Day 1&2 OSCE PDF

DAY 1 OSCE VITAL SIGNS Normal range of body temperature (Adults) PULSE RANGE: Normal pulse rate varies depending on age. For a BODY REGION...

DAY 1 OSCE VITAL SIGNS Normal range of body temperature (Adults) PULSE RANGE: Normal pulse rate varies depending on age. For a BODY REGION TEMPERATURE (°C) TEMPERATURE (°F) healthy adult the normal resting pulse ranges from 60-100 beats “Temperature, Pulse, Respiration and Blood Pressure are the Oral / Tympanic 37 98.6 per minute. vital signs, these are also called as cardinal signs.”  Tachycardia - An abnormal rapid heart rate over 100 Rectal 37.6 99.6 PULSE RATE. the beating of the heart beats/min. Axillary 36.4 97.6  Newborn: 60 - 120 bpm  Bradycardia - An abnormal slow heart rate below 60 PARTS OF THERMOMETER  Adult: 60 - 100 bpm beats/min. RESPIRATORY RATE. the act of breathing  Bounding - Strong full force pulse.  Newborn: 30-53 bpm  Thready / weak - Difficult to palpate, a pulse of diminished  Adult: 12-20 bpm strength. TEMPERATURE. to determine the degree of internal heat of a  Absent - No palpable pulse. patient’s body.  Irregular - When interval varies between pulse.  Newborn:  Bigeminal pulse - A regular irregular pulse occurring with  Adult: 36.4–37.5°C FEVER BODY TEMPERATURE premature beats. BLOOD PRESSURE: the force of blood pushing against artery walls  above than normal is called as fever or hyperthermia. The  Dicrotic - A split or double pulse beat the second being as the heart pumps blood throughout the body person having fever is indicated as febrile. weaker than first.  Adult: 120/80  a. Low grade fever - above 37.1°C but below 38.2°C C. RESPIRATION:  Systolic pressure: heart beatings (first sound to hear)  b. High grade fever - above 38.2°C  Respiration is the process of bringing oxygen to body  Diastolic pressure: heart resting (last sound to hear)  c. Hyperpyrexia - Higher than 40°C tissues and removing carbon dioxide from it. The lungs FACTORS AFFECTINGS PERSON VS:  d. Intermittent fever - Alternate febrile episodes with play a major role in this process. 1. Time of the day periods of normal temperature.  Respiration is the act of breathing which refers to two 2. Age  e. Remittent fever - Continuous fever but variations process 3. Gender throughout a day. 1. External respiration 4. physical exercise B. PULSE: The pulse is an index of the heart’s rate and rhythm. 2. Internal respiration 5. emotions Pulse provides valuable data about person’s cardiovascular status. CHARACTERISTICS OF RESPIRATION 6. pregnancy DEFINITIONS: “The pulse is a wave of blood created by 1. Respiration rate: It indicates the number of times the 7. environment changes contraction of the left ventricle of the heart.” person breathes in and out in one minute. 8. infection SITES OF MONITORING 2. Depth: It is estimated by observing the movement of chest 9. drugs 1. Temporal 5. Radial 9. Dorsal Pedis during inspiration, which may be deep or shallow. 10. food 2. Carotid 6. Femoral 3. Rhythm: It indicate the equal interval between two WHEN TO ASSESS VITAL SIGNS? 3. Apical 7. Popliteal respiration.  On the patient admission. 4. Brachial 8. Posterior Tibial NORMAL RESPIRATION  During physical examination.  Normal respiration is autonomic, effortless, and regular.  Before and after any invasive diagnostic or surgical  The normal adult rate of respiration is generally ranged procedure. between 14-20 breaths/minutes.  Monitoring during recovery. HOW TO TAKE RESPIRATORY RATE  Before and after medications that affect cardiovascular or  Place the patient arm in relaxed position across his respiratory functions. abdomen and place your hand on the patient’s arm. Now  In any emergency medical condition. observe complete respiratory cycle (Inspiration + A. BODY TEMPERATURE: is the balance between heat produced expiration). and heat lost by the body. SOME TERMS OF RESPIRATION  Tachypnoea - An increased respiratory rate more than 24  Heat production in the body is called thermogenesis.  Heat loss to the environment is called thermolysis. breath/min.  Bradypnoea - A decreased respiratory rate less than 10 breath/min.   Apnoea - Total cessation of breathing or respiratory rate. NEWBORN ASSESSMENT 5. Torch  Hyperapnoea - Increase in the depth of respiration. 6. Bowl containing cotton wisp DEFINITION: it is systematic examination (physical and 7. Weighing machine D. BLOOD PRESSURE (BP) neurological) of newborn. 8. Bowl with extra cotton  is the force exerted by the blood against the vessels walls NEWBORN BONES: A baby's body has about 300 bones at birth. 9. Mackintosh (arterial wall) which is measured in millimeter of mercury These eventually fuse (grow together) to form the 206 bones that 10. Kidney tray (mmHg). adults have. Some of a baby's bones are made entirely of a special 11. Paper bag  Systolic pressure - The maximal pressure exerted on the material called cartilage. Other bones in a baby are partly made of INITIAL ASSESSMENT OF NEWBORN arteries during contraction of left ventricles of heart. cartilage. IDENTIFICATION:  Diastolic pressure - The amount of pressure exerted on the A - appearance  Check and identify the sex of the infant and verify the arterial wall with the ventricles at rest. P - pulse records with the correct name, sex and registration  Normal: Systolic pressure is less than 120 and diastolic G - grimace number. pressure is less than 80 A - activity GESTATIONAL AGE FULL TERM/ PRE-TERM/ POST- TERM  Elevated: Systolic pressure is 120–129 and diastolic pressure R - respiration VITAL SIGNS: Check the vital signs in the following order: is less than 80 a test given to   RESPIRATION: normal value of respiration is 40-60  Stage 1 high blood pressure: Systolic pressure is 130–139 or newborns soon breaths/min. diastolic pressure is 80–89 after birth.  HEART RATE: normal value of heart rate is 120-140  Stage 2 high blood pressure: Systolic pressure is 140 or beats/min. higher or diastolic pressure is 90 or higher  TEMPERATURE: normal value of temperature is 36.5-  Hypertensive crisis: Systolic pressure is higher than 180 or 37.5 degree Celsius. diastolic pressure is higher than 120 1. PHYSICAL EXAMINATION LENGTH: Crown to heel length with infant supine/ upside down/ OBJECTIVES: with the knees slightly pressed down to obtain maximum leg 1. To provide an assessment of infant’s state of extension. (47-50 cm) development of well being. HEAD CIRCUMFERENCE: It is measured with a tape measure 2. To detect any deviation from normal. drawn across the center of the forehead and the most prominent 3. To assess the progress of the child. portion of the posterior head. ( 33-35 cm ) INDICATIONS: CHEST CIRCUMFERENCE: It is measured at the level of nipples  First examination: a detailed one in labor room within 2 and is about 2 cm less than head circumference. 30-33 cm hours of birth. WEIGHT: Average birth weight 2.5 - 3.5 kg  Second examination: Before discharge. POSTURE AND MOVEMENTS:  Third examination: After 6-8 weeks of neonatal life.  Supine position with partial flexion of arms, legs and TERMONOLOGIES hand commonly turned a little to one side. Hip joints  Small for gestational age (SGA) is less than 10% for are partially abducted. weight at the time of birth  Movement is most evident in face and limbs. Unusual  Large for gestational age (LGA) is more than 90% for movement or lack of movements and asymmetry weight at the time of birth should be noted and reported.  Appropriate for gestational age( AGA) is the birth 2. SKIN weight between 10-90% A. Colour: Most term newborns have a ruddy complexion FULL TERM: 37 to 42 weeks or 259 to 294 days. because of the increased concentration of red blood cells in the PRE-TERM: after 28 weeks and before 37 weeks. blood vessels and a decrease in the amount of subcutaneous fat. POST- TERM: after 42 weeks. This ruddiness fades slightly over the 1st month. EQUIPMENT NEEDED:  Peripheral cyanosis appear due to immature peripheral 1. Hand washing articles circulation. This is a normal phenomenon in the first 24 2. Apron to 48 hour after birth. 3. Stethoscope 4. Inch tape / tape measure   Central cyanosis indicates decreased oxygenation. It may be vessel crossing the periosteum. It does not crosses the suture line. V- Vertebral the result of temporary respiratory obstruction or an Disappears by weeks and months A- anorectal underlying disease C- cardiac B. VERNIX CASEOSA: It is a white, cream cheese-like substance 4.EYES: TE- tracheoesophageal that serves as a lubricant, is secreted by the fetal sebaceous  Newborn’s usually cry tearlessely because of the lacrimal R- renal glands and which disappear within a few days. ducts are not fully mature until about 3 months of age. L- limbic c. LANUGO: is the fine and downy hair that covers a newborn’s  Eyes should appear clear without any redness or purulent ABNORMALITIES shoulder, back and upper arms. It may be found also on the discharge. 11. BACK: forehead and ears.  we should observe for subconjuctival hemorrhage,  The spine of newborn typically appears flat in the lumbar  Pre-term newborns has more lanugo then post-term. opthalmia neonatorum etc. and sacral areas. The base of the spine should be free of d. DESQUAMATION: Peeling of the skin takes place few days 5.EARS: any pinpoint openings, dimpling, or sinus tracts in the after birth and most marked on the hands and feet.  The level of the top part of the external ear should be on a skin, which would suggest a dermal sinus or SPINA BIFIDA e. MILIA: Newborn sebaceous glands are immature, therefore line drawn from the inner canthus to the outer canthus or occulta, Lumbar hair tuft & haemangioma pinpoint white papule can be found on the cheek or across the of the eye and back across the side of head. 12. ANOGENITAL AREA: bridge of the nose of newborn. It disappear by 2 to 4 weeks.  Ear Cartilage: Pinna firm, cartilage felt along with the edge.  The anus of newborn must be inspected to be certain that is f. Erythema toxicum: It begin as a papule, increasing in severity  Ear Recoil: Instant recoil. present, patent, and not covered by a membrane to become erythema by the 2nd day and then disappearing by 6.MOUTH: (imperforate anus). the 3rd day.  Mouth should be observed for cleft lip, cleft palate and  Male Genitalia: Scrotum is pendulous and both the testes G. Forceps mark: If forceps were used for birth, there may be tongue tie. The palate of newborn should be intact. are present in the scrotum. Males with one or both circular or linear contusion matching the rim of the blade of the Occasionally, one or two small round, glistening, well- undescended testicles (cryptorchidism) needs further forceps on the infant’s cheek. This marks disappear in 1 to 2 days circumscribed cysts (EPSTEIN PEARLS) are present on the evaluation. along with he edema that accompanies it. palate, a result of the extra load of calcium that was  Female Genitalia: in female newborns labia majora fully H. Skin turgor: If a fold of skin is grasped between the thumb and deposited in utero. covers labia minora. Some newborns have a mucous fingers, it should feel elastic. When it is released it should fall back  Sometimes in some newborns one or two natal teeth may vaginal secretion, which is sometimes blood tinged, to form a smooth surface. If severe dehydration is present, the have erupted. called pseudomenstruation. This discharge disappears as skin will not smooth out again and will remain in an elevated ridge. 7. NECK: soon as the infant’s system has cleared the hormones. I. Mongolian spots: Slate-gray to blue- black lesions Usually over  The neck of newborn is short, often chubby and creased 13.EXTREMITIES: We should observe for syndactyly (TWO OR lumbo sacral area and buttocks Accumulation of melanocytes with skin fold. Head should rotate freely on it. MORE FINGERS FUSE) or polydactyly (EXTRA FINGERS) within the dermis. Generally fade by age 7 years 8. CHEST:  SIMIAN CREASE Unusual curvature of the little finger and a  It looks small because the infant’s head is large in simian crease (a single palmar crease) are signs of Down 3. HEAD proportion. syndrome.  A newborn’s head appears disproportionately large  Possible breast engorgement with possible secretion of thin’ 14.SOLES because it is one fourth of the total length. watery fluid popularly termed witch’s milk.  A full term newborn have creases covering the entire sole A. Fontanelles: The anterior fontanelle will be felt as a soft spot.  Absence of retraction. of the foot The posterior fontanelle is so small that it cannot be palpated 9. ABDOMEN:  Post –mature infants have deep crease over the foot readily.  Bowel sounds present within an hour after birth.  A premature infant sole crease mat partially cover the upper B. Sutures: Suture lines should never appear widely separated in  Edge of the liver usually palpable at 1 to 2 cm below the two-third or may be absent newborns. Separation denotes increased intracranial pressure right costal margin. 15.MECONIUM from either abnormal brain formation, abnormal accumulation of  Edge of the spleen usually palpable at 1 to 2 cm below the  MECONIUM It is the first fecal material , is a sticky , CSF in the cranium (hydrocephalus), or an accumulation of blood left costal margin. odorless material, greenish black to brownish green from a birth injury. Fused suture lines also are abnormal and 10.UMBILICAL CORD which is passed from 8-24 hours after birth need to be confirmed with X-ray and further evaluation.  It has 2 arteries and 1 veins  URINE The first urine is diluted because of immaturity of the C. CAPUT SUCCEDANEUM Swelling or edema of the presenting  At birth cord appears bluish white and moist kidneys and lack of ability to concentrate urine. portion of scalp. Goes away few days  After clamping , it begin dry and appears a dull yellowish NEONATAL REFLEXES D. CEPHALHEMATOMA Bleeding between the skull and brown and sheds after 6-10 days  Also known as developmental, primary, or primitive periosteum of newborn baby. Secondary to suture of blood If presence of 1 artery then it is associated with reflexes.   They can provide information about lower motor neurons  Elicited by the examiner placing his finger on the palmar  Head held to one side with chin pointing to opposite and muscle tone. surface of the infant’s hand and the infant’s hand side due to positioning in the womb  They are often protective and disappear as higher level grasps the finger.  Exercise the neck gently in opposite direction motor functions emerge 12. TONIC NECK (FENCING POSTURE)  Disappearance:7 months 1. BLINKING OR CORNEAL REFLEX  Elicited by rotating the infants head from midline to one LEOPOLD’S MANUEVER, FHT, FH  Infant blinks at sudden appearance of a bright light or at side. The infant should respond by extending the arm approach of an object towards cornea. on the side to which the head is turned and flexing the  A systematic method of abdominal palpation used to assess  It persists throughout life. opposite arm. The lower extremities respond similarly. fetal position, presentation, and engagement in the 3rd 2. PUPILLARY REFLX 13. MORO’S REFLEX trimester of pregnancy  Pupil constricts when a bright light shines toward it.  Onset: 28-32 weeks GA  named after the German obstetrician and gynecologist  It persists throughout life  Well-established: 37 weeks GA Christian Gerhard Leopold (1846–1911), are part of the 3. DOLL’S EYE REFLEX  Disappearance: 6 months physical examination of pregnant women.  As head is moved slowly to right or left, eyes lag behind and  The examiner holds the infant so that one hand PURPOSE: determine presentation and position of the fetus and do not immediately adjust to a new position of head supports the head and the other supports the buttocks. aid to in locating of the fetal heart sound.  Disappears as fixation develops. The reflex is elicited by the sudden dropping of the WHY IS IT PERFORMED?  If persists, indicate neurologic damage. head in her hand. The response is a series of  The aim of Leopold maneuvers is to determine the fetal 4. SNEEZING REFLEX movements: the infant’s hands open and there is presentation and position by systematically palpating  Spontaneous response of nasal passages to irritation or extension and abduction of the upper extremities. This the gravid abdomen, as well as estimate your baby's obstruction Persists throughout life. is followed by anterior flexion of the upper extremities weight. 5. GLABELLAR REFLEX and audible cry.  This process allows medical professionals to not only make  Tapping briskly on glabella (bridge of nose) causes eyes to 14. MORO’s SIGNIFICANCE a birth weight estimate but also address any underlying close tightly. Disappers as brain matures  An absent or inadequate Moro response on one side : problems that may occur down the road. 6. SUCKING REFLEX hemiplegia, brachial plexus palsy, or a fractured  This will help you and your provider be better prepared for  Disappears: around 12 months. clavicle your labor and determine if it might be safer to perform  Elicited by the examiner stroking the lips of the infant; the  Persistence beyond 5 months of age is : indicate severe  They're also low-cost, non-invasive, and don't require the infant’s mouth opens and the examiner introduces their neurological defects STARTLE REFLEX use of expensive equipment such as an ultrasound. Plus gloved finger and sucking starts. 15. STEPPING(DANCING) REFLEX they tell your provider how ready your baby is for birth so 7. ROOTING REFLEX  Disappearance: 3-4 months they can better prepare for your labor.  Disappears: 3-4 months Elicited by the examiner  Elicited by touching the top of the infant’s foot to the  Leopold’s preferably performed after 24 weeks of stroking the cheek or corner of the infant’s mouth. edge of a table while the infant is held upright. The gestation (about 6 months).  The infant’s head turns toward the stimulus and opens infant makes movements that resemble stepping. FACTORS AFFECTING its mouth. 16. BABINSKI REFLEX  Difficult to perform in obese women. 8. GAG REFLEX  Disappearance: 12 months  Women with hydramnios  Stimulation of posterior pharynx by food, suction or  Elicited by stimulus applied to the outer edge of the sole  Women with full bladder. passage of a tube causes infant to gag of the foot. The infant responds by plantar flexion and WHAT ARE THE 4 MANEUVER?  Persists throughout life. either flexion or extension of the toes  First maneuver: fundal grip. 9. EXTRUSION REFLEX 17. CRAWLING REFLEX  Second maneuver: umbilical grip.  When tongue is touched or depressed , infant responds  When placed on abdomen, infant makes crawling  Third maneuver: Pawlik's grip. by forcing it outwards. movements with arms and legs  Fourth maneuver: pelvic grip.  Disappears by age 4 months.  Disappears at about age 6 weeks. NURSING CONSIDERATIONS 10. YAWN 18. HARLEQUIN COLOR CHANGE  Instruct the women to empty her bladder  Spontaneous response to decreased oxygen by  Color changes as the infant lies on the side, lower half of  Wash hands (then dry) increasing amount of inspired air the body becomes pink or red, and upper half is pale  Provide privacy 11. PALMER GRASP REFLEX  It is entirely harmless and never been associated with  Verify the client  Disappears: 2 months permanent problem  Explain procedure 19. TORTICOLLIS (WRY NECK)  Place woman in dorsal recumbent position.   Warm hands by rubbing together  Good attitude – if brow correspond to the side that  Measuring of the fetal heart rate using special instruments  Use the palm for palpation not the fingers. contained the elbows and knees during the labor  Poor attitude – If examining, fingers will meet obstruction  Determine the rate, regularity, strengths, and any 1. FIRST MANEUVER: FUNDAL GRIP on the same side as fetal back deviation of the FHT What lies in the fundus? IDEAL POSITION:  While facing the woman, palpate the upper part abdomen  cephalic presentation is the ideal position for delivery. TYPES OF FETAL HEART RATE MONITORING: with both hands.  Most babies will settle into this position between the 32nd  Intermittent Auscultation - method of listening to the FHT  determines whether the fetus head is is cephalic or breech and 36th week of your pregnancy. This position makes for about 60 secs by using a fetal stethoscope in the fundus labor less complicated.  Electronic Fetal Monitoring - done by electronic monitor  determine the size, consistency, shape and mobility ABNORMAL POSITION & PRESENTATIONS that is used to continuously measure the FHT  fetal head is hard, firm, round and moves independently of A. Cephalic Posterior Position METHOD OF MONITORING: the trunk  This position is also known as an occiput position or it's  External: through mother abdomen (fetoscope is a most  While the buttocks, feel softer. It’s symmetric and has small sometimes nicknamed "sunny-side-up." basic type of monitor) bony prominences it moves w/ the trunk.  It means that your baby is positioned head down, but  Internal: through the womb if the water breaks and cervix 2. SECOND MANEUVER: UMBILICAL GRIP they're facing out instead of towards your spine. open to prepare for birth Where is the fetal back?  This position could increase your chances of a painful INDICATIONS  With both hands moving down, palpate the sides of the and prolonged delivery.  The doctor is more likely to use fetal heart rate monitoring uterus from top to bottom B. Breech Position when your pregnancy is high-risk.  fetal back is smooth, hard, resistant surface.  A breech position means that your baby's bottom is  You may need fetal heart rate monitoring when:  Fetal extremities feels like angular bumps or nodules facing downwards.  You have diabetes. (knees and elbows)  Frank breech: The baby's legs are up with feet near the  You have high blood pressure. 3. THIRD MANEUVER: PAWLIK’S GRIP head  You’re taking medicine for preterm labor. What is in the inlet?  Footling breech: One or both legs is lowered in the  Your baby isn’t growing or developing normally.  first grasps the lower portion of the abdomen just above the cervix  Preterm labour symphysis pubis w/ the thumb and fingers of the right  Complete breech: The baby's bottom is first and its  Previous cesarean hand knees are bent  Overweight mother  To determine which part of the fetus is at the inlets and  Any of these positions can make for a riskier delivery so  Multiple fetus mobility you are at risk of a C-section delivery if the baby  High-blood pressure  If head is engaged it will not move, if its soft that is the doesn't change position before labor. CONTRAINDICATIONS back C. Transverse Lie  Discomfort 4. FOURTH MANEUVER: PELVIC GRIP  transverse lie position at the end of the third trimester,  Infection What is the attitude? which means they are lying sideways across your uterus  Scratching in baby scalp  This manuever is only performed if the fetus is in the instead of vertically. cephalic presentation  If they don't change position, it could make for dangerous BAG TECHNIQUE  The health care provider faces the woman’s feet, as he or labor, so a C-section will be required. she will attempt to locate the cephalic prominence of OTHER PRESENTATIONS COMMUNITY BAG: A tool by which the nurse use during her visit brow. Face presentation, the neck arches back so that the face and it enable her to perform;  Nursing procedure with ease  To determine fetal attitude and degree of fetal presents first.  Save time and effort extension in the pelvis In brow presentation, the neck is moderately arched so that the  prevent the spread of an infection ATTITUDE: brow presents first.  Describes the position of the parts of the fetus body. PURPOSE:  The normal fetal attitude is commonly called the fetal FETAL HEART TONE 1. The bag is needed during each home, school or industrial position.  Average fetal heart rate id between 110 - 160 bpm visit.  The head is tucked down to the chest.  If the uterus is not contracting, place the bell of the 2. For inspection of the client’s like, TPR.  The arms and legs are drawn in towards the center of the stethoscope over the quadrant of the mothers abdomen 3. For performing certain procedure’s like, urine analysis, ante- chest. where the fetal back located natal assessment etc. IMPORTANT POINTS TO CONSIDER IN THE USE OF THE BAG   Should contain all the necessary articles, supplies and 1. Upon arrival at the patient’s home, place the bag on the 3. Include quality of nurse- patient relationship. equipment that will be used to answer emergency needs. table lined with clean paper.. The clean side must be out 4. Assess effectiveness of nursing care provided  Always clean the supplies and replaced and ready for use and the folded part, touching the table anytime. RATIONALE: To protect the bag from getting contaminate  should be well protected from contact with any article in 2. Ask for a basin of water or a glass of drinking water if tap ESSENTIAL EQUIPMENT AND SUPPLIES FOR HOME DELIVERY: the patients home. water is not available. Open the bag and take out the 1. Antiseptic soap  the arrangement of the bag contents must be convenient to towel and soap 2. Some clean blankets the user, to facilitate efficiency and avoid confusion. RATIONALE: To be used for hand washing 3. Clean clothes ARRANGEMENT OF THE PHN BAG: 3. Wash hands using soap and water, wipe to dry. 4. Clean apron A. FLAP RATIONALE: To prevent infection from the care provider to the 5. Thermometer 1. Receptacle client 6. Tetracycline oinment 2. Paper Lining 4. Take out the apron from the bag and put it on with the right 7. Clean plastic bag 3. Paper Waste bag in pocket of the bag side out. 8. Measuring tape 4. Plastic lining RATIONALE: To protect the nurse’s uniform 9. Small weighing scale B. FRONT 5. Put out all necessary articles needed for the specific care 10. Cord clamp 1. Oral and rectal thermometer RATIONALE: To have them readily accessible 11. Forceps 2. Gloves 6. Close the bag and put it in one corner of the working area. 12. Sterile gloves C. TOP CENTER RATIONALE: To prevent contamination 13. Betadine 1. Soap dish 7. Proceed in performing the necessary nursing care treatment. 14. Sutures 2. 2 hand towels RATIONALE: To give comfort and security and hasten recovery 15. Oxytocin 3. Apron 8. After giving the treatment, clean all things that were used 16. Lidocaine 4. Kidney basin and perform hand washing 17. Syringes D. CENTER RATIONALE: to protect the caregiver and prevent infection 18. LRS or NSS 1. Medicne glass 9. Open the bag and return all things that were used in their 19. Infusion set 2. Baby weighing scale proper places after cleaning them. 20. Watch E. RIGHT SIDE 10. Remove apron, folding it away from the person, the Sphygmomanometer and stethoscope are carried separately 1. Medicine dropper soiled side in and the clean side out. Place it in the bag. 2. Surgical scissor 11. Fold the lining, place it inside the bag and close the bag. NASOGASTRIC TUBE (GAVAGE AND LAVAGE) 3. Curved and straight forceps 12. Take the record and have a talk with the mother. Write 4. Sterile OS down all the necessary data that were gathered, GASTRIC GAVAGE 5. Tape measure observations, nursing care and treatment rendered. Give  The introduction of nourishment into the stomach by 6. Bandage instructions for care of patients in the absence of the means of a tube passed through nose (nasogastric) or 7. Syringes and needles nurse. mouth (orogastric). 8. Cotton applicator RATIONALE: for reference in the next visit PURPOSE: 9. Sterile cotton balls 13. Make appointment for the next visit (either home or  To provide nourishment with food and/or medication (ex. 10. Adhesive tape clinic visit) taking note of the date and time Surgery in oral cavity, unconscious or comatose state.) 11. Cord clamp RATIONALE: For follow-up care LUBRICATE: 12. Test tubes AFTER CARE:  Male: 5 -7 inches F. BACK 1. Before keeping all the articles in the bag, clean and  Female: 1 – 2 inches 1. 70% alcohol alcoholize them. EQUIPMENT: 2. Ammonia 2. Get the bag from the table, fold the paper lining (and insert), 1. Formula feed 3. Betadine and place in between the flaps and cover the bag. 2. Graduated container 4. Hydrogen peroxide EVALUATION AND DOCUMENTATION: 3. Large syringe (30 – 60 ml) 5. Benedict solution 1. Record all relevant findings about the client and members of 4. Water in a container STEPS IN PERFORMING BAG TECHNIQUE: the family. 5. Stethoscope 2. Take note of environmental factors which affect the 6. Kidney tray client’s/family health. 7. Towel and mackintosh  8. Clean gloves E. Blocked Tube: 4. Irrigation try INDICATIONS:  Inadequate or no flushing of tube 5. Adhesive tape 1. Head and Neck injury  Administering meds via tube 6. Suction equipment 2. Coma F. Deranged Electrolytes 7. Lubricating jelly 3. Obstruction of esophagus or oropharynx G. Fluid Overload 8. Catacine spry 4. Severe anorexia nervosa H. Intestinal Obstruction 9. 60ml syringe with catheter tip 5. Recurrent episodes of aspiration I. Dislodged Tube 10. Lavage tube 6. Increased metabolic needs – burns, cancer, etc., J. Weight / Loss Gain INDICATION: 7. Poor oral intake K. Excoriation Of Skin Around Tube  With patient has ingested poison CONTRAINDICATIONS: RISKS ASSOCIATED WITH NGT  collecting stomach acid for tests 1. head injury  Pneumothorax  cleaning the stomach before and upper endoscopy in 2. Rhinorrhea  coiling of the tube in the throat someone who has been vomiting blood. 3. obstructing esophageal  Sinusitis  relieving pressure in someone with blockage in the 4. epistaxis  acid reflux intestines 5. feeding above an obstruction  aspiration pneumonitis CONTRAINDICATIONS: 6. recent gastro esophageal anastomosis  severe sepsis  Loss of airway protective reflexes, such as in a patient 7. history of nasal or sinus surgery MEASURE LENGTH OF FEEDING TUBE: with a depressed state of consciousness. 8. Occlusions - from bridge of nose to ear to the bottom of xiphoid process.  Ingestion of a corrosive substance such as a strong acid TYPES OF NGT: POSITIONING OF PATIENT DURING INSERTION: or alkali. 1. Fine-Bore Feeding Tube: - Semi fowlers position (45 degree)  Ingestion of a hydrocarbon with high aspiration potential. - Short term enteral feeding (4 – 6 weeks) ALSO ASSESS THE ASPIRANT FOR VISUAL ASPIRATES:  Patients who are at risk of hemorrhage or  Malnutrition - Visual characteristics of feeding tube aspirates gastrointestinal perforation.  Head and neck surgery  GASTRIC: may be grassy green with sediment, brown (if TECHNIQUE:  Inadequate intake blood is present and has been acted upon by gastric acid). 1. Gastric lavage involves the passage of a tube via the mouth  Oral cavity fistulae May also appear clear and colorless (often with shreds of or nose down into the stomach, followed by sequential - to prolong and sustain life offwhite to tan mucus or sediment). administration and removal of small volumes of liquid. 2. Ryle’S Tube:  INTESTINAL: generally, more transparent than gastric 2. The placement of the tube in the stomach must be - to drain gastric contents aspirants and may appear bile-stained tanging in color confirmed either by air insufflation while listening to the  Abdominal distention from light to dark golden yellow or brownish green. stomach, by pH testing a small amount of aspirated stomach  Unconscious patient  RESPIRATORY: tracheobronchial secretions may consist of contents, or xray. This is to ensure the tube is not in the lungs.  Major surgery off-white to tan sediment. 3. Lavage is repeated until the returning fluid shows no further  Intestinal obstruction - Assessing aspirants for visual characters provides gastric contents. - to stop vomiting and prevent aspiration 4. If the patient is unconscious or cannot protect their airway COMPLICATIONS OF NGT FEEDING: GASTRIC LAVAGE then the patient should be intubated before performing lavage. A. Aspiration:  commonly called STOMACH WASH or GASTRIC SUCTION, COMPLICATION:  Due to feed regurgitation the process of cleaning out the contents of the stomach. 1. ASPIRATION PNEUMONIA: while taking the unwanted poison  Or incorrect tube placement  it has been used for eliminating poisons from the stomach. or drugs out of the stomach (lavage), the substances might B. Nausea And Vomiting: PURPOSE: accidentally enter the respiratory canal, into the lungs and cause  Due to rapid feeding  For urgent removal of ingested substance to decrease aspiration pneumonia.  Poor gastric emptying systemic absorption. 2. LARYNGOSPASM: uncontrolled and involuntary muscle C. Diarrhea:  to empty the stomach before endoscopic procedure. contraction (spasm) of the larynx cord.  Type of feed  to diagnose gastric hemorrhage and to arrest 3. HYPOXIA and HYPERCAPNIA: lack of oxygen in the body tissues.  Gut injection hemorrhage. 4. BRADYCARDIA: pulse slow and lower than normal. D. Constipation: EQUIPMENTS: 5. SHORTNESS OF BREATH: patient might experience dyspnea  Inadequate fluid intake 1. Normal saline due to a tube inserted through the oropharynx that can obstruct  Immobility 2. Bite block the patient airway, which cause low oxygen supply.  Use of opiates 3. Gastric tube 6. MECHANICAL INJURY: to the throat, esophagus, and stomach. PROCEDURE TYPES OF CATHETERS: 2. POSITION: dorsal recumbent for the female and supine for Preparatory phase  FOLEY CATHETER: common type of indwelling catheter. It the male using a form mattress or treatment table, Sim’s or 1. Protect the patient airway has soft, plastic or rubber tube that is inserted into the Lateral position can be an alternate for the female patient. 2. Keep the suction equipment ready bladder to drain the urine. 3. PROVISION OF PRIVACY 3. Cardiac monitor and pulse oximetry 1. INDWELLING CATHETERS: 4. IV line (20 Gauge)  one that is left in the bladder 5. Consent  can be used for short or a long time RETENTION OR INDWELLING CATHETER (FOLEY) 6. Patient position (Semi Fowler's position or left lateral with  collects urine by attaching to a drainage bag (the bag has  A catheter to remain in place for the following purposes: slightly elevated head) valve that can be opened to allow to urine to flow out.) A. The gradual decompression of an over distended bladder 7. Check baseline vitals with abdominal girth  may be inserted into the bladder in 2 ways: B. for intermittent bladder drainage 8. Check gag reflex 1. Catheter is inserted through the urethra. This is the C. for continuous bladder drainage Implement phase tube that carries urine from the bladder to the outside of  an indwelling catheter has a balloon which is inflated after 1. Hand hygiene the body. the catheter is inserted into the bladder. Because the 2. Insert lavage tube (same principle of NG tube insertion) 2. Insert a catheter into your bladder through a small hole inflated balloon is larger than the opening to the urethra, 3. Pour normal saline or tap water or antidote mixture into the in your lower belly. the catheter is retained in the bladder. irrigation container through or funnel  indwelling catheter has a small balloon inflated on the end POSITIONING: 4. Introduce 200 to 300 ml of irrigating solution via lavage tube of it. This prevents the catheter from sliding out of your FEMALE: Dorsal recumbent with knee flexed & thighs are 5. Aspirate the content with syringe or by gravity body. When the catheter needs to be removed, the externally rotated 6. If needed send the sample to lab for gastric analysis balloon is deflated MALE: Supine with thighs slightly abducted 7. Repeat the procedure until the goal is achieved 2. CONDOM CATHETER: PROCEDURE OF INSERTION: 8. Measure the amount, color and consistency  can be used by men with incontinence. A. FEMALE  there is no tube placed inside the penis.  Insert the catheter approximately 5-6cms. Once urine has  instead, a condom-like device is placed over the penis. started draining insert a further 3-5cms. CATHETERIZATION  a tube leads from this device to a drainage bag.  Inflate the balloon with 10 ml Sterile water URINARY CATHETERIZATION:  condom catheter must be changed everyday. B. MALE -- the introduction of a catheter through the urethra into the 3.INTERMITTENT CATHETERS:  insert catheter until urine has started to drain, then bladder for the purpose of withdrawing urine.  you would only use an intermittent catheter when you only insert a further 5cm or almost up to the bifurcation. PURPOSES: need to use a catheter to drain the bladder and then  Inflate the balloon with 10 ml sterile water  To relieve urinary retention remove it. C. Measures the amount of urine  To obtain a sterile urine specimen from a woman  this can be done only once or several times a day. D. Assess the patient is comfortable and the genital area  To measure the amount of residual urine in the bladder  the frequency will depend on the reason you need to use E. AFTER CARE  To empty bladder before and during surgery and before this method or how much urine needs to be drained from  On completion of procedure remove the and dispose of certain diagnostic examinations. the bladder. PPE and the articles SIZES URETHRAL CATHETER: DRAINAGE BAGS:  Remove drapes and help patient to put on clothes CHILDREN: 8 – 10 Fr  catheter most often attached to a drainage bag.  Give comfortable position FEMALE ADULT: 12 – 16 Fr  keep the drainage bag lower than your bladder so that urine  Documentation & report MALE ADULT: 16 – 20 Fr does not flow back up into your bladder. URINARY CATHETERS:  empty the drainage device when it is about one half full and WOUND CARE/DRESSING -- a tube placed in the body to drain collect urine from the at bedtime. bladder.  Always wash your hands with soap and water before  This is a process of cleaning and covering the wound. Urinary Incontinence: leaking urine or being unable to control emptying the bag. WOUND when you urinate. PREPARATION OF THE PATIENT:  An injury to living tissue caused by a cut, blow, or other Urinary Retention: being unable to empty your bladder when you 1. ADEQUATE EXPLORATION: on some instances, impact, typically one in which the skin is cut or broken. need to. catheterization is the last resort, use other techniques first for SURGICAL OR WOUND DRESSING STERILE Surgery on the prostate or genitals: Other medical conditions drawing out the urine before proceeding to catheterization.  dressing covering applied to a wound or incision using such as multiple sclerosis, spinal cord injury, dementia, or other aseptic technique with or without medication. operations. TYPES OF WOUNDS: Open wounds: Break the skin's surface and can damage lowering of the tissue temperature. Be sure to allow the  Plastic bag for waste disposal underlying tissues. flow from the cleanest area to the contaminated area to  Pad drum with sterile dressing pads and gauze pieces  Abrasions: Also known as grazes, these are superficial avoid spreading pathogens.  Towel or pad and mackintosh injuries to the upper layer of skin. They occur when the  Kidney tray skin scrapes against a rough surface.  Cheatle forceps  Lacerations: Deep cuts or tears in the skin with irregular TYPES OF DRESSING PROCEDURE edges. They can be caused by knives, tools, or  Gauze dressings 1) Position the patient comfortably machinery.  Non antiseptic dressing 2) Wash hand thoroughly  Punctures: Small holes caused by a sharp object like a nail,  Antiseptic dressing 3) Put on gown, gloves, mask etc. as necessary needle, or bullet. They can damage internal organs if they  Wet dressing 4) Open the sterile tray. Spread the sterile towel around the are deep enough.  Pressure dressing wound  Avulsions: Partial or complete tearing away of the skin and  Self adhesive transparent dressing 5) Pickup the dissecting forceps and remove the dressing and tissue beneath. They typically occur during violent PRELIMINARY ASSESSMENT put it in the paper bag. Discard the dissecting forceps in accidents. 1. Level of consciousness and understanding of the patient the bowl of lotion. Closed wounds: Don't break the skin's surface but damage 2. Vital signs 6) Note the type and amount of drainage present. underlying tissues. 3. Allergy to tape or cleaning solutions 7) Ask the assistant to pour small amount of cleansing solution  Bruise: a discoloration of the skin that occurs when small 4. Bleeding tendencies into the bowl. blood vessels break and leak blood into the surrounding 5. Doctor's order 8) Clean the wound from center to periphery, discarding the tissue 6. Bleeding or drainage from wound site used swab after each stroke. Other types of wounds 7. Condition of the wound 9) After cleaning dry the wound with dry swab. These include: PREPARATION OF THE PATIENT AND WARD 10) Apply medication if ordered.  Burns 1) Ensure that sweeping and mopping of ward is completed 11) Apply sterile dressings Gauze piece first then cotton pads  Diabetic foot ulcers 2) Explain procedure to the patient 12) Remove the gloves and discard it.  Osteomyelitis 3) All articles should be assemble at patient bed side 13) Secure the dressing with bandage or tapes.  Osteoradionecrosis 4) Proper lighting of the ward AFTER CARE OF PATIENT AND ARTICLES  Pressure ulcers 5) Switch off fan  Make the patient comfortable  Surgical wounds 6) Provide privacy by using screens  Replace equipment's  Traumatic wounds 7) Check the agency protocol about using cleaning solutions  Discard the disposable items  Venous stasis ulcers 8) Fix disposable plastic bags in holders on the trolley. Place  Wash hands PURPOSES within reach for disposal of soiled dressing.  Document the type of dressing, condition of the wound,  To promote wound granulation and healing EQUIPMENT NEEDED type of wound and patient's response  To prevent undue contamination of wound Sterile Articles required: Sterile dressing set containing the  Report is any abnormality is observed  To decrease purulent wound drainage (dressing materials following Artery forceps absorbs the drainage)  Scissors OXYGEN ADMINISTRATION  To apply medication to the wound  Small bowl  To provide comfort  Safety pin INTRODUCTION.  Oxygen is a gas found in air and has no colour, smell or taste INDICATIONS  Non-toothed thumb forceps  Open wounds  Cotton balls and very necessary for life.  Oxygen has the symbol O and atomic number eight (8).  Infected wounds  Gauze pieces  Oxygen makes up 21% of the atmosphere by volume.  Removal of stitches, staples or clips  Pads  Oxygen is obtained by two (2) methods, that is by  Shortening or removing drains  Gloves, mask gown PRINCIPLES FOR WOUND DRESSING Others Articles: distillation of liquid air and by passing a clean dry air 1. Use Standard Precautions at all times.  Cleaning solution prescribed through a zeolite that absorbs nitrogen and leaves the 2. When using a swab or gauze to cleanse a wound, work from  Sterile saline oxygen. the clean area out toward the dirtier area.  Prescribed solution for dressing wound  Oxygen is used in industries, water treatment and as a 3. When irrigating a wound, warm the solution to room  Adhesive or non-allergic tape therapy. temperature, preferably to body temperature, to prevent  Sterile gloves (1 pair) DEFINITION.   Oxygen administration is the process by which  Nasal catheter or Mask.  Oxygen precaution sign. supplemented oxygen is administered in high  Gallipot with cotton swabs.  Gloves. concentration than that of atmospheric air.  Water soluble lubricant. SOURCES OF OXYGEN IN HOSPITALS. PROCEDURE. Therapeutic oxygen is available from two sources: 1. Check doctors order including the date, time and flow rate. 1. Wall outlets. 2. Explain purpose and procedure to patient to gain his/her 2. Oxygen cylinders. cooperation and to allay fear/anxiety.  Stationary 3. Observe safety precautions in giving oxygen and let the patient,  Portable, mobile or ambulatory. other patients and visitors know the dangers involved. PURPOSE OF OXYGEN ADMINISTRATION. 4. Wash hands and dry. 1. To relieve dyspnea (shortness of breath) 5. Assemble the equipment's. 2. To prevent hypoxemia (low level of oxygen in the blood) and 6. Make patient comfortable in bed. hypoxia (low level of oxygen in cells). 7. Attach the flow meter with humidifier filled with 1/3 of water 3. To increase oxygenation in tissues. and pressure gauge to the threaded outlet of the oxygen cylinder. INDICATIONS FOR OXYGEN ADMINISTRATION. 8. Connect the tubing from the mask to the outlet on the 1. Severe respiratory distress (e.g. acute asthma and humidifier. pneumonia.) 9. Turn on the key on the oxygen cylinder and put the end of 2. Intra and post operatively tubing in the bowl of water to test for the flow of oxygen. 3. Hypoxia and hypoxemia 10. Apply the mask over patients nose and mouth and adjust the 4. Shock elastic strap over clients head to keep the mask in position. 5. Severe trauma 11. Use gauze or cotton swab to reduce irritation caused by the 6. Acute myocardial infraction (heart attack) elastic strap especially on patients scalp and ears. PRECAUTIONS FOR OXYGEN ADMINISTRATION. 12. Regulate flow meter as prescribed e.g. 2-3 liters/minute in 1. Avoid naked flames near oxygen cylinder. adults and half-2 liters in children. 2. Put a No Smoking sign at the entrance of the ward and near 13. Stand by to observe the flow of oxygen for some time before patient bed to warn others. leaving patients bed side. 3. Do not use oil on the oxygen cylinder. Oil can ignite if 14. Document the procedure and wash hands. exposed to oxygen. 15. Regularly check on patient for any abnormalities. 4. Do not use electrical gadgets or any article which can cause 16. Regularly check the flow meter and gauge for the amount of METHODS OF OXYGEN ADMINISTRATION. sparks near oxygen cylinder. oxygen in the cylinder and the water level in the humidifier. - There are many ways of administering oxygen to patients but 5. Do not give oxygen to a hyperventilated patient 17. Remove mask from patient when he/she is better. Turn off the most common ones are: 6. Keep oxygen cylinders in a dry and cool place oxygen and make patient comfortable in bed.  By mask. 7. Mark oxygen cylinder to indicate whether full or empty. 18. Record and report any abnormalities.  By nasal cannula. 8. Use only carriers with wheel to transport oxygen cylinder, do not roll the oxygen cylinder. 9. Oxygen must only be administered at the rate and percentage prescribed. 10. Do not adjust flow meter until instructed. 11. Encourage or assist patient to move about in bed to prevent hypostatic pneumonia or circulatory difficulties. ARTICLES/EQUIPMENTS NEEDED FOR OXYGEN ADMINISTRATION.  Oxygen source: wall outlets or oxygen cylinder. REQUIREMENTS. REQUIREMENTS.  Bowl containing water.  Oxygen source.  Oxygen source.  Flow meter.  Oxygen tubing.  Oxygen tubing.  Oxygen precaution sign.  Nasal cannula Mask.  Oxygen Mask.  Humidifier filled with sterile water.  Bowl containing water.  Bowl containing water.  Oxygen tubing.  Gallipot with cotton swabs. Oxygen precaution sign.  Gallipot with cotton swabs.   Gloves.  Patients can vomit and let oral secretion out easily without 1. For vaginal examination - to determine the presence of any interruption in oxygen delivery prolapse uterus  It delivers low concentration of oxygen 2. For orthopedic condition PROCEDURE. Disadvanatges 1. Check doctors order including the date, time, flow rate and  It can easily dislodge from patient nostrils PROCEDURE: method.  It causes irritation in the nostrils 1. Assist the client to stand either with slippers or in bare feet 2. Explain purpose and procedure to patient to gain his/her  It causes dryness in the nostrils on a piece of paper. cooperation and to allay fear/anxiety. MASK 2. Untie the gown and leave the uppermost taped. 3. Observe safety precautions in giving oxygen and let the patient, Advantages 3. Fold back the gown over both shoulders towards the front other patients and visitors know the dangers involved.  It delivers high concentration of oxygen when the physician is ready for examination. 4. Wash hands and dry.  Its quick and easy to apply B. HORIZONTAL/SUPINE OR RECUMBENT POSITION 5. Assemble the equipment's. Disadvantages - Position in which the patient lies flat on 6. Make patient comfortable in bed.  It must be removed while talking, eating, vomiting, and the back, with the head and shoulders 7. Attach the flow meter with humidifier filled with 1/3 of water drinking also flat on the bed and pressure gauge to the threaded outlet of the oxygen cylinder.  It obstruct coughing PURPOSE: 8. Connect the tubing from the nasal cannula to the outlet on the  It blocks vomitus in unconscious patient 1. General physical examination humidifier.  Carbon dioxide may build up in the mask 2. Various operative procedures 9. Turn on the key on the oxygen cylinder and put the end of  It causes skin irritation 3. For comfort by providing a change tubing in the bowl of water to test for the flow of oxygen.  Aspiration of vomitus is likely when mask is in place in position 10. Clean patient nostrils and place cannula in patients nostrils, SIDE EFFECTS OF OXYGEN ADMINISTRATION. PROCEDURE: send the tubing over patients head and adjust it behind patients  Oxygen toxicity. 1. Replace top sheet with a draping sheet. head/ears.  Drying of the mucus membrane. 2. Cover the patient from the shoulders to the foot part with 11. Encourage patient to breath through the nose and exhale  Infection. the sheet hanging loose at the sides. through the mouth to trap more oxygen into the trachea, which is 3. Assist the patient to lie flat on his/her back with the legs less likely to be exhaled through the mouth. POSITIONING/DRAPING together, extended or slightly flexed. 12. Regulate flow meter as prescribed e.g. 2-3 litres/minute in 4. Place one pillow under the head and another smaller one adults and half-2 litres in children. POSITIONING - to place or arrange the client to assume a certain maybe placed under the knees for support. 13. Stand by to observe the flow of oxygen for some time before position for physical examination or treatment 5. Place the arms along the sides of the body or comfortably leaving patients bed side. DRAPING - a piece of cloth placed over a patient's body during an flexed on the sides. 14. Document the procedure and wash hands. examination or operation C. DORSAL RECUMBENT POSITION 15. Regularly check on patient for any abnormalities, especially GENERAL CONSIDERATIONS: - the patient lies flat on the back the nares for irritations in an interval of four (4) hours. 1. The method of draping vary with the position of the patient, with head and shoulders slightly 16. Regularly check the flow meter and gauge for the amount of examination to be done and temperature of the examination elevated on a small pillow oxygen in the cylinder and the water level in the humidifier. room. PURPOSE: 17. Remove nasal cannula from patient when he/she is better. 2. Draping should be arranged so as to avoid all unnecessary 1. Vaginal examination 18. Turn off oxygen and make patient comfortable in bed. exposure, but at the same time not to interfere with a thorough 2. Digital rectal examination 19. Record and report any abnormalities. examination. (DRE) CLEANING THE CANNULA AND MASK. 3.. Draping should be loose enough to allow a quick change of 3. Pelvic examination After each use, the oxygen cannula and mask must be cleaned by: position but anchored securely so as not to be displaced by 4. For catheterization  Soaking the cannula or mask in a soapy water or savilon for patient's movement. PROCEDURE: an hour. 4. Methods of draping should be designed with consideration for 1. Replace the top sheet with the draping sheet.  Dry it properly. those who are embarrassed by exposure of the body. 2. Assist the patient to lie flat on his/her back.  Clean the tip of the cannula with a spirit swab. With the 5. Draping should be warm whenever the circumstances require it. 3. Separate the legs, flex the knees so that the soles of the feet mask, clean the interior before reapplying it to a patient. A. ERECT OR STANDING POSITION are flat on the bed. NASAL CANNULA. - the head and body is held in an upright position 4. Place the arms either above the head or flex with the hands Advantages PURPOSE: on the chest.  Patients are able to talk, eat and drink with oxygen in place 5. Bring buttocks of the patient to the edge of the bed.  6. Place one pillow under the head. 1. Assist the patient to lie on either side, preferably the left 4. Drape patient appropriately as in horizontal recumbent 7. Place the draping sheet diagonally on the patient so that the with the body inclined forward. position. opposite corners cover the legs. (Optional: Drape with two 2. Extend the left arm behind the back and flex the elbow of sheets placed over the body) the right arm forward. 8. Fold back the top corner over the chest. 3. Flex the right thigh towards the abdomen with the knees 9. Wrap the corner in the right side around the right foot. drawn up higher than the left knee, which is only slightly flexed. 10. Do the same with the left side. 4. Lay out the draping sheet as in horizontal recumbent 11. Fold the lower corner of the sheet pack on the abdomen to position. H. TRENDELENBURG POSITION expose the part to be examined when the doctor is ready to do 5. Fold back or gather a side of the sheet to expose the area to - the head and body are lowered so. be examined. PURPOSE: D. DORSAL LITHOTOMY POSITION F. PRONE POSITION 1. Used for surgery on the lower - back lying position with lower - the patient lies on the abdomen with abdomen and pelvis legs raised and supported by the head turned to one side 2. For treatment of shock or stirrups PURPOSE: PURPOSE: decreased blood pressure 1. For cystoscopic examinatio