HOSPICE FON (BY MRS. NANAKUMO).pdf

HEALTH CARE INSTITUTIONS INTRODUCTION Health care institution is where physicians admits clients in need of intense medical and nursing care, including surgery with other highly technical procedures. DEFINITION OF TERMS D...

HEALTH CARE INSTITUTIONS INTRODUCTION Health care institution is where physicians admits clients in need of intense medical and nursing care, including surgery with other highly technical procedures. DEFINITION OF TERMS Definition of Healthcare Institution: is a public or non-profit organization within a state that provide healthcare and related services including but not to the provision of impatient and out patient’s care or within diagnostic therapeutic services, laboratory services, drugs, nursing care, assisted living, housing including retainment community and equipment use for the provision of healthcare related services. HOSPITAL: Home of the sick people where treatment is given. It is a healthcare institution with staff and equipment for diagnosis of diseases and treatment. A place where the sick or injured persons are given medical care and attention. INSTITUTION: An institution provides medical nursing care, treatment, education, rehabilitation and support services for patients including sufficient basic services. ORGANIZATION: A group of persons formally joined together for some common interest. ORGANIZED: Following a set of Methods or arrangement or pattern. 1st Hospital built 805 in Baghdad by Harun Al. Rashid. WARD: is a large room in a hospital where people who need medial treatment stay. e.g. Maternity/general/geriatric etc. it could be a place where people with a particular medical condition receives treatment. HOSPICIES (Hotel, Hostel, Hospital): it is run by public or private agencies are designed to care for terminally ill clients and their families by providing supportive, palliative services. (Castro 1994). Many Clients receiving the services are: Multiple sclerosis, congestive heart failure, cancer, HIV and AIDs (Human Immune virus and Acquired Immune deficiency Syndrome and end stage of renal diseases. 1 Hospice is from Latin word mean guest, or stranger. Root of Hospice are Hotel, Hostel, Hospital. Nurses play a major role in hospice care, team approach, physician therapist, Social welfare. INVENTION OF THE HOSPITAL In the 4th Century under the ministry of St. Jerone a wealthy Christian widow named St. Fabiola build hospital for poor in Rome and cared for the sick herself. HOSPITALS Gradationally was main healthcare institutions. TYPES OF HOSPITAL GENERAL, SPECIALITY, GOVERNMENT, UNIVERSITY OR COLLEGE MEDICAL CENTERS. CLASSIFICATION 1. Acute Care Hospital: - Treats patients in the acute phase of an illness or injury. 2. Addiction/Substance Abuse Treatment: - Exist solely to provide assessment and treatment of individuals with addictions. 3. General (Community): - Non-federal, Short term (acute care) where diagnostic and therapeutic services are available the public. 4. Rural Hospital: - Located designated metropolitan statistical area e.g. Nursing Home, Health centre and mobile clinic. 5. Long-term care Hospital: - provides medical and skilled Nursing services to clients/patients with long term illness and require service not available in a nursing home. 6. Urban Hospital: - Located in towns and cities. 7. Psychiatric Hospital: - provides diagnostic and treatment services to patient with mental and emotional disorders. 8. Rehabilitation Hospital: - provides medical health related, social or vocational services to disable individuals to help them attain their maximum functional capacity. 9. Teaching Hospital: - has an accredited medical residency, training programs and usually has affiliation with a medical school. The word/hospital originates from latin hospes, meaning guest or stranger. It is the root of the word such as hospice, hostel, hotel and hospitality. 2 The word patient comes from “Patrior,” which means the ‘suffer’. Hence, hospice can be interpreted etymologically as a place where strangers who suffers come to be cared for. The Hospital is a space focused on whole patient and comprises of structurers and different departments units, providing quality services to patients/clients. DEPARTMENT IN THE HOSPITAL 1. Administrative Department 2. Nursing Administrative 3. Medical Record and Statistics Department 4. General outpatient Department (GOPD) 5. Laboratory Department 6. X-ray/Radiology 7. Physiotherapy 8. Ear Nose and Throat Department (ENT) 9. Dental Department 10. Eye/ophthalmology Department 11. Nutritional/Dietician Department 12. Social welfare Department 13. Works Department 14. Accident and Emergency Unit 15. Surgery Department. ❖ The Hospital Administrative Department: is also made up of sub- department like Account, Audit, procurement, Registry. ❖ Nursing Administration: Controlled head by a director of Nursing Services (DNS), Deputy Director of Nursing Services, Assistant Director of Nursing Services and other ranks in Nursing. They directs and control the Affairs of Nursing along wit Nursing, Audit units in the Hospital. ❖ The Hospital wards are organized to render quality Services and nursing care to patients/clients. It is headed/by head of department who is a Doctor or medical officer. He Supervises the Doctor, Nurses and other health team in the unit. ❖ Head of Unit: A Nurse who could be an Assistant Director of Nursing or Chief Nursing Officer, Assisted by Assistant Chief Nursing Officer with other ranks working together to achieve quality nursing care. e.g. 3  Principal Nursing Officer, Senior Nursing Officer, Nursing Officer I, II, Job aid, Health Assistants and Ward maids. ❖ A Change Nurse/Ward head is a Senior Nurse who is responsible for all services and activities in the ward. He/She supervises the Nurses and other team workers in the unit. ❖ Hospital have been dominant provider of care recently, various alternatives Structures have been developed such as alternative secondary care, NHIS (Natural Health Insurance Scheme), Social Services therapeutic Services, occupational or speech therapy and Hospices. MEANING OF HEALTH SYSTEM Health System can be broadly defined as a coherent whole of may interrelated components parts, both sectional and inter sectional as well as community itself which produces a combined effect of the Health of the population. Health System: consist of coordinated parts extending to the home, work place, school and community. AIMS OF HEALTH SYSTEM Delivering Health Services to the beneficiaries.it constitutes the management sector and involves organizational matter and in allocating resources, translating policies into services, evaluation and health education. The aim encompasses promotive, preventive, curative and rehabilitative aspects and also caters care for the extremely disabled and incurable. THE STRUCTURAL ORGANIZATION OF HEALTH SYSTEM Structural organization of health care is at 3 levels (3 tiers) 1. Federal 2. State 3. Local Level (Local Government) Each has important role to play in the health service in Nigeria. The official “organs” of the health system at the federal level consist of: 1. The Federal Ministry of Health 2. The National Council of Health Head Quarter in Abuja. 4  FEDERAL MINISTRY OF HEALTH It is headed by the Ministry of Health. It is a political appointment currently; the Federal Minister of Health has 5 Directorate’s Departments. These includes; i. Department of personal management ii. Department of Finance and supply iii. Department of planning research and statistics iv. Department of Hospital Services v. Department of Primary Healthcare and Disease Control. RESPONSIBILITIES OF THE FEDERAL MINISTRY OF HEALTH 1. Takes necessary action to review National Health policy and its adoption by the Federal Government. 2. Devise a broad Strategy forgiving effect to the National Health policy and through the implementation by Federal, State and Local Government in accordance with the provision of the constitution. 3. Submit for the approval of Federal Government a broad financial plan for giving effect to the Federal Component of the Health Strategy. 4. Formulate National Health Legislation as required for the consideration of the Federal Government. 5. Acts as Co-ordinating authority in all health work in the country on behalf of Federal Government. 6. Assess the Country’s Health Situation and trends undertake the related epidemiological surveillance and report back to Government. 7. Promote an informed public opinion on matters of Health. 8. Allocate Federal Resources for implementation of Health Strategies. 9. Support State and Local Government in Developing. 10. Define standards with respects to the delivering of Health care. 11. Promote research is relevant to the implementation of the National Health Policy. 12. Promote co-operation among scientific and professional groups as well as non-governmental organizations. 13. Monitor and evaluates the implementation of this National policy on behalf of government and report to it’s findings. THE NATIONAL COUNCIL OF HEALTH (STATES) i. The Honorable Minister of Health is Chairman. ii. The Honorable Commissioner of Health (State). 5 Apart from these two, there is technical committee of the National Council of Health, shall composed of: 1. The Federal and State Permanent Secretaries (MOH) 2. The Directors of Federal (Ministries) of Health 3. The professional Heads in the Armed forces Medical Services. 4. Director of Health Services, Federal, Capital Territory Abuja. Organization at the state level at present are 36 states and the Federal Territory Abuja has many types of Health Administration. In all the states, the management sector for Health lies with ministry of Health, while in some of the states, management board also participates in the management. THE STATE MINISTERY OF HEALTH In each State Federation, Ministry of Health handles second level of Healthcare deliveries. It is headed by the Honorable Commissioner while in Health Management Board, there is Governing Board with an Executive Secretary. The Commissioner is a political health of the Ministry, while permanent Secretary is the administrative Head. There are Directors assisted by Deputy and Assistant Directors and Head of unit. FUNCTIONS OF THE STATE MINISTERIES OF HEALTH 1. Directs and Coordinates authority on Health ensuring political Commitment 2. Ensuring economic commitment 3. Winning over Professional group 4. Establishing a managerial processes 5. Public information on Education 6. Financial and Material resources provision 7. Inter Sectoral action 8. Co-ordinating within the health sector. 9. Organizing primary Health care in communities 10. Federal System 11. Logistic System 12. Health Man power recruitment and retaining 13. Priority Health programmes. 14. Health Technology 6  15. Researches 16. Referral Services. LOCAL LEVEL There are 774 Local Government Areas in Nigeria with various Health facilities operating under the hinges of primary Health Care (PHS). The Local Government Headquarters Coordinates the activities of the Health Facilities, providing man power funds, logistics and control supervised by state. They form third level of Health Services. FUNCTION OF THE LOCAL GOVERNMENT 1. Provision and maintenance of essential elements of primary Health care, Environmental sanitation, Health Education. 2. Design and implements strategies to discharge the responsibilities designed to them under constitution, support and supervision of state Health Ministries. 3. Motivation of the Community to elicit the support of formal and informal leaders. 4. Local Strategy for health activities. 5. Recruitment, training, promotion and disciplines of staff. 6. Planning and organizing of PHC Services. 7. Leasing with state and federal Governments on primary Health care matters. 8. Enforcement of environmental health laws. 9. Referrals Services. LEVELS OF HEALTH CARE Nigerian operates three levels of health care delivery system for administrative convenience. 1. Primary 2. Secondary 3. Tertiary PRIMARY LEVEL This is the entry point of the healthcare delivery system. It is grass root, health care services nearest to where people hire and work. Services are health promotion and education with specific protection e.g. Immunization, 7 early detection and treatment of ailments. It encourages community participation in organization of Health Services. The community members should be involved in the planning, implementation and evaluation of health programme. Local Government Areas are responsible for primary health care activities. General hospital services as the main referral centers, more or large people are seen as out patients. There is decrease in hospitalization with better out comes. Examples of primary levels are: 1. Mobile Clinics 2. Health Centers 3. Nursing Homes 4. Cortege Hospital 5. Specialist Hospital 6. Private hospitals and other clinics. NOTE: Health promotion, Education, protection against diseases and screening exist in primary level. SECONDARY LEVEL This is the second level of healthcare, it performs those services that cannot be accessed by the primary level. There is more sophisticated equipment’s and also higher man power than primary. It has facilities for both in patients and out patients’ services with specialized care. Care is more of curative than preventive, they provides specialized services. Facilities that belongs to this group are: General Hospital/Divisional Hospitals 1. Federal Medical Centers 2. Specialist Hospitals e.g. Dental, psychiatric 3. Radiological centers Specialized care or services rendered at this level includes; Emergency care, Acute and critical care, collaborative diagnostic, obstetrics and 8 gynecological, surgical, pediatrics, eye, ear, nose and throat, burns and plastics etc. State and Federal Government are responsible for the smooth running of the programme. Teaching Hospital serves as the main referral centers, while care is preventive and curative. NOTE: Nursing education exist within the category of secondary & Tertiary levels. 9  TERTIARY CARE This is apex of Healthcare delivery system. It provides highly specialized services that the two levels cannot provide. They have received accreditations for several functions like: Training of Resident Doctors, psychiatric public Health, Nurses dialysis, researchers etc. 1. Advanced and expert management care or services are rendered. This is known as specialized consultive care e.g. a. Plastic Surgery b. Burns and plastic surgery 2. Cardiac Surgery 3. Cancer management or onychology 4. Neuro Surgery 5. Complex medical and surgical intervention 6. Urology 7. Hospice Care 8. Therapeutic Services to those with health problems. Examples of Facilities in this groups are: 1. National Hospital Abuja 2. University College Hospital, Ibadan 3. Teaching Hospitals in various states 4. Diagnostic Centers or Hospitals 5. Orthopedics Hospitals Dala, Kano. NOTE: Rehabilitation, Long-term care, supportive services and hospice care occur at third level. QUATERNANCY CARE 4th level of Care (very ill health) is considered to be an extension of tertiary care. It is even specialized and highly unusual care. it is specific care for particular medical conditions or systems of the body. This type of care might be experimental and medicines and procedures as well as highly uncommon and specialized surgeries like kidney transplanting or heart surgeries are carried out. 10  SIMPLE BED MAKING All Patients in the Hospital have their bed made at least once a day and more often, if their nursing care demands it. For example, unconscious patient who are incontinent. Hospital patients spend varying amount of the day in bed and its comfort, therefore is considerable importance. To ensure this, the bed should be made fresh, free from crumbs and creases, and the pillows arranged to give support where necessary. Beds treads Those used in the Hospital wards are usually made of metal with wire springs. The smooth out line of the metal facilities cleaning and prevents the collection of dust. Most common size is six feet, six inches by three, feet. It allows the Nurse to attend to the patient conveniently without physical strain. The hospital bed should be placed at least five feet apart. Mattresses Mattresses are the two types, most commonly used in hospital wards. They are sometimes covered with a protective water proof materials. Blankets Turkish toweling, cellular cotton, synthetic material or wool blankets may be used to provide warm when necessary without too much weight. They should always be washed with patient is discharged. Counterpanes These are usually light in collower and in weight. As they require to be laundered frequently, they should be made of a durable materials. Cotton draw sheets A fairly heavy cotton is the most suitable material. The standard size is two yards (one yard wide when folded) one and half yard long. This is placed across the under-patient’s buttocks so that, at frequent intervals, can be “drawn” to give patient a clean, cool, fresh piece of sheet of sheet to lie. 11 Water proof draw sheets These consists of pieces of rubber or plastic sheeting about thirty inches square with piece of material stitched to each end. It is tucked in and held firmly in position under the cotton draw sheet by which it must be completely covered. Sheets Cotton, polyester/cotton mixture or linen is used to cover the entire bed surface. Long water proof sheets In some hospitals these are used in all beds as a matter routine but in other hospitals, they are only for selected patients. They are long enough to stretch over the whole and bottom for the bed. Now a days some hospitals covers the entire mattress. General Rule to Be Observed in Making Hospital Beds 1. All requirements should be collected before starting. 2. Two Nurses are required and they should work in harmony, avoiding jerky movement and jarring the bed. 3. The patient’s face must never be covered by sheets or blankets. 4. The patient must never be exposed. 5. Extra assistance should be available and if necessary, should be called upon to help lift the patient. 6. When pillows are being shaking, the Nurse should turn away from the patient. 7. Any conversation during bed making should in dude the patient and not of personal matter between the Nurses. 1. UNOCCUPIED BED The requirements to make an unoccupied bed one: 1. Tubbed sheets 2. One cotton draw sheet if necessary. 3. One avatar proof draw sheet, if necessary. 4. Two pillow ships and pillows. 12  5. A flannet sheet to be put next to the patient if so desired. 6. Blanket if acquired. 7. One Counter paired. 8. One long water proof sheet if necessary. Method Check You Procedure Book Note: two chairs, hamper for soiled linen, items carried on trowley. An unoccupied bed refers to as a bed allocated to an ambulant patient or patient who can sit or move out of a bed. 2. UNOCCUPIED BED This refers to a bed where patient is not allowed to get out of bed e.g. unconscious patient and head injury. Method: refer to procedure/book for other special bed making e.g. Admission operation etc. Note: Bed is screened or ward closed near by window should be closed if necessary and procedure explained to the patient. All linen is removed to the sluice room. Patient’s must never be left uncovered. USES OF BED ACCESSORIES OR SPECIAL APPLIANCES USED IN BED MAKING Special beds are used on many occasions for the comfort of the patient, for the protection of bed linen, prevention of pressure sores, to facilitate putting the patient into bed without delay and in the care of patients with certain conditions and diseases. Extra appliances may be added to the requirement for a simple bed in preparation of special beds. 1. Water proof materials: - used to protect bed sheets, draw sheets, blankets, counter panes, pillows and mattresses. Water proof pillow cases can be specially made to protect pillows. It is also referred to as mattresses cover or protective/making tosh. 2. Hot – water bottles: - these are used to give added warmth to the patient. They maybe made of: rubber, earthenware, copper or aluminium. Care should be taken in filling of hot water bottles. 13 3. Rules for filling of Rubber hot – water bottles. a. It is never filled directly from the kettle. A funnel is placed in the opening of the bottle and water, which should be just off the boil, is poured into the bottle from a jug. b. The bottle is filled three quarter full. c. Air is expelled and the stopper screwed firmly in position. d. The bottle is inverted and inspected to ensure that there is not leakage. e. Bottle is placed in a flannel cover which is tied securely. f. When bottle is placed in a patient’s bed, there must be at least one fixed or fucked in blanket between the patient and the bottle. FOAM RUBBER RING This rings maybe placed under patient’s buttocks for relieve pressure. 3. WATER BED These appliances also helps in prevention of pressure sores. The water bed completely covers the mattress and is filled with water. REQUIREMENT FOR THE PREPARATION AND FILLING OF A WATER BED The water bed Fracture boards Two Blankets Ed linen as for a simple bed. A jug A Funnel A long water proof sheet A lotion thermometer METHODS OR PROCEDURES FOR FILLING A WATER BED The Bed is stripped, linen and blanket being placed neatly over two chairs. 14  ❖ Mattress is removed and fracture boards placed over the springs of the bed to immobilize and support the weight of the water bed, mattress placed over board and covered first with water proof sheet, then blanket. ❖ Put water bed on top of the blanket bed is wheeled to convenient water tap and using the funnel and jug the bed is filled with water at 380c (1000F) ❖ Air is expelled before securely fitting the stopper. ❖ Check that a suitable amount of water has been added. ❖ The Nurse should place her fore arm about a foot apart on the water bed and with moderate pressure, should just filled the under surface. ❖ The bed is then wheeled into position and the water bed covered with second blanket which is tucked in all round. ❖ It is the make up as usual way. ❖ Half sized water bed can also be used filled in the same manner. Pillows maybe used to make the surface level and equal amount of water at a temperature at the desired level. At the end of the fort night, the bed is emptied and washed and still required. It is refilled with fresh water at the temperature of 380c (10000F) Advantages of Water Bed Disadvantages of Water Bed 1. Extremely comfortable. 1. It can be deflated to save space if 2. Relief pressure and joint relief. need be. 3. It provide warmth and prevents 2. Portable easy to lift and ideal for use chilly in winter night due to heated. on campy tops. 4. It prevents pressure sore. 3. Soft and prevents pressure sore. 4. AIR BED Similar to water bed, but it is inflated with air in the same way as an air conclusion. It is lighter than water bed and fracture boards. Air is used to fill or for inflating. 5. ELECTRIC BLANKETS These are used when quick and concentrated heat is required. They should be placed on top of the first fixed blanket. They may be used in beds prepared for the return of patients from operating room (theatre). 15 Electric blanket is removed before the patient is put into the bed. They are usually thermostatically controlled, but the Nurse must ensure that they do not over heat. 6. Bed Cradles These appliances maybe made of metal or wicker and the wary in size. They are used to keep the weight at the bed clothes off the patient leg or body. When in use, a flannelette sheet or soft blanket maybe placed next to the patient. 7. Bed Rest/Trapeze Bar These maybe attached to or separated from the bed. The attached type forms part of the head of the bed and is pulled forward if required. The separate type is usually made of wood with canvas used when necessary for patient to sit upright in bed. Pillows are placed between patient and the rest. The bed rest also reduces the number of pillows required. Different degree of elevation can be arranged to suit the height required for individual patients. 8. Bed Elevators and Bed Blocks Bed Elevators: - are made of mental and hare several rungs at varying heights on which the bar of the bed maybe supported at desired height. They are used to elevate either the bottom or the top of bed in treatment of certain conditions. 9. Sand Bag These are specially made tables which can be drawn up in front of patient and maybe used for the following purposes. 1. During meal in which the patient’s tray may be placed. 2. For patient who is very breathless and to find breathing easier, sitting upright and leaning slightly forward. In this instance, a pillow is placed over the fable, which the patient may rest his arms and head. 3. It is also used for writing, if patient desire to do so. 10. Fracture Boards This is used in orthopedic and surgical wards. They are board which is hard, fix across the springs of bed and used to prevent the mattress from sagging. They are required when water beds are in used the treatment of some fractures and back injuries. If a single board is used and are not perforated, spaces are left between the board for ventilation purposes used in fractures of spines, pelvis, and femur to give firm support in bed. 16 11. Bed Rails It is attached to all beds of various types and is raised side failed to avoid patient’s falling from bed and prevent them from becoming injured. TYPES Portable rails for adult Portable rails for children; and Hospital rail attached to hospital or medical bed. BENEFIT OF BED RAILS 1. Aids turning and positioning in bed. 2. Provides comfort and security. 3. It provides and support to get out of bed. 4. Provides easy access to bed. 5. Prevent falling from bed, especially in unconsciousness. RISK OF BED RAILS 1. It can cause skin brushing, cut & scrapes in restless patients and mental health cases. 2. In struggling, suffocating/respiratory distress, when in uses. 3. It must be under supervision to prevent injury or death from falling aside between mattresses and rail. 12. Ceiling Lift This is a motorized device used to lift and transfer patient from one point to another along an over bad track. It can be mounted on ceiling or self-portable (self-standing or free standing tracked). The Ceiling lift greatly reduces the strain on a care giver as the patient can be involved easily, safely and with dignity and comfort. In Orthopaedic ward, some are attached to bed for easy. Sit up or support to patients. It is important to match individual’s need and mobility to the lifts capability and intend use e.g. if a patient is able to control and support themselves, may need a lift with hand, held controls that can be operated, while hand hold controls for a person who requires total support. 17 13. Bed Side Commodes It looks like a chair/bench and is set up near a bed. Also known as portable toilet, chair or commode chair, bed side commodes that has a seat similar to toilet seat. It has a detachable basin under the seat, collect urine and faeces which is emptied after use. It is used in recovery from an injury surgery or illness when going to bathroom toilet. TYPES OF COMMODES (FIVE) 1. All in one Commode 2. Drop arm Commode 3. Padded Commode 4. Ban citric Commode 5. Folding Commodes SPECIAL BEDS 1. Admission Bed 2. Operation Bed 3. Fractured Bed 4. Cardiac Bed 5. Divided Bed 6. Amputation Bed 7. Tent Bed 8. Plastered Bed AIM/OBJECTIVE OF THESE BEDS 1. To have it made up in such a way that patient can be admitted without delay. 2. For warmed, if necessary for the comfort of the patient. 3. To allow for immediate admission, for actively ill patient. After accidents, it is not always suitable to remove working clothes before admission to bed, in many cases certain treatment e.g. shock, must be carried out immediately. REQUIREMENT FOR ADMISSION BED 18 Requirement’s for simple bed plus long water proof sheet or mackintosh. Two bath sheets. Pillows (with mackintosh covers) and pillow cases Bed blocks or elevator, and bd cradle depending upon the condition of the patient being admitted. Most bed now come with elevator, which can be turn if need arise e.g. shock and profuse bleeding. METHOD OF MAKING ADMISSION The bed is made up for simple bed until the draw sheet is in position: Bottom linen and pillows are covered with long water proof or mack in tosh. Blanket is place over it. A bath sheet is placed over the blanket and tucked in all round and folded. Top bed clothes are now put on and folded under at one side leaving one side open a facilitate quick admittance. Other side of bed cloth is bucket in. Turn up 45cm of the bed clothes. When patient arrive, fold back into two from bottom and placed on a chair. Top Sheet is removed. Place patient on bed sheet and cover within 2nd bath blanket. Place back the bed sheet removing over patient and metered corners. Two long mackintosh and two bath sheets are removed after the patient has been bathed. OPERATION BED OR POST OPERATIVE BED OBJECTIVE 1. To receive patient after operation. 2. To counteract shock/prevent chilled. 3. To get the patient into bed as quickly as possible. 4. To protect linen from vomit and saliva and discharges. 5. To clear the mouth, saliva and vomitus, for which purpose a tray is prepared and also protect mattress from bleeding. EXTRA REQUIREMENT IN ADDITION TO THOSE SIMPLE BED ✓ Mackintosh 19  ✓ Flannelette sheets ✓ Two covered hot water bottles or an electric blanket, if necessary, or blanket or counterpane. ✓ Bed blocks or bed elevator, bed cradle, if intravenous infusion stand, and oxygen apparatus. ✓ A tray by the bedside containing a vomit bowl, dressing towel. ✓ A kidney dish containing swab, holding forceps, dissecting forceps, tongue forceps, tongue spatula. ✓ A gallipot for used soded solid swabs. ✓ A gallipot of cold water and mouth wash. ✓ Observation tray, screen, suction machine. METHOD OF MAKING THE BED Bed is made up as for a simple bed until the draw sheet is in position. Mackintosh and dressing towel are placed at the top of the bed in place of the pillows. Flannelette sheet is positioned loosely with hot water bottle or blanket (electric blanket). UPPER BEDDING: top sheet and counter pane turning up at bottom, fold over at in three neatly to form a long pack in Centre place pillows on a chair against wall. FRACTURE BED AIM OF FRACTURE BED 1. To provide a firm base 2. To prevent sagging of the mattress 3. To prevent movement of the injured part i.e. immobilize the fractured site. 4. Make patient comfortable ADDITIONAL REQUIREMENT ❖ Two fractured boards ❖ One top sheet ❖ A bed cradles ❖ Two sand bags ❖ Small mackintosh and large towel, if fracture is compound ❖ Roller support METHOD 1. Fracture boards one placed under mattress for firm support 2. Make bed up to draw sheet (as in simple bed) 20  3. Place roller towel over fracture. This is omitted if plaster has been applied 4. Cover patient with top sheets to provide warmth 5. Graddle is placed over the affected part or keep off the weight of the bed clothes 6. Top sheets are made over the cradle N.B If fraction is used, the leg on fraction is clear of the bed. The top bed cloths may be divided into two halves one half covers the trunk, second half covers the good leg and under the leg on fraction. PLASTERED BED REQUIREMENT 1. Fracture boards 2. One top sheet 3. One dressing mackintosh 4. One dressing towel 5. One hard pillow 6. A bed cradle METHOD ❖ Put fracture bed under mattress ❖ Dressing mackintosh and towel placed under leg on plaster for support. ❖ Place top sheet next top and good leg ❖ Make cradle over plastered limb to prevent weights of bed clothes. ❖ Lower and of bed is covered neatly and folded at edge of cradle to dry plaster of Paris (POP) DIVIDED BED Definition: as the name implies, this is made into two separate parts with a division in the Centre AIMS 1. For examination of the lower parts of abdomen 2. To conduct rectal and virginal examination 3. Use in carrying out procedures e.g. catherization 4. Use in perineal wound dressing 5. Use in treatment of femoral fracture 6. To facilitate of the stump and visibility 21 METHODS See procedure book or manual EXTRA REQUIREMENTS: 1. One additional top sheet 2. Counterpane (may not be necessary) AMPUTATION BED- modification of divided bed EXTRA REQUIREMENT 1. Sand bag 2. 1 roller towel top laced sand bags 3. Tourniquet and cloth. If an extra blanket is requirement to provide warmth, it is arranged not to cover the division for observation of the stump. The bed is made to facilitate the dressing if the stump and ensure is visible. Stump can be immobilized by using towel and two sand bags. Tourniquet is applied in place of bleeding. CONGESTIVE CARDIAC BED 1. A trolley with two sheets 2. 1 flannets sheet 3. Draw sheet 4. 5 pillows with case 5. 1 small pillow 6. A bolster, bed cradle, air ring EXTRA REQUIREMENT. Drip stand, oxygen cylinder containing oxygen suction machine, bedblocks or elevators. 5 resuscitations kits or items. ADDITIONAL TO CARDIAC BED i. A bed tables ii. A soft pillow placed on the bed iii. A sputum mug iv. A bell, bed cradle/ foot rest v. Tissue papers and paper bags pinned to sheet within patient react. 22 AIM: To ease difficulty in breathing NOTE: 1. Patient must remain upright all the time, position must be changed by allowing him/her rest the hand and arms on pillow or bed table pilled up closed to him. 2. If bottom sheet is dirty, roll some up to buttocks, clean sheet at end of the bed tuck and unstuck corner, roll extra up to patient’s buttock more down to end and finish the top end of the bed as the buttock end. STEPS/METHOD 1. Make bed draw sheet 2. Place back rest 3. The air ring is a cotton cover is put under patients buttock to prevent pressure sores. 4. Arrange pillows in arm, chair fashion. If patient is dyspneic, may prefer to be sitting in a high fowler’s position. 5. A foot rest may be placed between feet and bottom of the bed to prevent slipping down. 6. Bed cradle to take weight of bed clothes off 7. If patient is chilly or cold, a flannelette sheet can be used next to cradle PRECAUTION TO BE TAKEN DURING BED MAKING 1. The uniform of the nurse should not touch the bed while making the bed 2. Soiled linen should not be thrown on the floor 3. First lift the mattresses while loosening the bed linen or removing the sheet. 4. Bed /linen should be folded from top to bottom or side to side 5. Linen removed should be put into bag and move to sluice room 6. Patient must never be left uncovered or exposed 7. All communication during bed making must or should include patient. 8. Observe patient’s facial expression POSITION USED IN NURSING Positioning of patient is vital to safe and effective procedure. Proper patient positioning depends on the type of nursing care practice and length of procedure or comfort of the patient. The position used in nursing vary according to the needs of the patient and as a rule. Patient are nursed in the following ways or procedures. 1. Recumbent or dorsal 23  2. Semi recumbent or upright position 3. Prone 4. Semi prone recovery position 5. Left lateral 6. Coma position 7. Erect sitting position NOTE: The correct position is one in which the patient is most comfortable Common patient position for procedures. 1. Fowler’s position -high fowler position 2. Supine position 3. Jackknife position 4. Kidney position 5. Prone position 6. Lithotomy position 7. Sim’s position / sim’s semi position 8. Lateral position 9. Tendelenbury position – head slightly lower than the feet. GOALS OF PROPER PATIENT POSITIONING 1. To provide comfort and safety to patient 2. To maintain free flow of blood to organ system 3. To prevent pressure sore 4. To protect patient and prevent injuries or damage to nerve 5. Maintain airway and circulation 6. Allow surgeon accessibility to surgical site as well as anesthetic administration of drugs 7. Prevent soft tissues on musculoskeletal over injuries 8. Maintain patient’s dignity and privacy 1) Dorsal recumbent or supine position. When a patient lies flat on his/her back with one soft pull under the head and knees straight or very slightly flexed. This position provides full relaxation and this one position many acutely ill patients are nursed. Note: it is contra indicated in elderly person who are been subjected to chest infections. Breast and chest operation Neurological conditions. USES Examination of front of trunk and abdomen rectal and virginal examination. 24 2) Prone: Patient lies on abdomen with head turned to one side and the hips are not flex; Patient lies flat on his front of the body with pillow under his head which is buried to one side. The feet should be raised on a pillow to prevent toes pressing into the head. (developing pressure sore) second pillow is provided. In prone/recumbent position: - the patient lies on the front of his body. A pillow is placed beneath the chest or breast and usually one arm lies beneath the body. Prone: body position in which the patient lies flat o the stomach with their limbs unextend. Uses; - ventilation is delivered to a patient - Ease snoring by sluffing fleshy obstruction from airways. - Promotes drainage of secretions. Use in neurosurgery in spine and neck Contraindication – spine problems or injuries Semi Prone- patient lies on his side with upper most arm bent at the same shoulder level, leg and hip is bent, arm placed behind patient and other leg is straight. Semi Recumbent – patient lies on his back with two or three pillows under his head. Supine Position or Dorsal: The patient lies on the back with face up and shoulders slightly elevated using a pillow or no pillow. The arms may be parded arm board commonly used for procedures. Uses It provides comfort in general for patients under recovery after some types of surgery e.g. ENY cardiac & abdominal Use for general examination and physical assessment effect-risk pressure ulcer and nerve damage. LATERAL OR SIDE LYING. Patient lies on one side of the body with the top leg in front of the bottom let, the hip and knee flexed or bent, arm should be folded on the chest. Uses: examination of the patient and enema 3) ERECT UPRIGHT OR SITTING POSITION 25  Patient is placed in a sitting position, supported with pillows and a back rest. A water or air cushion is placed under the buttocks to receive pressure, sometimes, bed table may be required in front of patient with pillow for a change in position to lean forward. Note: this is used for patients with cardiac problem or respiratory distresses. COMMON POSITION FOR OPERATION OR PROCEDURES Fowler’s position: also known as sitting, typically used for neurosurgery and shoulder surgeries. It can be used for nasal, abdommoplasty, breast reduction surgeries. Note: always maintain the head in neutral position arm shoulder flex and secure across the body. Putlocks should be padded and knee flexed 300 degrees. HIGH FOWLER’S POSITION: Usually seated at the end of the operating table. Up half of body is between 600 and 900. In relation to the lower half of the body. Leg may be straight or bent. SIMIS POSITION Patient lies on outside with chest in Semi prone left side and leg near side of the bed, left arm behind the back right knee drawn up, heel touches left knee and right arm extend forward. Jackknife position: also known as Kraske, is similar to knee-chest or kneeling positions and often used for colorectal surgeries. Position often place pressure on knees. If use place extra padding on knee areas. Kidney position: resembles lateral position except that patient’s abdomen is plae over a lift in the operating table, bends the body to allow access to retro operational space. A kidney rest is placed under the patient at the location of the lift. Lithotomy – client assumes a back lying position and feet held in a support called Stirrups. Knees are flexed hips rotate to exposed, perineal region or area for examination USES: Typically used for gynecology, colorectal, urology, perineal or pelvis procedures. Risk – risk posed include fractures, nerve injury, hip dislocation, muscle injuries, pressure injuries and dimmished lung capacity. 26  METHOD OF LIFTING OF PATIENT. Lifting and hand hip patient is an important part of nursing skills and all nurses should practice the techniques so that, they become second nature. Certain principles needs to be observed carefully but first, it is necessary to understand some simple fact of body mechanics. 1. Centre of gravity 2. Base 3. Lifting METHOD OF LIFTING Basic point relevant to all lifting 1. Preparation for lifting 2. Choice of light 3. Position 4. Position of feet 5. Grasps 6. Lifting together 7. Posture 8. After lifting Centre of gravity - point a body from which, if suspended the body would be in balance. In adult, the centre of gravity is taken as the body of the second sacral vertebra i.e the eight of the body below it. BASE Base is part of the body which is a contact with the ground. The centre of gravity must always be above the base. The larger the base, the more stable the person and the small the base the cout side, the base the person will be off balance. In standing (upright) position the base is normally the area of the two fact, parallel and together. To enlarge the base, fact can be placed apart side way (stride standing) or they can be placed one in front of firm stable position from which to perform movements or action – the feet must always be pointing in the direction of the movement. LIFTING Many nurses suffers injury to their back through bad methods of lifting. These injuries are avoidable. 27  The sprime itself should not be used in lifting, it should be locked straight by tensing the back muscle and the lift should be performed by the use of the powerful leg and hip muscle. If a nurse lift a patient with her back in a flexed position, she will almost certainly injure her back as well as failing to lift the patient. METHOD OF LIFTING There are two methods of lifting patients 1. Orthodox lift 2. Shoulder (Australian lift) BASIC POINTS RELATED TO ALL LIFTING Preparation for lifting 1. There should be adequate space around the bed 2. Lifter should take care to adopt to correct posture. 3. To lift well, lifter must be posed with good muscular balance over a firm base. 4. Lifting must be performed with the least expenditure of energy compatible with minimum risk of cumulative strain SLEEP AND REST Sleeping is a basic human need. It is a biological process common to all people. Human beings spend about one third of their lives asleep. Definition: sleep is a state of altered Consciousness from which the subject or individual can be aroused by appropriate stimuli and there is decresed reaction to environment. Rest: this is a period of inactivity, relaxation or sleep a natural state of rest in which eyes are closed, mind is inactive and mind does nothing, eyes may be closed or open. REASONS FOR SLEEP/ IMPORTANCE OF SLEEP / BENEFIT 1. To restore the mind and body (recovery) 2. To enjoy life more fully 3. To conserve energy 4. To prevent fatigue 5. To cope with daily stress 6. To enhance daily time functioning 7. It is vital for optimal psychological functioning or well beings. 28  8. Sleep is necessary for protein synthesis and repair process 9. Proper sleep enhances emotional stability, high level of concentration i.e increase intelligence and co-ordination of activities. TYPES OF SLEEP There are two types of sleep 1. NREM -Non-Rapid Eye Movement 2. REM – Rapid Eye Movement. NREM - when activity in the reticular activity system is inhibited. About 75.80% of sleep during night. It is divided into four stages (Stage I, II, III & IV) NREM – usually reoccurs about every 90 minutes and last 5-30 minutes. Most dream occur during REM and usually not remembered unless arouse briefly. REM brain is highly active. Cirachia Rhythum - it exist in plant, and animals, and humans. (Biological rhythms). In humans, is controlled within the body and synchronized with environmental factors. E.g. sun light and darkness. Circadian Synchronization – i.e. the person is awake when the body temperature is highest and asleep when the temperature is lowest or cold. Graudian regularity begins to develop by the sixth week life and by the three to six months, months, most infants have a regularly sleep – wake cycle. NORMAL SLEEPING PATTERNS/REQUIREMENT New born – 16 -18 hours a day Infant – 14 -15 hours sleep in 24 hours Toddlers – 12 – 14 hours (1-3 years) Adolescent – (12 – 18 hours) 9 -10 hours of sleep each night right Adult NSF – 7 – 8 hours The national sleep foundation, 2006 world health organization and institute of medicine require individuals to sleep as above. 29  SLEEP STAGES FROM 1 -4 NREM Stage I Stage II Stage III Stage IV Light sleep, wakes Light sleep Deeper sleep Deepest sleep easily Relaxed breathing Brain activity slow Slow wave activity Body activity relaxed regular & deep Eye lids slowly open Eye is still, heart and Difficult to aroused Heart rate decrease and closed, roll to side respiratory rate (20 – 25% lower) decreasing Sleep is drowly and Sleeper is easily Snoring may occur If sleeper awakes, eye lid heavy aroused appears confuse 5-10 minutes 10-15 minutes 5-15 minutes Heart rate 5-30 minutes Account for 5% There is disconnection Melantonin is Called slow wave during night from the outside world released sleep Brain activity consist It is needed for of alpha wave and restoration purpose low frequently Delta (recovery) Growth hormone is released. Note: 1. Cycle repeat at interval of 90 minutes throughout 8 hours sleep 2. Circadian rhythms – consist of 8 hours awake 3. Circadian- cycle is control in biological clock located in the hypothalamus 4. Melatonin – is release by pineal body. Note: stage V – Deeper Sleep as one. One of the terms and terminology to be familiar with rest and sleep are; Insomia – simply is the absence of sleep There is two types of insomnia 1. Inducement insomnia 2. Maintenance insomnia Inducement: - patient affected have difficulty in falling asleep. 30 Maintenance: - Have difficulty in maintaining sleep and stays awake once they have fallen asleep. Some patient can be affected with both other short-lived episode and others may have chronic insomnia. Both types are caused by a number of factors such as pain and anxiety. PEOPLE AT RISK OF INSOMNIA - Females - People with severe injuries or chronic illness - Aging population – sleep lessness - Disappointment- Depressed - Divorce/single parents - doing many things to survive - Patient with respiratory or cardiac distress. - Drug addicts - lack sleep due to various use of medication SLEEPING DISORDERS. Dyssomnias – disorder characterized by disturbance of amount, quality or time of sleep e.g insomnia, Hypersomnia, sleeppenea and parasomnias. Hypersomnia: - patient’s failure to stay awake during day time hours even if he/she has had enough sleep at night before. Risk factors associated with hypersomnia - Disorders such as hypothyroidism; - it is a control nervous system dysfunction and alteration of the patient’s metabolism, including diabetic keto acidosis. - Parasomnia: - sleep disorder that interfere with sleep. There are numbers of it. E.g. sleep waking, sleep talking, grinding of teeth that is referred to as BRUXISM. Nocturnal enuresis-restless leg syndrome. - Sleep Apnea - occurs during sleep TYPES OF SLEEP APNEA 1. Obstructive – air ways obstruction due to diseases 2. Central 3. Mixed – mixed of obstructive and central STAGES OF SLEEP (5 STAGES) 1. Wake – stage 1 – time spent before falling asleep 5% 2. Light sleep – wakes up easily – 45% 3. Deep sleep – longsleep, reduces blood pressure/restore health4 31  4. Deeper sleep - person is difficult to aroused (Delta wave)\ 5. REM – Rapid Eye movement – re-energizes the mind. Narcolepsy;- excessive day time sleepness that a person can be affected with secondary to the paucity of hypocrethm within area of central nervous system that controls sleep. NURSING RESPONSIBILITIES IN SLEEP Client teaching promoting sleep. 1. Regular relaxation time e.g reading, listening to soft music and warm bath 2. Get adequate exercise. 3. Use bed for sleeping and sexually activity 4. Put off light to create dark, quitter environment 5. Sleep on well dressed and comfortable mattress and pillow 6. Diet – avoid heavy meal 2-3 hours before bedtime 7. Avoid alcohol and caffeine at night 8. Take snacks at bed time with milk drink L – cryptophane – found in cheese and milk induce sleep. 9. If client’s is in pain – give prescribed sleep medication in sleep disorders or insomnia THINGS THAT PREVENTS SLEEP 1. Smoking 2. Motivation Medication as Narcotics, tranquilizer, hypnotic and Beta-Blocker -are known to cause insomnia and night mare. DRUGS THAT CAUSES AND DISRUPT SLEEP EXCESSIVE DAYTIME SLEEP DISRUPT SLEEP 1. ANTI DEPRESSANT Alcohol 2. ANTI INSTAMINE Antihistamines 3. BETA BLOCKERS Bronchodilator 4. NARCOTICS Caffeine 5. HYDROCHLORIDE Steroids (DEMERO) Beta blockers 6. Meperidine Morphine. 7. Diazepam 8. Marijuana 32  HOSPITAL EQUIPMENT Definition: Hospital equipment’s are materials used in providing care specifically in the hospital. They are industrial equipment or portable items used for diagnosis, treatment and care of patients. They include consumable and disposable items used for patient’s treatments. EQUIPMENT’S 1. Hospital Beds – for sleeping/comforts 2. Hospital stretchers or medical stretchers – are used for transferring of patients from one point to another (transporting patients) important in emergency 3. Respiratory ventilators 4. Anaesthesia machines – use to deliver generally, oxygen and administering general anasethesia to patients going for surgery. It include ventilator, suctioning unit/ monitoring device. 5. Infusion pump 6. Autoclave machines – use for sterilization of hospital properties. 7. Infant radiant warmer 8. Defibrators – commonly used in life threatening situations e.g. cardiac arrithmias. Restores normal rhythm to the heart. 9. Infusion pump 10.Suction machines – use to clear airways and bring out secretions from patients. Useful in unconscious patients. 11.Phototherapy system – use for photo therapy in jaundice especially in special Baby Care Unit (SCBU). 12.Stethoscope – is a medical instrument used for listening to sound produced within the body. E.g. heart, lungs, bowel, and blood flow in other parts of the body. 13.Thermometer – used to check body temperature. 14.Scapel – it is a special kind of knife used by doctors to do surgery. There are different sizes. 15.Pateller harmmer – it is used to check for reflexes on the knee. 33 16.Infant radiant warmer – is a body warming device to provide heat to the body. Helps maintain the body temperature of baby. 17.Electro cardiogram machine – use for investigation of heart. It is use by health care provider to carry out the ECG test i.e. electrical activities of the heart. 18.Monitors – are used to monitor observations of vital signs and ECG of the heart. It is use for post-operative patient and patients with severe conditions. 19.Surgical or operating table – as the names implies is use to carry out operations in the theatre. It has adjustable sides for the purpose of functions/recovery. 20.Recovery couches – used after theatre to recover patients before transferring to the ward. 21.Medical aas – oxygen that can be given to patient to stabilize patient’s conditions. 22.MRI scanner – machine use to do magnetic resonance Imaging test. 23.CT scanner machine – use to do investigation of computed tomography. 24.Naso gastric, tube – used for feed and draining fluid or abdominal content in intestinal obstruction. It is a long tube and consist of different sizes. 25.Nebulizer – is used to dispense liquid medications into a fine mist, allowing for easy absorption into lungs. E.g. (asthma, and COPD) chronic hug diseases. 26.Dialyzer machine – machine use for dialysis in kidney issues/diseases. 27.Gas or oxygen cylinder – essential gases use to improve patient’s oxygen and nutrient level in the blood. 28.Sphygmanometer - it is used in measuring blood pressure and for effective monitoring of patient pressure/vitals. 29.Incubators – used to deep preterm infants in SCBU. It is used to regulate temperature according to the needs or weather and maintain microbiological. 30.Ultrasound machines – us to carry out investigations of ultrasonography. 31.Watch/stop watch – use by medical health care personnel to count pulse rate/fetal heart rate when doing observation of patients. 32.Pulse oximeter – use to carry out pulse of patients and for effective monitor. 33.Weighing scale with height – use to measure weight and height of patients in outpatient or hospital. 34 34.Crocodile forceps – use for removal of foreign bodies from ear and nasal cavity. 35.Diagnostic set – set of materials in a box use to diagnoses, ear nose and throat issue. 36.Spirometers – used to diagnose obstructive disease such as asthma, emphysema or restrictions. 37.Urine analyzer – is equipment that does automatic urine testing in a clinical context. 38.Blood analyzer – are used in complete blood count (CBC) blood typing and crossmatching, liver function test (LFT) and kidney function test (KFT). They are used to understand and detect conditions like Anemia. 35  CARE OF HOSPITAL EQUIPMENT Hospital equipment need to be care for to prevent damages to medical devices or extend life span. BASIC MAINTENANCE 1. Train and retrain staff 2. carry out daily routine check 3. replace reagents and lubricants 4. maintain a clean work environment and keep devices clean 5. turn off devices when not in use 6. sterilize and disinfect devices 1. Train and retrain staff: this step is very important, training of medical staff on how to properly maintain their devices is very key cleaning or sterilize and return for their various use. 2. Carrying out daily routine check: Routine checks on all devices and equipment are necessary in maintaining and also extending its life span ensure device is in good condition before it is been used for the day’s activities. 3. Replace reagents and lubricants: Some medical devices require reagents, lubricants and other consumable inserted or filled up on regular bases. 4. Maintaining a clean work environment and keep device clean: Clean environment cannot be over emphasized in ensuring that your medical device last long. Fluid and inflammable substance in your work space should be avoid near equipment/devices. They should be properly washed and dried properly. 5. Turn off devices when not in use: It will help conserve power and prevent over heating as well as damages from power supply. 6. Sterilize and disinfect devices: Always ensure to properly clean, sterilize and disinfect medical equipment for proper maintenance and spread of diseases. 36