• TABLE OF CONTENTS
HIDE
 Front Cover
 Bookplate
 Title Page
 Acknowledgement
 Foreword
 Title Page
 Introduction
 Bandages and binders
 Baths
 Bedmaking
 Bedpan and urinal
 Bladder-urinary
 Blood pressure
 Cold, application of
 Comfort, safety, support,...
 Dressings
 Ear
 Enemata
 Eye
 Feeding
 Fluids
 Hair
 Handwashing
 Heat, application of
 Inhalations
 Irrigations
 Isolation
 Medications
 Nose
 Operative care
 Safety appliances and restraint...
 Specimens
 Sterile technique
 Temperature, pulse, respiratio...
 Tests
 Therapeutic and diagnostic measures,...
 Throat and mouth
 Bibliography
 Back Cover














Group Title: Florida, State Dept. of Education, Bulletin 77F-4
Title: Manual of nursing measures for practical nursing
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00067128/00001
 Material Information
Title: Manual of nursing measures for practical nursing
Series Title: Florida, State Dept. of Education, Bulletin 77F-4
Uniform Title: Practical nursing education
Physical Description: x, 119 p. : illus. ;
Language: English
Creator: Florida -- Division of Vocational, Technical, and Adult Education
Boyles, Ruth M
Publisher: s.n.
Place of Publication: Tallahassee
Publication Date: 1967
 Subjects
Subject: Nursing   ( lcsh )
Technical and Health Occupation Education   ( lcsh )
Nursing -- Florida   ( lcsh )
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Bibliography: Bibliography: p. 149.
Statement of Responsibility: By Ruth M. Boyles.
General Note: Cover title: Practical nursing education.
Funding: Bulletin (Florida. State Dept. of Education) ;
 Record Information
Bibliographic ID: UF00067128
Volume ID: VID00001
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 01823877

Table of Contents
    Front Cover
        Front cover
    Bookplate
        Bookplate
    Title Page
        Page i
    Acknowledgement
        Page ii
    Foreword
        Page iii
    Title Page
        Page iv
        Page v
        Page vi
        Page vii
        Page viii
    Introduction
        Page ix
        Page x
    Bandages and binders
        Bandages and binders
        Page 1
        Page 2
        Page 3
        Page 4
        Page 5
    Baths
        Baths
        Page 7
        Page 8
        Page 9
        Page 10
        Page 11
        Page 12
    Bedmaking
        Bedmaking
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
    Bedpan and urinal
        Bedpan and urinal
        Page 19
        Page 20
    Bladder-urinary
        Bladder-urinary
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
    Blood pressure
        Blood pressure
        Page 27
    Cold, application of
        Page 28
        Page 29
    Comfort, safety, support, movement
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
    Dressings
        Page 44
        Page 45
        Page 46
    Ear
        Ear
        Page 47
        Page 48
        Page 49
    Enemata
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
    Eye
        Eye
        Page 55
        Page 56
        Page 57
        Page 58
        Page 59
        Page 60
        Page 61
    Feeding
        Page 62
        Page 63
        Page 64
    Fluids
        Fluids
        Page 65
        Page 66
        Page 67
    Hair
        Page 68
        Page 69
        Page 70
        Page 71
    Handwashing
        Page 72
        Page 73
        Page 74
    Heat, application of
        Heat, application of
        Page 75
        Page 76
        Page 77
        Page 78
        Page 79
    Inhalations
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
    Irrigations
        Irrigations
        Page 85
        Page 86
        Page 87
        Page 88
        Page 89
        Page 90
    Isolation
        Isolation
        Page 91
        Page 92
        Page 93
    Medications
        Page 94
        Page 95
        Page 96
        Page 97
        Page 98
        Page 99
        Page 100
        Page 101
        Page 102
    Nose
        Nose
        Page 103
        Page 104
    Operative care
        Operative care
        Page 105
        Page 106
        Page 107
        Page 108
        Page 109
        Page 110
        Page 111
        Page 112
    Safety appliances and restraint of movement
        Safety appliances and restraint of movement
        Page 113
        Page 114
        Page 115
    Specimens
        Page 116
        Page 117
        Page 118
        Page 119
    Sterile technique
        Page 120
        Page 121
        Page 122
        Page 123
        Page 124
    Temperature, pulse, respiration
        Temperature, pulse, respiration
        Page 125
        Page 126
        Page 127
        Page 128
    Tests
        Tests
        Page 129
        Page 130
        Page 131
        Page 132
    Therapeutic and diagnostic measures, assist with
        Therapeutic and diagnostic measures, assist with
        Page 133
        Page 134
        Page 135
        Page 136
        Page 137
        Page 138
        Page 139
        Page 140
        Page 141
        Page 142
        Page 143
        Page 144
    Throat and mouth
        Throat and mouth
        Page 145
        Page 146
        Page 147
    Bibliography
        Page 148
        Page 150
        Page 152
    Back Cover
        Back cover
Full Text



BULLETIN 77F-4


PRACTICAL
NURSING
EDUCATION

TECHNICAL AND HEALTH OCCUPATIONS EDUCATION


'r 1967
A GUIDE FOR PRACTICAL
NURSING
375. 009 757
F 3(o1b

ilmI]tvt


STATE DEPARTMENT OF EDUCATION
Tallahassee Florida
FLOYD T. CHRISTIAN STATE SUPERINTENDENT


tizl




- I--AI ]U ft







BULLETIN 77F-4


TECHNICAL AND HEALTH OCCUPATIONS EDUCATION





MANUAL

OF NURSING MEASURES

FOR

PRACTICAL NURSING


Prepared by
RUTH M. BOYLES R.N., M.S.,
I CONSULTANT


DIVISION OF VOCATIONAL TECHNICAL AND ADULT EDUCATION




3 75. 0o o0 75-7
F(5 36J I
,o, -7-7 F-f

The publication of this manual in printed form follows its successful use in rough draft and the
repeated requests for such an instructional aide.
The manual was developed in the State Department of Education through the efforts of Dr. Walter
R. Williams, Jr., Director Emeritus
of the Division of Vocational, Tech-
ACKNOWLEDGEM ENTS nical, and Adult Education; Dr.
Thomas W. Strickland, Director,
Technical and Health Occupations
Education Section; Miss Helen E. Shearston, R.N., former Consultant for Health Occupations Edu-
cation, and Mr. R. W. Scull, Educational Materials Assistant.
Miss Ruth Mary Boyles, R.N., Consultant, Nursing Education, was engaged by the State Depart-
ment of Education to prepare the manual and Mrs. Mary Lou Creek was responsible for the illustra-
tions. Miss Vivian M. Culver, Consultant, Nursing Education, assisted in developing the manual and
preparing it for publication. Mrs. Ruth Chapman, Editorial Associate, edited the manual and Mr.
Ray O'Keefe designed the cover and did the lay-out work. Mr. Finn Groover, Director, Publications
and Textbook Services, planned the distribution.
Printing of the manual was accomplished through the efforts of Mr. J. K. Chapman, Deputy Super-
intendent, Dr. Carl W. Proehl, Assistant Superintendent, Division of Vocational, Technical, and
Adult Education, and Dr. Joseph W. Crenshaw, Assistant Superintendent, Division of Curriculum and
Instruction.

I










Permission to reproduce or quote ny p
-. ..:. .-- -.1 \ "











tion of this manual must be obtained from
the State Department of Education in Florida

Copyright @ 1967 By Florida Department of Education
1
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1 FOREWORD
/'


The original version of the Manual of Nursing Measures
0 for Practical Nursing, designed as an instructional tool for
teaching practical nursing and to be used in conjunction
with the Curriculum Guide for Practical Nurse Education,
Bulletin 77F-2, was published by the State Department of
Education in 1965. The widespread use of this manual, the
I increase in the number of programs, and larger enrollments
have made it necessary to make a second printing of the
bulletin.

Careful research of recent source materials have preceded
the "what-to-do" and the "how-to-do" written into the
I nursing measures. General directions for carrying out a
measure have been written so that they can be used in
a variety of situations in which the practical nurse may
find herself. Simple line drawings, each designed to illustrate
S --- a specific point and to assist the student in visualizing the
r "how-to-do" have been placed throughout the manual to
correspond with the directions for that particular nursing
Measure.

Suggestions and reactions which will aid in the improve-
ment of this manual are invited. Please address all communi-
cations to the Division of Vocational, Technical, and Adult
Education, Tallahassee, Florida. Meanwhile, it is anticipated
that this manual will contribute to the improvement of
I instruction in practical nursing programs and to the de-
velopment of well prepared practical nurses to serve the
people of Florida.





Superintendent of Public Instruction











ACKNOWLEDGEMENTS ........................
FOREW ORD ........................
INTRODUCTION .................



TABLE OF CONTENTS


BANDAGES AND BINDERS

BATHS


Cleansing- Bed ............. ............
P artial ..................... ........ .. .
Show er ..................... ......
T u b . . . . . . . .. .
Therapeutic-Alcohol, Tepid, or Cold Sponge ............
M dedicated .............................


BEDMAKING
O occupied ...................
Unoccupied .............

BEDPAN AND URINAL

BLADDER-URINARY
Catheterization-Female ......
M ale .........
Indwelling Catheter-Insertion
Irrigation
Instillation ...............
Irrigation-Single .............
Indwelling Catheter


BLOOD PRESSURE ..

COLD, APPLICATIONS OF
C om presses, C old ............................. .....
Ice Bag or Cap or Collar ...........................
Sponge Bath-See Baths, Therapeutic


COMFORT, SAFETY, SUPPORT, MOVEMENT
Chair or Wheelchair, Patient Into and Out of .....
Devices and Methods, Use of Supportive ... ..
Out of and Into Bed, Assisting Patient ... .....
P position s ............. ... .. ......... ..... ....
Stretcher, Moving Patient To and From .. ..
Turning and Moving Patients in Bed .
Walking, Assisting Patient .......

DRESSINGS
D ry .. ... .. .. .. ..
Moist-See Heat, Compresses


. 1


S 31
. .. .. 3 3
35
36
38
40
42


.........................
.........................
.........................
........................
. . . . . . .
.........................
................... .....










EAR
Dressings and Bandages ......... ............... 47
D rops .... ....................................... 48
Irrigation ......................................... 48
ENEMATA
Can Method ..................................... 51
Funnel M ethod ................. .............. 53
EYE
Artificial ..... ... ........... .......... .. 55
Compresses-Cold .............. ... ........... 56
W arm ................ 57
Dressings and Bandages ......... .................. 58
Drops 59
Drops ............................................. 59
Irrigation ......................................... 60
Ointment.... 61
FEEDING
G astrostom y ...... ........... .. 63
Gavage ... ......... .... 64
FLUIDS
Hypodermoclysis ................................. 65
Intravenous Infusion ............................... 66
HAIR
Daily Care of ...... ....... ........... .... .. 69
Pediculosis and N its ..... ..... ................... 69
Sham poo .......................................... 70
HANDW ASHING ... ...................................... 73
HEAT, APPLICATIONS OF
Compresses, W arm ................................... 75
Cradle, Heater Lamp .................................. 76
Heating Pad (Electric) .. ... ....... 76
Irrigations-See Irrigations, Specific
Sitz B ath ......................................... 77
Soak, A rm or Foot ................................ 77
Steam-See Inhalations, Warm Steam
Stupes, Fomentations, Packs ........................... 78
Water Bag or Bottle, Hot ........................... 79
INHALATIONS
Carbon D ioxide ........................ .......... .. 81
Croupette ......................................... 81
Oxygen ................. ........................... 82
W arm Steam Inhalations ............................. 84
IRRIGATIONS
Bladder-See Bladder
Catheter, Indwelling-See Bladder










C olon ........ ..
Colostomy .... ..... ..........
Ear-See Ear
Eye-See Eye
Lavage-See Therapeutic and Diagnostic Measures
Nose-See Nose
P erin eu m ........................... ... ..
Throat and Mouth-See Throat and Mouth
V aginal ........ .. .. ..
ISOLATION
G own Techniques .....................
Handwashing-See Handwashing
Techniques in Daily Care
MEDICATIONS


Inhalations-See Inhalations
Inunction .................
Intramuscular Injection ..
Oral Administration ...
Subcutaneous Injection ......
Suppository ........
NOSE
D rops .. .
Irrigation .. ... .. ......
Spray ... ......


. . . .. . . 9 5
.... .. 96
... 9 8
. . . . . . . 9 9
. . . 1 0 2


. . 10 3
. . . .. 1 0 4
104


OPERATIVE CARE
Postoperative Bed and Unit .... ..
Postoperative Care, Immediate ...
Preoperative Care, Immediate
Skin Preparation, Surgical Sites .
PHYSICAL EXAMINATION, ASSIST WITH
SAFETY APPLIANCES AND RESTRAINTS OF MOVEMENT


SPECIMENS
S pu tu m ........................... . 117
Stoo l . ...... .. .. ...... ..... .. 117
U rin e ........ ... ............. .. .. ...... ... 118
STERILE TECHNIQUE
G loves, Sterile ............... ...... .. .121
Handling Sterile Equipment and Supplies ............. 123

TEMPERATURE, PULSE AND RESPIRATIONS
Pulse-Apical-Radial ............. .. .. ... 125
Radial ...................................... 125
Respirations ........................ ........... 126
Temperature-Axillary ...... ......... ... 127
Oral 128
Rectal ... .. ... 128


I8


92 I










TESTS
Urine-Acetone .............................. .... ... 129
A lbum in ......... .......................... 130
Phenylketonuria ...... ........................ 130
S u g ar .. .. .. .. .. .. .. .. .. ... .. .. .. .. 13 1
THERAPEUTIC AND DIAGNOSTIC MEASURES, ASSIST WITH
Abdominal Paracentesis .. .... ................. 133
Gastric Analysis ..................................... 134
Gastric or Duodenal Siphonage ......... ..... 135
Hypodermoclysis-See Fluids
Intravenous Infusion-See Fluids
Lavage ............................ ....... .. 136
Lumbar Puncture .................. ...... ...... 137
Suction, Mouth or Throat or Nose ............. .. 139
T horacentesis ...... .......... ............. .. 141
Tracheotom y ........... .......................... 142
THROAT AND MOUTH
Irrig atio n ................................. ... 14 5
Oral Hygiene ......... .............................. 146
Spray ............................ ................. 147
Suction-See Therapeutic and Diagnostic Measures
BIBLIOGRAPHY ........................................ 149




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A manual of nursing measures is a collection of actions carried out by the nurse and in some
instances by the physician with assistance from the nurse. Such a manual sets forth actions) of
what-to-do and how-to-do-it. It does not include the why-to-do-it. The "why" is made up of many
facts and concepts which the teacher and the
student bring together in their discussion of the
INTRO DUCTIO N meaning of the measure. The teacher prepares
for this discussion the same as for the presenta-
tion of any other content; so does the student.
In this way the manual becomes a tool the same as the textbook and other reference material. It is
a unique tool if appropriately used; it helps the student gain reasoning ability as he sees common
elements among measures and thus develops judgment which will serve well during years of practice
as materials and methods change.
To say this another way: A measure is not a ritual that is learned in step fashion concerned only
with what to do next. Such learning is but memorization and lends little to the student's reasoning
ability and judgment. Ritualistic performance does add to student apprehension however, and often
accounts for some anxieties which tend to block reasoning, clear thinking and good judgment.


THE ORGANIZATION OF THE MANUAL
The Table of Contents lists the major sections
of the manual in order of appearance. This por-
tion "Introduction" should be carefully read
before other sections are read and it should be
revisited as often as necessary thereafter.

Particular attention is called to the section
Nursing Measures and Medical Treatments. It
is organized as follows:
1. The measures and treatments are arranged
in categories. A category is an arbitrary collec-
tion of measures and treatments which have
some commonality among them. The common
factors) may be the part of the body being
treated i.e.; bladder and urinary tract, or it may
be the purposes) served as in the case of irriga-
tions, heat, cold, etc., or it may be a general
group of measures such as baths or specimens.

An attempt has been made to employ com-
monly used headings for these categories to pro-
vide means for quick and easy use of the manual.

The placement and sequence of the measures
and treatments in the manual should not suggest
placement and/or sequence of this content in
the curriculum. The placement of a nursing
measure in the curriculum (where it is taught)
is pre-determined by the faculty. Such place-
ment is governed by the objectives of the cur-
riculum as a whole or any segment of it. The
acceptance of this fact by the faculty dispells
the age-old anxiety of "teaching a list and check-
ing it off".


Nursing measures are fused into content as a
normal part of it and are not treated as
something separate and apart.
2. Within each category the measures and treat-
ments are arranged alphabetically.
3. A measure or treatment is presented accord-
ing to the following headings:
A. PURPOSES
In so far as possible these are all-inclusive state-
ments. They may be broken down, expanded,
and increased in number.
For the most part the statement of purposes)
takes care of a definition. This too may need to
be expanded.
B. EQUIPMENT, MATERIALS, AND SUPPLIES
Items included are permanent or reuseable items
and not disposable. Disposable items multiply at
such a rapid rate they all but defy inclusion in
such a manual.

C. GENERAL DIRECTIONS
Each sentence or paragraph is numbered to sin-
gle out action but not necessarily to make it a
1-2-3 pursuit of action. The continuity of action
by the nurse (what to do first and then next) is
governed by many factors pertinent to a given
situation. Some of these factors include: age and
size of patient, his state of dependency, the
equipment being used, his ability to understand
and follow directions.










D. ADAPTATIONS FOR THE INFANT AND
THE CHILD
Not all measures and treatments have this sub-
division because it would seem unnecessary to
repeat the many usual and expected adjustments
which accompany patient-centered care. When
such statements are included they are there to \
single out, for special emphasis, special equip-
ment, particular positions and/or needed pre-
cautions relative to the small patient.





SOME GENERAL STATEMENTS ABOUT CONTENT


There may be noticeable omission of some
measures which have long been found in such
manuals. These have been omitted for any one
of several reasons. Some functions, such as the
admission of a patient, are made up of a series of
actions; most of these are found elsewhere in
the manual. Some measures are not as commonly
used as they once were. Primarily many have
been deleted because they vary so from agency
to agency making it impossible to satisfactorily
describe what is done and how it is done. This
group includes such things as cleaning thermom-
eters, feeding, diapering and bathing the infant.
In such instances it will be up to the teacher
to explore (with the student) these practices in
the agencies where the student has his/her
clinical learning experience.
A further word about disposables: The use of
disposable equipment invades every phase of pa-
tient care at an increasing rate and predictably
will continue to do so. Most items carry trade
names and are being developed and improved
constantly.
Each agency sets up its own methods for dis-
posing of used items and for restocking the unit
supply. All such factors make it impracticable to
try to include specific disposable items. How-
ever, the elements of safety, patient comfort,
pertinent observation and the ability to read and
follow directions apply to the use of disposable
materials the same as with permanent equip-
ment.
Any illustration has limitations. Each of the
205 line drawings has been designed with a spe-
cific purpose in mind. No attempt has been


made to amplify any beyond that purpose. Body
parts are intentionally exposed to depict place-
ment, location, and position of that part or of
the equipment involved. All illustrations are lo-
cated in proximity to related content; some may
suggest ideas for use of other visual aids.
In an effort to hold descriptive content to a
minimum, such statements as: "assemble equip-
ment", "check the physician's orders", "inform
patient of what is to occur", "screen patient",
and "chart results" have been omitted. It is
understood by the teacher that each is a neces-
sary part of any measure and for this reason are
not repeated. This lack of repetition should not
preclude the necessity for teacher emphasis and
explanation of these and other common actions
which underlie effective nursing practice.
In so far as a principle is a statement of a
generally accepted fact which can be used as a
guide for action, the manual depicts many im-
portant principles.
Regarding some of the more complex meas-
ures, specific, pertinent observations are in-
cluded. The teacher should point out the role(s)
of the practical nurse in carrying out any one
of these complex measures. This will aid the
student in making required observations and re-
cording appropriate remarks.
It would be virtually impossible to prepare a
nursing measures manual which would encom-
pass all that all would hope to find in it. In so far
as possible, this manual incorporates the collec-
tive requests made by teachers prior to its incep-
tion. Its chief purpose is to serve as yet another
tool to help put the curriculum in motion.




















BANDAGES
AND
BINDERS










PURPOSES)
1 Hold a dressing in place.
2 Apply pressure to an area or part.
3 Limit motion of injured tissues or part.
4 Provide support to an injured tissue or part.
5 Hold splint in position.


EQUIPMENT NEEDED
Bandage or Binder
Adhesive tape or spray
Clips
Safety pins
Scissors


GENERAL DIRECTIONS

1 Know purpose of the bandage or binder.

2 Select the type, size and width of the band-
age or binder according to the purpose and
needs of the patient.

3 Clean and dry part before application.

4 Provide protection between two skin sur-
faces before application.
5 Place patient in a comfortable position;
place part in a normal, functioning position
(good alignment); stand facing body part.

6 Provide support for extremity; secure assist-
ance, if needed, to support extremity.

7 Use only clean and dry bandage or binder.

8 Apply with firm, even pressure; allow for-
slight motion of the part.

9 Remove and reapply, if too firm or loose.

10 Avoid pressure directly over wound area,
unless specifically ordered or indicated.

11 Examine often to keep clean, dry, and free
from drainage and odor.

12 Anchor or secure by using suitable method
according to purpose, material, and part;
avoid placement of means used directly over
the injured area, over a joint or bony promi-
nence, or where it will rub or press against
another part.

13 Write the date and time bandage was ap-
plied on the tape used to secure bandage, if
pertinent and indicated.
14 Tape waterproof material over the bandage
if used to cover dressing in certain areas of
the body, if needed and permitted.


ROLLER BANDAGES
FUNDAMENTAL TURNS


CIRCULAR TURN
1 Place the outer surface of the initial end of
bandage next to the skin or dressing; hold roll
uppermost.


2 Hold end in place with one hand while the
other hand passes the roll around the part.
3 Repeat turn 2 or 3 times; exactly overlap the
preceding turn.
4 Use equal tension with each turn.
5 Unwind bandage gradually and only as re-
quired.
6 Use circular turns to anchor any bandage, to
start and to end bandage; use to hold a dressing
over a small area.

SPIRAL TURN
1 Overlap each preceding turn by %]/ to %
the width of the bandage.










2 Ascend or descend overlaps to bandage a
part of fairly equal contour.












SPIRAL-REVERSE TURN
1 Use a spiral turn, making a reverse halfway
through each turn.


2 Use to bandage a part of unequal contour,
such as the forearm, thigh, or leg.
FIGURE-OF-EIGHT TURN
1 Make oblique overlaps (2 loops to form the
figure 8) to ascend or descend alternately;
cover each preceding turn % to % the width
of the bandage.


2 Use the bandage around joints, such as, el-
bow, knee, or ankle.


SPICA TURN
1 Use figure-of-eight ascending and descend-
ing turns; overlap all turns to form an angle
when crossing.


2 Use to bandage a part such as the thumb,
the shoulder and the groin.

RECURRENT TURN
1 Anchor bandage with circular turns.


2 Make turn over the center of the tip or the
rounded end or part and return to starting point.










3 Repeat turns back and forth over the tip;
make turn on one side of the center piece and
the next turn on the other side until the tip or
end surface is covered.


4 Use circular turns to keep ends of turns in
position and to secure bandage when finished.


5 Use to bandage a part, such as, the fingerss,
a leg or arm stump, or the head.

REMOVING ROLLER BANDAGES
1 Use bandage scissors to cut bandage on the
side opposite the injury or wound.
2 Unwind bandage, if to be reused; gather the
loose bandage as it is unwound, passing it as a
ball from hand to hand.


T BINDERS-(SINGLE AND DOUBLE)


I Place belt around the patient's waist.
2 Fan fold one side of the belt to the center
and have patient turn to opposite side or flex
knees and raise buttocks.
3 Place center of belt to center of back at
waistline and draw through fan folded portion to
opposite side; keep belt straight and smooth.
4 Bring ends of belt together in front and use
safety pin to fasten.
5 Bring tail(s) of binder down center of back,
up over perineum to belt and pin.
6 Use T-binders to hold dressings or give
support to the perineum; use the single T-binder
for the female and the double T-binder for the
male, usually.


TAILED BINDER-(SCULTETUS OR MANY
TAILED)
1 Fold top bedding back to across pubic re-
gion; turn gown back across chest.
2 Fan fold or roll tails to center back of binder
and ask patient to turn to opposite side.
3 Place center of binder to center of back;
ask patient to turn on back and draw through
half of binder to opposite side.
4 Straighten tails with the bottom tail placed
well down on the hips to cross the lower ab-
domen.
5 Secure tails from top to bottom or from
bottom to top, according to purpose of binder.
6 Wrap the first tails from either side across in
a straight position and fasten with a safety pin.
7 Bring next ends together to cross obliquely
at midline of abdomen; continue with remaining
tails, alternating from each side.


8 Place and fix ends to obtain snugness.
9 Wrap the last tails in a straight position and
fasten with a safety pin.


~V"

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STRAIGHT BINDER-(ABDOMINAL)
1 Fold top bedding back to across pubic re-
gion; turn gown back across chest.
2 Fan fold one side or one-half of binder to
center; have patient flex knees and raise but-
tocks; place center of binder to center of back;
draw through the half of folded binder to the
opposite side.









3 Have patient lie on back and on the center of
the binder.
4 Straighten and place binder so that lower
edge comes well down over top of buttocks.
5 Bring ends of binder together at midline of
abdomen, overlap about 2 inches and pin se-
curely; fold excess material under.
6 Place safety pins crosswise, about 2 inches
apart, beginning at the lower edge.
7 Fit binder snugly to patient; pin darts verti-
cally on either side unless darts are sewed in
place on top edge and the binder fits.

BREAST BINDER
1 Fold top bedding back to waistline; remove
gown.
2 Fan fold one side of binder to center of
back; have patient turn on opposite side and
place center of binder to center of back; draw
through the half of the folded binder to the
opposite side.



C C Crrnc 3 3


3 Have patient turn on back and lie on the
center of the binder.
4 Adjust and straighten binder to proper posi-
tion.
5 Bring ends of binder together at midline of
chest, overlap about 2 inches and pin securely;
raise breasts up and in toward center of chest
using binder.
6 Place safety pins crosswise, about 2 inches
apart, beginning at middle of center front.
7 Pin from center pin to bottom, then from
center pin to top of binder.
8 Bring straps over shoulders and pin to top
front of binder; place safety pins crosswise.
9 Fit binder snugly; pin darts vertically at
lower edge under breasts.

TRIANGULAR BANDAGE
SLING(S) METHOD A
1 Place open triangle (sling) on chest with the
affected arm placed across the sling; place point
(apex) of bandage under arm.
2 Place upper end of the sling around the neck
on the side of the affected arm.
3 Place affected arm in proper position and
height; place hand and wrist higher than elbow.
4 Bring the lower end of the sling over the
affected arm to the shoulder.
5 Tie the two ends together in a square knot;
place knot to side of neck, opposite affected arm.
6 Fold material at the elbow and secure with
safety pin on inner side.


M










STOCKINET


1 Place open triangle on chest with the affected
arm placed across the sling; place covers A
and B to form a straight line.
2 Place affected arm in proper position and
height; place hand and wrist higher than elbow.
3 Bring lower corner (C) up over affected arm
and shoulder.


4 Bring corner B under armpit of unaffected
side to corner C in the back and tie together in
a square knot.
5 Fold material at elbow, corner A, and pin or
tuck to fit snugly.











SCc
C A


1 Select width of stockinet to fit body part,
such as, the head, a finger, a foot, a leg, or an
arm.


2 Support body part; obtain assistance, if
needed.
3 Stand in front of or facing body part.
4 Cut needed length from the roll of stockinet.













3. 4.


5 Place tube of stockinet over the body part
and fold back on itself.
6 Secure with adhesive tape, knot, or safety
pin as appropriate to body part.









________________. -- _


METHOD B




I





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BATHS
I
CLEANSING
I BED
PARTIAL
SSHOWER
TUB
I THERAPEUTIC
3 ALCOHOL, TEPID, OR COLD SPONGE
MEDICATED
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CLEANSING BATHS

PURPOSES)
1 Provide cleanliness.
2 Provide relaxation and comfort.
3 Stimulate circulation.
4 Provide motion and exercise.
5 Observe condition of patient.


BED BATH

PURPOSE
1 Provide a cleansing bath to patient who must re-
main in bed, and who may or may not be able
to bathe or partially bathe himself.


GENERAL DIRECTIONS
1 Lower backrest and remove head pillows,
if permissible.
2 Remove spread, then blanket.
3 Replace top sheet with bath blanket.
4 Place face towel under head and neck.
5 Place bath towel across chest and top of
bath blanket.
6 Provide for oral hygiene.
7 Offer bedpan and/or urinal.
8 Move patient to near side of bed.
9 Remove gown.
10 Fill bath basin about % full of water 1050
to 1150 F. Change water as often as neces-
sary during bath, at least twice.
11 Wet washcloth and fold around hand; apply
soap.


12 Use firm, gentle strokes to wash, rinse and
dry well one part or area in the order usu-
ally followed for bathing self.
13 Bathe face, ears and neck.
14 Place towel lengthwise under arm and far
side. Lift and support arm to bathe. Give


EQUIPMENT NEEDED
Bath basin
Soap in soap dish
Rubbing alcohol or Lotion
Talcum powder
Bath towel, Face towel
Wash cloth
Bath blanket
Bed linen
Laundry bag
Gown or pajamas
Bedpan and/or Urinal
Articles and Supplies for care of mouth, teeth, nails,
and hair


particular attention to axilla. Apply deodor-
ant, if desired. Repeat to bathe near arm.
Place basin on towel near side of bed to wash
hands. Give necessary attention to nails.
15 Place towel across chest and fan fold bath
blanket to waist. Bathe chest and breasts un-
der towel. Give particular attention to area
beneath breasts.
16 Fan fold bath blanket to groin and bathe
abdomen. Give attention to umbilicus and
skin folds. Bring bath blanket up over chest
and remove towel.
17 Flex knee on far side and expose thigh, leg,
and foot. Place towel lengthwise under leg
and bathe thigh and leg. Place basin in posi-
tion to wash foot in water.
Give proper and adequate support to leg.
Repeat to bathe near leg. Give attention to
between toes and toe nails.









Give attention to between toes and toe nails.


18 Turn, or assist patient to turn, on abdomen
or on side with back close to near side of
bed. Place towel lengthwise on bed close to
body. Expose neck, back, and buttocks.
Bathe entire area; rub with rubbing alcohol
or lotion; powder. Give special attention to
body prominences, reddened areas or folds
in skin.
19 Turn patient on back and spread towel un-
der hips. Place basin and soap within easy



PARTIAL BATH


PURPOSE
1 Provide a cleansing bath to those areas or parts
of the body when a complete bath is contraindi-
cated or not needed.
Note: The Partial Bath may be known as Morning
Care (A.M.) and/or Evening or Afternoon Care
(P.M.).


GENERAL DIRECTIONS
1 Lower backrest, remove extra pillows, and
place bath blanket, if needed.
2 Place bath towel across top of bath blanket
or top bedding.
3 Provide for oral hygiene, if needed or de-
sired.
4 Offer bedpan and/or urinal.
5 Move patient to near side of bed and re-
move gown.
6 Fill basin about 2 full with water 1050 to
1150 F.
7 Bathe face and neck, then arms and hands
as in a complete bed bath.
8 Turn, or assist patient to turn, on abdomen
or on side with back close to near side of
bed. Bathe and give back care as in a com-


reach of patient. Hand patient lightly soaped
washcloth and instruct him to finish bath.
Provide needed assistance to bathe genitalia.
20 Provide clean gown; move patient to center
of bed.
21 Comb and arrange hair, or instruct and
assist as needed. (See Hair, Daily Care)
22 Remake bed. (See Bedmaking, Occupied
Bed)

EQUIPMENT NEEDED
Bath basin
Soap in soap dish
Rubbing alcohol or Lotion
Talcum powder
Bath towel
Wash cloth
Bed linen, if needed
Gown, if needed
Bedpan and/or urinal
Articles and supplies for care of mouth, teeth and
hair.


plete bed bath, especially if needed or when
preparing for sleep.
9 Bathe or provide for the bathing of the
genitalia and any other part of the body, if
needed.
10 Replace gown; move patient to center of
bed.
11 Loosen lower linens from under mattress;
brush clean and smooth; tighten and remake
unless change is necessary.
12 Comb hair, if needed.
13 Rearrange pillows and top bedding; adjust
back rest.
14 Give any instructions and assistance neces-
sary when patient is able to use the bath-
room to take a partial or sponge bath before
meals, bedtimes, or as desired.


i












SHOWER BATH


PURPOSE
1 Provide a cleansing bath to patient who is able,
permitted and prefers to use a shower.


EQUIPMENT NEEDED
Soap
Back lotion
Talcum powder
Deodorant
Bath towel and Washcloth
Bath mat or folded bath towel
Shower cap, if necessary
Robe, slippers, gown
Bathroom stool
Rubber mat (non-skid)
Bath blanket, if necessary


9


GENERAL DIRECTIONS


1 Prepare inside of shower stall:
Place rubber mat on floor.
Place small stool on rubber mat near door.
2 Place bath mat on floor outside stall.
3 Place shower stool or chair near shower
door and bath mat; arrange linen and sup-
plies on top.
4 Turn on warm water then cool to comfort-
able temperature; adjust to gentle force.
5 Give instructions and assistance necessary
for patient to disrobe, step into shower, and
sit on stool.
6 Permit and encourage patient to bathe self,
if possible.
7 Remain near shower stall.




TUB BATH


PURPOSES)
1 Provide a cleansing bath to patient who is able,
permitted and prefers to use a bath tub alone or
with assistance.


GENERAL DIRECTIONS

1 Place rubber mat or folded bath towel on
bottom of tub.


8 Instruct patient to ask for any needed assist-
ance, or to regulate temperature or force of
water.
9 Help patient out of shower, if necessary;
place bath towel or bath blanket around
patient.
10 Turn off water in shower, first the hot fau-
cet then the cold.
11 Give necessary assistance to patient in dry-
ing and dressing self.
12 Accompany patient to room and into bed
or chair, if necessary.
13 Make provisions for back care, oral hy-
giene, combing hair, and elimination ac-
cording to needs of patient.



EQUIPMENT NEEDED
Soap
Back lotion
Talcum powder
Deodorant
Bath towel and washcloth
Bath mat or folded bath towel
Robe, slippers, gown
Rubber mat (non-skid)
Bathroom stool or chair
Bath blanket, if necessary


9


2 Place bath mat on floor to side of tub.
3 Arrange linen and supplies on top of stool
or chair placed near bath tub.
4 Fill tub 1/ to 1/2 with water about 1050 F.










5 Assist patient to bathroom, to disrobe, and
to get into tub, if necessary.
6 Permit and encourage patient to bathe self,
if possible; wash back.
7 Drain water from tub before patient gets
out or instruct him to do so.
8 Use bath blanket to prevent exposure and
chilling when getting into and out of tub.
9 Remain in or near bathroom if patient
bathes self.
10 Instruct patient to call for assistance; ob-
serve frequently, if not in constant attend-
ance.
11 Give necessary assistance to patient to get
out of tub, and in drying and dressing.


THERAPEUTIC BATHS

ALCOHOL, TEPID, COLD SPONGE
BATHS


PURPOSES)
1 Reduce elevated body temperature.
2 Produce relaxation, comfort, sleep.


12 Give needed assistance to accompany pa-
tient back to room and into bed or chair.
13 Make provisions for back care, oral hygiene,
combing hair, and elimination according to
needs of patient.



ADAPTATIONS FOR THE CHILD
1 Stay with child throughout entire bath.
2 Provide a reasonable amount of water for his
size.
3 Allow time for child to help bathe self.
4 Lift from tub after water is drained or assist,
as necessary.


EQUIPMENT NEEDED
Bath basin
Bath towels-3
Wash cloths-3
Rubber or plastic pillow case
Large rubber or plastic sheet
Ice cap with cover
Hot water bag with cover
Small basin of cracked ice
Bath thermometer
Clinical thermometer in container
Paper and pencil
Bath blankets-2
Alcohol 70%, if to be used.
(1 part alcohol to 3 parts water, or as ordered)


9


GENERAL DIRECTIONS
1 Take temperature, pulse, respirations.
2 Offer bedpan and/or urinal.
3 Replace top bedding with bath blanket.
4 Fill bath basin with water or alcohol and
water, as ordered, and at the proper or spe-
cifically ordered temperature.
Tepid Bath, 900 to 1000 F.
Cold Bath, 700 to 900 F.
Alcohol Bath, 900 to 1000 F.
5 Use bath thermometer to measure tempera-
ture of water in bath basin and add ice as
needed to maintain proper temperature dur-
ing the sponge bath.
6 Place large rubber sheet covered with bath
blanket under patient.
7 Remove head pillows. Place rubber pillow-


case on pillow and recover with linen pillow-
case if pillow is used under head of patient.
8 Assist patient to move to near side of bed
and remove gown.
9 Place ice cap to top of head and hot water
bottle to bottom of feet.
10 Place washcloths in basin and use alter-
nately.
11 Sponge face and dry, if necessary. Use only
plain water on face.
12 Place one towel over top of bath blanket
and chest.
13 Place one towel lengthwise under far arm.
14 Sponge neck, upper shoulder, and outer part
of arm; sponge axilla and inner part of arm.
Change washcloths and continue to sponge










with -long, light strokes for 5 minutes. Pat
excessive moisture dry.
15 Place towel lengthwise under near arm and
sponge arm as described above.
16 Place towel lengthwise under far leg, sponge
and repeat process on near leg. Sponge from
top of hip over outer and inner surfaces of
thigh and leg, and the groin. Change wash-
cloths frequently and continue to sponge
with long, light strokes for 5 minutes on
each leg. Pat excessive moisture dry.
17 Cover with bath blanket.
18 Omit sponging of abdomen.
19 Take temperature, pulse, respirations fre-
quently. Observe patient closely and dis-
continue treatment if chilliness, cyanosis,
weak pulse, or other unfavorable symp-
toms occur.
20 Assist patient to turn on side and place bath


MEDICATED BATHS


PURPOSES
1 Relieve discomfort of skin conditions.
2 Treat skin conditions.
3 Provide relaxation and sedative effect.


GENERAL DIRECTIONS
1 Prepare the water in the proper container
according to the purpose of the bath, area
to be bathed, age of the patient and any
specific orders.
2 Follow the General Directions for the Tub
Bath, the Sitz Bath or the Arm or Foot
Soak.
3 Fill the bath tub at least one-half full of
water for the average size adult. (Average
bathtub holds 30 gallons)
4 Time the duration of the bath, as ordered;
the time varies from 15 minutes to 1 hour.
5 Stir, or instruct patient to stir, and keep
water in motion.
6 Omit use of soap, rubbing or any friction.
7 Add warm water to maintain correct tem-
perature.
8 Caution patient against slipping when get-
ting in and out of the bathtub.
9 Dry skin by patting or blotting lightly.
10 Apply the local medication or preparation


towel lengthwise on bed close to body.
Sponge back, from neck to over buttocks,
for 5 to 10 minutes using long, light, even
strokes.
21 Turn patient on back and replace gown.
22 Take temperature, pulse, respirations.
23 Remove hot water bottle and ice cap.
24 Remove bottom bath blanket and rubber
sheet then the top bath blanket, replacing
the top bedding. Remove rubber pillowcase
and replace pillow covered with clean, dry
pillowcase.
25 Take temperature, pulse, respirations 30
minutes after sponge bath has been com-
pleted.
26 Leave patient between bath blankets when
sponge bath is to be repeated soon.
27 Take 25 to 30 minutes to sponge an adult,
15 to 20 for a child.

EQUIPMENT NEEDED
Bath towels, 2 or 3
Washcloth
Bath mat or folded bath towel
Bath blanket
Non-skid mat or bath towel
Robe, slippers, gown


immediately, before leaving the bathroom.
11 Gown and robe the patient at once, and
take all precautions to avoid chilling and
irritation.


COMMON TYPES OF BATHS, INGREDI-
ENTS, AND PREPARATION
OATMEAL, SOYBEAN, BRAN COLLOIDD)
1 Add 2 cups of cereal to 2 quarts of boiling
water; stir while boiling for 5 minutes.
2 Pour into mesh or gauze bag over the tub of
water, 950 F.
3 Stir bag in water for a few minutes.

STARCH COLLOIDD)
1 Pour 2 quarts of boiling water over 1 cup of
cornstarch or laundry starch (without bluing or
scent) moistened with cold water; stir until it
thickens.




I
2 Use cold uncooked starch in the same quan-
tity.
3 Add to tub of water, 950 F. and mix well.
4 Add cup soda bicarbonate to starch, if to
be used.
Commercial preparations of concentrated sub-
stances are available for therapeutic purposes.
The directions for the specific preparations
should be followed closely.
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BEDMAKING

OCCUPIED BED
UNOCCUPIED BED












OCCUPIED BED

PURPOSES)
1 Provide a clean, safe, and comfortable bed for
the patient in bed.


GENERAL DIRECTIONS
1 Adjust bed to level position, if possible and
permissible, and lock bed.
2 Remove pillow(s); leave one pillow under
head if patient desires. Remove pillow
cases) and place pillow(s) on seat of chair
under clean linen; discard soiled pillow
casess.
3 Loosen top and bottom bedding: straighten
top bedding and unfasten top cuff; go to
head of bed on far side, lift edge of mattress
with one hand and pull linen out with the
other hand; loosen linen down side of bed,
across the end, then up the other side.
4 Handle soiled linen carefully. Fold from top
to bottom; fold before removing from bed;
fold soiled side of linen to the inside; hold
partially folded at elbow level, but up from
floor, and continue to fold linen with the
direction away from self.
5 Remove spread: fold from top to bottom,
then lift up at center in quarters and place
on back of chair, if to be replaced on bed.
Discard, if soiled.
6 Remove blanket by same method as the
spread.
7 Place folded bath blanket across chest of
patient and unfold over top sheet to foot
of bed; ask patient to hold top edge of bath
blanket; grasp upper hem of top sheet and
remove from under bath blanket by walk-
ing to foot of bed. Place folded sheet over
blanket on back of chair, if to be used as
bottom sheet, or discard.
8 Move mattress to head of bed; instruct pa-
tient how to assist, if possible; obtain assist-
ance of another person, if necessary.
9 Instruct or assist patient to turn or move to


EQUIPMENT NEEDED
Linen pack-for daily change
or
Cotton sheets-1 or 2 large
Cotton draw sheet
Pillow cases)
Bath blanket
Additional linen as needed:
Spread
Mattress pad
Large sheet


4


near side of bed; go to far side of bed.
10 Fan fold bath blanket lengthwise over pa-
tient.


11 Fan fold cotton draw sheet close to patient.
12 Fan fold plastic draw sheet under cotton
draw sheet.
13 Fan fold bottom sheet under draw sheet up
close to patient.
14 Straighten mattress pad; fan fold to under
bottom sheet close to patient, if it is to be
replaced.
15 Place clean sheet on bed and unfold; fan
fold sheet lengthwise to center of bed, al-
lowing 18 to 20 inches of sheet at top of
mattress; straighten sheet with bottom hem
even with the foot of mattress; place sheet
over top end of mattress and fit fitted
corner.
16 Straighten sheet; place sheet tight and
straight under side of mattress, working
toward foot of bed.
17 Bring plastic draw sheet back into place;
straighten, pull smooth, and place end well
back under side of mattress; work from cen-










ter toward top edge, then from center to-
ward bottom edge. Remove plastic draw
sheet from under patient and replace at de-
sired location on bed, if needed.
18 Fold cotton draw sheet in half and place
center over center of plastic draw sheet;
overlap top edge of plastic draw sheet by
3 inches.
Fan fold upper half close to patient;
straighten, smooth, and place near end un-
der mattress the same as the plastic draw
sheet.


19 Assist patient to turn or move onto clean
linen, to the near side; go to opposite side
of bed.
20 Fold and remove soiled cotton draw sheet,
then the soiled bottom sheet; fold both care-
fully from top to bottom and discard.
21 Straighten and smooth mattress pad.
22 Pull bottom sheet straight and smooth;
place under top of mattress and fit fitted
corner; straighten, tighten and place sheet
under side of mattress.
23 Pull plastic and cotton draw sheets straight
and smooth; tighten and place ends under
sides of mattress.


24 Instruct and assist patient to turn on back
in center of bed.


25 Unfold and spread top sheet lengthwise
over the bath blanket; place wide hem to
the top with wrong side up; withdraw bath
blanket from top to bottom, fold and re-
move.
26 Straighten and center top sheet; allow suffi-
cient length at top to make a 6 to 8 inch
cuff over edge of blanket.
27 Place blanket over top sheet with top edge
across upper chest or shoulders of patient;
straighten and center.
28 Flex the patient's knees or use some method
to provide ample room for patient's feet
under the top sheet and blanket.


29 Place the end of the top sheet under the
end of the mattress and fit corner, then the
blanket.
30 Place spread over blanket with lengthwise
fold in center and right side up; unfold
from top to bottom.
31 Turn top edge of spread over top edge of
blanket, then cuff top hem of top sheet over
both.
32 Place end of spread under end of mattress










and fit corner with last fold loose; leave
spread loose over patient's feet.
33 Return to first side of bed; complete top
bedding.

UNOCCUPIED BED

(Closed and Open)


PURPOSES)
1 Prepare a clean, safe, and comfortable bed
ready for the patient.
2 Provide a neat, finished appearance to bed and
unit.


GENERAL DIRECTIONS


1 Adjust bed to level position and lock bed.
2 Turn mattress, if type of mattress and hos-
pital policy permits; obtain assistance, if
necessary, and turn from top to bottom and
side to side; place top end of mattress to
top of bed with the sides evenly placed.
3 Cover mattress with plastic case protector
with the open end at the foot; close zipper
or fasten ties.
4 Place the folded mattress pad at top of mat-
tress and unfold from top to bottom of mat-
tress; adjust placement and remove wrin-
kles.
5 Place bottom sheet on the bed:

STRAIGHT SHEET
a. Place folded sheet to center and top of
mattress.
b. Place wide hem at the top, right side up.
c. Unfold sheet carefully, from top to bot-
tom, on the far side and then on the near
side.
d. Center and straighten sheet with the bot-
tom hem even with the foot of the mat-
tress.
e. Allow 18 to 20 inches of sheet at top
of mattress.
f. Stand facing side of mattress at top cor-
ner; lift corner of mattress and with upper
hand pull sheet over top end ot mattress,
working from the center toward the outer
edge of mattress.
g. Make fitted or mitered corner as:


F..


34 Insert pillow(s) into pillow cases) and
place under patient's head; place smooth
side of case next to neck and the closed end
toward the door.
EQUIPMENT NEEDED
Mattress protector, usually
Mattress pad
Cotton sheets-2 large
(one may be fitted)
Cotton draw sheet
Plastic or rubber draw sheet
Pillow case
Blanket
Spread






I


6 Place rubber or plastic draw sheet, if to be 3
used, in center of bed about 15 inches from
top of mattress; unfold near side.
S7 Place cotton draw sheet over plastic draw
sheet; overlap 3 to 4 inches at top edge.
8 Place ends of both draw sheets under side
of mattress; work from center toward top
edge, then from center toward bottom edge.
9 Go to opposite side of bed; straighten bot-
tom sheet and pull taut; cover top end of
mattress and fit mitered corner of sheet.
10 Continue to tighten sheet and place under
side of mattress; work from head toward
foot of mattress. Cover lower corner with
fitted sheet, if used.
11 Straighten and tighten drawsheets; place
both ends under side of mattress, as on the
first side.
12 Place and unfold top sheet on bed; place
wide hem even with top edge of mattress;
wrong side up; straighten and center sheet.




h. Make square corners, if preferred by
agency.
i. Hold the hands palm downward to grasp I
sheet and place edge under side of mat-
tress; work toward foot of bed; flex the
knees and separate the feet slightly.
FITTED OR CONTOUR SHEET
a. Place sheet on mattress and unfold as the
straight sheet. 13 Bring top sheet over end of mattress on near I
b. Lift mattress at top corer and cover half and miter corner.
with fitted corner of sheet.











S14 Place blanket on bed with top edge 6 to 8
c. Cover lower corner of mattress on same inches from top edge of mattress; unfold,
side. straighten, and center; bring over end of
mattress on near side and miter corner.
16










15 Place spread on bed with top hem right side
up and even with top edge of mattress;
unfold, straighten, and center; bring over
end of mattress on near half; miter corner,
omit last fold to let spread hang.
16 Return to first side of bed; straighten top
sheet, blanket, and spread; bring each sepa-
rately over the end of the mattress and
miter corners as on the opposite side.
17 Place pillow into pillow case:
a. Place pillow on foot of bed; unfold pil-
low case.
b. Grasp end of pillow and pull into case.
c. Fit corner of pillow into corner of case
on smooth side; fold or pleat excess of
case on the side with seam.
18 Place pillow at head of bed with seam side
to top and closed end toward door; cover
pillow with spread if length will permit.


OPENING A CLOSED BED


1 Fold top of spread over top edge of blanket.
2 Fold top sheet back over spread to make
cuff.
3 Face foot of bed; grasp folded edge of cuffed
linen with both hands; walk toward foot of
bed and fan fold top covers to necessary or
desired placement.


MAKING AN OPEN UNOCCUPIED BED
SFollow the General Directions for the Closed
Unoccupied Bed except, place edge of spread
over top edge of blanket and cuff with sheet
as top bedding is placed; fan fold top bedding
to partially open.
REMOVING OR STRIPPING SOILED LINEN
FROM UNOCCUPIED BED
1 Adjust bed to level position and lock bed.
2 Remove pillow case from pillow; place pil-
low on seat of chair; discard soiled pillow
case and other bed linen according to desig-
nated method and facility provided.
3 Straighten top bedding; unfasten top cuff;
lift edge of mattress with one hand and pull
linen out with other hand; start at head of
bed and work down one side; across the
end of the bed, then up the other side, to
loosen top and bottom bedding.
4 Handle soiled linen carefully by folding
while on bed; if necessary, hold partially
folded linen at elbow level and continue to
fold linen with the direction away from self.
Avoid holding linens above shoulder level.
5 Remove spread: fold from top to bottom,
then lift up at center in quarters and place
over back of chair, if to be replaced on bed.
Discard, if soiled or to remake bed as a clean
closed bed.
6 Remove blanket and then the top sheet by
same method as the spread.
7 Fold cotton draw sheet with soiled side in
and discard.
8 Fold and remove plastic draw sheet; place
for cleaning or replacing on bed.
9 Remove bottom sheet and then the mattress
pad; fold from top to bottom; discard or
place according to plans for remaking bed.
10 Follow hospital policy for removing mattress
protector if bed is to be cleaned and made
ready for another patient.
ADAPTATIONS IN BEDMAKING
1 Know the purpose or therapeutic effect the
bed or frame is intended to serve the patient.
2 Use the same General Directions given above
in making any type of bed or frame.
3 Make adjustments according to type of bed
or frame and to meet the needs of the patient.
4 Follow directions and use materials provided
by the hospital to adapt bedmaking for any
type of bed or frame or patient with unusual
need.




I

I
I

II,
* 7


I *

I
BEDPAN
I AND
I URINAL
I
I
I
I
I
I
I










BEDPAN AND URINAL

PURPOSES)
1 Provide means for the patient's elimination.
2 Provide for safety and comfort during elimination.
3 Help prevent complications.


EQUIPMENT NEEDED
Bedpan and/or urinal
Bedpan cover
Urinal cover
Toilet tissue
Wash basin with warm water
Soap
Wash cloth
Towel


I.


GENERAL DIRECTIONS


1 Bring clean and dry, warmed, covered
bedpan to bedside; use warm running water
to warm bedpan, then dry.
2 Place bedpan on chair near side of bed;
fold cover and tuck under edge of mattress
toward foot of bed.
3 Cover or pad the seat or flattened back por-
tion of bedpan, if necessary.
4 Raise the head of the bed slightly, unless
contraindicated.
5 Fold or turn back corner of top bedding
onto the patient; prevent exposure of pa-
tient; adjust placement of gown or pajamas.
6 Instruct or assist patient to raise buttocks:
ask patient to flex knees, rest weight on
heels, and with palms turned down press
hands and forearms on bed; ask patient to
use trapeze to lift pelvis, if one is available.


7 Place palm of one hand under'lower back
and assist patient to raise buttocks.


8 Hold side of bedpan with other hand and
slide bedpan under the buttocks, with the
flattened portion just below the hip bone.
9 Adjust placement and make certain bedpan
is well placed for use and comfort.
10 Adjust bed to bring patient into a sitting
position, unless contraindicated.











11 Use pillows to support the body in good
alignment when elevation of bed rest is not
permitted or possible. Roll patient on side,
place pillows and adjust after placement of
bedpan, if patient cannot lift self.


12 Place roll of toilet tissue and signal button
for ease of use. Instruct patient to turn on
signal light when finished.
13 Leave patient alone, if condition permits;
remain with patient, if condition indicates.
14 Use toilet paper to clean and dry patient, if
patient is unable to care for self.
15 Remove bedpan: flex patient's knees; place
one hand under lower back; ask patient to
raise buttocks; hold side of bedpan with
other hand and slide out carefully.


16 Turn patient on side to complete toilet, if
necessary.
17 Provide basin of warm water, soap, and
towel for patient to wash and dry hands;
assist, if necessary.
18 Adjust position of patient and top bedding.
19 Observe contents of bedpan; measure and/
or take specimen, if necessary, before dis-
carding.
20 Take urinal with bedpan when bedpan is
given to male patient.


URINAL
1 Place covered urinal on side of bed within
easy reach.
2 Place the urinal in position if the patient is
helpless, or obtain assistance of orderly, if avail-
able.
3 Place the signal button for ease of use and
leave patient alone, if condition permits.
4 Cover urinal when removed; handle care-
fully.
5 Observe contents; measure and/or take
specimen, if necessary, before discarding.
6 Provide basin of warm water, soap, and towel
for patient to wash and dry hands; assist, if
necessary.































BLADDER-

URINARY


CATHETERIZATION


FEMALE
MALE


INDWELLING CATHETER


INSTILLATION


IRRIGATION


INSERTION
IRRIGATION


SINGLE
INDWELLING
CATHETER










CATHETERIZATION

(Urinary Bladder)

FEMALE AND MALE



PURPOSES)
1 Empty the bladder.
2 Relieve retention.
3 Determine residual urine.
4 Obtain urine specimen.
5 Help keep perineum clean and dry.
6 Determine whether absence of urine is due to
retention or suppression.


EQUIPMENT NEEDED
Sterile
Catheter-No. 14 and No. 16 French for the female
No. 20 and No. 22 French for the male
No. 8 and No. 10 French for the child
Small basin with cotton balls and appropriate solution
Small basin, curved
Lubricant (water soluble) in small container
Towel or treatment sheet
Gloves in wrapper or finger cots
Specimen bottle, if needed
Non-Sterile
Bath blanket and/or drape sheet
Light
Container for urine
Protector with cover
Paper bag or waste container


GENERAL DIRECTIONS


FEMALE


1 Open or set up a catheterization tray using
sterile technique: add needed materials or
supplies such as solutions) and lubricant.
2 Place patient on treatment table, if available
and permissable. If patient is to remain in
bed, replace top bedding with bath blanket.
3 Place covered protector under buttocks;
support buttocks, if necessary.
4 Place patient in dorsal recumbent position
and drape.


5 Place light to focus on perineum.
6 Wash the labia (or the glans penis) and the
local area thoroughly with soap and warm
water; rinse well.


7 Arrange equipment to provide for conveni-
ence and to maintain technique.
8 Wash hands thoroughly before continuing
or putting on sterile gloves (or finger cots
or wrapping finger tips of one hand with
cotton balls); use hand-washing technique,
if gloves are not worn.
9 Place thumb and the first or second finger
of one hand between the labia minora,
spread and pull upward toward the sym-
physis pubis; locate and expose meatus;
keep this hand in place.











10 Cleanse the area: Use the cotton balls in
the solution; wipe from above downward
and discard cotton ball after one stroke.
Use at least 3 cotton balls, more if neces-
sary: One to wipe down one side, one to
wipe down the other side, and one to wipe
down the center directly over the meatus.
11 Continue to hold the labia apart.
12 Pick up the catheter at least 3 inches from
the tip and lubricate the catheter tip for
about 1% inches; avoid getting lubricant
into eye of the catheter.
13 Place catheter in basin and put in position
to receive urine.
14 Insert catheter gently for 2 or 3 inches, or
until urine begins to flow. Discontinue and
report if unable to insert catheter or if no
urine appears.
15 Collect specimen, if needed; use the thumb
and first finger to pinch sides of catheter
and place specimen container in position to
collect 100 cc to 200 cc.
16 Continue to hold catheter in place; allow
urine to flow until flow reduces, then grad-
ually withdraw catheter when drips appear.
Pinch catheter and remove gently and
quickly.
17 Measure urine. Withdraw no more than be-
tween 750 cc to 1,000 cc without reporting
or, unless otherwise ordered.


INDWELLING CATHETER

INSERTION-FOLEY CATHETER

(Urinary Bladder)

PURPOSES)
1 Maintain or restore normal functioning of the
urinary system.
2 Prevent infection and trauma in the urinary tract.
3 Keep accurate record of urinary output.
4 Keep incontinent patient dry.


GENERAL DIRECTIONS
1 Obtain Foley catheter specified by the phy-
sician, as to size of the catheter and the size
of the bag.


MALE
1 Follow policy and practice of the institu-
tion or agency regarding the catheterization
of the male patient according to personnel
and circumstances.
2 Follow directions 1-8 given above for the
female patient.
3 Grasp the penis just back of penis head;
retract foreskin, if possible. Cleanse head of
penis with several cotton balls in the solu-
tion; place penis on sterile field.
4 Lubricate the catheter: Place a few drops
of the lubricant onto the meatus. Pick up
the catheter and lubricate the tip for about
1% inches.
5 Place catheter in small basin between the
thighs.
6 Hold the penis at a 600 to 900 angle to the
body; insert the catheter gently (about 7 to
8 inches) until the urine begins to flow. If
resistance occurs after catheter is inserted
5 or 6 inches, wait and then continue; lower
penis and catheter slightly then push for-
ward with slight twist and gentle pressure.
7 Continue according to directions 15-17
given above.
CATHETERIZATION FOR RESIDUAL URINE
1 Have patient void; measure urine.
2 Catheterize at once; measure urine.

EQUIPMENT NEEDED
Articles for catheterization-Sterile and Non-sterile

Sterile
Foley retention catheter-No. 18, 5 cc (commonly
used)
Syringe, Asepto or 5 to 10 cc with adaptor
Connecting rod
Solution (usually water or normal saline)
Drainage tube with clamp
Drainage bottle or container-calibrated, if avail-
able
Holder for bottle


2 Empty the bladder by catheterization; leave
catheter inserted in bladder.
3 Inflate balloon of the catheter. Use syringe










to inject the amount of solution through
lumen connected to balloon, as indicated on
the catheter (about 3 cc for a 5 cc bag).
Clamp inlet if catheter is not the self-sealing
type. If the patient has discomfort, stop
injecting the solution; then withdraw solu-
tion and insert catheter farther into the
bladder. Clamp sidepiece (inlet) through
which the solution was introduced to dis-
tend the balloon. Use a syringe with a No.
20 needle to distend balloon, if inlet is self-
sealing.
4 Test to see that catheter is secure in bladder;
put slight tension on the catheter after dis-
tension of balloon.
5 Use connecting rod to attach catheter to
drainage tubing; place end of drainage tub-
ing in the drainage bottle; place drainage
bottle in holder fastened to bedframe.
6 Anchor the catheter and secure the drainage
tubing to the bottom sheet.


7 Allow sufficient tubing between the fastener
and the patient; avoid any pull on the cath-
eter, also prevent kinks or loops in tubing.
8 Keep the drainage end of the tubing above
the level of the urine in the bottle.














r \1\J**.











FREQUENT IRRIGATION

(Indwelling Catheter)

SYRINGE METHOD


GENERAL DIRECTIONS
1 Prepare irrigating solution in amount and at
temperature ordered.
2 Arrange top bedding to expose catheter.
3 Place small basin on bed between patient's
thighs under catheter connector.
4 Disconnect catheter from drainage tubing
and place open end of catheter in curved
basin; place end of tubing with connector
into a sterile container or enclose in sterile
gauze or linen.
5 Draw solution into syringe, expel air, and
insert tip into catheter; or, pour solution into
barrel of syringe.










FLASK METHOD


GENERAL DIRECTIONS
1 Hang flask of solution on standard.
2 Connect one side of Y-tubing to tubing at-
tached to flask.
3 Attach catheter to stem outlet of Y-tube.
4 Attach drainage tube to the other side of
Y-tube.
5 Close clamp on drainage tube.
6 Open clamp on tubing leading from the
flask.
7 Allow about 50 cc solution to enter bladder.
8 Close clamp on tube to flask and open


EQUIPMENT NEEDED
Sterile-Syringe, Asepto
Small Basin, curved
Graduated pitcher or container
Solution or medication, as ordered


6 Allow solution to flow into the bladder
slowly and gently. Refill barrel or continue
to add solution before barrel becomes empty.
Instill 2 to 4 syringe barrelsful.
7 Invert barrel over basin and allow solution to
drain from bladder; do not aspirate.
8 Repeat inflow and outflow (steps 5, 6, 7
above) of solution according to orders (usually
until return is clear or until a certain amount
of solution has been used).
9 Connect catheter to connecting rod and
tubing.











EQUIPMENT NEEDED
Sterile-Glass Y-connecting tube
Container (flask) of solution, as ordered
Tubing, with clamp closed, attached to flask
Standard


clamp on drainage tube; allow return of
fluid to flow into drainage bottle.
9 Repeat inflow and outflow of solution
(steps 5-8) several times until return flow is
clear, or as ordered.
10 Keep an accurate record of the amount of
solution used to irrigate; subtract this
amount from the total amount in the drain-
age bottle to obtain the amount of urinary
output.


i










INSTILLATION

(Urinary Bladder)
PURPOSES)
1 Introduce medication into bladder to remain.


GENERAL DIRECTIONS
1 Prepare solution or medication in amount
and at temperature ordered.
2 Catheterize the patient; leave the catheter
inserted.
3 Attach the funnel (or barrel of syringe) to


IRRIGATION

(Urinary Bladder)
SINGLE AND FREQUENT

PURPOSES)
1 Cleanse the bladder.
2 Apply medication to bladder.
3 Apply heat to bladder.


GENERAL DIRECTIONS
1, Prepare solution or medication in amount and
at temperature ordered.
2 Catheterize the patient; leave the catheter
inserted keeping the end sterile.
3 Attach the funnel (or barrel of syringe) to
the catheter.
4 Hold the funnel low and slowly pour about
50 cc to 100 cc solution into the bladder;


EQUIPMENT NEEDED
Solution or medication, as ordered, in sterile con-
tqiner
Sterile funnel or barrel of syringe
Articles for Catheterization-Sterile and Non-sterile


9


the catheter.
4 Pour solution or medication into funnel and
allow it to flow slowly into the bladder.
5 Pinch and withdraw catheter.

















SINGLE IRRIGATION

EQUIPMENT NEEDED
Articles for Catheterization-Sterile and Non-sterile
In addition-Sterile small basin
Sterile funnel, or Asepto syringe, or bar-
rel of 20 cc syringe
Solution or medication, as ordered, in
sterile container


avoid letting the funnel become empty.
5 Invert funnel over basin and allow solution
to flow from bladder.
6 Repeat inflow and outflow (steps 4 and 5
above) of solution according to orders (usu-
ally until returns are clear or until a certain
amount of solution has been used).
7 Remove catheter.


I-











INDWELLING CATHETER

IRRIGATION-FOLEY CATHETER
(Urinary Bladder)

PURPOSES)
1 Cleanse the indwelling catheter.
2 Keep the catheter open and draining.


GENERAL DIRECTIONS
1 Turn top bedding to expose catheter.
2 Place sterile curved basin on bed between
patient's thighs under catheter connector.
3 Disconnect catheter from drainage tubing
and place open end of catheter in the curved
basin.
4 Place end of tubing with the connector
into a sterile container or enclose in sterile
gauze or linen.
5 Draw solution into syringe; expel air, and
insert tip into catheter.
6 Inject 15 cc to 30 cc solution very care-


EQUIPMENT NEEDED
STERILE
Syringe, Asepto
Curved basin
Solution, as ordered
Graduated pitcher or container


fully; prevent using force.
7 Pinch catheter and disconnect syringe and
catheter; allow solution to 'drain by gravity
into basin. Report failure of solution to re-
turn; do not inject additional solution.
8 Repeat injection of solution with drainage
until solution returns clear and with ease, or
until the amount of solution ordered has
been used, or as otherwise ordered.
9 Connect catheter to connector and drain-
age tubing; fasten tubing securely.




















BLOOD
PRESSURE










BLOOD PRESSURE

(Arterial)

PURPOSES)
1 Aid in making a diagnosis and/or a prognosis.
2 Determine condition or changes in the circulatory
mechanism.


EQUIPMENT NEEDED
Sphygmomanometer,
Mercury manometer or Aneroid type.
Stethoscope


i


GENERAL DIRECTIONS
1 Select a cuff with width according to size
of arm and age of patient. The blood pres-
sure cuff should be about 20 per cent wider
than the diameter of the arm on which
it is applied or, wide enough so that it cov-
ers only about two-thirds of the upper arm.
2 Place the mercury manometer in a conveni-
ent position at eye level. Manometer may
be in a case, fastened to a standard, or
attached to the wall near the head of the
bed.
3 Test all parts of the apparatus for leakage
of air.
4 Place patient in sitting or lying position,
with the arm to be used (usually left) well
supported and the palm of the hand turned
up. If the patient is sitting, support the arm
on a hard surface at heart level.
5 Turn gown sleeve up at least 5 inches above
the elbow; remove sleeve from arm, if sleeve
is tight.
6 Deflate cuff completely; wrap evenly and
securely around the arm above the elbow
and with tubing toward the upper side.
Tuck narrow end of cuff under last turn.
If aneroid type, fasten hooks of the gauge
or dial to an upper edge of cuff.
7 Place earpieces of the stethoscope into ears.
8 Close the valve on the rubber bulb.
9 Locate the strongest pulsation of the bra-
chial artery with finger tips and place the
bell of the stethoscope at this place, tight
against the bare skin without touching the
cuff.
10 Squeeze the bulb to inflate the cuff quickly
and the pulsations of the artery can no
longer be heard with the stethoscope.
11 Keep eyes on column of mercury or the
dial.


12 Open the thumb screw of the valve slowly
and carefully.
13 Listen for the first sharp, distinct and rhyth-
mic sound. Note the number on the dial
or scale for the systolic pressure.
14 Continue to deflate the cuff, listening for a
change in sound to a soft thump. Note this
number on the dial or scale for the diastolic
pressure.
15 Open valve and expel all air in cuff. Allow
the mercury to fall to "O."
16 Repeat the process (steps 7-14) after one
minute.
17 Remove cuff from arm; fold or roll and
place in case.
18 Cleanse ear tips of stethoscope.

ADAPTATIONS FOR THE INFANT AND CHILD
See step 1 for width of blood pressure cuff.
The following widths are usually satisfactory
for the ages given:
1 inch to 1 Y inch...... infant to 1 year
3 inch................. 2 to 8 years
4 inch............ 8 to 12 or 14 years
Flush technique or method used to obtain a
relatively accurate reading of blood pressure on
the infant:
1 Apply blood pressure cuff above the ankle
or wrist.
2 Press blood from the hand or foot below the
cuff by wrapping it snugly with elastic bandage.
3 Inflate cuff to a point higher than the ex-
pected systolic reading.
4 Remove elastic bandage.
5 Lower the pressure slowly. The reading at
which flushing of the blanched hand or foot
occurs (color returns) gives the mean or aver-
age pressure.



























COLD,
APPLICATION OF

COMPRESSES, COLD
ICE BAG OR CAP OR COLLAR
SPONGE BATH-See Bath, Therapeutic










COMPRESSES, COLD

APPLICATION OF

PURPOSES)
1 Prevent or reduce swelling or congestion.
2 Prevent or slow inflammation.
3 Check local hemorrhage.


GENERAL DIRECTIONS
1 Provide and carry out medical or surgical
asepsis according to orders of physician, or
as indicated by the area or condition of the
area where compresses are to be applied.
2 Fill small basin % full of chipped ice; stretch
gauze over top of basin and hold in place
with rubber band or tie; place moistened
gauze compresses over ice to cool, then apply
to affected area; leave uncovered.
3 Put smaller basin with a solution, if ordered,
in the basin of chipped ice; place compresses
for 1 application in the solution until moist-


ICE BAG OR CAP OR

COLLAR APPLICATION OF

PURPOSES)


1 Prevent or
2 Prevent or
3 Prevent or


reduce swelling or congestion.
slow inflammation.
check local hemorrhage.


GENERAL DIRECTIONS


EQUIPMENT NEEDED
Compresses, gauze
Small basin
Chipped ice
Paper bag
Smaller basin with solution, if ordered


ened and cooled; wring out compresses, ap-
ply to affected area; leave uncovered.
4 Fill small basin about 1/ full of chipped ice;
cover with water; immerse compresses, wring
dry and apply to affected area; leave un-
covered.
5 Replace compresses every 2 to 3 minutes.
6 Continue applications for length of time or-
dered for the treatment, usually for 15 to 20
minutes.
7 Follow specific orders to repeat treatment
at definite time intervals.



EQUIPMENT NEEDED
Ice bag or cap or collar
Small pieces of ice
Cover, appropriate for device


1 Fill device with small pieces of ice to about
% full; remove air; close opening; dry out-
side.
2 Cover filled device with appropriate cover.
3 Place to or around affected area or part.


4 Apply ice application for to 1 hour, then
remove for 1 hour for greatest effectiveness;
or, apply for duration of time ordered.
5 Refill device to maintain constant cold to
part during application.





























COMFORT,

SAFETY,

SUPPORT,

MOVEMENT

CHAIR OR WHEELCHAIR,
PATIENT INTO AND OUT OF
DEVICES AND METHODS,
USE OF SUPPORTIVE
OUT OF AND INTO BED,
ASSISTING PATIENT
POSITIONS
STRETCHER, MOVING PATIENT
TO AND FROM
TURNING AND MOVING PATIENTS IN BED
WALKING, ASSISTING PATIENT










CHAIR OR

WHEELCHAIR PATIENT

INTO AND OUT OF

PURPOSES)
1 Promote physical and mental rest and comfort.
2 Provide for change in position and some physi-
cal activity.
3 Help maintain or promote return to normal body
functions and processes.
4 Prevent fatigue and/or complications.
5 Assist with rehabilitation.
6 Transport patient who is unable to walk.


GENERAL DIRECTIONS


EQUIPMENT NEEDED
Chair or Wheelchair
Pillow(s) with protective covers
Hassock or Footstool
Blanket
Bathrobe
Slippers


1 Place chair near side of bed, at foot, facing
the head of the bed.
2 Anchor chair: turn and lock wheels of
wheelchair; place back of chair against wall;
ask another person to hold back of chair;
place heavy sandbags in front of and back of
big wheels.
3 Prepare chair:
a. Place pillow against back of chair, if
needed for good alignment.
b. Arrange blanket over chair and pillow;
allow sufficient to cover legs and lap.
c. Turn footrests on wheelchair up or back
and lower leg rests.
4 Check pulse when getting patient out of bed,
when in chair, and when returned to bed.

ASSISTING PATIENT WHO CAN STAND OR
WALK INTO CHAIR AND BACK INTO BED
1 Assist patient out of bed. See Out of and Into
Bed, Assisting Patient.
2 Face patient; stand with feet apart and sup-
port patient; place hands under patient's axillae,
and patient's hands on shoulders; turn patient
until back is toward chair.
3 Ask patient to place palms of hands on arms
of chair; assist patient to lower self into seat of
chair; hold back of chair and prevent from mov-
ing.
4 Arrange bathrobe and blanket over legs and
lap.
5 Support head.


6 Support feet and legs:
a. Turn footrests on wheelchair under feet
and raise leg rests for proper support; place
pillow under legs, from heels to back of knees.













b. Elevate legs with support continuous with
the seat of chair and to follow contour of legs;
provide support under legs with slight flexion of
knees.










7 Place chair according to wishes of patient
and fasten signal bell within easy reach; provide
desired articles for patient; make sure patient
knows how to manage wheelchair safely.
8 Reverse the above steps to assist patient from
chair back into bed.

MOVING PATIENT WHO CANNOT WALK
INTO CHAIR AND BACK INTO BED
(ONE METHOD)
1 Obtain assistance of another person, or more
than one if necessary.
2 Place and prepare chair as described above.
3 Move patient to side of bed and place in a
sitting position, with one person standing on
either side of patient.
4 Put bathrobe and slippers on patient.
5 Place one arm (near patient's knees) under
patient's thighs and clasp hands; place other arm
across under upper thighs or across back and
clasp hands. Or, use the four-handed seat carry:
pass arms under thighs; grasp own right wrist
with left hand and with right hand grasp the
other person's left wrist. Flex knees and keep
back straight.


6 Instruct patient to place one arm across the
shoulders of each nurse.
7 Raise patient (one person gives signal to
start) and carry to chair. Step together, the one
on patient's left first steps with left foot, and the
other steps with right foot first.
8 Stand on either side of chair and lower pa-


tient into seat; make certain chair is secure or
have third person hold it; place buttocks well
back on seat.
9 Support head, legs, and feet as described
above.
10 Arrange bathrobe and make ample cover
with blanket.
11 Reverse the above steps to move patient
from chair back into bed.

ASSISTING PATIENT WITH A LEG CAST INTO
A WHEELCHAIR AND BACK INTO BED
1 Obtain assistance of another person, if pos-
sible.
2 Place wheelchair facing foot of bed, adjacent
to side of bed with leg cast; place seat of chair
opposite patient's buttocks.
3 Stabilize wheelchair with heavy sandbags
placed in front and behind big wheels, or have
assisting person stand back of chair to hold.
4 Prepare chair with pillow and blanket.
5 Assist patient to sit up and put on bathrobe.
6 Assist patient to slide to side of bed; stand in
front of chair facing bed; place one hand under
knee area and one hand under ankle area to sup-
port leg with cast.
7 Ask patient to reach across chair to grasp far
arm of chair for support, keeping other hand
palm down on the bed. Instruct patient to place
weight on palms of hands.
8 Continue to support involved leg while pa-
tient transfers self to arm of chair next to bed.
9 Step back as patient slips over and lowers
self into seat of chair, keeping knees and hips
flexed and back straight.
10 Place the leg with the cast on the raised and
extended leg rest. Adjust other leg and foot rest;
provide support to both legs and cover.
11 Carry out the above steps in reverse to as-
sist patient from wheelchair back into bed.










DEVICES AND METHODS

USE OF SUPPORTIVE

PURPOSES)
1 Promote physical and mental rest and comfort.
2 Provide for change in position.
3 Prevent fatigue and/or complications.
4 Help maintain or promote return to normal body
functions and processes.
5 Assist with rehabilitation.


GENERAL DIRECTIONS
1 See General Directions, Turning and Moving
Patients in Bed.
2 Use one or more of the following devices,
according to specific needs) of a patient:
a. Back rest and/or knee gatch.
b. Blanket (bath) roll.
c. Cradle.
d. Foot boards, mattress end.
e. Hand roll.
f. Over-bed table.
g. Pillows, large and small.
h. Sandbags, Trochanter roll.
i. Sponge rubber roll.
PATIENT IN BACK-LYING (SUPINE, DORSAL)
POSITION
1 Place pillow(s) under head; place second pil-
low under upper shoulders and/or neck; use
small pillow(s) under head or neck.
2 Place pillow(s) under forearms at side of
body.
3 Place hand rolls.
4 Place sandbags or trochanter roll on either
side of hips and upper part of thighs; use sand-
bags on in and out sides of lower leg.


EQUIPMENT NEEDED
As given below in General Directions


5 Place small blanket roll(s) or pillow or
sponge rubber under knees and ankles.
6 Place feet at right angles against footboard,
or firm roll of pillow or blanket.
7 Support of leg in long leg cast.


8 Support of stump.


9 Support top bedding with bed cradle placed
over extremity or portion of body, as necessary.
PATIENT IN FACE-LYING (PRONE)
POSITION
1 Turn head to one side.










2 Place flat or small pillow under head; fit
small pillow under neck.
3 Place one arm flexed above the shoulder and
the other along the side.
4 Place small pillow under upper abdomen.
5 Place ankles on end of mattress or on blanket
roll or rolled pillow, with soles of feet and toes
held up from touching bed or a surface.
6 Support of stump.


PATIENT IN SIDE-LYING POSITION


1 Place pillow under head and neck.
2 Place entire upper arm, in flexed position,
on pillow in front of upper abdomen and chest;
place hand roll.
3 Place lower arm, with elbow flexed, in front
of head and pillow.
4 Place lower leg in slightly flexed position.
5 Place upper leg in flexed position, supported
on pillow placed on bed from the groin to the
foot.
6 Place firmly rolled pillow(s) against the pa-
tient's back.
7 Support feet.

PATIENT IN SITTING OR SEMI-SITTING
POSITION


1 Raise knee gatch slightly or use rolled pillow
under knees.
2 Raise back rest to desired height.
3 Place pillow(s) under patient's head, neck,
and upper shoulders.
4 Place pillows on either side of patient to
support arms, place hand rolls.
5 Support feet against footboard or firmly
rolled blanket or pillow.
6 Keep mattress up toward head of bed with
a mattress end, or such devices, placed between
end of mattress and foot of bed.


7 Use the over-bed table and pillows for the
orthopneic patient.










OUT OF AND INTO BED

ASSISTING PATIENT

PURPOSES)
1 Promote physical and mental rest and comfort.
2 Provide for change in position and some physical
activity.
3 Help maintain or promote return to normal body
functions and processes.
4 Prevent fatigue and/or complications.
5 Assist with rehabilitation.


GENERAL DIRECTIONS
1 Bring bed to level position and lower height
of bed, if possible.
2 Place footstool at side of bed ready for use.
3 Bring patient to a sitting position on side of
bed:
METHOD A-Instruct patient who needs no
assistance.
a. Flex knees and hips.
b. Turn on side; bring knees near side of bed.
c. Place hand of upper arm on bed in front,
and leave under arm at side.
d. Turn body toward the erect position and
swing legs over the side of the bed at the
same time.
e. Place both hands with palms down on
the bed on either side.
f. Place feet on footstool.
METHOD B-Assist patient who needs assist-
ance.
a. Stand with one foot forward (one toward
head of bed) at side of bed.
b. Place hand of upper arm under patient's
neck.
c. Place hand of lower arm under both of
patient's knees.
d. Brace forward leg against bed; keep back
straight; and contract muscles of abdomen
and buttocks.
e. Rotate hip (one toward foot of bed) out-
ward and pivot patient to a sitting posi-
tion, swinging legs over side of bed.
METHOD C-Assist patient who needs assist-
ance.
a. Stand with one foot forward (one toward


EQUIPMENT NEEDED
Footstool
Bathrobe
Slippers


head of bed) at side of bed.
b. Reach across patient's upper chest with
lower arm and around the patient's neck
with palm of hand on cervical vertebrae.
c. Place hand of upper arm under patient's
neck on near side; instruct patient to flex
both elbows and place palms of hands on
bed to either side of pelvis.
d. Instruct patient to push on bed with palms
of hands and assist patient to sit up. Keep
feet in position, knees and hips flexed, back
straight, and thighs supported against side
of bed.
e. Place hand of lower arm under both of
patient's knees; keep upper arm under pa-
tient's head and shoulders; swing patient
slowly to a sitting position over the side
of the bed.
4 Stand directly in front of patient to support
patient; place hands below axillae, or around
sides of chest; and, keep one leg between pa-
tient's knees.
5 Instruct patient to place hands on either
shoulder.
6 Support patient's feet on footstool.







_T


i










7 Place robe and slippers on patient.
8 Support patient, and assist to a standing posi-
tion on the floor.


9 Assist patient to chair or wheelchair, or to
walk.
10 Carry out, in reverse, the steps of method
used above to assist patient back into bed.


POSITIONS

PURPOSES)
1 Prepare for a physical examination.
2 Provide for, or to receive, a treatment, medical
or nursing.
3 Prevent fatigue and/or complications.
4 Help maintain or promote return to normal body
functions and processes.
5 Assist with rehabilitation.
6 Promote physical and mental rest and comfort.


GENERAL DIRECTIONS

1 Direct and/or assist patient to assume de-
sired position.
2 Support patient to maintain position, and to
provide for safety, as designated or indicated.
3 Fan fold top bedding to foot of bed and
replace with large sheet, if patient remains
in bed and according to purpose of position.
4 Provide for draping:
a. Select linen for drape according to posi-
tion and purpose of the position.
b. Use specific linen(s) and clothing desig-


EQUIPMENT NEEDED
Linen(s) for drape-draping sheet, large sheet, draw-
sheet, bath blanket.


nated and appropriate for certain examina-
tions or treatments.
c. Drape for only necessary exposure to an
area or part.
d. Drape according to environmental condi-
tions.
DORSAL POSITION (HORIZONTAL, SUPINE)
1 Lower back rest and flatten bed.
2 Place patient flat on back with one pillow
under head.










3 Extend legs and keep together; flex knees
slightly.
4 Place arms along side of body, folded on
chest, or above head.


DORSAL RECUMBENT POSITION
1 Place patient in dorsal position.











2 Flex knees and separate legs to extent needed.
3 Separate feet and place soles of feet flat.

ERECT POSITION (STANDING)
1 Dress patient according to purpose; use short
or long gown open in back; trunks, or drape
sheet.
2 Provide protection for feet with shoes, slip-
pers, or paper towels on floor.
3 Have patient stand; give support, as needed.

FOWLER'S POSITION (LOW, SEMI OR MODI-
FIED, HIGH)
1 Place patient in dorsal position.


2 Elevate back rest to desired height.


3 Elevate knee gatch to desired height, or place
rolled pillow(s) under knees.


4 Place footboard or like device between end
of mattress and foot of bed.
5 Support shoulders and arms with pillows.
KNEE-CHEST POSITION (GENUPECTORAL)
1 Assist patient to turn or raise on knees and
place chest flat on bed, table, or floor.










2 Turn head to one side.
3 Separate lower legs and knees slightly, usu-
ally about 12 inches.
4 Place lower legs flat on surface, and provide
for front part of feet to turn over end, if pos-
sible.
5 Bring thighs straight up and down with hips
directly above knees.
6 Flex arms and place forearms to side of head
on either side, or place above the head.
LITHOTOMY POSITION (DORSAL
LITHOTOMY)
1 Place patient in a dorsal recumbent position.










2 Flex knees and separate legs and feet well
apart.
3 Place feet in stirrups; place shoes on feet, if
necessary.
4 Assist patient to slide buttocks to edge of
table.
5 Place arms to sides or on chest.

PRONE POSITION
1 Place patient on abdomen; turn head to one
side.










2 Flex elbows and place forearms well up along
sides of head, or along sides of body.
3 Use pillow under head, if permitted.
4 Provide for front part of feet to turn over
end of mattress or table.



STRETCHER MOVING

PATIENT TO AND FROM

PURPOSES)
1 Transport patient who must remain in a hori-
zontal position.
2 Transport patient who is unable to walk or sit in
a wheelchair.


I


GENERAL DIRECTIONS


SIM'S POSITION (LEFT, OR RIGHT, LATERAL)
1 Assist patient to turn on left side with but-
tocks near edge of bed or table.


2 Use pillow under head, if desired or per-
mitted.
3 Flex right knee and bring up to abdomen.
4 Flex left knee slightly.
5 Bring left arm back of body; place right arm
in a flexed position.
TRENDELENBURG POSITION
1 Lower back rest and flatten bed.
2 Place patient in desired position, according
to purpose.
3 Raise and support foot of bed higher than
head of bed.
4 Protect head and stabilize body, if necessary.


EQUIPMENT NEEDED
Stretcher
Sheet-drawsheet or
large sheet


Bath blanket or
Large sheet


1 Fit clean sheet over stretcher pad.
2 Determine if one end of stretcher is station-
ary; if so, place pillow and patient and pa-
tient's head on this end.
3 Push stretcher from stationary end, or the
end with the patient's head.
4 Fan fold top bedding to foot of bed replac-
ing with large sheet over patient.
5 Fan fold cover sheet lengthwise up to pa-
tient.


6 Obtain assistance of sufficient number of
other persons to help support and move pa-
tient; take care to avoid strain or to lift
excess weight.
7 Place patient's arms next to body and hold
with the linen brought up from both sides
to cover patient.

ASSISTING PATIENT WHO CAN MOVE SELF
ONTO STRETCHER










1 Place stretcher parallel to and touching side
of bed; turn wheels on stretcher and lock.
2 Place stretcher to side of bed next to side of
patient with an involved part, if any.
3 Stand at side and center of stretcher, facing
bed across stretcher; hold stretcher steady with
body weight held against it.
4 Instruct patient to move self next to
stretcher: flex knees and elbows with palms of
hands on bed; push on bed with heels and
palms, and lift and swing buttocks up onto
stretcher; bring arms then legs onto stretcher
and lie flat.
5 Hold cover sheet to keep patient draped
during transfer from bed to stretcher.
6 Obtain another person to lift and support an
involved extremity or part during the transfer.
7 Reverse the above to assist patient from
stretcher back into bed.

MOVING PATIENT WHO IS HELPLESS ONTO
STRETCHER
METHOD A-(LIFTING SHEET)
1 Loosen drawsheet on both sides of bed, or
place a drawsheet or large sheet under patient;
fan fold both sides of drawsheet up to patient.
2 Move patient to side of bed where stretcher
will be placed.
3 Place stretcher parallel to and touching side
of bed; turn wheels on stretcher and lock.
4 Have one person stand at head of stretcher
to support, patient's head, neck, and shoulders.
5 Have one person stand at foot of stretcher
to support patient's legs and feet.
6 Have one person (two, if necessary) stand
on far side of bed and grasp the drawsheet.
7 Have one or more persons (orderlies, if pos-
sible) stand at center of stretcher to reach across
and grasp drawsheet.
8 Pull on the sheet together to carefully slide
the patient from the bed onto the stretcher.
9 Reverse the above to move patient from
stretcher back into bed.

METHOD B-(3-MAN LIFT)
1 Obtain assistance of at least 2 persons, one
an orderly.
2 Place stretcher at a right angle to bed, with
head of stretcher at the foot of bed; turn wheels
on stretcher and lock, or use sandbags to sta-
bilize.


3 Move patient to near side of bed; place pa-
tient's arms along side of body, or ask patient
to hold far arm, if able.
4 Stand side by side facing the patient, with
the orderly in the center; flex knees, advance
same leg and get wide base; rest thighs against
bed.


5 Place arms well under patient reaching op-
posite side.
a. Have person at head end support head,
neck, and shoulders with one arm and the upper
back with the other arm.
b. Have person in center place arms under
lower part of back and buttocks.
c. Have person at foot end place one arm
under upper thighs and the other arm under
ankles.
6 Lean over close to patient and, at a given
signal, rock back and lift together to turn and
roll patient's body up to and against chests; hold
securely.










7 Take one step backward together and pivot;
walk in step to stretcher.
8 Lower patient onto stretcher; all advance
same leg forward, flex knees, and move together
to place patient.
9 Reverse the above to return patient from
stretcher back into bed, except:
a. Lower patient close to side of bed.
b. Have one person stand close to bed at
center, and the other two (one, the orderly)
go to the other side of bed.
c. Place arms under patient and all slide pa-
tient to center and up in bed.
10 Use the 3-man lift to lift a person from the
floor, or a patient with excess weight or heavy
cast. Obtain assistance of 4 or 5 persons, if nec-
essary, and without hesitation. Take no chances
for injury to patient or self.


TURNING AND MOVING

PATIENT IN BED

PURPOSES)
1 Promote physical and mental rest and comfort.
2 Provide for change in position and some physi-
cal activity.
3 Help maintain or promote return to normal body
functions and processes.
4 Prevent fatigue and/or complications.
5 Place into position to receive treatments) or to
carry out nursing measuress.


GENERAL DIRECTIONS
1 Lock bed; lower back rest and flatten bed.
2 Obtain assistance of other persons) to move
helpless and heavy patients.
3 Use methods of good body mechanics for
patient and self, such as:
a. Stand near and face object or the location,
the center or the direction of work.
b. Place feet apart with one foot slightly in
front of the other and shift weight of
body as object is moved.
c. Flex knees and pelvis; keep back straight.
d. Hold an object as close to body as possible.
e. Support body part against bed, if possible.
f. Slide or roll or turn or push or pull rather


EQUIPMENT NEEDED
Large sheet or drawsheet-for some methods.


than lift patient.
g. Support body partss, injured or involved
body part.








h. Use weight of body and rock
-forward to push.
-backward to pull.










i. Move an object toward rather than away
from self, if possible.
4 Encourage and instruct patient to assist self,
if possible, for example:
a. Flex knees and push on bed with heels.
b. Flex elbows, place palms of hands on bed
and push.
c. Use trapeze or lifting bar.
5 Use lifting sheet or device to help move
patient.

MOVING PATIENT UP IN BED

PATIENT WHO CAN ASSIST
1 Stand one pillow on side against head of bed.
2 Place patient in dorsal position in center of
bed.


3 Place upper arm under head and shoulders
of patient; cradle patient's head in bend of elbow
and place hand in the patient's axilla.
4 Grasp patient's near arm close to axilla with
other hand.
5 Ask patient to flex knees and, at signal, to
lift buttocks and to push backward using the
heels.
6 Slide patient toward head of bed with sev-
eral such movements.
7 Have patient grasp bars at head of bed with
both hands to pull self, if able or possible.

PATIENT WHO CANNOT ASSIST
METHOD A
1 Stand one pillow on side against head of bed.
2 Obtain assistance of other personss.
3 Place in dorsal position in center of bed with
knees slightly flexed, if possible.


4 Stand on opposite sides of bed: one person
places upper arm under head and shoulders, and
the other arm under the lower part of the back;
one person places upper arm under small of back
and the other arm under the buttocks.
5 Slide patient together, at given signal, toward
head of bed; take several such movements
slowly, if necessary.
METHOD B
1 Place patient in dorsal position in center of
bed.
2 Place a drawsheet under patient lengthwise,
from midthigh to extend above the head.
3 Roll upper end of drawsheet close to pa-
tient's head and shoulders.
4 Assume correct posture, brace one thigh
against lower part of bed frame, and pull to-
gether bringing patient on drawsheet toward top
of bed.

MOVING PATIENT TO SIDE OF BED
1 Place patient in dorsal position.
2 Ask patient to flex knees, or place patient's
knees in a flexed position.
3 Place upper arm under patient's head and
shoulders; slide upper portion of body toward
self.
4 Place upper arm under patient's lower back
and lower arm under thighs; slide buttocks to-
ward self.
5 Place one hand under knees and the other
hand under ankles and slide lower legs toward
self.
6 Take several such movements, if necessary,
to move or assist patient to move to side of bed.

TURNING PATIENT IN BED
TOWARD SELF
1 Move patient up in bed, if necessary.
2 Bring far arm of patient across chest; flex
patient's far knee and bring leg up over other
leg toward near side of bed.
3 Place upper hand on patient's far shoulder
and the lower hand on the far side of hips; brace
self against side of bed.
4 Roll and turn patient toward self, slowly.
5 Adjust and support position of patient.
AWAY FROM SELF
1 Move patient up in bed, if necessary.
2 Move patient to near side of bed.










3 Flex patient's near knee and place leg over
other leg.
4 Place near arm of patient over front of chest.
5 Place upper arm under patient's shoulders
and the lower arm under the hips.
6 Roll and turn patient away from self; draw
hips toward self.
7 Place hands under lower shoulder and then
under lower hip to pull toward self.
8 Adjust and support position of patient.
LIFTING THE PATIENT'S HEAD AND SHOUL-
DERS, OR ASSISTING TO SITTING POSITION
METHOD A
1 Place upper arm under patient's shoulders;
support head and neck with hand.


2 Grasp patient's near arm above the elbow.
3 Ask patient to grasp lower arm just above
elbow.
4 Pull and assist patient into upright position;
support thighs against side of bed.
METHOD B
1 Bring lower arm across to patient's far
shoulder; place hand on patient's upper back
with fingers between scapulae; place other hand
on the bed next to the patient's neck and
shoulder.
2 Push against bed with the one hand and pull
patient into upright position with the other arm.


WALKING


ASSISTING PATIENT

PURPOSES)
1 Promote physical and mental rest and comfort.
2 Provide for change in position and some physi-
cal activity.
3 Help maintain or promote return to normal body
functions and processes.
4 Prevent fatigue and/or complications.
5 Assist with rehabilitation.


GENERAL DIRECTIONS
1 Assist patient out of bed. See Out Of and
Into Bed, Assisting Patient.


EQUIPMENT NEEDED
Bathrobe and shoes
or
Patient's clothes and shoes
Footstool
Walker


Straight chairs-2


2 Assist patient to dress appropriately, and ac-
cording to needs.










3 Support patient, as needed:














a. Grasp belt or clothing from the rear at the
waist.
b. Place arm near patient around patient's
waist and hold forearm with other hand.
c. Place arm near patient under forearm of
patient and grasp hand.
d. Slide arm to place hand in patient's axilla,
if patient feels faint.
4 Instruct patient to move alternate arms and
legs; move right arm and left leg forward,
then left arm and right leg forward. Walk in
step with patient.
5 Use two straight chairs to provide support
for patient to walk; provide additional sup-
port, as needed.


6 Instruct patient in use of a walker; bear
weight on the hands, not the axillae. Adjust
hand bars (and arm-pit extensions) to pa-
tient's height for use. Provide additional sup-
port, as needed.




I

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I
I DRESSINGS
| DRY
MOIST
See Heat, Compresses
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STERILE DRY DRESSING

PURPOSES)
1 Help prevent infection of wounds.
2 Protect wounds from trauma.
3 Absorb secretions from wounds.
4 Restrict motion of area.
5 Provide pressure on wound.
6 Keep medications on area.
7 Provide esthetic effect to an area.


GENERAL DIRECTIONS
1 Wash hands thoroughly before and after
changing, or assisting with changing, a dress-
ing; wash hands more often, if indicated.
2 Use sterile technique.
3 Arrange bedside unit and immediate environ-
ment.
4 Place patient in comfortable and convenient
position, depending upon area to be dressed;
support part or patient, as needed.
5 Expose area: turn or fan fold top bedding, as
needed; lift, loosen, or remove gown, as
needed.
6 Unfasten, untie, or loosen the means used to
secure the dressing; remove adhesive tape
strips with short quick pulls toward the
wound, or with adhesive remover spray.


7 Place and prepare nonsterile items: place
waste container near foot of bed, usually;
cut and arrange adhesive strips or prepare
other means of securing dressing.
8 Wash hands.
9 Provide a sterile field with needed instru-
ments, supplies, and dressings from a dress-


EQUIPMENT NEEDED
Lifting Forceps
Sterile instruments
Sterile dressings
Sterile cotton balls and gauze
Antiseptic solution
Sterile gloves
Item(s) for securing dressing
Solvent agent
Waste containers)


ing cart or dressing tray, or by opening an
instrument packages) and dressing pack-
age(s); use lifting forceps to handle and ar-
range items on the sterile field.

REMOVING SOILED DRESSING
1 Remove outer dressing by lifting from top to
center; avoid touching edges. Use or provide
sterile gloves or an instrument, if needed, or if
preferred by physician.
2 Discard soiled dressing in suitable waste con-
tainer.
3 Discard gloves or instrument, if used.
4 Use sterile tissue forceps to remove dressing
next to wound.
5 Apply appropriate solvent agent to remove
any adhesive markings from skin; use moistened
sponge; avoid friction.
6 Observe appearance and condition of wound
and skin area; report any change in appearance.

APPLYING DRESSING
1 Cleanse the wound and surrounding area
with solution specified by agency or preference
of physician.
2 Use tissue forceps to hold cotton ball moist-
ened with solution; place cotton ball on center
of wound, wipe or stroke away from center and
discard cotton ball; repeat, using a different
sterile cotton ball each time, until cleaning is
completed; discard forceps.
3 Apply any medication which may be or-
dered; use a sterile item which is suitable to
apply, such as, applicator, instrument, or a spray
from a can.


I
























4 Use instrument to place dressing over wound,
use size, type, and number of dressings accord-
ing to the wound.
5 Cover with sterile absorbent dressing, usu-
ally.

SECURING DRESSING-(See BANDAGES AND
BINDERS)
1 Use appropriate means and method to hold
dressing in place, or that used or preferred by
the physician; consider the frequency the dress-
ing needs changing and the activities of the
patient.
2 Use, in most cases, one of the following
means:
a. Bandage(s).


b. Binder(s).
c. Adhesive tape strips.











d. Adhesive, liquid.
e. Montgomery straps.


f. Stockinet.






























EAR

DRESSINGS AND BANDAGES

DROPS

IRRIGATION


', ,










DRESSINGS

Ear

PURPOSES)
1 Keep wound surgically aseptic.
2 Apply pressure.


GENERAL DIRECTIONS
1 Place patient on the unaffected side, without
a pillow; if patient is ambulatory, provide a
straight-back chair for him to sit and an
overbed table in front for him to place his
head, turned on the unaffected side.
2 Prepare ear for dressings, such as: remove
old dressings, apply medication, cleanse, or
give treatment. Outer dressings only may be
changed, as ordered.
3 Hold dressings in place by an appropriate
method, or the specific method ordered:
BANDAGE FOR EAR AND MASTOID
I Use 2 or 3 inch roller bandage; secure band-
age by making 2 circular turns around the head.
The circular turns should be clockwise if the
left ear is to be bandaged, and counterclockwise
if the right ear is to be bandaged.
2 Make first turn over the dressing: with an
oblique turn bring the bandage from the fore-
head to below the affected ear, covering the
dressing and to the back of the head and the
circular turn.
3 Repeat this turn until dressing is adequately
covered, keeping tension even; overlap each
ascending turn by / to 3 the width of the
bandage.





K,


EQUIPMENT NEEDED
Sterile ear dressings
Sterile forceps
Provisions for holding dressing in place: gauze, elas-
tic bandage, adhesive tape.
Ear dressings are usually applied and changed by
the doctor; some ear dressings (according to the
purpose and/or the doctor's orders) may be
changed, or reinforced by the nurse.


4 Anchor bandage by one or two circular
turns around the head and fasten over the fore-
head or temple on the affected side.
If both ears or mastoid areas have dressings, an
effective method of applying the bandage:
1 Use 1 inch roller gauze bandage; place a
strip from top of head down over the temple
under the chin and up the other side of the
face; tie in a bow knot on top of head.


2 Use 2 or 3 inch roller bandage; secure band-
age with 2 circular turns around the head. Apply
bandage, as described in method above, to one
and then the other ear.
3 Cut the 1 inch strip under the chin, untie
the bow on top of head, and tie the 2 ends
together on both sides over the temple.












DROPS OR INSTILLATION
Ear

PURPOSES)
1 Instill medication into auditory canal.
2 Soften cerumen.


GENERAL DIRECTIONS
1 Use separate equipment for each ear, if drops
are to be instilled into both ears.
2 Place patient's head in correct position. If
patient is lying in bed, place in a dorsal
recumbent position with head tilted slightly
backward and the affected ear uppermost. If
patient is ambulatory, provide a straight-back
chair for him to sit with head erect.
3 Cleanse and remove crusts or discharge on
external ear, if necessary. Soak, loosen and
remove carefully with cotton applicator, as
ordered.
4 Straighten the ear canal:
Adults-lift the auricle (pinna) upward
and backward gently.
Children-lift the auricle backward gen-
tly.


EQUIPMENT NEEDED
Medication or Solution, as ordered, warmed to room
temperature in a warm water bath
Medicine dropper
Cotton ball, sterile


Infants up to 2 years-lift the auricle
downward and backward gently.
5 Instruct patient not to cough, swallow, or
sneeze.
6 Draw up the required amount of medication
or solution into medicine dropper and instill
the number of drops ordered into the ex-
ternal auditory canal without inserting the
tip of the dropper. A small piece of cotton
may or may not be placed lightly in the
auditory canal, according to the physician's
orders.
7 Instruct patient to remain in position on his
nonaffected side for 15 to 30 minutes.
8 Dry external ear thoroughly.


IRRIGATION


Ear

PURPOSES)
1 Cleanse the external auditory canal.
2 Apply heat.
3 Remove cerumen or some types
of foreign bodies.


tion with his head tilted slightly backward
and toward the affected side.
2 Cleanse external ear of discharge or crusts,
if necessary. Use cotton ball or small gauze


EQUIPMENT NEEDED
Ear syringe
Solution, as ordered
1000 to 1050 F.
(Syringe and solution may need to be sterile)
Waterproof protector covered with towel
Covered basin
Large basin
Paper bag or waste container


GENERAL DIRECTIONS


1 Place patient in sitting or upright position,
if possible, with protector and towel under
the head and over the shoulder. Otherwise,
place the patient in a dorsal recumbent posi-


I


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squares to apply ordered solution or mate-
rial to soften and loosen material: remove
carefully with cotton applicator.
3 Straighten the ear canal:
Adults-lift the auricle upward and
backward gently.
Children-lift the auricle backward
gently.
Infants up to 2 years-lift the auricle
downward and backward gently.
Grasp the auricle between the base of
the middle and index finger or, be-
tween the tips of fingers.
4 Place a curved basin under the ear and ask
the patient to hold firmly against face, if
possible.
5 Instruct patient not to cough, swallow, or
sneeze.
6 Expel air from the syringe and fill with
solution.
7 Place tip of syringe just within the external
meatus directed toward the roof of the


canal, not straight inward or toward the
center.


8 Express solution slowly, gently and continu-
ously until treatment is completed; discon-
tinue if patient has any complaints or dis-
comfort. Allow solution to flow back freely
during entire irrigation.
9 Instruct patient to remain in position, lying
on the affected side for several minutes.
10 Dry the external ear with a cotton ball.




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I \

I ENEMATA
CAN METHOD
FUNNEL METHOD
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ENEMATA

ENEMA-CAN METHOD

(Non-Retention Type)

PURPOSES)
Enemas are usually classified as Non-Retention or
Retention, according to the purpose:
Non-Retention (to be expelled)
1 Anthelmintic-to expel worms.
2 Astringent-to contract tissue.
3 Carminative-to expel flatus.
4 *Cleansing-to cleanse of fecal material.
Retention (to be retained)
1 Diagnostic-to outline colon for x-ray.
2 Emollient-to coat mucous membrane.
3 *Lubricating-to soften feces.
4 Nutrient-to provide nourishment.
5 Sedative-to induce sleep.
6 Stimulating-to stimulate body processes.
*The Cleansing and the Lobricating are the two
most common.
The age, size, and condition of the patient as well
as the amount and type of fluid to be given de-
termine the equipment and method to be used.


EQUIPMENT NEEDED


Tray with-Irrigating can with tubing, clamp, glass
connector. Rectal tube No. 28 to No. 32 Fr. for
adults.
Small basin
Paper towel, or toilet tissue
Toilet tissue with lubricant
Pitcher or large graduate
Bath thermometer
Solution, as ordered, at temperature of
1050 F-1100 F.
Bed protector with cover
Bed pan and cover, roll toilet tissue
Standard
Bath Blanket


GENERAL DIRECTIONS





1 Have patient empty bladder before giving
enema.
2 Place patient in position and drape with
bath blanket. The preferable position is the
left lateral with knees flexed (Left Sims)
and the buttocks close to edge of bed.
Right lateral, dorsal, or knee-chest positions
may be used, if ordered or necessary.


3 Skim off any froth or foam on top of solu-
tion.
4 Lubricate tip of rectal tube for about 2
inches; avoid covering the openings.
5 Let solution run through tubing and to tip
of rectal tube.
6 Lift upper buttocks to locate anus.










7 Ask patient to take a deep breath, and insert
the rectal tube slowly for 4 to 5 inches.


8 Release flow of solution.
9 Maintain low pressure by giving solution
slowly. Adjust height of irrigating can to
keep level of fluid in can not over 18 inches
above anus.
10 Instruct patient to breathe deeply as solu-
tion is given.
11 Clamp or pinch tubing to stop flow for a
few minutes if patient becomes uncomfort-
able before sufficient or desired amount of
solution is taken. Discontinue at once if
patient has severe pain.
12 Place patient on bedpan before starting en-
ema if unable to control anal sphincter
while enema is being give.
13 Shut off flow as last of solution leaves rectal
tube.
14 Remove rectal tube, rotating slowly, and
place tip in paper towel.
15 Apply slight pressure over anal region.
16 Encourage patient to retain solution for 5
to 10 minutes by remaining in the same
position.
17 Place patient on the bedpan in a sitting
position, if possible, or, assist him to the
bathroom.
18 Leave the patient alone to expel the enema
unless he must be assisted or supported.
19 Place call button and toilet tissue within
easy reach.
20 Return to check on patient's condition.
21 Observe results as to amount, color, consist-
ency, flatulence, and any unusual materials
or reactions.
22 Report at once if no solution or fecal mate-
rial can be expelled. It may be necessary to
siphon off the solution by inserting the rec-
tal tube into the rectum with the open or
free end placed in the bedpan.










ENEMA-FUNNEL METHOD


(Retention Type)


EQUIPMENT USED
Tray with-Funnel with tubing and glass connector.
Rectal tube.
Paper towel, or toilet tissue.
Toilet tissue with lubricant.
Pitcher or graduate with solution at temperature
of 1050 F. unless otherwise ordered.
Bath thermometer.
Bed protector with cover.
Bed pan and cover, roll of toilet tissue.
Bath blanket.

GENERAL DIRECTIONS


1 Have patient empty bladder before giv-
ing enema.
2 Place patient in position and drape with
bath blanket. The left lateral position with
the knees flexed (Left Sim's) should be
used, if possible. Bring the buttocks close
to edge of bed. If ordered or necessary,
the right lateral, dorsal, or knee-chest posi-
tion may be used.
3 Lubricate tip of rectal tube for about 2
inches; avoid covering the openings.


4 Let solution run through tubing and to tip
of rectal tube.
5 Lift upper buttocks in order to locate anus.
6 Ask patient to take deep breath and slowly
insert rectal tube for 4 to 5 inches.
7 Release flow of solution.
8 Hold funnel not over 18 inches above anus
and give slowly.
9 Instruct patient to breathe deeply as solution
is given.
10 Pour solution into funnel, as necessary, to
prevent it becoming empty and allowing
air to enter tubing and rectum before all of
solution is given.
11 Pinch or clamp rectal tube close to anus as
last of solution enters rectum.
12 Remove rectal tube, rotating slowly, and
place tip in paper towel.
13 Apply slight pressure over anal region.
14 Instruct patient to remain in same position
for a short time to help avoid desire to expel
solution.
15 Return to check on patient's condition.
16 Observe results as to duration of retention,
reaction, and comfort of patient. If solu-
tion is not retained for desired length of
time or the desired results, observe evacua-
tion as the amount, color, consistency, and
any other difficulties encountered.

ADAPTATIONS FOR THE INFANT AND CHILD
1 Use No. 10 to 12 French catheter; insert
from 2 to 4 inches.




I

2 Prepare solution for cleansing enema at
1050 F. and, for the oil retention enema at
1000 F.
3 Give not more than 300 cc of solution for
the cleansing enema and, from 60 to 150 cc of
oil.
4 Prepare infant: place pillows under head and
back; pad bedpan with a folded diaper under
buttocks. Use another diaper to restrain the legs
in position over the side edges of the bedpan.





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5 Stay with infant or child until results are
obtained.








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EYE
ARTIFICIAL
COMPRESSES
COLD
WARM
DRESSINGS AND BANDAGES
DROPS
IRRIGATION
OINTMENT










ARTIFICIAL EYE


(Prosthesis)
PURPOSES)
1 Remove artificial eye from eye socket.
2 Insert or replace artificial eye into eye socket.


GENERAL DIRECTIONS
1 Place patient's head over bed. Hold cupped
hand against the patient's cheek. Pull the
lower lid down with tip of forefinger and
press in under the eye with finger tip, or
applicator, to slip eye from socket.


2 Cleanse the artificial eye with mild soap and
lukewarm water by rubbing gently between
thumb and forefinger. Rinse in plain luke-
warm water. Use special solution to cleanse
plastic eye.
3 Place artificial eye pn the gauze in the small
container in a safe place until it is to be re-
placed in socket. Plain water is usually used
to cover the eye.
4 Irrigate the socket, if necessary, with the
ordered solution.
5 Insert the artificial eye by raising the pa-
tient's upper lid, drawing it slightly outward.


EQUIPMENT NEEDED
Small basin or container lined with gauze (not cotton)
Small basin with lukewarm water or saline solution
Cotton-tipped applicator


6 Wet the eye. Hold the eye with the point of
the eye toward the nose and slip it under
the upper lid.


8 Pull the lower lid down until it slips over
the lower edge of the eye.


7 Hold the eye in position with one finger.


i










COLD COMPRESSES


Eye

PURPOSES)
1 Prevent or control edema around the eye (peri-
ocular).
2 Relieve inflammation of the eyelid or eyeball.
3 Help control bleeding.
4 Help prevent spread of infection.


GENERAL DIRECTIONS
1 Place the plastic sheet, covered with a towel,
under the patient's head and upper shoulders.
2 Cleanse the eyelid and lashes with a moist
cotton ball, and apply a thin layer of petro-
leum jelly on the eyelid from the inner
canthus to the outer canthus.
3 Use separate equipment, materials, and sup-
plies if compresses are to be applied to both
eyes, washing hands carefully between ap-
plications on each eye.
4 Apply sterile compresses with the sterile for-
ceps after wringing compresses from the
sterile solution.

Apply non-sterile compresses after placing
gauze or cotton directly on the pieces of ice.
5 Place the compresses over the eyelid and
cheek, if the eyelid only is involved. If the
eyeball is involved, place the compress over
the eye and eyebrow.
6 Change the compresses as ordered, or every
1-2 minutes.
7 Use new compresses with each change, if
sterile or when there is an infection or dis-
charge. Discard used compresses into paper
bag.


EQUIPMENT NEEDED
Sterile Compresses
Small basin of chipped ice
Small container of sterile solution
chipped ice
Sterile forceps-2
Sterile compresses or gauze squares
Sterile applicator


placed in the


Non-sterile Compresses
Small basin with small pieces of ice
Small gauze squares or cotton balls
Applicator
Small plastic or rubber sheet covered with towel
Paper bag or waste container
Petroleum jelly


8 Continue continuous application of com-
presses for the prescribed length of time,
usually 15 or 20 minutes, and at regular in-
tervals.
9 Dry the area and apply another thin layer
of petroleum jelly; apply dressing, if ordered.
Apply finely chipped ice to the eye by filling
one or two fingers of a rubber glove or, a
small plastic bag. Hold in place with scotch
tape.







Tc^ ,y\(


-










WARM COMPRESSES


Eye

PURPOSES)
1 Relieve inflammation of the eyelid or eyeball.
2 Relieve pain.
3 Improve circulation.


EQUIPMENT NEEDED
Sterile basin
Sterile forceps-2
Sterile solution
Sterile gauze compresses or squares
Sterile solution thermometer, if specific temperature
is ordered
Sterile applicator
Small plastic or rubber sheet covered with towel
Petroleum jelly, sterile
Paper bag or waste container
Electric plate


GENERAL DIRECTIONS
1 Use individual or separate equipment, mate-
rials, and supplies for each patient receiving
compresses to the eye(s); use separate
equipment, materials, and supplies for each
eye of the same patient if compresses are
to be applied to both eyes.
2 Wash and scrub hands thoroughly before
and after applications to eye and, between
applications to one and then the other eye
if both eyes are to receive the compresses.
3 Place basin of solution on electric plate at
bedside and heat to desired temperature or
not over 490 C or 120 F.
4 Place the plastic sheet, covered with a towel,
under the patient's head and shoulders.
5 Turn head slightly to affected side, if pos-
sible; provide protection to uninvolved eye.
6 Cleanse the eyelid and lashes with a moist
cotton ball, using sterile technique and wip-
ing from the inner canthus to the outer
canthus. Discard cotton ball after one wipe;
use additional cotton balls as necessary.
7 Apply a thin layer of petroleum jelly on the
eyelid, from the inner canthus to the outer
canthus, with the sterile applicator.
8 Use sterile forceps to place the sterile com-
presses in the hot sterile solution, and then
to lift and wring compresses dry; fluff com-
presses before placing.
9 Place the compresses over the eyelid and
cheek, if the eyelid only is involved; if the


eyeball is involved place the compress over
the eye and the eyebrow.
10 Change the compresses every 3-5 minutes
for 15 minutes, or as ordered, and at regular
intervals.
11 Discard used compresses after each appli-
cation; use new sterile compresses for each
application.
12 Prevent force or pressure on the eyeball or
eyelid when applying compresses.
13 Dry lid carefully with cotton ball; apply
thin layer of petroleum jelly.











DRESSINGS


Eye

PURPOSES)
1 Prevent cross-infection or injury to good or normal
eye.
2 Apply pressure over the eye socket.
3 Provide protection against injury to affected eye.


GENERAL DIRECTIONS
1 Prepare eye for dressing and instruct patient
to close eye(s).
2 Place dressings over closed eye(s).
3 Hold dressing(s) in place by an appropriate
method, or the specific method ordered:

ADHESIVE OR CELLOPHANE TAPE
1 Anchor the strips of tape on the forehead
above the opposite eye.
2 Bring the tapes diagonally across the dressing
and attach firmly to the cheek. Avoid putting
tape over the eyebrow or onto the hairline.


EQUIPMENT NEEDED
Sterile eye dressings
Sterile forceps
Provisions for holding dressing in place:
adhesive tape
cellophane tape
bandage
mask
shield


4.


MASK
1 Use eye mask when both eyes are covered
with dressings.
2 Mark the affected eve(s) with small pieces of
adhesive tape.

SHIELD
1 Place aluminum shield over eye dressing and
use cellophane tape to hold in place.


I J

BANDAGES
1 Use 2 inch roller bandage; secure bandage
by making 2 circular turns around the forehead
and occiput.
2 Make first turn over the dressing; bring the
bandage under the ear then up over the cheek,
the dressing, and up to the opposite side toward
the center of the head.
3 Repeat this turn until dressing is adequately
covered, keeping tension even; overlap each turn
by % to % the width of the bandage.























4 Anchor bandage by one or two circular turns
around the head and fasten over the temple.
1 Use 2 inch roller bandage; secure bandage
by making 2 circular turns around the forehead
and occiput.
2 Make first turn over the dressing. Bring the
bandage over bridge of the nose, the dressing
and the cheek to below the ear and up to the
back of the head.


DROPS OR INSTILLATIONS

Eye
PURPOSES)
1 Apply medication into the eye for examination,
or for treatment of the eye.


3 Make a circular turn around the head.
4 Make second turn over the dressing by re-
peating step #2, keeping the tension even;
overlap each turn by 1/ to % the width of the
bandage.
5 Repeat turns until dressing is adequately cov-
ered; anchor by one or two circular turns
around the head and fasten over the temple.


Alternate turns from one eye to the other, if
both eyes are to be covered, in using either
method described above.


EQUIPMENT NEEDED
Ophthalmic solution (sterile), as ordered
Sterile medicine dropper between sterile gauze
Sterile cotton balls
Paper bag or waste container


4.


GENERAL DIRECTIONS
1 Use sterile eye droppers; one for each eye
if drops are to be placed in both eyes.
2 Place patient's head in position with head
straight tilted backwards slightly and chin
up; patient should be seated or lying down.
3 Draw required amount of medication into
dropper and hold downward.
4 Use small gauze wipe with finger of free
hand to gently draw the lower lid downward
and outward.
5 Hold dropper to approach eye from the side;
keep parallel with the margins of the lid and
one-half inch from the eye.
6 Support or rest hand on the patient's fore-
head.










7 Place required drop(s) just inside the inner
surface of the lower lid near the center; take
care not to touch the eyelid, the conjunctiva,
or the eyeball with the dropper. Discard un-
used solution from dropper.
8 Instruct patient to close the eyelids gently
and, to roll his eye a few times unless eye
motion is contraindicated.
9 Wipe excess solution with cotton ball.
Cleanse the eyelid(s), if necessary, before
instillation of drops. Use moistened cotton
ball and wipe gently from the inner canthus
of the eye to the outer canthus. Use a sepa-
rate cotton ball for each wipe and for each
eye.

ADAPTATIONS FOR THE INFANT AND CHILD
1 Secure assistance, if necessary, from a second
person to steady the patient's head.
2 Use restraints, if necessary; the type depend-
ent upon the age and size of the child.


IRRIGATIONS


Eye

PURPOSES)
1 Cleanse the eye
2 Provide warmth
3 Relieve pain


GENERAL DIRECTIONS
1 Warm the solution in a hot water bath to
950 to 1000 F, or to temperature ordered.
Use a sterile solution thermometer to meas-
ure temperature.
2 Place the protector and towel under the
patient's head and shoulder.
3 Tilt the patient's head to the side to be
irrigated.

60


EQUIPMENT NEEDED
Sterile eye syringe
Sterile small basin or container
ordered
Sterile cotton balls
Sterile curved basin


with solution, as


Waterproof protector covered with towel
Paper bag or waste container
Separate equipment is required for each eye, if both
eyes are to be irrigated.


4 Place the curved basin next to the patient's
face; ask patient to hold basin in place.
5 Place sterile cotton ball on unaffected eye.
6 Use syringe to moisten cotton balls with
the solution to cleanse the eyelid and eye-
lashes of the affected eye; wipe from the
inner to the outer canthus; use each cotton
ball once and discard.











7 Use small gauze wipe under tip of thumb
to pull lower lid down by gently pressing
on the bony orbit.


8 Instruct the patient to look up.
9 Place the tip of the syringe on the bridge of
the nose parallel to the eye; support or rest
hand holding the syringe gently against
patient's forehead.
10 Direct a steady, gentle flow of solution into
the inner canthus.
11 Continue the irrigation for the time or dura-
tion prescribed; or, until the return flow is
clear; or, until the prescribed amount of
solution has been used.
12 Dry the eyelid gently with a sterile cotton
ball, wiping from the inner to the outer
canthus.


OINTMENT


Eye

PURPOSES)
1 Apply medication into the eye for examination,
or for treatment of the eye.


EQUIPMENT NEEDED
Ophthalmic ointment, as ordered
Cotton balls
Paper bag or waste container


6


GENERAL DIRECTIONS
1 Place patient's head in position with head
straight, tilted backwards slightly; patient
should be seated or lying down.
2 Wipe the tip of the tube with a sterile cot-
ton ball.
3 Use small gauze wipe with finger of free
hand to gently draw the lower lid down-
ward and outward.
4 Hold ointment tube parallel with the mar-
gins of the lid and one-half inch from eye.
5 Support or rest hand on the patient's fore-
head.
6 Instruct the patient to look up.
7 Express a ribbon of ointment onto the inside
of the inner surface of the lower lid (con-
junctiva) from the inner canthus to the
outer canthus; take care not to touch any
part of the eye with the tube.
8 Twist the ribbon off before the lower lid is
entirely filled.


9 Instruct the patient to open and close his
eyes gently and then to roll the eyeball in
all directions; caution patient not to squeeze
eyelids.
10 Wipe excess ointment with cotton ball.
Cleanse the eyelids and eyelashes, if necessary,
before applying ointment. Use moistened cotton
ball and wipe gently from the inner canthus of
the eye to the outer canthus. Use a separate
cotton ball for each wipe and for each eye.

ADAPTATIONS FOR THE INFANT AND CHILD
1 Secure assistance, if necessary, from second
person to steady the patient's head.
2 Use restraints, if necessary; the type depend-
ent upon the age and size of the child.


'L




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I FEEDING

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GASTROSTOMY


PURPOSES)
1 Introduce nourishment, or fluids and/or medica-
tions, through a tube inserted directly into the
stomach through a surgical opening in the ab-
dominal wall.


GENERAL DIRECTIONS


EQUIPMENT NEEDED
Feeding-type, amount, and temperature, as ordered
Pitcher-small and suitable for nourishment
Funnel or Syringe, Asepto or 50 cc
Small pitcher of warm water


4


(for Indwelling Tube)
1 Instruct patient to lie flat, or place in a sit-
ting or semi-Fowler's position as specified
by the physician.
2 Attach funnel or barrel of syringe into open
end of tube and fill with water before clamp
is opened. If no clamp is used double the
tubing on itself at the open end, attach the
funnel and fill with the warm water.
3 Allow small, measured (usually about 30
cc) amount of warm water to flow slowly
through tube.
4 Pour feeding slowly into funnel and allow
feeding to flow slowly through the tube
without force or pressure.
5 Keep the funnel half full by adding more
of the feeding as the funnel empties; con-
tinue until the entire amount of feeding has
been given.
6 Regulate rate of flow by raising and lower-
ing the height of the funnel; allow at least
10 to 15 minutes for a feeding of 200 to
500 cc to be given.
7 Pour a measured amount of warm water
(30 to 60 cc) into funnel.
8 Close clamp as water is passing through out-
let of funnel or, place a rubber band around
the folded end of the tube before removing
funnel.


9 Instruct patient to remain quietly in posi-
tion for 20 to 30 minutes.
10 Observe and report reactions of patient to
feedings.
11 Make careful observations of condition of
skin at time of each feeding. Provide clean-
liness and protection to skin at time of each
feeding and as often as necessary.
12 Pour medications) into funnel just before
starting the feeding, or include medica-
tion(s) with the feeding according to direc-
tions.
ADAPTATIONS FOR THE INFANT AND CHILD
1 Provide sterile equipment, water and feeding,
as specified.
2 Provide appropriate and necessary restraint
and security.
3 Use a needle as an adaptor to connect barrel
of syringe to the tube, if necessary.
4 Follow preference of physician for placing
infant or child into position.
5 Follow directions of physician for method of
caring for open end of tube. Clamp and close
open end of tube, or place above the level of
the infant's body if the tube is to be left open.
6 Observe closely for reactions such as fatigue,
distention or nausea.










GAVAGE
(Nasogastric Gavage)

PURPOSES)
1 Introduce nourishment and/or medications di-
rectly into the stomach when the patient is unable
or refuses to swallow or take food.


GENERAL DIRECTIONS

(for Indwelling Tube)
1 Assist patient to a sitting or semi-Fowler's
position, if possible; provide necessary sup-
port.
2 Make certain that tube is still inserted in the
stomach; adhesive tape holding tube in place
should be secure and undisturbed. If tube is
marked with a line, the end of the tube is
in the stomach when the line is at the nose.
a. Open end of tube may be inverted into
a glass of water; if the tube is in the
stomach there will be no bubbles in the
water when the patient exhales.
b. Ask the patient to hum; if the tube is
in the stomach the patient will be able
to hum.
3 Attach funnel or barrel of syringe to the
tube.
4 Open clamp and pour about 30 cc of warm
water into funnel; let water flow slowly into
the stomach. (See 12 below)
5 Pour the warmed feeding slowly down the
side of the funnel. Keep the funnel half full
by adding more of the feeding; let it flow
slowly into the stomach without force or
pressure.
6 Repeat until entire amount of feeding has
been given.
7 Regulate rate of flow by raising and lower-
ing the height of the funnel; allow at least
10 minutes for 150 to 200 cc of feeding to
be given.
8 Pour 30 cc of warm water into funnel after
the required amount of feeding has been
given.
9 Remove the funnel and close the clamp on


EQUIPMENT NEEDED
Feeding-type, amount, and temperature, as ordered
Pitcher-small and suitable for nourishment
Funnel or Syringe, Asepto or 50 cc
Small pitcher of warm water
Napkin or fresh face towel
Note: The tube for a gavage is inserted by the
physician; the practical nurse may be asked to assist.


the tube; fold end of tube over on itself
and secure with an elastic band; support
and anchor tube with tape.
10 Instruct patient to remain quietly in posi-
tion for 10 to 15 minutes.
11 Provide mouth care; observe for irritation
of nostril through which the tube passes
and provide necessary skin care.
12 Give medications at this time, before start-
ing to give the feeding (see 5 above). Pour
prepared medications, according to physi-
cian's order, into the funnel.
ADAPTATIONS FOR THE INFANT AND CHILD
1 Provide sterile equipment, water and feed-
ing, as specified.
2 Apply appropriate restraint, as necessary.
3 Use a needle (usually No. 20) to act as an
adaptor to connect barrel of syringe to the cath-
eter which has already been inserted into the
stomach by the physician.
4 Follow specific directions for placing on
back or in a raised or held position.
5 Hold barrel of syringe no higher than 6 to 8
inches above the level of the bed and pour the
feeding very slowly into the barrel.
6 Observe closely for indications of fatigue
and/or distention.
7 Use a small, measured (usually specified)
amount of sterile water to pour into funnel after
feeding is given.
8 Follow directions of physician for method of
caring for open end of indwelling catheter.
Clamp and close open end, or place above the
level of the infant's body if the tube is to be left
open.
9 Turn on right side with head and shoulders
elevated slightly; support back with diaper or
small blanket roll.


1




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I FLUIDS




I FLUIDS
* HYPODERMOCLYSIS
INTRAVENOUS INFUSION

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HYPODERMOCLYSIS


(Subcutaneous or Clysis)

PURPOSES)
1 Restore and maintain body fluid concentration.


GENERAL DIRECTIONS
Observe sterile technique.
1 Place patient in proper position, usually dor-
sal recumbent.
2 Expose area for sites of injection; protect
from exposure.
a. Fanfold top bedding to knees and replace
with bath blanket to below pubic region,
if the anterior thighs are to be used.
b. Fanfold top bedding to abdomen and raise
the patient's gown, if the area directly be-
low the breasts is to be used.
3 Assist the physician, as needed, to:
a. Cleanse and prepare sites. Have alcohol
sponges ready to use.
b. Close both clamps before tubing (attached
to stem of Y-tube) is inserted into the
container of fluid.
c. Hang container of fluid on the standard.
d. Permit fluid to flow through tubing
slowly, releasing one tube at a time, clos-
ing clamps.
e. Attach needles to tubing.
f. Inject needles and start the flow of so-
lution.
g. Support and anchor needles and tubing.
Have sponges and adhesive tape ready to
use.
h. Adjust and regulate rate of flow of so-
lution.


EQUIPMENT NEEDED
Solution-in bottle or flask, kind and amount as
ordered.
Tubing connected to stem of glass Y-connector and
with 2 pieces (about 14 inches) of tubing con-
nected to each arm of the Y-tube.
Clamps-2, one on each of the 2 pieces of tubing.
Needles-2, No. 19-to No. 22-gauge, 11/2 or 2/2 to
3 inches in length.
Adaptors-2
Gauze sponges
Alcohol
Local anesthetic, may be used
Standard


4 Check rate of flow and rate of absorption
frequently. Report at once if area of injection
becomes swollen and the skin becomes taut.
5 Observe tubing to prevent kinks.
6 Observe for desired and/or undesired reac-
tions of patient during and following the
treatment.
TO DISCONTINUE
1 Check with the nurse in charge as bottle be-
comes empty and before closing clamps.
2 Close both clamps on tubing before bottle is
completely empty.
3 Remove adhesive tape strips from needles.
4 Remove needles: Place alcohol sponge over
insertion site and withdraw needle quickly; ap-
ply firm pressure to site immediately with
sponge. Apply small, sterile, dry dressings to
sites, if necessary.

ADAPTATIONS FOR THE INFANT AND CHILD
1 Provide type and size of equipment accord-
ing to amount of solution and the specific
method to be used, as designated by the phy-
sician and/or agency. Needle(s), No. 19-to
No. 22-gauge, 11 to 2 inches long are com-
monly used.
2 Use suitable restraints and devices so that
site chosen for the insertion of the needles) is
immobilized.










3 Place and hold the infant or child in the
proper position for the area of site to be exposed
and so that movement is impossible; take care to
provide for ample breathing space.
4 Check frequently at the site of the insertion
of the needless.
5 Check restraints carefully and frequently.


INTRAVENOUS INFUSION

(Venoclysis)

PURPOSES)
Give solutions, plasma, or blood directly into a vein
to:
1 Restore or maintain body fluid concentration.
2 Supply nutrients or drugs.
3 Obtain a rapid effect.


t


EQUIPMENT NEEDED
Solution-in bottle or flask, kind and amount as
ordered
Tubing with clamp, drip chamber
Needle-No. 18-, 20-, or 22-gauge, 11/ to 2 inches
in length, medium bevel, and adapter.
Gauze sponges, cotton balls
Alcohol
Arm board
Tourniquet
Gauze bandage, 2 or 3 inches in width
Adhesive tape
Standard
Note: Additional or variations in equipment may be
requested, e.g., syringe with side arm, tubing, adapt-
ers, etc.


GENERAL DIRECTIONS
Observe sterile technique.
1 Place patient in proper position according to
site, if known; usually lying on the back if
veins in the arm, thigh, or ankle are to be
used.
2 Roll sleeve of gown to well above elbow; re-
move sleeve from arm if necessary.
3 Assist the physician, as needed, to:
a. Immobolize the arm. Place the arm on
the arm board and help to secure arm
with bandage (or ties); avoid interference
with circulation. Keep arm in good po-
sition with normal body alignment.
b. Apply the tourniquet. Place the tourniquet
under the arm above the elbow, about 1 1
to 2 inches above the site, ready to tighten
and tie or hold with forceps; keep the ends
of tourniquet away from site.


c. Cleanse and prepare site. Have alcohol
sponges ready to use.
d. Connect tubing to solution bottle and to
needle, if not already attached. Have tub-
ing and needle ready for physician to con-
nect, or use; close regulating clamp on
tubing. Hang the bottle of solution on the
standard about 18 to 24 inches above the
level of the vein, or at the height directed.
e. Expel air from tubing and inject the
needle. Release the tourniquet, if and
when directed.
f. Start the flow of solution.
g. Support and anchor needle and tubing.
Have sponge or cotton ball and adhesive
tapes ready to use.
h. Adjust and regulate rate of flow for a cer-
tain number of drops per minute.
4 Check rate of flow frequently and closely;










count drops per minute. Report at once if
rate is different from that started and ordered
by the physician.
5 Observe site of insertion frequently. Close
clamp on tubing and report immediately if
needle is dislodged from vein or there is
pain and swelling in tissues at site.
6 Observe tubing to prevent kinks.
7 Observe for desired and/or undesired reac-
tions of patient during and following the
treatment.


TO DISCONTINUE THE INFUSION
1 Check with the nurse in charge as bottle
becomes empty and before closing clamp.
2 Close clamp on tubing before bottle is com-
pletely empty.
3 Remove adhesive tape strips from needle
gently.
4 Place alcohol sponge over insertion site of
needle.
5 Keep the hub of the needle flush with the


skin and remove needle quickly; apply firm
pressure to site immediately with sponge.
6 Handle all equipment and materials very
carefully until proper disposal or cleaning is
performed.

ADAPTATIONS FOR THE INFANT AND CHILD
I Use suitable restraints and devices so that
site chosen for the insertion of the needle is
immobilized. After restraint is applied sandbags
are often placed on both sides of the head or the
extremity and then taped in place.
2 Place and hold the infant or small child in
the proper position for the area of site to be
exposed and so that movement is impossible;
take care to provide for ample breathing space.
3 Provide type and size of equipment accord-
ing to type and amount of solution and the
specific method to be used, as designated by the
physician and/or agency.
4 Stay with infant and small child (and older
child, if necessary) during the administration of
fluids, regardless of the length of time.




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I HAIR
DAILY CARE
PEDICULOSIS AND NITS
| SHAMPOO
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HAIR, DAILY CARE OF

PURPOSES)
1 Help keep hair clean and in healthy condition.
2 Improve appearance.
3 Contribute to general comfort and to a feeling of
well-being.


GENERAL DIRECTIONS
1 Allow patient to comb, brush, and arrange
hair, if able; encourage patient to care for
hair as condition permits and requires.
2 Place towel across pillow under head.
3 Give assistance, as needed, to male as well
as female patient.


EQUIPMENT NEEDED
Comb
Brush
Face towel


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4 Use comb and brush alternately to remove
snarls from hair; hold portion of hair slack
between scalp and portion being combed;
work from ends toward scalp, first on one
side and then the other.
5 Part hair in the center especially if hair is
long and heavy and/or matted or filled with
debris.
6 Braid and tie ends of long hair especially for
the child and older person as necessary and
acceptable to patient. Coil and pin or tie
braids as patient prefers. Avoid having braids
too tight or placed on back of head.
7 Clean comb and brush; wash, as necessary.
8 Seek direction from nurse-in-charge and ob-
tain written order and permission to cut
hair, for any reason.


PEDICULOSIS AND NITS, TREATMENT AND REMOVAL


(Pediculus Capitis)

PURPOSES)
1 Remove pediculi and nits from hair and head.
2 Prevent transfer of pediculi and nits.
3 Prevent infection.
4 Make patient more comfortable.


EQUIPMENT NEEDED
Medication, as ordered
Gauze flats or cotton balls
Bath towels-2
Wash cloth
Comb, fine tooth
Small basin
Protector for pillow, covered
Safety pins
Waste container


GENERAL DIRECTIONS I


1 Place covered protector over pillow.
2 Assist patient to move to near side of bed.
3 Place folded wash cloth over eyes; ask pa-


tient to hold in place.
4 Follow directions of specific agent to be
used.










5 Separate hair in small sections; saturate
gauze or cotton ball with medication and
apply to scalp and strands of hair, applying
from scalp over ends of hair; moisten well.
6 Continue application systematically to cover
entire scalp and hair; give extra attention to
back and lower part of head and area be-
hind ears.
7 Enclose head and all hair in a bath towel;
wrap and pin securely.
8 Unfasten towel after designated time; exam-
ine hair carefully for live pediculi; report
to nurse-in-charge if live pediculi are found.


SHAMPOO

PURPOSES)
1 Clean the scalp and hair.
2 Improve appearance.
3 Contribute to general comfort and to a feeling
of well-being.


GENERAL DIRECTIONS
1 Comb and brush patient's hair; wash and
dry comb and brush.
2 Give the shampoo in the patient's room
with the patient in bed or on a stretcher;
or, take patient to a lavatory with running
water, if possible.
3 Place patient in a comfortable and conveni-
ent position, according to condition of pa-
tient and the equipment and facilities avail-
able.
4 Place patient in a recumbent position with
the head and shoulders moved to the end of
the stretcher or bed or, moved to the upper
near side of the mattress. Use a sitting posi-
tion if condition of patient demands.


9 Repeat treatment if directed.
10 Apply agent to remove nits if necessary
part of treatment.
11 Shampoo thoroughly.
12 Comb hair.
13 Cut hair or shave infested areas) only with
order and permission.
14 Take precautions to prevent transmission or
reinfestation of pediculi.
15 Wear a long sleeve gown and cover own
hair with tight cap, if indicated, especially
when giving treatment to a child or heavily
infested patient.




EQUIPMENT NEEDED
Shampoo
Pitchers-2 or 3 large
Pitcher, small
Trough-Kelly pad, shampoo pan,
or large rubber sheet rolled
Rubber or plastic draw sheet, large
Linen draw sheet
Cotton ball
Comb and brush
Bath towels-3 or 4
Wash cloth
Bath blanket
Hair dryer, if available
Safety pin
Pail
Newspaper


5 Remove pillow or, if needed, use pillow to
provide slight elevation of head and shoul-
ders; cover patient with bath blanket.
6 Cover rubber draw sheet with linen draw
sheet and place under head and shoulders
to cover top part of mattress on bed or
stretcher.
7 Cover the bend of the rubber trough with
a bath towel and place under patient's head
with slight elevation; place the ends of the
trough in the lavatory or in a pail placed on
the seat of a stool covered with newspaper.
Use a Kelly pad or shampoo pan or make
trough by rolling side of rubber sheet over
a bath towel folded or rolled lengthwise.





























8 Untie gown at neck and turn back; place
bath towel around neck and pin or ask pa-
tient to hold.
9 Place cotton in ears, if desired or indicated.
10 Place folded wash cloth across eyes.
11 Wet hair thoroughly with water from faucet
(use spray, if available) or from the small
pitcher. Use temperature of water pre-
ferred by patient or according to purpose.
12 Pour small amount of shampoo in palm of
hand and apply to hair; use both hands to
spread shampoo, then fingertips to lather
hair and massage scalp.
13 Rinse well with water; move fingertips
through hair as water flows through.
14 Repeat applications) of shampoo, the mas-


sage, and the rinse until hair and scalp are
clean and well rinsed.
15 Turn head from one side to the other when
shampooing and rinsing.
16 Lift head from trough and wrap in bath
towel; remove trough and place in pail or
lavatory.
17 Dry hair with bath towel; use hair dryer, if
available and acceptable with patient.
18 Brush, comb, and arrange hair according to
preference of patient, if possible; allow and
encourage patient to care for hair, if condi-
tion permits.
19 Give a dry shampoo by following the direc-
tions for the use of the specific agent fur-
nished.




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| HANDWASHING
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HANDWASHING

PURPOSES)
1 Assist in preventing the spread of infection.
2 Practice promotion of health in daily living.


EQUIPMENT NEEDED
Soap (bar or liquid) or Detergent
Hand and nail brush
Running water
Towel(s)-paper


GENERAL DIRECTIONS
1 Wash hands under warm running water at
sink with foot, knee, or elbow-controlled
faucets, if possible.


2 Open water faucets to regulate flow and
temperature of water.
3 Use elbow and hand-controlled faucets as to
whether they are considered clean or con-
taminated: Use paper towel to open the fau-
cets if considered clean. Use paper towel to
close the faucets if considered contami-
nated. Consider foot and knee controls as
contaminated.
4 Wet hands and use cleansing agent to wash.


5 Bar Soap: Pick up bar of soap at start and
hold in hands during the entire time when
washing hands. Hold bar on back of brush
when brush is used. Rinse brush and bar,
and drop into proper containers when wash-
ing is completed.






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6 Liquid Soap or Detergent: Dispense with 3
foot lever or according to appropriate tech-
nique for container of liquid or powder of
cleansing agent. l
7 Clean fingernails; use orangewood stick, nail
file and brush, as necessary.
8 Apply cleansing agent to both surfaces of
hands, between the fingers and on forearms.
Include washing forearms to elbows with
mechanical action and friction, using a ro-
tary motion. If gown with long sleeves has
been worn, wash area covered by cuff.
9 Rinse frequently.
10 Hold hands and forearms lower than el-
bows while washing and rinsing.
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12 Wash hands-for at least 1 minute, or longer
as required or necessary.
13 Repeat entire washing procedure and time
period if hands) happen to touch inside of
laboratory or any contaminated area or part.
14 Soak hands and forearms the required
length of time in the specified solution as
may be required by the particular institu-
tion (agency) ain certain situations.
15 Use paper towels) to dry hands thor-
oughly.
16 Rub lotion or cream on hands after each
washing, or as frequently as possible.








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* HEAT,
| APPLICATION
OF
COMPRESSES, WARM
CRADLE, HEATER, LAMP
HEATING PAD (ELECTRIC)
IRRIGATIONS
See Irrigations, Specific
5 SITZ BATH
SOAK, ARM OR FOOT
3 STEAM
See Inhalations, Warm Steam
3 STUPES, FOMENTATIONS, PACKS
WATER BAG OR BOTTLE, HOT
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COMPRESSES, WARM

APPLICATION OF

PURPOSES)
1 Relieve pain and congestion.
2 Relieve inflammation and promote healing.


GENERAL DIRECTIONS
1 Provide and carry out medical or surgical
asepsis according to orders of physician, or
as indicated by the area where compresses
are to be applied.
2 Place hot plate or heating unit on bedside
table a safe distance from side of bed.
3 Heat compresses for one application in the
small basin of solution to 1100 F. to 1150 F.
4 Cover skin of affected area or around an
open area with a smooth layer of petrola-
tum, unless otherwise ordered or indicated.
5 Use forceps to wring compresses as dry as
possible, and to apply, untwist compresses
and fluff before applying to area.
6 Use protector to cover compresses accord-
ing to area, purpose, technique, or orders
of physician.
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EQUIPMENT NEEDED
Compresses, gauze
Solution, as ordered
Basin, small
Forceps
Petrolatum
Plastic protector
Bath towel, or an appropriate binder
Heat lamp, if ordered
Hot plate, at bedside
Paper bag


9 Protect the bed with placement of water-
proof material under the affected part.
10 Discard compresses after each use; use fresh
compresses for each application.
11 Change compresses every few minutes to
continue treatment for length of time or-
dered.
12 Follow specific orders to repeat the treat-
ment at definite intervals.


7 Use a folded towel or appropriate binder or
linen to hold in place, if necessary.
8 Place hot water bottle against, or a heat
lamp over, compresses; use heat lamp only
according to orders of physician or the
policies of the hospital.












CRADLE OR HEATER OR LAMP, HEAT


APPLICATION OF

PURPOSES)
1 Provide for relief of pain, congestion, inflamma-
tion, swelling, and muscle spasms.


GENERAL DIRECTIONS
1 Place patient in comfortable position with
good body alignment; expose area to receive
the application of heat.
2 Place device to direct heat only to area to re-
ceive the application of heat.
3 Place device so that electric bulb is safe dis-
tance from a skin area; prevent direct place-
ment of bulb against paper, linen, or blan,
kets.
4 Place and support the device in a stabilized


HEATING PAD (ELECTRIC)

APPLICATION OF

PURPOSES)
I Provide warmth and comfort.
2 Provide for relief of pain, congestion, inflamma-
tion, swelling, or muscle spasms.


EQUIPMENT NEEDED
Heat cradle, Heater, Heat Lamp


position.
5 Use size of bulb specified, and protected by
a wire cage.
6 Set and maintain desired temperature with
thermostat, if one is attached; check temper-
ature frequently.
7 Observe area closely during time of applica-
tion.
8 Remove device after length of time ordered
for the treatment.


EQUIPMENT NEEDED
Electric heating
Flannel cover


GENERAL DIRECTIONS
1 Use electric heating pad with a waterproof
covering.
2 Use pad only if in good condition.
3 Cover with clean dry flannel, or similar ma-
terial; keep cover dry.
4 Make certain pad is operated in a dry con-
dition and environment.
5 Heat the pad before applying to patient;
turn on "high" (if on the control), then re-
duce to "medium" or "low."
6 Place pad against or over an area rather than
under with body weight on it.
7 Place pad so that only intended area re-
ceives application of heat.

76


8 Place control for regulating heat within
easy reach of patient; instruct and caution
patient in the control of heat; check heat
control and skin area frequently.
9 Use no pins to secure pad; avoid crushing
or bending wires.
10 Remove pad after length of time ordered
for the application of heat.


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SITZ BATH

APPLICATION OF


PURPOSES)
1 Produce relaxation in pelvic area.
2 Relieve congestion in pelvic area.
3 Cleanse and promote healing in a wound.


EQUIPMENT NEEDED
Sitz tub or chair
or
Bath tub with mat
Bath mat
Bath thermometer
Bath towels
Bath blanket


GENERAL DIRECTIONS I


1 Prepare Sitz tub or bath tub with desired
amount and temperature of water.
2 Prepare temperature of water, as ordered,
or according to policy of hospital, usually:
a. 1100 F. to 115 F. to produce relaxation.
b. 940 F. to 98 F. to cleanse.
3 Prepare amount of water according to size
of patient; fill tub so that water reaches the
umbilicus and midthighs when patient sits
in tub.
4 Instruct and assist patient in getting into
tub and the position to take.
5 Keep feet and legs, or legs out of the water
(flex knees): prevent pressure against
thighs or legs, and support feet if chair is
used.
6 Provide for comfort and support of patient
with support of back and feet; use folded
towel or rubber ring or sponge for patient
to sit, on, if needed.


SOAK, ARM OR FOOT

APPLICATION OF

PURPOSES)
1 Provide for relief of inflammation, swelling, and
pain.
2 Aid in cleansing a sloughing wound.
3 Apply medication to a locally infected area.
4 Aid in making the movement of a painful area
easier.


7 Test temperature of water frequently with
a bath thermometer; keep temperature of
water constant; discard some water and re-
place with water at a higher temperature;
mix water.
8 Protect against exposure; drape bath blanket
over patient's shoulders and across tub; or,
allow patient to wear short gown and place
folded towel across pubic area.
9 Observe reactions, pulse, and color closely
during and following treatment; discontinue
treatment if untoward symptoms occur.
10 Discontinue treatment after the length of
time ordered by the physician, usually 15 to
20 minutes.
11 Drain water from tub and assist patient in
getting out.
12 Keep patient warm after the treatment; re-
turn patient to bed, usually.


EQUIPMENT NEEDED
Foot tub or Arm basin
Water, or Solution, as ordered
Bath Thermometer
Bath towel(s)
Bath blanket
Plastic or waterproof protector


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GENERAL DIRECTIONS
1 Prepare and scrupulously clean tub or ba- 7 Test temperature of water frequently with
sin; use sterile equipment and technique, if a bath thermometer; keep temperature of
indicated or ordered, water constant; remove extremity from tub,
2 Follow orders of the physician for the solu- discard some water, and replace with wa-
tion, the temperature, and the duration of ter at a higher temperature; mix water and
the treatment, immerse part.
3 Prepare temperature of water or solution, 8 Provide protection to bed; use protector un-
as ordered, usually between 1050 F. to der tub.
1100 F. 9 Discontinue treatment after length of time
4 Prepare amount of water or solution to im- ordered by the physician, usually 15 to 20
merse part. minutes.
5 Place tub so that patient is comfortable and 10 Remove part from water, dry thoroughly
in good body alignment; adjust position of but gently, cover and keep warm; follow
tub, relieve pressure, and support a part. orders for use of sterile technique, and ap-
6 Make certain that the portion of the ex- plication of a medication or dressings fol-
tremity to receive heat is immersed.- lowing treatment.



STUPES, FOMENTATIONS, OR PACKS

APPLICATION OF


PURPOSES)
1 Relieve inflammation.
2 Relieve muscle spasms.
3 Relieve pain and congestion.
4 Relieve distention.


EQUIPMENT NEEDED
Large basin of hot water
Stupe wringer
Electric hot plate
Electric pack machine
Petrolatum
Bath towel and wash cloth
Flannel or woolen material
Plastic or waterproof material
Protector(s), for bed and/or pillow(s)
Rectal tube, if abdominal stupe


GENERAL DIRECTIONS
1 Observe medical asepsis.
2 Prepare 2 pieces of flannel or woolen ma-
terial of sufficient size to cover the body
part of area; prepare 2 sets.
3 Place and support patient in good body
alignment for application of stupe; prepare
body part or area before bringing the
heated flannel to bedside.
4 Place protector on bed; place protector(s)
on pillow(s), if to be used under or near the
application.
5 Cover skin in affected area with smooth ap-


plication of petrolatum, unless otherwise
ordered or indicated.
6 Cover the plastic material with 1 dry flan-
nel piece and place -under the extremity or
part.
7 Heat 1 flannel according to method pro-
vided by the hospital; wring out or take out
of machine; release steam from hot wet
flannel by fluffing.
8 Apply pack to the area or part; lift pack to
determine effect of heat on skin; fit pack to
surface and wrap around area or part.


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9 Cover the pack with the dry flannel and the
plastic material.
10 Change the stupe to maintain constant
warmth to part.
11 Discontinue the treatment after the pre-
scribed length of time.
12 Wash the part with soap and warm water,
dry, cover, and keep warm; or, carry out
orders of physician for, such as, application
of medication or dressings.

WATER BOTTLE OR BAG, HOT

APPLICATION OF

PURPOSES)
1 Provide warmth and comfort.
2 Provide for relief of pain, congestion, inflamma-
tion, and swelling.


EQUIPMENT NEEDED
Hot water bottle
Bath pitcher or large graduate
Bath thermometer
Paper towel
Cover, or face towel and safety pins


GENERAL DIRECTIONS I


1 Test water bottle for leaks before and after
filling.
2 Use bath thermometer to measure tempera-
ture of water in large pitcher before pour-
ing into water bottle.


a. 1150 F. to 1250 F. for adults
b. 1050 F. to 1100 F. for children under 2
years.
3 Pour water into water bottle until 1/ to %I
filled.
4 Expel air; close top securely.


5 Dry and cover bottle.


6 Apply to affected area with neck of bottle
and pins away from skin.
7 Place water bottle against an area rather than
on or under with body weight on it.
8 Observe skin area regularly and frequently.
9 Maintain constant temperature to area; refill
bottle as often as necessary, or use a second
bottle to alternate.

























INHALATIONS

CARBON DIOXIDE
CROUPETTE
OXYGEN
WARM STEAM INHALATIONS




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