Universal Precautions (Standard and Transmission Based Precautions) ### Definitions: * **Universal Precautions:** are steps we follow to prevent the transmission of infectious diseases. * **Standard Precautions:** are measures that are used to prevent the spread of infection among all patients at all times whether or not they have a known infection. By implementing these practices, we help prevent transmission of infectious diseases from one to another (ex: patient to nurse, nurse to patient, or patient to patient). ### When we suspect or know a patient has an infectious disease we add on transmission-based precautions * **Transmission Based Precautions:** are special measures that are used to prevent the spread of infection. Transmission based precautions are based on the pathogen mode of transmission (ex: contact, airborne and droplet). ### Elements of standard precautions: 1. Hand hygiene. 2. Use of personal protective equipment. 3. Appropriate handling of patient care equipment. 4. Prevention of needle stick/ sharp injuries. 5. Environmental cleaning and spills management. 6. Appropriate handling of waste. 7. Keeping Personnel Health & staff training. ## Hand Hygiene Hand Hygiene is defined by the world health organization (WHO) as a general term that applies to hand washing, anti-septic hand washing, antiseptic hand rub or surgical hand antisepsis. ### Purposes: 1. To reduce the number of germs on hands. 2. To prevent the spread of germs. 3. To prevent contamination of the patient's, clients, or resident's environment. 4. To promote comfort. ### Five moments of hand hygiene 1. Before touching a patient 2. Before a procedure 3. After touching a patient 4. After a procedure or a body fluid exposure risk 5. After touching patient surroundings ### Types of hand hygiene: 1. **Routine hand washing:** use of water and non-antimicrobial soap for the purpose of removing soil and transient micro-organism (40-60 second). 2. **Anti-septic hand washing:** use of water and antimicrobial soap (chlorhexidine and iodine). 3. **Anti-septic hand rub:** use of alcohol based hand rub (20-30 second): Alcohol-based hand rub is the recommended method of hand hygiene in any healthcare setting when hands are not visibly soiled. 4. **Surgical antisepsis:** use of water and antimicrobial soap (chlorhexidine and iodine) for the purpose of removing or destroying transient micro-organism and reduce resident flora. It takes (3-5 minutes) this procedure made before surgical operation. ### 1- Routine hand washing Soap and water are the recommended method when hands are visibly soiled. Plain soap is used for routine hand hygiene while anti-microbial soap is used in acute care high-risk areas. ### Equipment: -Running water -Towel -Soap and soup dish -Tissue paper ### Procedure: | Nursing steps | Rational | | ------------- | ------------- | | Prepare equipment. | To save time. | | Remove any jewelry on your hand and roll sleeves to above elbow. | To facilitate cleaning and prevent cross of infection. | | Stand in front of the sink and open the source of water, don't allow your clothes to touch it. | The sink may contaminate your clothes. | | Adjust flow of water and temperature. | To prevent splashing of water. | | Wet hands with water. | | | Apply enough soap on hand. | | | Rub hands together vigorously. Palm to palm with fingers interlaced to create a good lather. | | | Rub your right palm up and down the back of the other hand with interlaced fingers and vice versa. | | | Rub palm to palm with your fingers interlaced. | | | Rub back of your fingers to opposing palm with fingers bent and interlaced. | To remove microorganisms from nickels. | | Rub each thumb clasped in opposite hand. | | | Rub tip of fingers in opposite palm in circular motion. | | | Rub each wrist with opposite hand. | | | Rinse hand with water from tip of fingers to wrist. | To prevent recontamination of hands. | | Use elbow to turn off tap.| | | Dry thoroughly with a single use towel. | | ### 2-Alcohol-based hands rub: Alcohol-based hand rub is the recommended method of hand hygiene in any healthcare setting when hands are not visibly soiled. ### Equipment: -Alcohol (concentrated 70%) ### Procedure: | Nursing action | Rationale | | ------------- | ------------- | | Apply a palmful of hand sanitizer into palm of dry hands and cover all surfaces of your hands. | | | Rub hands palm to palm. | | | Rub your right palm up and down the back of the other hand with interlaced fingers and vice versa. | | | Rub palm to palm with your fingers interlaced. | | | Rub back of your fingers to opposing palm with fingers bent and interlaced. | | | Rub each thumb clasped in opposite hand. | | | Rub tip of fingers in opposite palm in circular motion. | | | Rub each wrist with opposite hand. | | | Once dry, your hands are clean | | | Don't rains & wipe off. | To prevent recontamination.| ## 2- Personal protective equipment (PPE) Personal protective equipment (PPE) refers to a variety of barriers, used alone or in combination, to protect mucous membranes, airways, skin and clothing from contact with infectious agents. PPE used as part of standard precautions includes aprons, gowns, gloves, surgical masks, protective eyewear and face shields. Selection of PPE is based on the modes of transmission of infection. ### 1. Gown **: Include:** - **Nonsurgical gowns:** these multiple purpose gowns are worn when there is a low to moderate risk of contamination. - **Surgical / Surgical Isolation Gowns:** these gowns are designed for surgery. Surgical gowns are used during controlled procedures when the risk of contamination and splashes is lower. Surgical isolation gowns provide more protection for the upper chest and arms. They are used during surgical procedures with high risk of contamination. ### 2. Gloves - (a) Disposable gloves - (b) Surgical gloves ### uses: 1. Wear when touching blood, body fluids, secretions, excretions, mucous membranes, non-intact skin. 2. Change between tasks and procedures on the same patient after contact with potentially infectious material. 3. Remove after use, before touching non-contaminated items and surfaces, and before going to another patient. Perform hand hygiene immediately after removal. ## Personal Protective Equipment | Mode of transmission | Contact | Droplet | Airborne | | ------------- | ------------- | ------------- | ------------- | | Precautions | gloves & gown | gloves & gown surgical mask eye protection | N95 respirator | | Common Infections | Norovirus & other Gl infections C. difficile MRSA Scabies | Influenza Common cold Whooping Cough| Tuberculosis Measles Chicken pox Rubella | | Examples of symptoms | Diarrhea or vomiting Open wounds Patches of open skin | Coughing Sneezing | Chronic cough Fever with unidentified rash | ## 4- Prevention of needle stick/ sharp injuries * Take care to prevent injuries when using needles, scalpels and other sharp instruments or equipment. * Never recap or bend needles (Use a one-handed scoop technique only). * Place used disposable syringes and needles, scalpel blades and other sharp items in a puncture-resistant container with a lid that closes (safty box). ### Characterstic of sharp containner (safty box): * Leak proof. * Puncture proof. * Clearly labelled with warning (easy for people to understand). * Do not overfill (only three quaeter (3/4th) is safe. * Donot transfer contents to other containers. ## 5- Waste disposal Treat waste contaminated with blood, body fluids, secretions and excretions as clinical waste, in accordance with local regulations. | General waste | Pathological waste | Sharp Waste | | ------------- | ------------- | ------------- | | Paper Packaging material Food | inatomical waste Teeth Placenta Pathological waste Sputum container Test tube containing specimen | Cannula/branula Broken slides Broken vial Broken ampules Lancet | Retractables Scalpels Blades Needles Suture needle|